Integrated Care Nurses

Improved Essays
In 2012 the new movement towards integrated care organisations, which refers to new models called “integrated care pilots”. The policy aims to deliver independency for people with LTC at all stages, therefore provides new ways of collaboration between organisations as well as cross the boundaries between primary, secondary, community and social care (Department of Health, 2012). Even with applying the new policy there some existing setback such as, the IT infrastructure were patient do not have unified record to access and interact with their individual health online as well as share it with other hospital around the country. Moreover, monitoring and providing care to the patients in the public need workforce and budget. According to Margereson and Trenoweth (2010) the NHS need to look at their plans as patients still going back to the emergency department to seek for help.

According to Griffiths, (2012) every patient needs an individual intervention therefore; Mr. Jack needs exclusive intervention as individual, which includes measure dietary intake by
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The service user involvement is about listening to the voices of the people who use the services provided and gives them the chance to evaluate and make changes (Welch et al., 2010). Evaluation part is important for both the patient’s status and the effectiveness of the nursing care plan therefore it must be continuously obtained, and the care plan modified as needed (RCN, 2006). Mr. Jack will ultimately need liver transplant to enhance his quality of life. The patient was in liver transplant list before he was discharged as well as his discharge package, which include GP notification latter, medication and transport. He also was admitted for a month where he did not drink alcohol thus, his health status improved. However, evaluation for the over all case could not be obtained as the patient went to the community

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