LONG TERM/COMPLEX CONDITIONS (LTC)                      11/04/2024

 

The learning outcomes and the learning objectives were discussed. A question, what is long term condition was asked. These are conditions or chronic diseases are conditions for which there is currently no cure, and which are managed with drugs and other treatment.

It was said that these LTC are more prevalent in older people and in more deprived groups. 

 

The NHS long term plan for LTC 2019 is as follows:

• More people are living with cancer or dementia largely due to increase in life expectancy and falls in the rate of premature death.
• The United Kingdom mortality rate from heart and circulatory diseases has declined by more than three quarters in the last 40 years.
• Mental health, respiration and musculoskeletal conditions are responsible for a substantial amount of poor health.

The following are the LTC we have heard of:

• Asthma
• Cancer
• CKD
• COPD/Pulmonary fibrosis
• Diabetes
• Coronary heart disease
• Hypertension
• Heart failure 
• Dementia
• Depression
• crohn’s / ulcerative colitis
• Epilepsy
• Hypothyroidism
• Stroke
• Multiple sclerosis(MS)
• Parkinson’s disease
• Motor Neurone disease (MND)
• Chronic fatigue syndrome
• Arthritis.

The  following are the increase risk of LTCs:

• Genetics
• Lifestyle choices( smoking, diet, alcohol,recreational drugs taking, lack of exercise)
• Socioeconomics status (class)
• Obesity
• Stress
• Environmental factors -triggers.

The following can be the impact of living with LTCs:

For the physical;

• Mobility – independence
• Personal care/hygiene
• nausea/vomiting
• Pain
• Bowel disturbance
• Sleeping
• Breathing
• eating/diet restrictions
• Hair loss/amputation
• Acutely unwell episodes (hospitalisation).

With regards the psychosocial aspect:

• Financial 
• stress/anxiety/depression
• Employment/study
• Body image
• Role model within family
• Relationships
• Social life/sports
• Sexuality
• Grief

We looked at assessment as the process that identifies and defines the service user’s problems.

• Evaluates the service user’s wishes, mental, physical, social, cultural, spiritual and personal needs.
• Finding out what the service user’s can or cannot do.
• A multi-stage procedure.
• True likeness of the service user as an individual, highlighting their needs( present and near future) and the resources that they have  available to them.

The reason why assessment is important, failure to recognise and respond to an individual’s needs can result in them not being met and in a failure of care.

 

The following are the reasons assessment can be complex in service user’s with LTCs:

• Multiple LTCs.
• Symptoms may change over time.
• Often experience more than one symptoms
• May be taking multiple medications
• Complex need.
• Holistic assessment.
• Person-centred care.

In assessing people with LTCs, these are the assessment tools used:

• APIE
• ADPIE
  ASPIE.

The following are the skills required for assessment:

• Interviewing
• Observation
• Taking measurements.
• Review documents.
• Communication
• Listening.

In assessing  for service user’s with LTCs, the following should be considered:

• Understand the pathophysiology of the condition.
• Services for people with LTCs must take into account the emotional and psychological impact of being diagnosed or living with a LTCs.
• For many their condition will be relatively stable over a period of time with only irregular flare-ups.
• For people with more complex needs or with more than one LTC, their situation may be less stable and as a result more intensive or ongoing periods of care and support will be required.
• Integrated working.
• Consider the needs of carers/family members.

 

People with LTCs may need the following in their care:

• They may want to be involved in decisions about their care – they want to be listened to.
• They want access to their information to help them make those decisions.
• They want support to understand their condition and confidence to manage –  support to self care.
• They want to be joined up, seamless services.
• They want proactive care.
• They do not want to be in hospital unless it is absolutely necessary and then only as part of a planned approach.
• They want to be treated as a whole person and for the NHS to act as one team. (King’s Fund, 2014).

The following are the models of nursing:

• Give direction to the nurse when assessing the needs of the service user.
• There are many models which are selected for their appropriateness to the care setting and service user.
• Help to add consistency and continuity to person-centred care, because everyone will be working the same underpinning philosophy.
• Provide a framework to direct practitioners in their assessment and care- planning process.

 

The RLT model stresses the importance of cultural, environmental and economic factors affecting both health and well-being and encourages a nursing role in preventing, alleviating or coping with illness.

The important ideas that can be found within the model are:

• Individuality
• The activities of living
• A dependence – independence continuum
• The progression of a person along a life-span
• Influencing factors

 

                                    KSBs ADDRESSED.

 

                                                              KNOWLEDGE  

 

 

K1: Understand the Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates (NMC, 2018), and how to fulfil all registration requirements. 

K4: Understand the principles of research and how research findings are used to inform evidence-based practice 

K6: Understand and apply relevant legal, regulatory and governance requirements, policies, and ethical frameworks, including any mandatory reporting duties, to all areas of practice.

K8: Understand how discriminatory behaviour is exhibited 

K9: Understand the aims and principles of health promotion, protection and improvement and the prevention of ill health when engaging with people 

K10: Understand the principles of epidemiology, demography, and genomics and how these may influence health and well-being outcomes 

K11: Understand the factors that may lead to inequalities in health outcomes 

K12: Understand the importance of early years and childhood experiences and the possible impact on life choices, mental, physical and behavioural health and well-being 

K13: Understand the contribution of social influences, health literacy, individual circumstances, behaviours and lifestyle choices to mental, physical and behavioural health outcomes 

K14: Understand the importance of health screening 

K15: Understand human development from conception to death, to enable delivery of person-centred safe and effective care 

K16: Understand body systems and homeostasis, human anatomy and physiology, biology, genomics, pharmacology, social and behavioural sciences as applied to delivery of care 

K17: Understand commonly encountered mental, physical, behavioural and cognitive health conditions as applied to delivery of care 

K18: Understand and apply the principles and processes for making reasonable adjustments 

K19: Know how and when to escalate to the appropriate professional for expert help and advice 

K20: Know how people’s needs for safety, dignity, privacy, comfort and sleep can be met 

K21: Understand co-morbidities and the demands of meeting people’s holistic needs when prioritising care 

K22: Know how to meet people’s needs related to nutrition, hydration and bladder and bowel health 

K23: Know how to meet people’s needs related to mobility, hygiene, oral care, wound care and skin integrity 

K24: Know how to support people with commonly encountered symptoms including anxiety, confusion, discomfort and pain 

K25: Know how to deliver sensitive and compassionate end of life care to support people to plan for their end of life 

K26: Understand where and how to seek guidance and support from others to ensure that the best interests of those receiving care are upheld 

K27: Understand the principles of safe and effective administration and optimisation of medicines in accordance with local and national policies 

K28: Understand the effects of medicines, allergies, drug sensitivity, side effects, contraindications and adverse reactions 

K29: Understand the different ways by which medicines can be prescribed 

K30: Understand the principles of health and safety legislation and regulations and maintain safe work and care environments 

K36: Understand the roles of the different providers of health and care 

K37: Understand the challenges of providing safe nursing care for people with complex co-morbidities and complex care needs 

K38: Understand the complexities of providing mental, cognitive, behavioural and physical care needs across a wide range of integrated care settings 

K39: Understand the principles and processes involved in supporting people and families with a range of care needs to maintain optimal independence and avoid unnecessary interventions and disruptions to their lives 

K40: Understand own role and contribution when involved in the care of a person who is undergoing discharge or a transition of care between professionals, settings or services 

K41: Know the roles, responsibilities and scope of practice of different members of the nursing and interdisciplinary team, and own role within it 

K43: Understand the influence of policy and political drivers that impact health and care provision Skills 

 

                                             SKILLS

 

S1: Act in accordance with the Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates (NMC, 2018), and fulfil all registration requirements 

S13: Apply the aims and principles of health promotion, protection and improvement and the prevention of ill health when engaging with people 

S14: Promote preventive health behaviours and provide information to support people to make informed choices to improve their mental, physical, behavioural health and well being 

S25: Meet people’s needs for safety, dignity, privacy, comfort and sleep 

S26: Meet people’s needs related to nutrition, hydration and bladder and bowel health 

S27: Meet people’s needs related to mobility, hygiene, oral care, wound care and skin integrity 

S28: Support people with commonly encountered symptoms including anxiety, confusion, discomfort and pain 

S30: Recognise when a person’s condition has improved or deteriorated by undertaking health monitoring, interpreting, promptly responding, sharing findings and escalating as needed 

S38: Prioritise and manage own workload, and recognise where elements of care can safely be delegated to other colleagues, carers and family members 

 

                                          BEHAVIOURS

 

B1: Treat people with dignity, respecting individual’s diversity, beliefs, culture, needs, values, privacy and preferences 

B2: Show respect and empathy for those you work with, have the courage to challenge areas of concern and work to evidence based best practice 

B3: Be adaptable, reliable and consistent, show discretion, resilience and self-awareness