Introduction

There are high expectations in the United Kingdom that the issue of health and social care is going to take a new shape due to the increase in the number of people who are now being diagnosed with long-term conditions (LTC) or chronic illness. This essay aims at using a qualitative approach to conduct in-depth and extensive research about the complex health and social care needs of patients diagnosed with the cardiovascular disease in Newham, United Kingdom and the various mechanisms and strategies that can be possibly used to promote health care and enable the affected population access appropriate care. The paper will also critically discuss multiple barriers faced by patients diagnosed with this long-term condition and how they can be solved, the role that is played by the nurse in promoting holistic nursing and healthcare intervention that can be employed to support recovery of the patients and enhance coping ability, wellbeing and health of the affected people. Moreover, this essay will assess the various local and community needs of patients and procedures that can help in enhancing their wellbeing and also examine the different communication strategies that can be employed in timely addressing the escalation of care of the patients.

Epidemiology of the Cardiovascular Disease in Newham

It has been discovered that multi-morbidity is becoming the new norm across the world and it is evident that the current models of dealing with long term conditions such as cancer, stroke and cardiovascular are no longer sustainable both locally and internationally. There has been a rapid increase in the number of people who have been diagnosed with a cardiovascular disease which is a long term condition that has become most prevalent across the United Kingdom especially in Newham which is part of the inner borough of London.

There various factors that have facilitated the rapid increase in cases of cardiovascular disease amongst the residents in Newham. For instance, inappropriate living style such as smoking has significantly facilitated the rapid increase in patients suffering from cardiovascular disease (Pérez-Piñar et al., 2016, pp.9). Moreover, increase in age has also contributed to the high rate of cardiovascular disease patients in Newham whereby the number of individuals with 55 years of age above is growing at an alarming rate (Pérez-Piñar et al., 2016, pp.9). Most of the older adults are always vulnerable to long-term conditions such as cardiovascular and stroke due to low body activity and failure of taking the appropriate diet hence leading to deterioration in health status.

Barriers to Engagement with Healthcare

Various factors have limited the ability of the patients who are suffering from cardiovascular disease (CVD) in Newham to access the much need health and social care needs in this borough. The below spine chart illustrates the various areas or levels of health care delivery that are affected by the different barriers that will be discussed in this section with the target population being 55 and above years old patients in Newham who are suffering from cardiovascular disease.

Figure 1: Spine Chart of Areas in Which Health Care Barriers Affect

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Firstly, high levels of unemployment and limited access to well-paying jobs have significantly inhibited the ability of the residents especially those who are 55 years of age and above from getting quality healthcare which can help in eradicating cases of cardiovascular disease. According to the findings in the Black Report, the problem of health inequality has persisted in the United Kingdom since the late 1970s, and this has continuously acted as a significant barrier to access of high-quality care by patients with complex health and social care needs. In this black report, it is stated that one of the critical causes of health inequality in most parts of the United Kingdom is an inequitable distribution of resources and job opportunities thus leading to the development of social classes over time.

In its recent survey, the Department of Health in the United Kingdom discovered that most of the individuals belonging to lower socioeconomic groups and who are 55 years and above old are the most vulnerable population to the long-term conditions such as cardiovascular disease both in the United Kingdom and across the globe.

Another barrier facing the existing cardiovascular disease patients in Newham towards engaging with high-quality health and social care is the presence of a negative socio-political environment that has overtime increased the number of bureaucratic barriers for patients suffering from cardiovascular disease among other long term conditions to get the best health and social care. Thirdly, there exists a weak health care system in the United Kingdom that is inappropriately structured to deal with the health care needs of patients suffering from long term conditions such as cardiovascular. Moreover, this health care system has poorly integrated primary and secondary care programs and processes that inhibit the ability of the patients especially the elderly who are 55 years and above to get the best treatment and social care that they require. Additionally, various individual behavioural factors that are limiting the ability of the elderly residents who are 55 years and above in Newham to have better access to quality health care. Some of these individual health behaviours include low self-esteem that has resulted in such victims opting for risky behaviours such as smoking, unhealthy diet and increasingly sedentary lifestyle.

Various strategies can be implemented towards eliminating the above barriers. These strategies are the vital components of the five-year forward and projective plan. For instance, establishing programs that will help increase the incomes of the residents can play a significant role in eradicating this deadly disease in Newham since people will manage to lead healthy lives. In Newham, the residents will manage to find and maintain jobs for a long duration through Newham’s Council establishing an innovative workplace program that will see the majority of the people manage to acquire jobs that help them meet their daily requirements including health and social care needs.

Moreover, the 2016-2018 Joint Strategic Needs Assessment (JSNA) has been in the frontline in proposing some of the ways that can help improve health delivery in Newham and has even suggested areas where there is the need of joint effort by critical stakeholders in the healthcare sector in the attempt of accelerating improvements in health of the existing population in the next two decades (Kneale, Rojas-García, Raine and Thomas, 2017, pp.53). Moreover, there is a need for intruding new policies within the healthcare sector that will help in reducing the current complex bureaucratic system in the health care sector. Such policies will also assist in transforming the existing complex and weak health system in the United Kingdom. Additionally, introducing a health behavioural prevention program will help in effectively addressing the occurrence of disorders that are related to drug abuse which in most of the cases culminate into an individual suffering from long term conditions.

Examination of the Healthcare Needs of People with Complex Care needs and Possible Interventions

Individuals ranging from frail older adults with at least 55 years and above, patients diagnosed with long term conditions such cardiovascular disease to people with behavioural health and social needs have been found to have clinically complex needs. According to the Joint Strategic Needs Assessment reports, there are various social and care needs that cardiovascular patients in Newham and other parts of the world require in the effort of enhancing their health status. For instance, cardiovascular disease patients having 55 years and above and also suffering from cardiovascular disease are faced with a variety of social needs. For example, residents in Newham who are in the last stages of their cardiovascular disease are forced to stay in bed from where they can receive special treatment thus limiting their ability to interact with other people. Furthermore, cardiovascular patients face physical needs that may emanate from the pain that may be may be attributed to medical conditions that are related to cardiovascular.

Additionally, patients who are 55 years and above and who are suffering from the cardiovascular disease have various physiological needs. For instance, they require balanced diet meals, clean water, fresh air and shelter. As these patients grow weaker and weaker, they are unable to meet most of these physiological needs hence resulting in the need for an intervention from a third party. Again, there are several psychological needs that the cardiovascular patients in Newham face such as the need for a safe environment that is free of accidents and events that may end up endangering their health. Furthermore, this group of patients is faced by biological factors such as genetic vulnerabilities that make them vulnerable to multiple ailments. The below figure illustrates the biopsychosocial model that demonstrates the various social, biological and psychological needs of the patients with cardiovascular disease among other long term conditions.

Figure 1: Biopsychosocial Model

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One of the best interventions to implement include establishing patient-centred care which will enable the caregivers to identify the different care and social needs of the cardiovascular patients and effectively respond to them.  Another way of meeting the complex needs of cardiovascular disease patients who are 55 years of age and above in Newham and other parts of the United Kingdom would be through creating social sessions and focus groups. Such social interaction sessions or programs in which there is direct interaction between these patients may enable them to share their experiences and meet most of their social needs.

Moreover, these programs help in eradicating cases of morbidity that is caused by other diseases such as depression. The best way to facilitate the reconstruction of the cardiovascular patients in Newham who have been found to suffer from depression and stress-related disorders include increasing their social interactions and helping them engage in physical activities such as jogging, running and moving around. Lastly, implementing a psychosomatic therapeutic intervention would help the cardiovascular patients deal with issues to do with isolation, personality traits, risk behaviour and effects of the psycho-endocrinological or psycho-immunological stress responses.

Role of Nurse in Promoting Holistic Care Aimed At Supporting Health and Well-Being of Cardiovascular Patients

Nurses are considered to have the most significant impact on the patients’ experiences and health care delivery since they are always in constant contact with the patients. According to the American Holistic Nurses Association, holistic nursing care entails the process of promoting health care that is aimed at facilitating complete healing of the body, mind and souls of the patients especially those who are suffering from long term conditions such as cardiovascular disease thus making it become the heart of nursing practice. Given the fact each patient has a particular need that is different from that of another, the nurses have taken upon themselves the task of determining these needs and putting into place a holistic care strategy that meets all these needs at an individual level. Nurses who are primarily involved in providing care to patients with long term conditions are task and goal oriented. Holistic nurses play a significant role in meeting the physical, spiritual, social and psychological needs of the patients as illustrated by the below figure.

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In Newham, patients who are 55 years of age and above and who are suffering from cardiovascular disease are benefiting from the holistic care that the nurses operating within the local hospitals are providing. Nurses are fond of using non-pharmacological methods in assisting patients diagnosed with cardiovascular among other long term disease overcome the much pain that they tend to face. Secondly, in Newham, nurses are helping cardiovascular patients improve their health and well-being by educating them about self-care. Self-care is an excellent way of empowering the patients towards improving their health status.

Nurses are also actively involved in the provision of home care services to patients who are unable to visit the healthcare setting by assisting them to undertake their daily activities such as bathing, toileting, eating and getting dressed among others. This has been common especially with those cardiovascular patients who in the last stages of their ailment and who due to old age are unable to do things on their own. Thirdly, nurses are involved in the provision of palliative care to those patients who are suffering long term conditions such as cardiovascular disease. The Palliative care that is being provided to cardiovascular patients who are located in Newham is significantly helping them meet their physical and emotional needs and also improving the quality of their lives.

Moreover, nurses in Newham where there is a rapid increase in patients who are diagnosed with cardiovascular disease and who are above 55 years of age are also involved in the provision of patient-centred care following the introduction of the patient-centered medical home model by the local government. This model is aimed at bringing care to patients with long term conditions such as cardiovascular given the fact that most of the patients with chronic health conditions tend to require more health services than those without such conditions. The patient-centered care that is delivered using the homecare approach in Newham is aimed at providing social services to the cardiovascular patients since these individuals often experience life-threatening complications and progressive chronic illnesses due to the complexity of their health problems.

Communication Strategies Used in Provision of Holistic Care especially when addressing Timely Escalation of Care of the Patients with Complex Health and Social Care Needs

The “Chronic Illness Trajectory Model” that was first introduced in 1991 by Corbin and Strauss is one of the best tools for use in facilitating collaborative work in any healthcare environment. According to Corbin and Strauss, effective communication is the only way that the nurses and all care providers in a hospital can facilitate better care delivery to patients with complex care needs as the trajectories that are proposed in this model tend to map out various phases of the clinical conditions. This model also provides proper guidelines on the expected actions that are supposed to be undertaken by different participants within the healthcare setting towards shaping care delivery.

Thus, effective communication strategies are required to ensure that all the involved parties in the provision of care within a hospital setting have an adequate flow of information. Proper communication helps in ensuring that the primary care clinicians in conjunction with other health care providers are aware of the new medical challenges that the cardiovascular patients are experiencing at any given time hence giving allowance for timely medical interventions in case healthcare emergencies, and complications arise in patients.

It is only through regular monitoring of the patient’s health status and needs and ensuring frequent communication and exchange of information amongst the professionals involved in the provision of care within the hospitals located in Newham and other parts of the country that coordination and holistic care can be accomplished. Adequate flow of information during delivery of holistic care requires multiple modes of communication which can be by phone, in writing or face-to-face communication. Moreover, in the modern health care delivery, reliable communication is being enhanced by the use of electronic tools such as networked electronic health records (EHRs), informed decision-making tools, patient education modules, automated data acquisition and data reminders and remote physiologic monitoring techniques.

These communication strategies help in ensuring that proper care is provided to patients with long term conditions such as cardiovascular disease. The frequency of communication occurs at different levels within the healthcare system. For instance, communication is increasingly required amongst the health and social service professionals who are in direct contact with the patients who have complex health and social care needs. Moreover, efficient communication also takes place across the entire care spectrum especially in those incidents in which the patients transfer from one health care setting to another.

Assessment of Local Community Needs concerning Patients with Complex Health and Social Care Needs and Placing them Within the National Level

Majority of the patients with long term conditions such as cardiovascular have a wide range of complex health and social care needs. For instance, patients with 55 years and above and who are suffering from cardiovascular disease require different social support and more intensive medical services that are comprehensively coordinated across multiple providers. Moreover, various local community needs affect patients with complex health and social needs especially in Newham, United Kingdom. For instance, there is a rapid increase in the level of poverty in Newham among other communities in the United Kingdom. High poverty ration at the community level has inhibited the ability of the patients with complex health, and social care needs to obtain medical services given the fact that this group of people require constant health services that may not be affordable to them due to the high cost involved in acquiring such services. The current poverty rate in Newham is about 37%. This challenge extends even to the national level in the United Kingdom.

Secondly, there are high instances of health disparities in Newham whereby most of the residents in this borough are of South Asian origin and have limited access to health care services when compared to their counterparts who of English origin. Health disparity is one of the essential community challenges that is facing Newham and even extends to the national level in England. Another critical local community need in Newham, and most of the cities in England is the presence of high level of inequality that has made it hard for patients having complex health and social care needs access better services. For instance, the slope index of inequality (SII) as reported in the 2015 marmot indicator shows that 35.6% of most of the employees in Newham belong to the low-income earners group, and this makes it hard for them to have adequate resources that they can invest in better health care services for themselves and their families. The issue of inequality equally prevails across the United Kingdom whereby there exist different social classes countrywide, and this determines the quality of health care that an individual can manage to access. Moreover, in Newham and most of the communities in England, there exist poor emergency services that have made it hard for patients with complex health and social needs to access better care especially when their health conditions escalate. According to the 2015 marmot indicator, this local community need is also present at the national level in England, and this has increased the mortality rate in the country by 5% in the past two years.

One of the best government based-approaches in dealing with this local community needs would be introducing an equitable health care system that will help in eliminating the health disparity and lack of emergency services problems that are facing patients suffering from cardiovascular disease those that have 55 years of age and above. Lastly, ensuring that community-based multidisciplinary support is offered to patients with complex health and social care needs such as those diagnosed with a cardiovascular disease which is common especially in those with the ageing problem can help in improving care delivery. The multidisciplinary team may be composed of community-based services liaison worker, community pharmacist, social workers and occupational therapist.

 
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