Clinics in Integrated Care最新文献

Specific body systems have focused examinations. In this article the cardiovascular history and assessment is discussed. Building on from the previous article – Clinical History Taking, this article will guide the reader into the requirements of how to assess a patient with a cardiovascular presentation, how to clinically focus when presented with the multitude of possibilities and what information is required to establish a differential diagnosis. History taking and clinical examination is discussed in detail to allow the reader to develop their assessment skills to an advanced practice level.

Shared decision making (SDM) is a process in which individuals and clinicians work together to select tests, treatment and agree on management decisions based on the best available evidence, individual preferences, and values. SDM is based on a two-way communication on what matters most to individuals and empowers both the individual and clinician to arrive at a final management decision, which also includes medication management, self-care, and lifestyle changes. SDM is associated with better outcomes and greater patient satisfaction. Older people are a heterogeneous group of individuals whose needs often span several domains including social, psychological, cognitive as well as physical and as such require a different approach to SDM. Personalised care support planning is a future focused conversation that supports older people living with multimorbidity, frailty and disability. Goals for long term treatment and management plans are obtained through holistic, multidisciplinary led Comprehensive Geriatric Assessment (CGA).

People with dementia, and their families are likely to have multiple needs across the biological, psychological, and social domains. These complex needs are best met by multidisciplinary teams who can work across different healthcare settings and apply models of integrated care. In this review, we describe several examples of integrated care for people living with dementia such as specialist dementia wards, psychiatric liaison teams, community mental health teams and Admiral Nurses. Gaps in services for people with dementia are likely to include crisis or out-of-hours support, and specialist end-of-life or palliative care services.

There are many variables when it comes to delivering wound care from the person to the wound, the type of wound, the available resources, and the knowledge and skill of the clinician delivering this care.

Approximately three quarters of wound care occurs in the home setting where practitioners are often working without the immediate support of another clinician to help them with that decision making.

Research informing practice remains sparse and currently few institutions devote core classes dedicated to teaching wound care in medicine, nursing, and other health professionals.

Although there is fragmented knowledge of the outcomes associated with wound care nurses’ practice, their knowledge and practice are a key element for improving health outcomes. Therefore, further research is needed, dissemination of that research needs to reach the frontline clinicians, acknowledging the clinical context in which they practice.

Non-medical staff are often required from their role to take a medical history from patients. The skills to do this to the level of a doctor are not taught in other fields and can lead to a limited ability to collect the knowledge required. The systematic sequence of history taking can increase any clinician's ability to make critical judgements and clinical decisions to safely treat the patient. The sequence of taking a clinical history has been established for generations of doctors but not often communicated to the wider health network. By understanding the basics and the structure will enable a non-medical clinician to take a concise history from a patient to aid in further diagnostic assessments.

Effective leadership by healthcare professionals is vital in modern healthcare settings. The major factor underpinning this is the drive to improve the quality of healthcare provision. There are many reasons why quality improvement programmes fail, however the lack of engagement of clinicians and their resistance to change are amongst the most important factors. Clinicians who assume leadership roles need to overcome these barriers and adopt a style of leadership that is inclusive and meets the needs of healthcare professionals.

Provision of health and social care to our ageing population is one of the biggest challenges faced by health care systems today. Older adults living with frailty have complex care needs secondary to multimorbidity, polypharmacy, physical dysfunction as well as social and psychological factors. Consequently, they are often subject to disjointed and fragmented care that carries a high predisposition to lower treatment and care plan adherence as well as more adverse drug reactions. The main principle for delivering effective integrated care is through a patient-centred approach, with improved co-ordination amongst health care professionals. By minimising variation in the approach to care delivery, patient care and experience can improve. Favourable outcomes from integrated care models depends on the application of multicomponent strategies with vertical and horizontal integration of objectives identified by shared decision making and Comprehensive Geriatric Assessment. In this brief review, we describe frailty; the methods used for screening and discuss successful models of integrated care.

Resilience is defined by the OED as ‘The capacity to recover quickly from difficulties; toughness.’ but recent literature reviews are now linking it with both ‘growth’ and ‘thriving’. Rather than just bouncing back, it is believed that facing, and overcoming, crisis can create the conditions to spring forwards. This article 1. highlights a model of resilience which includes an outcome of flourishing; 2. identifies 3 key areas in which building resilience supports continued wellbeing; 3. offers practical ways in which it is possible to continue to flex, stretch and build inner strength without the need for the catalyst of crisis; concluding that when we build and commit to exercising mental and emotional fortitude reguarly, not only is it possible to overcome any adversity, but thrive beyond it.

Compassion is central to human wellbeing, benefiting those who give and those who receive it. Compassionate cultures in healthcare enhance staff wellbeing, learning and innovation, and reduce stress, absenteeism and errors, leading to improved patient outcomes. Compassionate cultures need collective, inclusive, compassionate leadership, good teamwork, compassionate design, and a shift from the model of the organisation as machine to one of the organisation as a living, complex system. Developing and sustaining leadership and cultures of compassion are key to the ability for healthcare organisations to provide safe, high quality, patient centred care, even at times of crisis. This is particularly relevant during the COVID-19 pandemic which has created added strains to already-burdened healthcare systems in many countries.