At the end of the module, each student will submit an individual assignment. The assignmentfor the module is a 2,400 word reflective “patch-work” requiring the student to analyse their learning and reflect on the implications for their future IP practice.

Service Improvement – A Collaborative Approach

Section 1

The subject of this essay is 81-year-old Alice who was admitted to hospital with a fractured neck of femur 6 weeks ago. Now ready for home discharge, a multi-disciplinary team (MDT) (alongside Alice) have prioritised three needs that will enable Alice’s recovery. These needs have been decided based on and short-term goals and long-term care, they are as follows: Mobility, addressing Social Isolation and Home Improvement.

Many elderly individuals lose confidence in their mobility following a prolonged stay in hospital, as is possible in Alice’s case. Arora (2017) suggests if an individual does not mobilise enough, they have an increased chance of reduced bone mass and muscular strength, labelled as Deconditioning Syndrome. This not only increases the chance of further falls and breaks but could be linked to the decline in Alice’s weight from muscle wastage. A study by Mayer et al (2011) highlights reduced muscle mass in the elderly can impair motor function having a large impact upon balance, which may show links to Alice’s fall and break profile. MDT working is needed to ensure Alice can be mobile, gain strength, recover and reduce the chance of further falls when returning home. When planning Alice’s discharge, support will be needed to continue to build her strength and confidence in her own mobility. This may involve a physiotherapist or occupational therapist to ensure equipment, like walking aids, are available to increase confidence to be active and involved in social activities (Gooberman-Hill, 2007). Also, due to Alice’s pressure ulcer the community nurses will be heavily involved in re-dressing them and encouraging regular movement to prevent them worsening. 

Studies indicate hip fractures cause elderly patients to struggle to return to normal life, effecting their overall health and wellbeing, including aspects like social isolation (Barn-Olsen et al, 2018; McMillan et al, 2012). Persistent social isolation can have a significant effect on quality of life and associated with conditions ranging from poor mental health to premature death (American Psychological Association, 2017). Therefore, it is important that professionals involved in Alice’s discharge ensure they consider ways to encourage Alice to participate in activities in her community. Effective methods include befriending services, social group schemes and community navigators who can help to build social participation (Landiero et al, 2016, Public Health England, 2015). Voluntary agencies such as Age UK also offer transport to arranged social events for elderly people. The Royal College of Nursing (2019) recommend that clinicians visiting the home look for signs of social isolation including verbal outpourings and address these feelings with service users to offer support. Additionally, the National Institute for Health and Care Excellence guidance for recovery from falls and hip fractures include referral to a fall prevention class (NICE, 2019). Also offering an opportunity for Alice to build relationships with others in a similar situation. 

Before admission, Alice lived alone with little contact to family. As mentioned, it will be paramount to get Alice involved in social activities in the community but whilst at home, her environment needs to be as safe as possible. Occupational therapists will need to contribute to falls prevention by suggesting modifications to Alice’s physical environment. District Nurses and Social workers will help to facilitate change in Alice’s interaction with her environment (Peterson and Clemson, 2008). Research also shows that a comprehensive home assessment by occupational therapists are an effective falls‐prevention strategy- reducing the risk of falls by 21% overall, and by 39% in high‐risk falls patients (Clemson et al, 2008). It is essential Alice has adequate access to her kitchen, bathroom and bedroom to maintain her physical and mental health needs. This will include the assessment of the height of her bed, chairs and toilet seats.  Other aids that may need to be provided are stair rails, pressure mattress and pressure cushions all to both aid recovery and prevent deterioration. Providing Alice with a safe environment should, in turn, minimise her readmission to hospital because of a fall-based injury