Uploaded by Jack Waddington

Care of Acute physical and mental health

LO1: Demonstrate an understanding and discuss the contemporary political health and
social care agenda in relation to the management of acute conditions.
Acute care services is a urgent responding outlet of secondary health care which aims to treat
acute exacerbation of chronic illnesses and life threatening injuries with diagnostic and medical
intervention to improve health (WHO, 2013). An acute condition is distinguished as rapid sudden
onset severe exacerbation of ill-health, trauma and injuries, this is dissimilar to chronic as a prolonged
worsening illness (ACI, 2017).
The National Health Service (NHS) has recognised acute care will need to be integrated into the
other services to allow patient care to be fit for the growing populations needs, accessibility,
financial local sustainability (Naylor, et al., 2015). More people are using A&E compared to five
years ago, the NHS handles around 3,500 extra attendances every day. A&E recordings of
between 1.5 and 3 million people who come to A&E each year could have their needs addressed
in other parts of the urgent care system This is supported by the Five Year Forward View
showing (NHS, 2017b). The model of acute care has not developed sufficiently to respond to the
changing needs of the population, with less than a third of services rated as good or outstanding for
being responsive (CDC, 2017).
To address the areas of acute care services which present challenges to patients not receiving
quality care and treatment Five Year Forward view plans to target areas of development (NHS,
2014). To achieve ‘the right care at the right time at the right place’ because when health and
social services are unavailable this leads to health deteriorating causing A&E to be over used
(Imison et al., 2014) (NHS England, 2018). A range of solutions allowing more available
alternative resources to relieve the burden on A&E departments have been proposed by Five
Year Forward View such as urgent care centres, GP out-of-hours services, NHS 111, and
ambulance services.(FYF)
The availability of primary care has been argued to be inaccessible for general society relying
on the General practioners available in-hours for working people, whilst the accident and
emergency (A&E) department has commissioning reports highlighting fragmentation in need of
alternate pathways because of the lack of in-hours support from accessing primary care services
(Care UK, 2014) To achieve this, all types of health service professionals and organisations will
need to be modelled on a system wide integration to allow partnership to be effective and
structured (Naylor, et al.; 2015). This brought into consideration sharing accountability in to local
areas and a cross over of specialists and resources so acute ill health models could be focused
on population’s accessibility and need rather than organisational need (Ham, 2018). Multi
community specialty provider (MCP) and Primary and Acute care system (PACS) are models to
bridge the gap for patients to have less discharge delays with patients in the acute setting with
person- centred co-ordinated care and health information to be available with budget funding
primary care teams (ref). A further aspect of improving acute care is to structure the flow of
patients which includes strengthening clinical triage. Patient flow is a focused objective in acute
care this impacts on the patients experience and health outcome, this entails efficient transfer of
patient care throughout health and social services which involves sharing intervention and
assessment information (NHS, 2017a). For example, mental health care accounts for almost a
quarter of all NHS activity, however spending on NHS services is equivalent to only half of this.
CCG’s have underinvested in mental health services relative to physical health services due to
low prioritisation and the obscured way that spending on mental health conditions is leading to
strain on acute services (NHS, 2016). Mental health triage team (raid?)
Overall The Government’s revised mandate to NHS England for 2018-19 shows objectives of
how integration will improve health and social outcomes with the Department of Health and
Social Care and NHS Digital sharing data on reducing acute inappropriate usage to ensure
optimum responsive care is available to improve each year (NHS England, 2018).
The Acute Care Model (Iyer et al., 2011)
Name lots acute conditions even mental
How five forward view will help acute treatment
Introduce NMC code
LO2: Understand the pathophysiology and discuss the presentation of common acute
physical and mental health conditions.
The understanding of acute conditions there can be subdivided into minor and major illnesses,
minor include respiratory tract infections, gout, infective diarrhoea and vomiting, lassitude
(lethargy), heart palpitations, allergies and anxiousness. (Ref below) Major acute conditions are
more serious needing urgent treatment such as strokes, hypovolaemic collapse, sepsis, although
some presenting through an exacerbations of a chronic condition such as an asthma attack,
hypoglycaemia and inflammatory bowel disease (Jones et al., 2010). The presentation of an acute
condition is not always observable to looking at the patient, to confirm diagnosis and treatment
investigations into carryout blood tests and vital signs will show biological abnormalities although
using nursing assessment criteria confirms rationale and allows person centred care…(ref)
Symptoms can present on different levels such as objective, subjective..
These decisions are made based on recognizing and understanding the importance of changes in
physical or mental status of residents and the impact of these changes on residents' quality of life.
(Ashcraft and Owen, 2014) (reword)
Acute mental illness is characterised by significant and distressing symptoms of a mental
illness requiring immediate treatment. This may be the person's first experience of mental illness, a
repeat episode or the worsening of symptoms of an often continuing mental illness (reword)
(Joseph’s Health Care London, 2019). Anxiety will be displayed as excessive worrying, Bipolar
Disorder presents as manic behaviour and depressive mood swings, delusions can be experienced as
false beliefs not grounded. An independent inquiry into acute mental health patient support was
carried out evidencing a lack of humanity, depersonalised care, treating the illness or managing the
crisis rather than supporting or healing the individual, and emphasising risk rather than needs, were
all themes that arose. To some extent these reflect the way that priority may be given to the
medical management of acute mental health needs, while the other things that can help are
devalued.(reword)(Mind, 2011)
Schizophrenia is associated with:
double the risk of death from heart disease and three times the risk of death from respiratory
disease. This is because people with mental health conditions are less likely to receive the physical
healthcare they're entitled to. Mental health service users are statistically less likely to receive the
routine checks (like blood pressure, weight and cholesterol) that might detect symptoms of these
physical health conditions earlier. They are also not as likely to be offered help to give up smoking,
reduce alcohol consumption and make positive adjustments to their diet (Mental Health
Foundation, 2019)Reword.
Sepsis is a serious condition resulting from the presence of harmful microorganisms in the
blood or other tissues and the body’s response to their presence, potentially leading to the
malfunctioning of various organs, shock, and death. Reword. There is more people
developing sepsis, an estimated 123,000 cases each year in England, with approximately
37,000 deaths are related with the condition and 65,000 people suffering serious long term
complications reword (NHS England) (Angus and Van der Poll, 2013). It is known as a ‘silent
killer’ because it can be extremely difficult to identify for both professionals and the public alike,
with symptoms often suggesting less serious illnesses such as influenza (NHS England, 2015).
The roles of inflammation and coagulation in the pathophysiology of sepsis are described. Sepsis
results when an infectious insult triggers a localized inflammatory reaction that then spills over to
cause systemic symptoms of fever or hypothermia, tachycardia, tachypnoea, and either leukocytosis
or leukopenia. These clinical symptoms are called the systemic inflammatory response syndrome.
Severe sepsis is defined by dysfunction of one of the major organ systems or unexplained metabolic
acidosis. (J.Jacobi, 2002) (reword and shortened)
The acute care journey of a patient presenting with sepsis will be discussed to present justification
of contemporary use of acute care provision. The case-study will be anonymous to protect
confidentiality and named Gabe (ref). This will provide an insight into how a patient is transitioned
through stages of health care in relevance to the policy and guidelines when following evidencebased practice. This ultimately relies on the practioner’s interpersonal and professional skills to
carry out responsive, safe care (Chen et al., 2017).
How they arrive- end of bed assessment/ look, listen and feel Physical symptoms
Gabe 74yrs old arrives by ambulance after a collapse his presented symptoms were handed over to
the emergency department. Firstly, the A-E assessment (Airway, Breathing, Circulation, Disability,
Exposure) was carried out, this is a systematic pneumonic taught alongside resuscitation training to
prioritise actions to support life and assess an acutely ill patient to recognise and assess, effective
training uses the look, listen and feel techniques (Atkinson, 2013; Resuscitation Council, 2014). Gabe
examined to have a patent airway (unobstructed), tachypnoea using external respiratory muscles,
skin was pale and clammy on touch CRT or CRP <2 (unperfused over 2 seconds) The vital
observations were measured at a heart rate of 125 (tachycardia); oxygen saturation 95%; respiration
count 25; blood pressure 80/45 (hypotensive); blood sugar 2.1mmol (hypoglycaemia) and
temperature of 35.3c (below 36) (Appendix 1). This was recorded using the National Early Warning
Score (2012) (NEWS) which assigns a score of the severity of the six routine based physiological
parameters scoring at 8 and is now returned to consciousness with no pain expressed when asked
between a score of 0-3 mild, moderate or severe (Royal college of physicians, 2012) . The NEWS
system guides escalation or de-escalation of intervention and observation which gave Gabe 15
minutes observational intervals?) Although a study found cultural behavioural were barriers leading
to depending on being task driven, inhibiting the use of the nursing clinical judgment therefore
further training is needed when following the escalation protocols (C.foley and M.dowling). Neuro
observations are a component in the NEWS this is a neurological assessment ‘AVPU’ standing for
‘Alert, Verbal, Pain, Unresponsive’ are commenced using the glycomascale this policy stated( ) when
the reason for a unknown unconscious collapse.. describe.
His vital signs and symptoms have required investigation into a query of the symptoms can be
treated this doesn’t mean the condition will resolve and following tests are carried out to diagnose
the underlying infection.
Sepsis is a serious medical condition. It is caused by an overwhelming immune response to infection.
The body releases immune chemicals into the blood to combat the infection. Those chemicals
trigger widespread inflammation, which leads to blood clots and leaky blood vessels. As a result,
blood flow is impaired, and that deprives organs of nutrients and oxygen and leads to organ
damage. (National Institute of General Medical Science, 2018). Sepsis can be directly related to
many chronic conditions being developed in older people to acquire sepsis are elderly, healing
wounds, low immunity, recent surgery and contributing chronic conditions (P.Nasa, D.June, 2012)
Sepsis 6
LO3. Demonstrate an understanding of the physical, psychological and social aspects
associated with acute conditions.
Gabe was due a transfer onto a general ward and on arrival he was updated with his current
condition and informed of his condition and treatment and was considered, NICE guidelines are
integrated on a specific acute care pathway ensuring the patients well-being is trained to be
advocated through continuity of care (NICE,2007). Gabe was given a sepsis brochure this explained
that the vast social and psychological impacts of suffering from sepsis (Anna Coles, 2012).
Use nursing model- for patient symptoms for holistic
your focus should be on the holistic nursing assessment of the patient not their medical assessment.
It is accepted that your work may refer to the medical diagnosis and/or interventions offered to the
patient, but this should not be the focus of your discussion. Below is a non-exhaustive list of factors
you may want to consider; -
LO4: Be able to support people experiencing acute conditions and plan their care
effectively as part of the multidisciplinary team by reflecting on the holistic management
of an acute condition from practice. review the nurse’s role in promoting self-care for
patients and families.
The handing over of care and multi- disciplinary teams will improve the quality of caring intervention
however communication in relevance to acute care is susceptible to missed diagnoses, medication
Introduce the reason nursing care models are used- holistic and person centred planning
What is the medical model ,give benefite? Although nursing modelallows..
What assessment tools models where used
How was care planned, did it make use of any tools or metrics?
What published guidelines/recommendations relate to your chosen patient and how did
these influence your case study
What government initiatives and/or legislation influenced the situation
How, where and by whom was care delivered
What provision was given to the family and friends of the patient
Models of communication- sbar
Kings Fund- Minor Acute illnesses/ Major
The key to high-quality care of acute illness will be found in the balance seen between
acceptable access, satisfactory consultation, accurate diagnosis, effective treatment,
appropriate referral, safe outcome, and efficient use of resources. These seven domains led
to the development of nine measures of quality of acute illness that were submitted to the
Inquiry team separately, the key headings for which are described below: 1. Good access for
patients with acute medical problems, in terms of availability of face-to-face and telephone
contact. 2. Sufficient time and facilities within the consultation to address problems and
make an accurate assessment or diagnosis 3. Accurate diagnosis/assessment with an
emphasis on not missing serious illness 4. Adequate patient information about diagnosis
and its implications 5. Symptom resolution – patients with acute problems are treated
appropriately and their symptoms resolved 13 The King’s Fund 2010 GP Inquiry Paper 6.
Appropriate prescribing. Patients should not be given unnecessary antibiotics, non steroidal
anti-inflammatory drugs etc. 7. Resources are used in a cost-effective manner 8. Patient
satisfaction. Patients should be satisfied with their treatment and feel more empowered to
deal with their problems 9. Appropriate referral, without over-referral (wasting resources)
and under-referral (missing important diagnoses)
L05: Demonstrate achievement of designated competencies supporting achievement of
NMC requirements. Work as part of a team to ensure the effective delivery of safe and
effective nursing care and demonstrate achievement of the NMC competencies, identified
essential skills cluster / progression points for year 2 to progress to year 3.
2 sentences
Curriculum of acute care- essential skills cluster
Relate to Nmc competencies- preserve safety, prioritise people, practice effectively
NMC Essential Skills Cluster states by entry to the register
‘Acts autonomously and appropriately when faced with sudden deterioration in people’s
physical or psychological condition or emergency, abnormal vital signs, collapse, cardiac
arrest, self-harm, extremely challenging behaviour, attempted suicide.’
‘Measures, documents and interprets vital signs and acts autonomously and
appropriately on findings’
Within this essay you are required to present a case study and discussion of a patient suffering from
an acute physical or mental illness. The patient can be of any age as long as they have presented
with an acute physical or mental illness. You must give the reader a brief but informative overview
of the patient, their condition and presenting state of physical/emotional wellbeing. From here you
will need to describe how they had been assessed and how their care had been planned and
delivered. Keep in mind that your focus should be on the holistic nursing assessment of the patient
not their medical assessment. It is accepted that your work may refer to the medical diagnosis
and/or interventions offered to the patient, but this should not be the focus of your discussion.
Below is a non-exhaustive list of factors you may want to consider; -
What assessment tools models where used
How was care planned, did it make use of any tools or metrics?
What published guidelines/recommendations relate to your chosen patient and how did
these influence your case study
What government initiatives and/or legislation influenced the situation
How, where and by whom was care delivered
What provision was given to the family and friends of the patient
Screen Capture (20 Sep 2019)
Appendix 1