Introduction
This essay critically evaluates the care interventions, frameworks, risks, and social determinants associated with the case of Lilian Moore, a 77-year-old woman admitted following an ischaemic stroke. Lilian presents with moderate hemiparesis, expressive aphasia, and anxiety, alongside a medical history of atrial fibrillation and chronic kidney disease (Stage 3). Socially, she lives alone in a second-floor flat with limited family support, raising concerns about her ability to manage independently upon discharge. Key issues include her mobility limitations, medication management, financial vulnerability, and lack of a recorded Power of Attorney. This analysis, written from a nursing perspective, aims to explore the appropriateness of care interventions, assess relevant frameworks, identify risks, and consider the impact of social determinants on her health and recovery. The essay will argue that a multidisciplinary, person-centred approach is essential to address Lilian’s complex needs while mitigating risks associated with her discharge.
Care Interventions and Multidisciplinary Approaches
Lilian’s care following her ischaemic stroke requires a range of interventions tailored to her physical and psychosocial needs. The presence of moderate hemiparesis and limited mobility necessitates physiotherapy to improve strength and coordination, alongside occupational therapy to adapt her living environment for safer transfers and daily activities (Stroke Association, 2020). For instance, the use of a standing hoist, as noted in her care plan, is a practical intervention, though long-term equipment provision or home modifications will be crucial for discharge. Additionally, her expressive aphasia warrants speech and language therapy to support communication, which is vital for reducing frustration and enhancing her ability to express needs (Royal College of Speech and Language Therapists, 2019).
Moreover, Lilian’s anxiety and low mood highlight the need for psychological support. Cognitive behavioural therapy or counselling, delivered by a clinical psychologist, could help address these issues, while regular mental health assessments by nursing staff are essential to monitor her emotional wellbeing (NHS England, 2016). A multidisciplinary team approach, involving nurses, therapists, and social workers, is critical to ensure holistic care. However, challenges may arise in coordinating these services, particularly in a resource-constrained healthcare system, where delays in therapy or equipment provision could hinder recovery (King’s Fund, 2018). Therefore, effective communication and care planning within the team are imperative to prioritise Lilian’s needs.
Application of Care Frameworks
To structure Lilian’s care effectively, nursing frameworks such as the Roper-Logan-Tierney Model of Nursing can be applied. This model focuses on activities of daily living (ADLs), assessing areas such as mobility, communication, and personal care, which are central to Lilian’s current challenges (Roper et al., 2000). By using this framework, nurses can identify specific deficits—such as her inability to prepare meals independently—and develop targeted interventions, including referral to community support services. However, this model has limitations; it may not fully address the psychosocial aspects of care, such as Lilian’s anxiety, requiring integration with other approaches like person-centred care.
Person-centred care, as advocated by the Nursing and Midwifery Council (NMC), prioritises the patient’s values and preferences (NMC, 2018). In Lilian’s case, this approach would involve discussing her concerns about medication management and financial control, ensuring her voice is heard despite her communication difficulties. While this framework promotes autonomy, its application can be challenging if resources or family involvement are limited, underscoring the need for advocacy from nursing staff to safeguard her interests.
Identification of Risks and Safeguarding Concerns
Several risks are evident in Lilian’s situation, particularly as discharge planning begins. Physically, her limited mobility and dependence on a hoist increase the risk of falls and pressure injuries if adequate support is not provided at home (National Institute for Health and Care Excellence [NICE], 2013). Additionally, her ability to manage medications such as Apixaban, crucial for preventing further strokes, is questionable given her hemiparesis and potential cognitive impacts of the stroke. Non-adherence could result in serious health complications, highlighting the need for a medication review or blister pack provision by a pharmacist (NICE, 2015).
A significant safeguarding concern arises from Lilian’s statement that her grandson manages her finances using her cash card, with no formal Power of Attorney in place. This arrangement raises the possibility of financial abuse, a recognised issue among vulnerable older adults (Age UK, 2019). Nurses have a duty to escalate this concern to the safeguarding team, ensuring an assessment of her capacity and potential exploitation is conducted under the Mental Capacity Act 2005 (Department of Health, 2005). While family support from her grandson could be beneficial, the lack of legal oversight poses a clear risk, necessitating sensitive yet assertive intervention.
Social Determinants of Health and Discharge Challenges
Social determinants play a substantial role in Lilian’s recovery and quality of life post-discharge. Living alone in a second-floor flat presents a major barrier to mobility and access, particularly given her physical limitations. Social isolation, compounded by intermittent family support, may exacerbate her anxiety and low mood, as social connections are critical for mental wellbeing (Marmot and Wilkinson, 2006). Furthermore, socioeconomic factors, such as potential financial constraints, could limit her ability to afford private care or home adaptations if public services are delayed.
From a nursing perspective, addressing these determinants requires collaboration with social services to explore options such as sheltered housing or reablement packages to support Lilian’s independence (King’s Fund, 2018). However, access to such services is often inconsistent, particularly in areas with high demand, and delays could leave Lilian vulnerable. Advocating for timely assessments and interim support—such as daily carer visits—is therefore essential to bridge the gap between hospital and community care.
Conclusion
In conclusion, the case of Lilian Moore illustrates the complexity of post-stroke care for older adults with multiple health and social challenges. Interventions such as physiotherapy, speech therapy, and psychological support are critical to address her hemiparesis, aphasia, and anxiety, while frameworks like the Roper-Logan-Tierney Model and person-centred care provide structured approaches to nursing practice. However, significant risks, including falls, medication non-adherence, and potential financial abuse, must be mitigated through safeguarding measures and multidisciplinary collaboration. Additionally, social determinants such as isolation and unsuitable housing underscore the need for comprehensive discharge planning and community support. Ultimately, this analysis highlights the importance of holistic, individualised care to ensure Lilian’s safety and wellbeing, while acknowledging systemic limitations that may impede optimal outcomes. Nurses play a pivotal role in advocating for vulnerable patients like Lilian, ensuring their needs are prioritised within a challenging healthcare landscape.
References
- Age UK. (2019) Safeguarding Older People from Abuse and Neglect. Age UK.
- Department of Health. (2005) Mental Capacity Act 2005. HMSO.
- King’s Fund. (2018) Delayed Transfers of Care: What Are the Issues? King’s Fund.
- Marmot, M. and Wilkinson, R.G. (2006) Social Determinants of Health. Oxford University Press.
- National Institute for Health and Care Excellence (NICE). (2013) Falls in Older People: Assessing Risk and Prevention. NICE.
- National Institute for Health and Care Excellence (NICE). (2015) Medicines Optimisation: The Safe and Effective Use of Medicines. NICE.
- NHS England. (2016) Improving Access to Psychological Therapies for Older Adults. NHS England.
- Nursing and Midwifery Council (NMC). (2018) The Code: Professional Standards of Practice and Behaviour for Nurses, Midwives and Nursing Associates. NMC.
- Roper, N., Logan, W.W. and Tierney, A.J. (2000) The Roper-Logan-Tierney Model of Nursing: Based on Activities of Living. Elsevier Health Sciences.
- Royal College of Speech and Language Therapists. (2019) Standards for Stroke Care: Speech and Language Therapy. RCSLT.
- Stroke Association. (2020) State of the Nation: Stroke Statistics. Stroke Association.
