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During the first two weeks in placement, students, in consolidation with their mentor, will select a patient for this case study coursework. Discuss the role of the health and social care proffessionals that were involved in the care of your patient. Reflect the decision-making processes that you observed.

During the first two weeks in placement, students, in consolidation with their mentor, will select a patient for this case study coursework. Discuss the role of the health and social care proffessionals that were involved in the care of your patient. Reflect the decision-making processes that you observed.

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An essay for the 2012 Undergraduate Awards Competition by Chantal Baxter. Originally submitted for Adult Nursing at None, with lecturer Vidar Melby in the category of Nursing & Midwifery
An essay for the 2012 Undergraduate Awards Competition by Chantal Baxter. Originally submitted for Adult Nursing at None, with lecturer Vidar Melby in the category of Nursing & Midwifery

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Published by: Undergraduate Awards on Aug 30, 2012
Copyright:Attribution Non-commercial

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11/24/2013

 
 1 |Page 
Abstract
Title:
Multidisciplinary Assessment and Rehabilitation:
 
Discuss the role of the health and socialcare professionals that were involved in the care of your patient. Reflect on the decision-makingprocess.
Aim:
The aim of this essay is to explore the literature relating to the roles of the Multidisciplinary
Team during Multidisciplinary Assessment and Rehabilitation to recognise how Audrey’s holistic
needs were identified and met from admission to discharge within the Inpatient RehabilitationUnit.
Background:
Several studies indicate that the prevalence of hip fracture incidents increases withage, with 86% of hip fractures occurring in individuals aged 65years+. Agate (1985) emphasisesthe need for a multidisciplinary approach, as it would be ina
 ppropriate to only treat Audrey’s left
fracture femur. The loss of independence associated with falls in the elderly can often result indeteriorating social, cognitive and emotional conditions.
Methods:
A literature search was conducted using Medline and SAGE Journals Online, usingthe key words identified in table 1, including multidisciplinary rehabilitation for hip fracturepatients, hip fracture inpatient rehabilitation, mortality and outcome. The literature search waslimited to the past 10years, apart from relevant key work. The literature reviewed examined theroles of the multidisciplinary team involved in rehabilitation for patients suffering from hipfractures, from admission to discharge.
Discussion:
The discussion explores the roles of the multidisciplinary team members that wereinvolved in the care of Audrey to recognise how her holistic needs were identified and met,taking into account the main principles of rehabilitation.
Conclusion:
In conclusion a holistic multidisciplinary approach to rehabilitation enables anindividual to reach their optimum physical, mental and social functioning level, whilst increasingtheir confidence and reducing their fear of falling. Continual coordination and cross referralwithin the multidisciplinary team also enables effective and efficient goal setting and earlysupported discharge planning to ensure the ultimate goal of rehabilitation, of returning theindividual to the community with adequate social support networks, is achieved.
 
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Introduction:Within this essay the roles of the Multidisciplinary Team that were involved in the care of Audrey Smith, a pseudonym (NMC, 2008), will be discussed. The focus will recognise how
Audrey’s holistic needs were identified and met
whilst using a multidisciplinary approach, fromadmission to the inpatient rehabilitation unit until discharge, taking into account the mainprinciples of rehabilitation.A literature research was conducted, as seen in table 1, were research studies relevant to thispiece of work were extracted.
Table 1
Database Key words Hits Relevant sourcesMedline
-
Hip fracture rehabilitation
-
Hip fracture inpatient rehabilitation
-
Hip fracture mortality
-
Hip fracture outcome
-
Hip fracture falls prevention
-
Multidisciplinary teamrehabilitation for hip fracturepatients
-
Physiotherapy after hip fracture
-
Occupational therapy after hipfracture
-
The Barthel Index and RivermeadMobility Index
-
Clinical pathway for hip fractures
-
199
-
26
-
244
-
446
-
92
-
7
-
24
-
2
-
16
-
7
-
30SAGE Journals online
-
home rehabilitation and hipfracture
-
14
-
3Timeline: Published in the last 10yearsLanguage: EnglishText options: links to free full textAges: Aged 65+years / 80+yearsTypes of article: Historical articleRelevant if: discussed the roles of thedifferent multidisciplinary team members,fractured hips, prevalence rates, identifiedassessment and evaluation tools, dischargeplanning etc.Epidemiology:Beaupre et al (2005a) reported that the second leading cause for acute hospitalisation in theelderly population is hip fracture incidents. Schnell et al (2010) reported that 86% of hip fracturesoccur in individuals aged 65years+, with the prevalence increasing with age, from 22.5 and 23.9per 100,000 population aged 50years rising to 630.2 and 1289.3 per 100,000 population aged80years (Chudyk et al 2009). Due to the aging population it has also been projected by Chudyk et
 
 3 |Page 
al (2009) that the annual number of hip fractures will increase from 23,375 in 1993/94 to 88,124in 2041.Patient profile:Audrey Smith an 87year old woman was admitted to acute care following a fall at home on30/10/11 when she lost her balance whilst helping her husband get dressed, as he suffers from
Parkinson’s
. She sustained a Left Femoral Fracture.
On admission Audrey’s Haemoglobin was 8.1, therefore 1 unit of blood was transfused prior to
theatre. Due to this
Audrey’s
latency time (the time delay between the fracture incident andsurgery) was 2/3days. Hershkovitz et al (2007), using an inpatient rehabilitation survey on 133patients, found that patients with a latency time of more than 5days had a significantly longerlength of stay, affecting rehabilitation outcomes. Although
Audrey’s
latency time was 2/3days(<5days), if her medical condition had of been stable on admission, then her surgical procedurecould have been preformed sooner. Orosz et al (2004) found that early surgical interventionresulted in better functional outcome, reduced mortality rate, shorter length of stay and a betterquality of life. Yet Grimes et al (2002) found no variation in mortality and morbidity in patientswho had surgery more than 96 hours after their hip fracture in comparison to those within 48hours.Audrey had a Left Femur IM Gamma Nail on 1/11/11. Post operatively she remained well andher observations were stable. She was deemed medically fit for further rehabilitation andtransferred to the Inpatient Rehabilitation Unit on 8/11/11. Gerold et al (2005) found that theshorter length of stay in acute surgical wards,
in Audrey’s case 10days
, results in efficient andrelatively brief rehabilitation programmes.The culture change of rehabilitation:An old historical study conducted by Agate (1985) reported that rehabilitation took place once allmedical or surgical treatment had stopped. However Gerold et al (2005) has reinforced thisculture change of rehabilitation from the third phase of medicine to being an integral part of acutenursing care, starting as early as possible,
with the stabilisation of Audrey’s medical condition
and the prevention of postoperative complications (Shabat et al 2005). Gerold et al (2005)reported that the need to be able to identify an
individual’s
need for further rehabilitation in theacute setting is crucial, to enable the planning for an appropriate rehabilitation setting to begin.Spinks and Wasiak (2009) found that a Multidisciplinary approach adapted in the
 patient’s
homehas a greater chance of success. However in
Audrey’s
case this was not feasible as she did nothave the presence of a caregiver or adequate social support.

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