As per Markwick et al. (2019), the Aboriginal and Torres Strait Islanders people face interpersonal and social racism. This is the reason that they have a low socio-economic status in the world. Racism is a type of social determinant that affects the health of the people of Aboriginal and Torres Strait Islanders. These people do not have enough healthcare facilities and healthcare professionals. The patient, Bill, is a twenty-year-old aboriginal man suffering from type 1 diabetes. Although he was diagnosed with diabetes at 12 years of age, still, he was unable to manage his disease effectively. A number of factors have affected patient's disease management skills, for example, his place of birth. The patient was born in a place where there was scarcity of healthcare services, hospitals, opportunities, and a high population of diseased people. Health literacy is also a factor that affects the patient's ability for disease management, as it acts as a foundation for successful disease management (Pourseslami, 2016). Patient is illiterate, which implies that he has the least knowledge of health literacy, type 1 diabetes, and the management of this disease. The patient's current circumstances are also non-supportive for disease management, for example, low income, no growth opportunities, social pressure, and no permanent home. As per Zhao et al. (2019), social support is a crucial external factor for diabetes care and management. However, the patient has no social support, which has affected his diabetes management abilities. Thus, both personal and social factors have impacted patient's ability of diabetes management.
As per Jennings and Astin (2017), two models of teamwork are used for treating the patients, which are interdisciplinary and multidisciplinary models. The model that includes the collaboration of healthcare professionals to treat a patient without their interaction is termed as multidisciplinary. The members of a multidisciplinary team use their skills and knowledge to treat the patient and do not consult the other members for improving the patient outcomes. However, the model that includes collaboration, as well as the interaction of the members, is termed as an interdisciplinary model. In this type of model, the members interact with each and combine their knowledge to build a better patient care plan.
The Neurology Ward of Acute Hospital adopted the interdisciplinary model to treat the patient while the Rehabilitation Centre opted for the multidisciplinary model. This is because the team members of the Neurology Ward conducted three meetings to discuss the patient's case. They collaborated, interacted with each other, and share their knowledge to provide quality care to the patients. On the other hand, the health professionals of the Rehabilitation Centre did not conduct any meeting to discuss the patient's health condition, and there was no interaction or sharing of skills and knowledge between them. As a result, the team of Rehabilitation Centre was unable to detect type 1 diabetes in the patient and only treated the neurological symptoms mentioned in the discharge report. However, the Nursing Ward was able to detect the prevalence of type 1 diabetes in the patient with the help of an interdisciplinary model.
Nurse Unit Manager of the Rehabilitation Centre took an impulsive decision to discharge the patient. A number of factors influenced this decision, such as less resources. The Nurse Unit Manager was under pressure to clear the patient's beds to accommodate a greater number of new patients. The number of patients suffering from chronic diseases is much more than healthcare professionals. As a result, the healthcare industries of various countries are not having enough resources and services for the patients. Moreover, the budget for the healthcare industry is also fixed by all countries of the World that implies that healthcare professionals have a limited budget to treat a high population of diseased patients. The second factor that influences the decision of the Nurse Unit Manager is unfinished business.
As per Scott, Harvey and Felzmann (2018), around 50 to 90 percent of the registered nurses discharge the patients with unfinished care. It is one of the emerging concerns of the healthcare world that affects the long-term recovery of the patients. Most of the nurses miss few healthcare services that should be provided to the patients due to the immense work pressure and other factors (personal and professional). The position of the Nurse Unit Manager also influenced the intuitive decision of discharging the patient. This is because the Nurse was very experienced and the head of the nursing staff due to which she did not consult any of the fellow nurses or other health professionals before discharging the patient. In case the Nurse Unit Manager would have consulted other members of the Rehabilitation Centre, then probably she would not have taken this quick decision.
Moreover, the team of nursing staff, physiotherapist, occupational therapist, and doctors used a multidisciplinary model for treating the patient. They did not conduct any team meeting due to which they were unable to discuss the patient's case deeply. As a result, they did not detect any other health complications in the patient, and these complications were left untreated. This is also a factor that influenced the decision of the Nursing Unit Manager to discharge the patient quickly. The medical experts of the Rehabilitation Centre did not collect any additional information from the Neurology Ward of the Acute Hospital, due to which they were unable to detect other health complications of the patient. They just treated the neurological symptoms of the patients, such as loss of balance, difficulties in ambulating and body coordination. The misinformation and communication gap between the Rehabilitation Centre and Neurology Ward of Acute Hospital have also influenced the intuitive decision of the Nursing Unit Manager. This is because the medical expert's team of Neurology Ward was aware of the patient's diabetic conditions; still, they were not able to inform the health professionals of the Rehabilitation Centre. As a result of this, proper care was not provided to the patient by the medical experts of the Rehabilitation Centre. All these are the factors that have influenced the intuitive decision of the Nursing Unit Manager to discharge the patient on an early basis without any assessment for future treatment.
An interdisciplinary team with an endocrinologist, neurologist, psychologist, dietician, occupational therapist, and nurses can provide better treatment to the patient. All the health professionals of an interdisciplinary team work together to improve the efficiency of healthcare systems and to have a positive impact on the patient's health (Reilley et al. 207). Every health professionals of this team have the goal of improving the health outcomes of the patient. The role of endocrinologists is to treat type 1 diabetes in the patient by providing a diabetic diet plan and medications to control blood sugar levels such as insulin. The endocrinologist also plays a vital role in improving the health literacy of the patient. This is because it is the responsibility of all medical experts to inform the patient about their medical complications and health conditions. The endocrinologists can guide the patient about the optimal dose of insulin that should be used for treating diabetes. The patient got a head injury after the fall due to insulin shock that caused neurological symptoms such as a problem in maintaining the body balance and difficulty in walking. There are chances that these neurological symptoms can occur again in the future; thus, there is a need of neurologist who can provide proper care to the patient. The neurologist can treat the neurological symptoms by providing medications and therapies to the patients.
The interdisciplinary team must include a dietician as the patient is suffering from type 1 diabetes in which diet is very important. Diabetic patients are recommended a diet with low carbohydrate content as it helps in maintaining their blood glucose level. The patient in the given case study is not financially rich and also lacks knowledge about diabetic self-management. This implies the importance of a dietician in the interdisciplinary team as a dietician can provide a nutritious diet plan that will improve patient outcomes. The psychologist helps diabetic patients in diabetic management by providing them assistance and helping them in adhering to their treatment plans (American Psychological Association, 2016). The patient can fail in availing the successful treatment plan due to the financial conditions and mental stress; thus, the psychologist can provide guidance and motivation to the patient for following the complete treatment plan.
An occupational therapist is also beneficial for improving the health conditions of the patient. This is because the patient is jobless with low income, and this has negatively impacted his medical conditions. The role of the occupational therapist is to improve the skills of the patient so that he can get a good job in the future. A stable income will help him in affording the expensive medications of type 1 diabetes, which can eventually improve patient's health conditions. Registered nurses are required to provide optimal care to the patient, monitor the improvement of the patient's health conditions. They also improve the communication between all the health professionals of the interdisciplinary team. Moreover, the patient can be recommended to home care where the patient will get shelter, food, all medical facilities, and services. Thus, all these health professionals and healthcare survives can improve patient's health conditions.
American Psychological Association. (2016). Psychology plays vital role in tackling diabetes. Retrieved from https://www.apa.org/news/press/releases/2016/10/psychology-diabetes
Jennings, C. & Astin, F. (2017). A multidisciplinary approach to prevention. European Journal, 24(4), 77-87. https://doi.org/10.1177/2047487317709118
Markwick, A., Ansari, Z., Clinch, D. & McNeil, J. (2019). Experiences of racism among Aboriginal and Torres Strait Islander adults living in the Australian state of Victoria: a cross-sectional population-based study.BMC Public Health,19(1), 309. https://doi.org/10.1186/s12889-019-6614-7
Poureslam, I., Nimmon, L., Rootman, I. & Fitzgerald, J. M. (2016). Health literacy and chronic disease management: drawing from expert knowledge to set an agenda. Health Promotion International, 32 (4), 743–754. https://doi.org/10.1093/heapro/daw003
Reilley, P., Lee, H. S., Sullivan, M., Cullem, W., Kennedy, C. & MacFarlane, A. (2017).Assessing the facilitators and barriers of interdisciplinary team working in primary care using normalisation process theory: An integrative review. PLOS ONE, 12(5), n.d. Retrieved from https://doi.org/10.1371/journal.pone.01770264
Scott, A. P., Harvey, C. & Felzmann, H. (2018). Resource allocation and rationing in nursing care: A discussion paper. Nursing Ethics, 26(5), 1528-1539. doi: https://doi.org/10.1177/0969733018759831
Zha, F. Suhonen, R., Katajisto, J. & Leino‐Kilpi, H. (2019). Factors associated with subsequent diabetes‐related self‐care activities: The role of social support and optimism. Nursing Open, 7(1), 195-205. https://dx.doi.org/10.1002%2Fnop2.379
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