Table of Contents
- Patchwork task one
- Patchwork task 2 – service user safety decision
- Patchwork task three – reflection
- Description
- Feelings
- Evaluation
- Conclusion
- Action
- References
Patchwork task one
Concerning the case study, health inequalities are a part of the healthcare institutes. Addicott (2014) states that the health inequalities are causing problems for the patients as well as for the entire healthcare department. According to the case study, the healthcare issue that Mrs. Kohli is facing requires proper care and assessment as per her medical condition. Patients who have dementia have to face social inequalities. This social inequality was also faced by Mrs Kohli as her husband could not provide her with care and became exceedingly anxious at the time of the separation. It reflects that Mrs Kohli is also facing access to healthcare for services users who may lack capacity. NHS is taking measures for controlling the issues in the mental health institutes. The Mental Capacity Act 2005 focuses on the best interests and the inability to make decisions.
Let us analyse the entire case by referring to the mental capacity act. This act has been a part of England since 2005 and has been in force since 2007. This act aims to deal with the primary purpose that are causing an increase in healthcare inequalities. This increase in healthcare inequalities challenges the entire legal framework. Here in the case, Mrs Kohli was not able to make decisions for herself. Both the healthcare service providers and her husband were making decisions for her. The primary purpose of this legal framework is to empower people for making decisions for themselves whenever possible. Also, this legal framework is to protect those people who lack capacity. Mrs Kohli had dementia, and the separation from her husband makes her suffer even more. The mental health care department must implement this acts legal framework to allow people to plan ahead of time. Principle one of this act is the presumption of the capacity, which provides the patients with the right to take every decision by themselves. No one has the right to make decisions for them due to their medical condition or eh disability. Supporting the individuals according to their own decision will increase these individuals capacity for making decisions. In the current situation, Mrs Kohli was not supported, and her decision was not taken into account during the entire situation. So, it goes against all the principle that MCA has set.
Mr Kohli wants to take her wife to his home, and he wants to take care of her by himself, but the decision made by DoLS was not in support of this act. It means that the healthcare departments stakeholders were not supporting the decision made by her husband, which is against article 5 of the Human Rights Act 1998. Allen et al., (2014) states that this article of the act states that everyone has the right to liberty and personals security. The mental health care service providers were not giving them the right to liberty and security, which means that their health can even worsen. Human rights act 1998 also provides humans with the right to respect private and family life. The service providers on Mrs Kohlis discharge have decided to send the health care service providers for providing her with care. But Mr Kohli refused to do so as it was no less than a way to interfere in her personal life. So, article 8 of the Human Rights act is a qualified right and provides humans with the right that no one is supposed to interfere in the private and the family life of any individual. Barr, Kinderman, and Whitehead (2015) researched out and found out the trends of the mental health inequalities. Compared to the evidence with the current research, the primary two health care inequalities that Mrs Kohli faced include access to healthcare for service users who may lack capacity and the inability to provide Mrs Kohli with the rights to make decisions themselves (Bamford et al., 2020).
Moreover, the dementia 2020 challenge, review in 2018, also provides guidelines to provide support and care to those who have dementia. This dementia challenge involves 19 key commitments and the four key themes. These key themes are dementia awareness, health and care delivery, risk reduction and research and funding. The entire case studys analysis in correspondence to this case study indicates that the health care department was not using the right approach for treating dementia, especially in health and social care. Mrs Kohli must be provided with the proper care and treatment to identify the dementia risks. Giving her the rights of liberty and decision making will highly help her is no less than a risk reduction advice. She is supposed to assist the National Institute for Health and Care Excellence Guidance for meaningful care. All the restrictions were bounding Mrs Kohli, and she was not enjoying the proper rights for life planning, and by the stakeholders, she was forced to become a part of the mental health institute.
The case analysis of Mrs Kohli’s case study also refers to the fact that the mental health care department was not practising the leadership. NHS provides a healthcare leadership model providing the nine dimensions to be appropriately addressed. These dimensions are highly essential for providing them proper care and treatment to those who suffer from mental health issues. Overall, the health inequalities and the policies and acts of mental health states that the health care service providers must make changes in their departments and provide the patients with the rights for the liberty of the decisions and security. These practices must be following the Mental Capacity Act, Human Rights Act 1998, and the Dementia 2020 challenge: 2018 Review (2019).
Patchwork task 2 – service user safety decision
The decision will be made based on the theoretical perspectives of both decision making and problemsolving. This decision will be made to make improvements for ensuring the safety of the service user. The perspective that will be analysed is the impact on the services provided to the patients.
The evidencebased practice that will be considered in the decisionmaking model is Gopee and Galloway, 2017. Firstly, all the facts that lead to the mental health inequalities will be considered appropriately. These facts will lead to the final decision. Berwick and Knapp (1987) states that the availability of the appropriate evidence, previous experience, and professional judgement will be considered. The main problem to be addressed here is to deal with the access to healthcare for service users who may lack capacity. The entire healthcare department needs to make quality improvements. This quality improvement will be based on the problemsolving approach. Quality improvement is defined as the systematic approach to deal with the issues faced in the health care departments (Bond et al., 2005).
Bolton (2015) defines decisionmaking approach is defined as the perspective that involves diagnosing the problems and making a specific decision. The quality improvement in the health care department is based on the interventions that will improve mental health care. Decision making involves three stages, micro, mesco, and macro. Gopee and Galloway (2017) states that these stages of decision making are based on structural factors. In this situation, these structural factors are analysed by analysing the entire case study and the inequalities that Mrs Kohli has faced. The decision of the quality improvement was allocated after consulting with the stakeholders (Botsford, Clarke, and Gibb, 2017). Consultation with the stakeholders helps in knowing and analysing the critical factors involved. Hamm (1988) suggests that these decisions are supposed to be made by analysing the critical situation and implementing the intuitive approaches. The decisionmaking process is supposed to be highly structured and involves six structural stages in common. These structural stages includes the scientific decision, controlled trial, quasiexperiment, systemaided judgement, peer aided judgement and intuitive judgement. The above case study analysis demands to go for the cognitive continuum to make decisions. It allows a detailed diagnosis and the analysis of the clinical audits and the system aided judgements (NHS England, 2019). Overall, this entire decisionmaking process follows the clinical, theoretical model, which helps sort out the healthcare departments issues (Botma & Labuschagne, 2019).
The decision made to solve the problem is the quality improvement of the mental health care department. Schmadl (1979) defines quality improvement in nursing perspective to provide the patients with treatment by the continuous measurement and evaluation. It will lead to all the activities required to deal with the health inequalities that Mrs Kohli is facing. The quality improvement in the mental health care department requires six elements to be considered as per Maxwell’s elements of quality theory. Charles, Whelan & Gafni (1999) introduces these elements as acceptability, accessibility, appropriateness, effectiveness, efficiency, and equity. Focusing on all these elements will increase the service users access with the increase in the capacity. Following this approach will also help in dealing with the health inequality issues. But the mental health care department needs to involve several resources as well (Wiig et al., 2014). According to Wakefield (2008), the four drivers considered in the quality improvement of the mental health care institutes are cost, error/patient safety, effectiveness, and consumerism. These drivers will improve the services provided to those who suffer from mental health issues (Plsek, 1999). Collins (2019) defines four levels of quality improvement: international (WHO), national (CQC), organisational improvement (NHS improvement), and local improvements. Friedli & WHO (2009) state that stakeholders also need to be involved. Outcomes of this decision include increased capacity, time savings, improved timeliness, cost reduction, and reduced errors in service provision (Grey et al., 2013).
The second alternative decision considered is balancing healthcare measures by involving legal policies and the Human Rights Act 1998. The theoretical perspective applied is Donabedian’s theory, which involves structures, processes, and outcomes to improve healthcare efficiency (Kobayashi et al., 2011).
Moreover, this decision follows national guidelines to improve quality of care. Structural improvements include organisational and physical changes, while process improvements focus on care delivery. In the case study, legal regulations were not applied effectively, including Article 5 and Article 8 rights. This lack of policy application increases challenges for patients and departments (Lynn et al., 2007). Introducing these policies would improve services and balance efficiency measures. This alternative decision may enhance clinical effectiveness, patient safety, and patient experience, while improving leadership and management (McCradden et al., 2020).
Patchwork task three – reflection
Adeani et al. (2005) define Gibbs’ cycle as a reflection cycle that helps improve future performance by analysing learning experiences. It is widely used by health professionals and provides structured stages: description, feelings, evaluation, conclusion, and action.
i. Description:
The module research focused on health inequalities and strategies to address inequalities and violence faced by the nursing department. Although the module was challenging due to COVID-19, I worked hard and reflected on areas where I lacked. The module covered perspectives on contemporary health issues and inequalities faced by mental health departments and patients, including policies and legal frameworks. Despite challenges, I found it motivating and worked consistently with my peers. My professor clarified key concepts related to leadership, theoretical perspectives, and improvement models.
ii. Feelings:
At the start of the module, I felt confused and stressed due to COVID-19. Over time, I realised I could manage the workload through consistent effort. With support from my module leader, I felt more relaxed after understanding the concepts. Overall, the experience involved mixed feelings.
iii. Evaluation:
A positive aspect was learning many concepts and receiving detailed information on contemporary healthcare issues. Initially, I struggled with case studies, but I learned practical problem-solving through guidance. A negative aspect was the disruption caused by COVID-19, which increased stress and reduced effective and practical learning.
iv. Conclusion:
The experience was positive and helped me learn new concepts. It improved my interpersonal and transferable skills, supporting future leadership and problem-solving. Skills I need to develop further include stress management and time management.
v. Action:
I will take future actions to strengthen practical learning that was limited due to COVID-19. This will help me address gaps and improve my understanding of practical situations and inequalities affecting nurses and patients with mental health disabilities. Overall, Gibbs’ reflective cycle supports self-analysis and awareness of both strengths and areas for improvement.
References:
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