Ben was having a medically complex medical history because of the disorders that were faced by him such as back injury, stress disorder, traumatic stress disorder, and depression. These are those health conditions that make a person physically, mentally, and socially weak. Depression is the state in which the person suffers from a serious medical illness that affects the mental state of the patient. The person starts getting negative feelings towards life and others. The person loses interest in activities that at one time he was enjoying. How the person starts feeling is both depression and grief due to which the person withdraws himself from everything. However, this is the psychological disorder that affects the individual emotional and physical life. Moreover, the immune system of the patient's body is also affected, and the person becomes weak and faces problems in fighting against infection. This results in the body of a patient in more exposed to chronic ailments. Post-traumatic is a disorder that is also related to the mental status of a person that happens after the person has got hit with some injury. Ben's L4 – L5 was fused when he met with an accident and got injured from a back injury. It causes severe pain to him and the condition of the patient was becoming more severe because its only treatment is to go after surgical operation, there is no other operation to this ailment. The surgical procedure of this condition is also very complex because this condition involves the fusion of vertebrae which is quite complex (Kavalidou, Smith & O’Connor, 2017). It has also been observed that the surgical operations done to this ailment have not been found always successful due to which there is always feared to go for surgical operation. The reasons stated presents that the situation of Ben is becoming more complex. The complications like chronic pain, post-traumatic stress, and depression are interlinked to each other and however are contributing to Ben's condition in a complex manner. The combination of these physical and mental ailments together is said to as multimorbidity. Multimorbidity is defined as the term that is used to define the condition of the patient in which he/ she is suffering from three or more than three morbidities. This suffers the life of an individual with poor quality of life, high risk of death, mental stress, and a disability (Zulman, Chee, & Wagner et al.,2015). In addition to this, multiple requirements are linked to multimorbidity are that they cause severe impact on individuals' health as well as to the healthcare system. The wide range of resources is involved in the impact on healthcare delivery systems such as the involvement of a wide range of resources and the need for strategies to focus on the organization to provide care to the individual so that the condition of the patient is improved. Hence, this is the type of situation in which the individual has a severe effect on the health of the patient. This was the same scenario that happened with Ben as he was suffering from multiple complex conditions that impacted his health a lot.
The nursing management plan is the document that provides details about the care of an individual according to their need. The emphasis of the nursing management plan is to provide patients with holistic, standardized, and evidence-based care. Here, in the case of Ben, his treatment plan was both contradicting as well as conflicting. The conflicting management plan is advising Ben to visit a mental health specialist as he was experiencing post-traumatic disorders. According to the nursing management plan, the psychiatrist has to visit weekly for consultations and that was contradicting one for Ben. Oxycodone was the medication that was prescribed to him as noticed in the prescription. Here, in the case of Ben, he was suffering from mental illness named depression and it is proven by the medical scientists that the administration of Oxycodone is not safe because it is opioid (Read, Sharpe & Modini et al., 2017). It is because the opioid is not safe for the patients suffering from depression as it worsens the health. Opioids are advised to patients who are suffering from severe pain, but also it increases the risk of bipolar disorder, anxiety, and depression. An opioid is a substance that has a greater risk of adopting addiction as it changes the body's functioning and makes the individual perform differently. The person also starts demanding for more, if he/ she taste once. Ben in this case is the patient of mental illness the use of Oxycodone can lead to addiction to the drugs which are very risky for the patient suffering from mental illness. Hence, the treatment of Ben in this case both conflicted and contradictory.
Situational complexity is the situation in which the person has a distinction between social and technical situations. In the situational complexity, the prescribed course of action is followed by responsively and flexibly. Ben in this case is facing multiple problems known as situational complexity such as self stigmatization, loss of employment, and family’s condition. Due to mental illness, Ben lost his job and is now unemployed that disturbs the psychological state of the person. This is the situation that creates a barrier in the nursing care plan because the emotional state along with the psychological state is to be taken care of by nursing professionals (Stickley & Koyanagi, 2018). Hence, Ben is here suffering from multimorbidity; this is the situation in which the person suffers from more than one type of disease. It requires lots of expenses for complete treatment but at the time of unemployment, this is a hard time for Ben to manage everything. The family condition of Ben is also contributing as a barrier to the nursing management plan. He uses to stay alone at home and says that no one at home talks to him. This is the reason for the development of depression in Ben. However, in the case of depression, family support is needed to retrieve the patient from such a difficult situation related to health. Emotional support can also be given by the member of the family along with family support. This will finally result in the betterment of the condition of the patient. If the patient like Ben lacks social support, then the individual starts feeling the strain on itself. The relationship of Ben is also not good with his father that is the reason why Ben is not sharing anything with him and struggling with the problem on his own. On the other hand, Ben does not want to discuss anything with his mother. So, this reflects that he is having no one to talk to and discuss with. This is acting as the biggest barrier in the care of Ben and limiting his betterment of health. Moreover, there is one more factor that is self-stigmatization which is the one amongst the biggest barrier to nursing care management plan. In this situation, the patient face mental health issues that affect individuals by getting across discrimination, negative stereotyping, isolation, and rejection that results in a change of behavior. The factors that result in withdrawing of individuals are a rejection of help, social support, treatment withdrawal, and avoidance of treatment (Han, Duncan & Arcila-Mesa et al., 2020).
Multimorbidity is the state in which a person suffers from three or more than three diseases. The condition of the patient becomes persistent to many disease conditions. It worsens the condition of patients along with increasing treatment cost burden of healthcare services. The primary healthcare physicians are not that efficient to diagnose patients from mental illness and it contributes in long term suffering by patients due to chronic health conditions. As there is a rise in the number of mental health patients, but the major focus of the regulating bodies is still on measuring the effectiveness of patient (Coventry, P., Lovell, K., Dickens, et al., 2015). The pattern of disease should be studied along with understanding the diagnosis and treatment of disease. The patterns differ and these presented can be mono-versus multimorbidity, somatic-mental, mental-mental, and somatic-somatic that relate to disorders of different conditions. Further, it has been classified into subgroups and these subgroups are related to the types of specialized services. The most challenging factor that has been found in the co-occurrence of chronic conditions and long-term as well as effective care management. The challenges in this system are faced by all the individuals such as healthcare providers, family members, and society that help by providing funding for improvement of healthcare services (Allison, Lix Lisa & Kim, 2017). Hence, multiple complications arise in the state of multimorbidity that affects decision making and resource allocation. This complexity has a wide range of differences in dealing with patients.
Allison, F., Lix Lisa, M., & Kim, R. (2017). Estimating multimorbidity prevalence with the Canadian chronic disease surveillance system. Health promotion and chronic disease prevention in Canada: research, policy, and practice, 37(7), 215. https://dx.doi.org/10.24095%2Fhpcdp.37.7.02
Coventry, P., Lovell, K., Dickens, C., Bower, P., Chew-Graham, C., McElvenny, D., ... & Baguley, C. (2015). Integrated primary care for patients with mental and physical multimorbidity: a cluster randomized controlled trial of collaborative care for patients with depression comorbid with diabetes or cardiovascular disease. BMJ, 350. https://www.bmj.com/content/350/bmj.h638.long
Han, B. H., Duncan, D. T., Arcila-Mesa, M., & Palamar, J. J. (2020). Co-occurring mental illness, drug use, and medical multimorbidity among lesbian, gay, and bisexual middle-aged and older adults in the United States: a nationally representative study. BMC Public Health, 20(1), 1-9. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-09210-6
Kavalidou, K., Smith, D. J., & O’Connor, R. C. (2017). The role of physical and mental health multimorbidity in suicidal ideation. Journal of affective disorders, 209, 80-85. https://doi.org/10.1016/j.jad.2016.11.026
Read, J. R., Sharpe, L., Modini, M., & Dear, B. F. (2017). Multimorbidity and depression: a systematic review and meta-analysis. Journal of affective disorders, 221, 36-46. https://doi.org/10.1016/j.jad.2017.06.009
Stickley, A., & Koyanagi, A. (2018). Physical multimorbidity and loneliness: A population-based study. PloS one, 13(1), e0191651. https://doi.org/10.1371/journal.pone.0191651
Zulman, D. M., Chee, C. P., Wagner, T. H., Yoon, J., Cohen, D. M., Holmes, T. H., ... & Asch, S. M. (2015). Multimorbidity and healthcare utilization among high-cost patients in the US Veterans Affairs Health Care System. BMJ Open, 5(4). https://bmjopen.bmj.com/content/5/4/e007771.short
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