Critique A Plan Of Care For A Patient With Complex Needs In Adult Nursing Assignment

 Introduction to Critique A Plan Of Care For A Patient With Complex Needs In Adult Nursing Assignment

The term “complex care” is used to define a co-operated initiative and a specialised approach to fulfil a bunch of requirements of people who have severe, tough conditions, extremely serious injuries and disabilities, which need robust social, psychological and most importantly, medical interventions. Unlike simpler disorders that affect only one system, complicated medical problems affect numerous organs or portions of the human body at the same time, making diagnosis and treatment more difficult. In the context of complex care, it can be said that through multidisciplinary care terms as well as cross-sector collaborations, complex care tackles the underlying reasons for ill health conditions by providing person-centred care, which depends on the main priorities and objectives of the candidates. These concerned factors encompass psychological drivers of health, such as trauma, housing insecurity, poverty, food uncertainty, or lack of proper treatment, in addition to physical well-being and health.

On the other hand, in health and social care, a proper care plan is considered essential for providing assurance that patients receive the appropriate amount of care and treatment, directing medical staff and acting as their main source of data and information throughout the procedure of delivery process. According to Nuffieldtrust.org.uk (2023), in the context of the UK’s healthcare system, it can be stated that about 10.113 groups offer domiciliary care in the UK, while there are roughly 17,000 residential and nursing care facilities. Also, it can be seen that there are significant differences in the amount as well as the distribution of governmental, private and non-profit providers among the four nations.

This assignment is based on a critical care plan for a patient who is suffering from two health issues, CHF or Congestive Heart Failure and COPD or Chronic Obstructive Pulmonary Disease. This study thoroughly demonstrates the need for the ultimate care plan, the value of communication skills, interprofessional working abilities, proper decision-making and risk management capacity. 

Patient/service user profile

As per the NMC (2018) Code, all registrants are required to make sure that all of the data and information they provide to service consumers is supported by evidence (Britishjournalofnursing.com, 2023). In order to follow the NMC Code (2018) and properly maintain confidentiality, the patient for this study is referred to as Alex, who is a 74-year-old retired accountant, living in the UK. The patient is known as a smoker with a history of almost 40 packs per year and a body mass index of 34, and has moderate-stage Chronic Obstructive Pulmonary Disease and Congestive Heart Failure. As per Malik et al. (2023), the complicated clinical illness known as HF or CHF (congestive heart failure) is typified by the heart’s incapacity to pump blood efficiently because of anatomical or functional abnormalities. Although ischaemic heart disease is the most frequent cause of heart failure, valve disease, myocarditis, and hypertension are other contributing causes. On the other hand, the other health issue, COPD, is known as a disorder brought on by injury to the lungs’ airways or other components (Adeloye et al. 2022). Inflammation and other issues that obstruct airways and make breathing difficult are caused by this health damage.

The referred patient has little family support, and he lives in municipal housing in the UK by himself. Alex’s health issues were exacerbated by economic difficulties, moderate depression and social isolation. All of these also impact his compliance with therapy and quality of life. After suffering from severe dyspnoea as well as limb oedema, Alex was brought to the hospital. The patient’s frequent hospital stays have been mostly caused by fluid accumulation and recurrent chest infections. The concerned patient takes furosemide and bisoprolol for his heart issues and uses a salbutamol inhaler, which helps him to breathe. As per NHS.uk (2021), combining furosemide with bisoprolol can cause one’s blood pressure to drop and their heart rate to decrease. On a level of emotion, it can be said that the patient suffers from melancholy and anxiety, a lot of which is related to the worries and panics that accompany shortness of breath and the more profound fear of death. According to Quevedo-Blasco et al. (2024), it can be stated that when a person has a terminal health issue for which there are fewer cure processes, death anxiety is very common. The patient struggles to continue with the physiotherapy treatments and care, and doctor’s appointments since he lacks proper access to transport. This is why it can be said that when combined, these difficulties make it tougher to handle Alex’s diseases and emphasise the necessity of a team-based as well as empathetic initiative that pays attention to Alex more than just a regular patient. 

Critique the care plan

In order to optimise the plan for the best results, a care plan criticism entails evaluating its advantages, concentrating on how well it can address the patient’s unique requirements (Morrison et al. 2021). Also, it can be said that a care plan criticism is essentially a methodical procedure of introspection and assessment with the ultimate goal of enhancing the standard of care for the difficult patient. In this portion, the care plan is criticised to determine whether this is the appropriate care plan or if any modifications are needed for the patient care. 

Inhaler Therapy:

In order to handle the COPD symptoms, the concerned patient, Alex, has recently taken a salbutamol inhaler. As per Tchana and Caffarelli (2023), this pattern of medication belongs to the SABA group or “short-acting beta-agonist”, which is known for working rapidly to ease the breathing process and open up the airways. Nice.org.uk (2025) suggests that salbutamol and terbutaline are in the category of SABAs, working within minutes and lasting up to 4 hours. Even if it makes it easier to breathe, the treatment can cause more harm than good when it comes to Alex’s heart. Lehrer and Rheinstein (2024) note that since beta-2 agonists are alike in activity, they could cause issues such as the adrenergic receptor becoming desensitised and affecting receptors alpha-1, alpha-2 or beta-1 unintentionally. Problems with the heart, metabolism or musculoskeletal system are typical adverse effects. This is why it can be said that this type of beta-agonist can badly affect a patient like Alex, who is suffering from CHF issues. It can be worthwhile to look at alternative therapies that better support the concerned patient’s heart, as well as lung health, given his complicated and serious health situation.

According to Buhl et al. (2024), since 14 randomised placebo-controlled trials have shown improvements in lung function, dyspnoea, exacerbations and health status, LAMAs or long-acting muscarinic antagonists are advised for individuals with COPD issues. As per the literature search, it can be observed that GLY and tiotropium have greater proof than umeclidinium as well as aclidinium, especially when it comes to exacerbation decreament. As per Mussatti et al. (2023), compared to beta-agonists, LAMA drugs have less cardiac adverse impacts and longer-lasting relief for a patient. For the concerned patient, Alex, adding or changing to LAMA might help the patient breathe better without putting more strain on his heart. The respiratory team can modify the course of treatment to suit Alex’s particular requirements.

On the other hand, one of the most significant areas of the patient’s care is the way he uses his inhaler. As per the study by Volerman et al. (2021), it can be seen that between 50% and over 80% of individuals with chronic asthma and COPD lack the proper knowledge of how to utilise their inhalers appropriately. This is why it can be said that even with the correct dosage, improper inhaler technique might cause the medication to not reach the lungs as intended, thus reducing its effectiveness. Also, studies reveal that most medical personnel, like 67-90%, are unable to explain or illustrate the procedures required for proper inhaler usage, highlighting the fact that inhaler abuse is not limited to patients (Volerman et al. 2021). In Alex’s case, it can be suggested that the use of an inhaler is an essential part that should be improved with proper guidance.

Management of medicine:

Alex’s care plan for treating his heart includes administration of bisoprolol, a cardio-selective beta-blocker. The study by Roghani et al. (2024) found that treating stable congestive heart failure patients with bisoprolol fumarate, a beta-1 receptor blocker, reduces their chances of suffering from the illness and dying. Alex is expected to keep operating with his medications so that both his heart and health do not suffer more. Yet things are more complicated in Alex’s case because he has COPD as well. The study authored by Tanwar et al. (2022) explains that beta-blockers may be hard for people with asthma or similar conditions, since these drugs can worsen breathing problems. People report that beta-blockers do occasionally influence the lungs’ beta-2 receptors, which are responsible for opening the airways. Gulea et al. (2021) argue that, if administered cautiously with a first low dose and later increased step-by-step while monitoring breathing issues, bisoprolol is usually safer for people with COPD. It is for this reason that Alex should get regular communication, and his medical team should occasionally read his oxygen level and breathing rate, so that any needed actions can be taken before his breathing gets worse.

The concerned patient is on furosemide, which is a basic need in HF. According to the study by Eid et al. (2021), it can be said that furosemide is known as an assisting treatment for swelling and fluid retention brought on by liver disease, renal disease, and most importantly, congestive heart failure or CHF. However, the medication has some drawbacks of its own. According to Bell and Mandalia (2022), in addition to causing electrolyte imbalances such as potassium and sodium, it eventually overburdens the kidneys. Also, due to its strong diuretic properties, which can lead to excessive water and electrolyte loss and dehydration with electrolyte depletion, a boxed warning advises using furosemide with caution. In the context of Alex’s case, it can be stated that for a patient who is already struggling with severe health issues, it is very crucial that the mentioned medication is handled with proper care and observation.

Change in behaviour and self-care:

Alex’s care and treatment plan appropriately incorporates crucial components to encourage self-care and management, including pulmonary rehabilitation, quitting smoking and nutritional advice. As per Savoli and Bhatt (2022), speaking up offers patients a sense of agency and can ease the strain on healthcare professionals by increasing the likelihood of proactive rather than reactive actions. Patients with chronic diseases benefit from health self-management skills. Alex, the referred patient who has stopped smoking to help his heart and lungs, is coping with other problems that could adversely affect his health at home and his partnership in treatment for both CHF and COPD. According to the study from Alharbi et al. (2021), it has been uncovered that pulmonary rehabilitation in people with COPD significantly raises their physical ability, reduces discomfort while breathing and chiefly improves their quality of life. Nevertheless, Alex seems to have trouble because he does not have easy access to transportation and lives alone. For this reason, reliable transport for him is necessary so that he can go to his meetings safely. In addition, the way patients handle various other situations is an essential part of self-management. The patient is having problems with both body and mind, which result in difficulties with his healthcare. The COM-B model can help manage a patient’s mental health situation and deficits in behaviour. As per Whittal et al. (2021), usually, the COM-B model of behaviour is used to identify what changes are needed in the environment to help a behaviour modification work.

Psychological therapies:

The case of Alex, the patient who is struggling with COPD and CHF issues, is identified as a complex care case. In this case, the care plan should include his mental health concerns as well. In this context, it can be said that the present care plan needs to involve a referral to “improving access to psychological therapies or IAPT”. This is necessary as there is a need for handling the patient’s chronic depression and anxiety. As per Wakefield et al. (2021), it can be observed that access to psychological treatments as well as care at the primary care stage has increased, thanks in large part to the IAPT initiative. Nevertheless, it is still unclear if the frequently reported successes of IAPT involve a decrease in the number of service users who are referred to secondary care services. Also, if the treatments offered by IAPT services are commensurate with the complexity of the presenting issues of those referred. According to Mayoclinic.org (2023), exercise and other physical activities can reduce anxiety as well as improve mood and other health issues. On the other hand, the utilisation of CBT or cognitive behavioural therapy for a variety of health issues in individuals with COPD is supported by the evidence base. It can be said that when comparing high-resource-intensive CBT therapies to standard care, consistent benefits were shown (Nakao et al. 2021).

Value of interprofessional collaboration, effective communication, frameworks for decision-making, and patient-specific risk management

Interprofessional collaboration:

The complexity of Alex’s medical requirements exceeds the capacity of any one specialist or agency to handle them. Also, it can be said that in order to adequately give support to him, a properly maintained and co-operated group of medication experts must be assembled. Also, it should be kept in mind that each of those experts needs to contribute their area of expertise. There are several advantages to collaborative care for both patients and healthcare professionals. Also, it can be seen that together, healthcare workers can expedite procedures, increase communication and interaction and develop patient results while promoting a culture of learning and job happiness (Fernández-Salido et al. 2024). This is why it can be said in this case that respiratory experts, as well as cardiologists, are very crucial for the care of Alex’s CHF and COPD issues. Also, it can be seen that as these specialists frequently interact with the concerned patient, nurses play an important part here to track symptoms, provide daily care and treatment and develop the pattern of trust that actually helps the patient’s mental health and reduces the amount of anxiety or death-fear (Reilly et al. 2024). On the other hand, it can be assured that psychologists and a group of psychotherapists can help Alex remain emotionally strong. As per the case of Alex, it can be observed that he has little family support and lives in an isolated situation. This is why he lacks proper emotional support and guidance. His critical health condition makes him overthink his life and future. In the meantime, if proper psychological guidance is provided by experts, Alex can cope with his emotional imbalance, and it can dramatically increase the quality of his care plan.

Effective communication:

Efficiency in communication and interaction helps remarkably in the patient care plan, especially when it comes to cases like Alex. Effective communication is not only based on providing advice or giving strict instructions to patients, but it also includes clearly interacting with the patient, gathering information about their emotional concerns, medical history, living background or past experiences (salehmohsen Alyami et al. 2024). In the context of Alex’s case, it can be said that nurses, who are responsible for taking care of Alex and spending more time with him compared to others, must have clear communication with the patient. The patient will definitely open up to the healthcare professionals with a clear communication process, and also it will help the experts to know about his concerns, worries, and most importantly, his health issues. The healthcare staff must pay attention to his words and clearly listen to whether he really needs anything. After focusing on Alex’s case, it can be seen that he is emotionally broken as he lacks proper family support and lives in an isolated situation. Nurses must show some empathy to the patient so that he can confess anything that bothers him without any hesitation (Watson, 2024). In healthcare and proper treatment, an establishment of clear communication is really needed.

Procedure of decision-making:

In a case like Alex, where a patient suffers from both CHF and COPD, healthcare professionals must focus on an efficient and fast decision-making process. Also, it can be said that Alex’s health condition can change overnight. This is why a robust observation, and a team of quick decision-makers are actually needed. In this context, it can be said that, in a care plan of complex care, healthcare experts must have effective decision-making skills (Fraze et al. 2021). Doctors can not be available all the time in one patient’s care, as they have to pay attention to all patients. This is why it is suggested that nurses should pay more attention to the concerned patient, and they have to be always ready for any instant treatment need for the patient, as he is struggling with heart failure issues. Alex also suffers from his inhaler consumption. This is why nurses should focus on that matter too, so that they do not face any kind of issues while breathing. The most important thing in the decision-making process is the participation of the patient (Sox et al. 2024). The healthcare experts and all members who are involved in this care plan must include Alex when making an important decision. A patient has the right to know about all decisions the healthcare experts take in the context of their health issues.

Risk management:

Every care plan needs proper risk management while dealing with patients with critical health conditions. In a treatment plan for a patient like Alex, who suffers from both COPD and CHF is very critical to maintain. In this context, the healthcare professionals must pay attention to handling the patient’s symptoms, providing health advice, the patient’s food consumption, providing information about the care plan and most importantly, providing sufficient education to the patient so that they do not panic during the treatment process. As the patient has COPD and CHF, nurses must pay attention to his diabetes, smoking or alcohol usage, blood pressure and inactivity.

Conclusion 

In conclusion, it can be said that the overall case of the patient, who is suffering from Chronic Obstructive Pulmonary Disease and Congestive Heart Failure, shows a valuable aspect of preparing a care plan. In this case, the concerned patient, Alex, lives in an isolated situation and has little family support shows how much care patients like him need. The study focused on the valuable medication and also critically discussed the care plan for the patient to understand the important treatment and effective care. Also, the importance of interprofessional collaboration, efficient decision-making and effective communication is properly demonstrated here.

 

References

• Adeloye, D., Song, P., Zhu, Y., Campbell, H., Sheikh, A. and Rudan, I., 2022. Global, regional, and national prevalence of, and risk factors for, chronic obstructive pulmonary disease (COPD) in 2019: a systematic review and modelling analysis. The Lancet Respiratory Medicine, 10(5), pp.447-458.
• https://nativeassignmenthelp.blogspot.com/2026/08/bfa438qho422-business-finance-for.html
• Alharbi, M.G., Kalra, H.S., Suri, M., Soni, N., Okpaleke, N., Yadav, S., Shah, S., Iqbal, Z. and Hamid, P., 2021. Pulmonary rehabilitation in management of chronic obstructive pulmonary disease. Cureus, 13(10).
• Bell, R. and Mandalia, R., 2022. Diuretics and the kidney. BJA education, 22(6), pp.216-223.
• Britishjournalofnursing.com, 2023. “Delivering evidence-based care for the registered nursing associate” Available at <https://www.britishjournalofnursing.com/content/regulars/delivering-evidence-based-care-for-the-registered-nursing-associate/#:~:text=The%20NMC%20(2018)Code%20identifies,service%20users%20is%20evidence%20based.> [Accessed on 19.05.2025]
• Buhl, Roland, Marc Miravitlles, Antonio Anzueto, and Stephen Brunton. "Long-acting muscarinic antagonist and long-acting β2-agonist combination for the treatment of maintenance therapy–naïve patients with chronic obstructive pulmonary disease: a narrative review." Therapeutic Advances in Respiratory Disease 18 (2024): 17534666241279115.
• Eid, P.S., Ibrahim, D.A., Zayan, A.H., Elrahman, M.M.A., Shehata, M.A.A., Kandil, H., Abouibrahim, M.A., Duy, L.M., Shinkar, A., Elfaituri, M.K. and Minh, L.H.N., 2021. Comparative effects of furosemide and other diuretics in the treatment of heart failure: a systematic review and combined meta-analysis of randomized controlled trials. Heart Failure Reviews, 26(1), pp.127-136.
• Fernández-Salido, M., Alhambra-Borrás, T., Casanova, G. and Garcés-Ferrer, J., 2024. Value-based healthcare delivery: a scoping review. International journal of environmental research and public health, 21(2), p.134.
• Fraze, T.K., Beidler, L.B., Briggs, A.D. and Colla, C.H., 2021. Translating evidence into practice: ACOs’ use of care plans for patients with complex health needs. Journal of general internal medicine, 36, pp.147-153.
• Gulea, C., Zakeri, R., Alderman, V., Morgan, A., Ross, J. and Quint, J.K., 2021. Beta-blocker therapy in patients with COPD: a systematic literature review and meta-analysis with multiple treatment comparison. Respiratory research, 22, pp.1-14.
• Lehrer, S. and Rheinstein, P.H., 2024. Salbutamol, a short acting beta-2 agonist, reduces risk and improves prognosis of prostate cancer. American journal of clinical oncology, 47(12), pp.591-594.
• Malik, A., Brito, D., Vaqar, S., Chhabra, L. and Doerr, C., 2023. Congestive heart failure (nursing). In StatPearls [internet]. StatPearls Publishing.
• Mayoclinic.org, 2023. “Depression and anxiety: Exercise eases symptoms” Available at <https://www.mayoclinic.org/diseases-conditions/depression/in-depth/depression-and-exercise/art-20046495> [Accessed on 19.05.2025]
• Morrison, R.S., Meier, D.E. and Arnold, R.M., 2021. What’s wrong with advance care planning?. Jama, 326(16), pp.1575-1576.
• Mussatti, G., Mazza, L., Dini, S., Gianturco, V., Rossi, F.F., Brunori, M. and Paglia, A., 2023. Chronic obstructive pulmonary disease and respiratory failure. Geriatric Care, 9(3).
• Nakao, M., Shirotsuki, K. and Sugaya, N., 2021. Cognitive–behavioral therapy for management of mental health and stress-related disorders: Recent advances in techniques and technologies. BioPsychoSocial medicine, 15(1), p.16.
• NHS.uk, 2021. “Common questions about bisoprolol” Available at <https://www.nhs.uk/medicines/bisoprolol/common-questions-about-bisoprolol/> [Accessed on 19.05.2025]
• https://www.nativeassignmenthelp.co.uk
• Nice.org.uk, 2025. “CKS is only available in the UK” Available at <https://www.nice.org.uk/cks-uk-only#:~:text=Short%2Dacting%20beta%2D2%20agonists,for%20up%20to%204%20hours.> [Accessed on 19.05.2025]
• Nuffieldtrust.org.uk, 2023. “What does the provider market look like across the four countries?” Available at <https://www.nuffieldtrust.org.uk/news-item/what-does-the-provider-market-look-like-across-the-four-countries#:~:text=There%20are%20approximately%2017%2C000%20residential,10%2C113%20organisations%20providing%20domiciliary%20care.&text=The%20distribution%20between%20public%2C%20private,considerably%20across%20the%20four%20countries.> [Accessed on 19.05.2025]
• Quevedo-Blasco, R., Díaz-Román, A. and Vega-García, A., 2024, January. Death anxiety in caregivers of chronic patients. In Healthcare (Vol. 12, No. 1, p. 107). MDPI.
• Reilly, S., Hobson-Merrett, C., Gibbons, B., Jones, B., Richards, D., Plappert, H., Gibson, J., Green, M., Gask, L., Huxley, P.J. and Druss, B.G., 2024. Collaborative care approaches for people with severe mental illness. Cochrane Database of Systematic Reviews, (5).
• Roghani, S.H., Khan, S., Shafiq, A., Akbar, A., Mustafa, W., Shah, S.Q.A., Khan Jr, M. and Ali, H., 2024. Efficacy of Different Beta Blockers in Reducing Mortality in Heart-Failure Patients. Cureus, 16(11).
• salehmohsen Alyami, A., ALZAHRANI, A.A.H., Al Zubayd, I.H.M., Almansour, H.H.A., al Mansour, A.H., Al Mansour, A.H. and Al Mansour, F.H.M., 2024. The Importance of Effective Communication Between Nurses and Patients. Journal of International Crisis and Risk Communication Research, 7(S8), p.712.
• Savoli, A. and Bhatt, M., 2022. Chronic Patients' Emotions Toward Self-Managing Care IT: The Role of Health Centrality and Dependence on IT. Journal of Organizational and End User Computing (JOEUC), 34(4), pp.1-14.
• Sox, H.C., Higgins, M.C., Owens, D.K. and Schmidler, G.S., 2024. Medical decision making. John Wiley & Sons.
• Tanwar, S., Dhingra, G., Goyal, S., Chaturvedi, V. and Tanwar, K., 2022. Beta-2-agonists in the management of asthma and chronic obstructive pulmonary disease. J Pharmaceut Educ Res, 11, p.4.
• Tchana, B. and Caffarelli, C., 2023. Inhaled Short-Acting Beta Agonist Treatment-Associated Supraventricular Tachycardia in Children: Still a Matter of Concern in Pediatric Emergency Departments?. Children, 10(4), p.699.
• Volerman, A., Kan, K., Carpenter, D. and Press, V.G., 2021. Strategies for improving inhalation technique in children: A narrative review. Patient preference and adherence, pp.665-675.
• Wakefield, S., Kellett, S., Simmonds‐Buckley, M., Stockton, D., Bradbury, A. and Delgadillo, J., 2021. Improving Access to Psychological Therapies (IAPT) in the United Kingdom: A systematic review and meta‐analysis of 10‐years of practice‐based evidence. British Journal of Clinical Psychology, 60(1), pp.1-37.
• Watson, N.A., 2024. Effective Communication for Nursing Practice.
• Whittal, A., Störk, S., Riegel, B. and Herber, O.R., 2021. Applying the COM-B behaviour model to overcome barriers to heart failure self-care: a practical application of a conceptual framework for the development of complex interventions (ACHIEVE study). European Journal of Cardiovascular Nursing, 20(3), pp.261-267.