Hematoma Reflection

A client that I was assigned was admitted for developing a hematoma on a foot that had the toes amputated. The physician’s note documented the client as being noncompliant with his instructions to keep weight off his affected foot, and stated that the development of the hematoma was a direct result of his noncompliance. As I looked further into the health history of this client, I discovered that the client had a history of bipolar disorder. The nursing staff and physical therapists that were assigned to him that week was having a very difficult time administering care. He refused to take his medications, refused to keep weight off his affected limb and was often very rude to some of the staff members. Once I heard him tell a nurse that she …show more content…
Integrated care programs and insurance plans have undertaken a number of strategies to address these barriers, such as having plans credential providers, creative employment and contract structures for care managers and pay for performance, but these strategies are limited in scope. The financing problem is exacerbated by the structure of contemporary primary care, where practices are often dealing with various insurance plans. Inconsistent payment policies across plans make it hard for practices to undertake the necessary investment to implement integrated care (Butler et al., 2008). Organizational barriers to integrated care include both issues related to change and the process of care. Resistance to change, new staff and new roles, and balancing competing demands are difficult to overcome without strong leadership that is committed to integrated care (Butler et al., 2008).