Connecting the dots in health Care System
A practical guide to understand health care through big ideas.
By Prajwal Basnet | Dec 4 2024 | 7 minute read
Introduction
After working in residential aged care, my curious mind began exploring big ideas of system. For an outsider with no clinical degree, i was not fortunate with head start; As a result my relentless pursuit for uncovering know-how started.
Following the directive of great algebrist, Jacobi, to “Invert always invert”; That most hard problems are not solved by thinking forward, rather by thinking backwards; Similarly, i started by the pursuit of recognizing simplicity –that is, to form bedrock ideas, rather than deconstructing intricate complexity –to learn thousand of technical nuance. As a result, this endeavor aims to: unviel the complexity, serves as vague guide in documentation without compromising core ideas, and -most importantly, interconnectedness of ideas from various discipline.
1. Checklist
The surest means to avoid failure and to decrease complexity is through the use of checklist. In aviation industry, checklist has been used successfully from very early in almost every pilot endeavor resulting in one of the safest means of transportation. Pilots are trained to trust their checklist more than their instinct.
"No pilots ever fly without checklist"
Similarly, medical professionals have to go through intense pressure. They have to get the knowledge right and then make sure 100 daily task that follow are done correctly -despite monitor sign going off, despite patient in bed crashing, and despite nurse poking head around curtain.
After learning from aviation industry, WHO began creating their own checklist which after implementation resulted in major complication decrease by 36 percent and deaths fell by 47 percent. Also, 78 percent observed checklist to have prevented an error in operating room. Now the whole health sector has evolved with the use of checklist, knowing or unknowing. Checklist are different for different operation and circumstance.
In residential aged care, the whole system, more or less, are implemented based on checklist to monitor changes of hundreds of consumer with the use of charts and notes. Each consumer are assigned specific chart to track key areas such as behaviour, mobility, sleep, pain, bowel etc. Then, the charts and notes serves as component of checklist that needs to be completed individually.
2. Individual liberty [Person Center Care]
Individual liberty is the right to believe, act, and express oneself freely. It is right of every men as far as it does not hurt or control the rights of another which is the only check it ought to suffer.
Accordingly, Person center care is a care philosophy that puts individual liberty into practice by ensuring that care is tailored to support individual autonomy and dignity.
"As having their own way is the greatest comfort of life to aged people. I think their friends should endeavor them in that, as well in anything else, when they lived long enough; They are almost as closely connected with it as tortoise with its shell; old folks and old trees, if you remove them it is ten to one that you will kill them"~ Benjamin Franklin
However, In practice especially with cognitively impaired person putting this into practice is not always straight forward. For carer and nurse, this can be slippery slope. As they have a duty to care (not to neglect), as well as supporting individual liberty. Therefore, one should be prepared for “careful yes” or “respectful no” by providing careful explanation, alternatives, in conjunction with statute and policy.
3. Four Dimension of Care - Physical, Behavior, Cognition, and Mental Health
There are lot of tool that clinical experts assess to determine state of consumer health and well being. By large sense, these tools are centered around four pillars: Physical, behaviour, cognition, and mental health.
However, For an outsider, like myself, it is challenging to determine declining state of consumer health, creating inconsistency in actual reporting system and state of consumer. Consequently, To overcome this i decided to pen down my understanding. I wrestled with whether to make this content concise or thorough, and decided to strike a balance - highlighting key concepts in a list with examples, to aid outsiders."
- Physical ability (including pain)
- a) Mobility
- - How well person can move - includes walking, standing, sitting, etc.
- b) Balance.
- c) Reaching and bending.
- d) Cordination.
- Behaviour [subject to frequency and cognition]
- a) Lack of co-operation
- - Refusing to participate in daily activities.
- - Ignoring staff requests to join meals or group activities.
- - Not following basic care routines, requests, or instructions.
- - Avoiding eye contact or turning away when asked to engage.
- - Expressing disinterest or boredom during planned activities.
- b) Agitation
- - Exhibiting restless motions, like tapping, pacing, or excessive movement.
- - Believing they have an urgent task to complete.
- - Raising voice or shouting during minor frustrations.
- - Becoming easily irritated by changes in the environment.
- - Displaying physical signs of stress, like clenching fists or crossing arms.
- - Sudden mood swings or frustration.
- c) Disinhibited behaviour
- - Lack of social awareness or impulse control, such as undressing in common areas.
- d) Aggression
- - Manifests as shouting, hitting, or resisting care.
- - Physical or verbal outbursts directed at others.
- - Perceived as a threat or intrusive due to frustration, fear, or misinterpretation.
- - Difficulty in controlling emotions or argumentative behaviour during interaction.
- e) Paranoia and suspicion
- - Accusing others of taking their belongings.
- - Being suspicious of others' intentions or constantly questioning their motives.
- - Feeling monitored or that people are conspiring to gather information.
- - Unrealistic delusions, making it difficult to distinguish thoughts from reality.
- f) Sleep disturbance
- - Waking up frequently during the night, believing it's morning, and getting ready.
- g) Repetitive behaviour
- - Asking the same question over and over.
- h) Wandering
- - Aimlessly walking around.
- a) Lack of co-operation
- Cognition
- a) Short and long term memory
- - Short and long-term memory retention.
- - Misplacing personal belongings.
- - Confusing past and present experiences.
- - Ability to recall identity, time, place, or instructions.
- b) Communication
- - Struggling to find the right words (e.g., using “things” instead of “toilet”).
- - Discussing unrelated topics during conversations.
- - Difficulty following conversations.
- - Speaking in short or incomplete sentences.
- - Inability to engage in back-and-forth conversations.
- c) Sequencing
- - Mixing up steps in multi-step tasks, such as wearing clothes in the wrong order or folding clothes incorrectly.
- - Forgetting to get dressed before or after bed.
- - Difficulty understanding the awareness of time and order of actions.
- d) Social skill deficit
- - Not responding when greeted by others.
- - Interrupting others without realizing it or dominating discussions.
- - Failing to pick up on non-verbal cues, like body language or facial expressions.
- - Struggling to make friends or maintain relationships.
- - Unable to understand or respond to the emotions of others.
- e) Problem solving difficulties/poor judgment
- - Becoming frustrated when faced with simple puzzles or games.
- a) Short and long term memory
- Mental Health
- a) Depression
- - Feelings of sadness, hopelessness, or low energy.
- - Withdrawal from social activities or lack of interest in surroundings.
- - Sleep disturbance or change in appetite.
- - Slow movement.
- - Isolating in room.
- b) Anxiety
- - Excessive worry or fear about everyday situations.
- - Symptoms of restlessness, irritability, or difficulty concentrating.
- - Physical manifestations such as sweating or rapid heartbeat.
- a) Depression
Pdf file can be found here: Here!
Conclusion
For an outsider without clinical background, understanding and navigating these system may initially seem daunting. To overcome this challenge, my journey underscores habitual use of checklist, ability to assess unique declining state of consumer and principles of person center care.
Disclaimer
The information provided in this blog is based on personal observations and insights gained from working in residential aged care. It is not intended to replace professional medical or clinical advice. The views expressed are for informational purposes only and should not be considered expert guidance. Unless stated otherwise, some of the information may not be fully accurate. Always consult with a qualified healthcare professional and verify the policies of your state or organization before making any care-related decisions or addressing concerns.