The Australian Psychological Society Nursing Essay
In this essay we will be discussing a case study involving Bruce, 84-year-old male. Bruce has osteoarthritis in the hip which has become severe causing a lot of pain.
His medication does not seem to help. His eyesight and hearing are deteriorating. Due to increased pain from osteoarthritis and deteriorated senses, he can no longer attend regular social activities. He is watching television and listening to the radio instead. His wife finds him difficult, anxious and annoyed. For a better outcome of his learning program, we will focus on his osteoarthritis which is causing the most pain and preventing him from socializing.
We will also discuss about primary health care as well as aspects of wellbeing in relation to Bruce’s osteoarthritis care. Finally, an education program and resources will be discussed to enable Bruce to manage the chronic disease.
Part 1 : Primary health care
Primary health care is referred to the health services that people visit with health problems. Its strategy emphasizes the development of multidisciplinary primary health care team including GP, nurses and allied healthcare team such as physiotherapists, dietitians and occupational therapists etc (Hughson, Koutoukidis & Stainton 2013, p.69). In this scenario, Bruce needs access to primary health care services such as physiotherapist and occupational therapist to manage his osteoarthritis as well as to support him with daily activities. To complete the Bruce’s learning program, it is important to understand the different aims of each primary health care service, particularly allied health professional, to develop the right plan. By doing this, best outcome is expected to be reducing pain, allowing him to return to his previous social activity and making him stay independent.
Part 2 : Principles of Wellness
Along with primary health care, wellness is a very important key for Bruce to fight a chronic disease. "Health is defined not only by the absence of disease but also includes the importance of psychosocial wellbeing, including the ability to make and maintain healthy relationships, to cope with daily stresses and to remain optimistic and motivated" (Hughson, Koutoukidis & Stainton 2013, p79).
As his pain is preventing him from leaving house, he is no longer able to gain routine life but is watching TV or listening to the radio.
The principles of maintaining healthy relationship and being optimistic need to be applied to Bruce due to his long-term suffering. Therefore, Bruce needs support in regards to his full balance of emotional and physical health throughout his care.
Part 3A : Outline of the disability
To manage the chronic disease, it is important that Bruce learns about the pathology and incidence of osteoarthritis.
According to the Department of Health and Ageing (2010), osteoarthritis is more commonly diagnosed among women than men and it is estimated that over 1.6 million of Australian have been diagnosed with osteoarthritis.
Osteoarthritis, the most common form of arthritis, causes degradation of the cartilage in the joint. This chronic degenerative joint disease is commonly found in the hips and knees and results from a breakdown of chondrocytes. (Springhouse 2001).
Osteoarthritis, called ‘wear and tear’ disease, is thought to be an age-end-stage of the articular cartilages which becomes severely painful with ageing. By a number of different diseases, influences and movements on cartilage, surfaces irreversibly fray and eventually break down (Dickson & Hosie 2008, p.11). As the disease advances, cartilage is exposed and becomes thicker. In addition, extra bone tissue (bone spurs) grows around the deteriorated cartilages and it affects the joint movement. Thus patients with osteoarthritis suffer from stiffness and experience joint crunching noise. Osteoarthritis symptoms are controllable in most cases with mild analgesic drugs and light exercises by maintaining joint movement (Marieb 2012, p.172).
Part 3B : Learning Program
Before we commence his learning program we have to take his other ageing conditions into account. In regards to his impaired eyesight and hearing, learning program outcome will be successful if it is possibly delivered in the personal session with a loud voice and with appropriate materials. Learning program material should be in large print. Coloured illustration or audio visual materials are more helpful.
In some cases, patients often fail to follow the program due to anxiety (Dickson & Hosie 2008, p.66). For this reason, as Bruce behavior has changed, it is important to give Bruce a written information booklet to take with him to read later on. Furthermore, his wife is a primary caregiver who is relatively healthy so the learning program should be delivered to both Bruce and his wife and reassurance should follow after the session.
There are several environmental and life style changes that Bruce needs to consider. Wearing well-fitting support shoes, installing safety grab bars, using a cushion when sitting and using an elevated toilet seat may help him with pain management or easy mobility (Springhouse 2001).
Joint protection skill which spreads the workload and avoids stress on joint is an effective method to minimize further joint deterioration. Bruce also needs to be aware that sitting on a chair all day does not help at all; however, general exercises will decrease pain if joint is used regularly and certain exercises can improve the specific joint musculature (Dickson & Hosie 2008, p.70).
People usually do not want to work out if the pain makes movement difficult. However, as mentioned earlier, joint mobility is increased if it is used regularly. Thus learning program to be designed for Bruce will be the joint movement increasing program.
Tai Chi is a one of the most effective exercises that can help to reduce the vicious symptoms of osteoarthritis. It has been scientifically proved by many researches that Tai Chi can help to relieve pain and stiffness and improve joint flexibility (Horstman and Lam 2002). By improving Range Of Movement and re-gaining daily activities, Bruce can overcome anxiety and depression. As a result, general well-being will be improving
Part 3C : Resources
There are several resources are available to assist with osteoarthritis.
A booklet called ‘Osteoarthritis’ provided by Arthritis Australia is available for Bruce to read. It contains information based on the latest research and helps people to manage symptoms and lead healthy life (Arthritis Australia 2012). People can down load a booklet or printed booklet is available. http://www.arthritisaustralia.com.au
The Australian Psychological Society (APS) provides lists of psychologists available within residential area to assist with emotional side of disease (The Australian Psychological Society 2013). APS helpline 1800 333 497 connects patient to psychologists. Or patient can visit
Independent Living Centres Australia provides relevant information on choosing right products and services for those who want to remain independent (Independent Living Centres Australia 2011). Web page http://ilcaustralia.org.au/ or advisory service 1300 885 886 is available.
Medicines Line, 1300 633 424 or www.nps.org.au, provides information on any types of medicines (NPS Medicinewise 2012). Progressing osteoarthritis needs pain control by anti-inflammatory medicine thus, it will help Bruce to take medicines safely without confliction between different medicines.
Many Australians are suffering from osteoarthritis however, unlike most people think, osteoarthritis may be controlled by regular exercise and life style changes. Since Bruce’s pain could not be controlled by medicine, he became difficult. Therefore, Bruce should not rely only on pain management by medicine but also has to start using an alternative method. There are many different allied health professionals and resources available for Bruce to use. This learning program is designed for Bruce and his wife to use wide range of primary health care to enable him to adjust correctly to his needs. From this point of view, it is expected that Bruce’s general health and wellness will positively increases. (Word count 1,262)