The General Practitioner

The General Practitioner GP could also be referred to as the family physician or family practitioner who provides primary care. The GP can treat acute or chronic illnesses or offer preventive care and health based education to his/her patient.

The GP is a medical doctor and he is able to establish the problem and books for emergency appointment with the ENT consultant. The role of the GP is to identify the problem and react swiftly depending with whether the problem calls for immediate attention.

            Panendoscopy entails using direct laryngoscopy or bronchoscopy in the evaluation of the patient. It is a risky process and there is no guarantee that he will get better. A doctor or a consultant doctor conducts the procedure but first a consent form is filled. The doctor must therefore explain in details the risks and health options that the patient has.

            Surgeons will be involved in this process as they will be required in the removal laryngectomy. Radiotherapists would also be required in offering the radiotherapy for their patients. Chemotherapists will be required to use drugs to kill the cancer cells.

            Patients with terminal illnesses like cancer need to be handled with care from the initial state of breaking the bad news that the health professionals fear; they could be suffering from a deadly disease.

            Facilitators should be used and they should be of different backgrounds for instance one could be with a psychoncology background and other with a clinical background. Breaking bad news should be done in an interactive way. In George’s case the fact that he has cancer and is responsible for his wife who has arthritis is disastrous. He will suffer psychological distress due to this. The heath professional addressing him ought to be courteous in recognizing and managing the case.

            Interprofessional approach in George’s case will ensure division of labor and involvement of diverse health professionals each with his/her own expertise. With shared goals geared to improving George’s condition the staff will work to see to it that their patient is well. Interprofessional teams operate under shared decision making among the team members. Kevin G & Thomas B. (2004, 1240). In case of any emergency or a situation that calls for critical attention can be solved. There must be effective communication between the two parties and this will lead to effective and efficient handling of the patient Pollard K. (2006, 51)

 . Teamwork establishes share accountability and will therefore work jointly to produce quality work. Since all team members are called to work on that particular case, then the care offered is patient centered. Again as they work together to solve the problem successfully teams provide a learning base and continuous self improvement which works to benefit the current professionals and future patients inter professional approach reduces the risks associated with the cancer. Loxley A. (1997, 25)

            To be more effective interproffesional teams ideal needs to implement fundamental changes. There should be modified regulations change in the payment system different communication systems, change in clinical leadership dynamics as well as changes in the work cultures. Zwarenstein M. (2001, 13)

            With inter professional teams the leaders can be able to effectively address pain management, or increase knowledge or training. Cancer patients have different needs which can be handled well by diverse professional. Buck. M. & Tilson R. (1999, 176)

            Teams working as interprofessionals need effective administrative structure as well as good leadership. Consistence government policies and approaches will also work to promote teamwork among interprofessionals. Clouder L. & Sellars J. (2004, 265)

The legislature frameworks ought to promote unity and the models of remuneration should encourage collaboration. Successful team interventions work to improve the quality of care offered through better coordinated health care services. To implement long-term teamwork commitment at all levels of the health care system. Sectors like the courts, professional regulatory bodies, education institutions and patient must be ready to review current practices and look for ways to improve the healthcare. Hayward L. M. DeMarco & R. Lynch. (2000, 240)

            Interprofessional or interdisplinary collaboration helps in providing best care service at reduced costs. Patients’ diverse needs are well attended to under this arrangement. George has diverse needs both medically and socially and hence requires broad care. Barr H., Hammick M., Koppel I. & Reeves, S. (1999, 105)

            The government’s role has been reformed in delivery of health care and greater attention to market economics and the commodity of heath has ensured that service providers use resource to best effect and for the value of money gained.

            Interprofessionalism promotes clear definition of patient’s needs and interests. The government can influence the way interprofessionalism will take place. To ensure that only competent staff members are operational, professional registration is applied to legitimize them as practitioners. Banks S., Janke K. (1998, 135)

            George will need psychological support and good post and preoperative care to minimize complications and speedy recovery. The doctor will advice George in how to maintain good oral hygiene. He also needs to be guided on how to choose appropriate temporary non-speaking communication methods.

            Laryngectomee should visit George; he will explain the suctioning, nasogastric feeding and Laryngectomy tube care and their results to help him adjust for any functional losses. A psychiatrist should be sought so that depression does not occur. The psychiatrist will enable George to adapt new physical confidence so that he is able to heal faster. Surgeons treating patients will have to use modern methods of voice rehabilitation to ensure easy adaptation.

            Other healthcare professionals who provide support and rehabilitative service for instance a head and neck surgeon, radiation and medical oncologists, nurses and experts in speech, swallowing and hearing rehabilitation social workers and dietitians to guide him on what onto feed. Freeth, Delia, & Nicol M. (1998, 460)

            The National Patient Safety Agency (NPSA) works to improve on the safety of patients who just had a laryngectomy. Ventilation needs ought to handle appropriately so that they are well contained. Investment in quality education will help health professionals handle such patients with care. Bellack P., Gerrity P., Moore M., Novotny J., Quinn D., Normal, L. et al. (1997, 310)

            The staff will effectively administer oxygen and administering suction through the stoma. Availability of appropriate equipment for treating laryngectomy could work positively to handle the patients.

            Side effects could occur at different levels for instance during surgery, radiation therapy, chemotherapy or oral complication bleeding, pain and infection can occur after surgery and they would lead to organ damage and could result dysfunctions in the body systems. The nurses can in conjunction with the doctors curb this by reacting according. Such interprofessional interaction will enable the patients to overcome complications that would see them have difficulties in speaking swallowing or breathing. Freeth D. & Nicol M. (1998, 460).

            During radiation complications like fatigue, nausea, eating problem, hair loss, skin irritation and dryness. To ensure that George is not adversely affected by these effects. The dieticians will advice him on his feeding problems and the nausea problem could be controlled. The doctor will offer prescription of how to deal with fatigue and skin irritation as a psychiatrist will console him on the temporary hair loss.

            During the chemotherapy nausea, vomiting, hair loss fatigue, bleeding, low white blood cell count and anemia could occur to George. To handle this problems interprofessional care would suffice. Since anemia would bring detrimental effects to his health advising him on how to change his diet so that all the nutritional requirements are met would be appropriate.  The psychiatrist will help George and his family members adapt and cope effectively to the situation. The doctor will give the appropriate treatment for the bleeding and the integration of this interprofessional care will help George to manage his condition. The doctor can advice George on how to plan his day so that he has ample time to rest especially around treatment times. Pollard C, Ross K & Means R. (2005, 340)

            Reporting fatigue to the doctor will help George to adequately contain his situation. This is because the fatigue could be caused by depression and psychiatrists and the doctor can handle this situation. The doctor and other medical teams can approve the appropriate skin care products.

            Some organizations can be approached to handle the hair loss. Some insurance companies help to purchase the wigs which can be used to cover the head. A dentist will help in oral care plan. Proper nutrition helps the body tolerate cancer treatment while maintaining energy levels, resisting infection and heal tissues. Care for the mouth will ensure that tooth decay, mouth sores and infection are reduced.

            Much mucus will be removed during the process and the nurse will suction it. The nurse will offer appropriate information on how to take care of one’s self. George needs self care so that even after being discharged he can take care of himself. Writing can be used for communication gestures as well as pointing out what one wants.

            Follow up care reduces the risks of recurrences the stoma care must be well developed .Before taking any health care measure for instance any exercise plan the health care plan should be consulted.

            Clinical care pathways (CCP’S)   help organize daily intervention. For specific diagnosis or procedure along a given time line. This plan entails outlining a daily care plan and providing a structure that ensures the documentation of the patient’s progress. It is important in reducing inappropriate stay in the hospital. This way the costs of attaining health care will be reduced. This will be appropriate for George’s care as it incorporates physical, respiratory, speech therapy and nutrition. George will be discharge not later than after the 10^th day when the medical group of interprofessionals has critically assessed his condition and found it manageable. A care package could consist of many pathways which entail different approaches in handling George’s case. Lindeke L., & Block E. (1998, 216)

            Psychosocial impact of the process includes stigmatization due to the physical disfigurement that involves use of the stoma. Loss of voice is a functional disability that has to be dealt with. George may feel unattractive and this could effect his self expression. This can result to low self esteem and consequently depression. Quality psychological adjustment will ensure satisfaction with the social support groups and the new lifestyle after surgery. Financial constraints will be experienced as the whole process entails money.

Initial GP referral – ENT establishment- EUA and biopsy – care diagnosis

Treatment decision – pre-laryngectomy – discharge and continued support – follow up services

Initial Consultation

After visiting the GP who establishes the severity of the illness George is referred to an ENT specialist who conducts a test to establish if it is cancer.

He is given the options of treatment he has and their implication. He is told of the side effects expected and the strategies at hand that can help in coping with them. This is in the outpatient department. Assurance of assistance through the process will assist them cope with the situation.

The day before the surgery he spends it on the surgical ward where he is about his wife petty and hope that he will be okay will reduce his anxiety.

  Post Consultation Nursing Assessment and Counseling

Pre-operative counseling is crucial for post operative adjustment. The speech therapist’s visits together with fellow laryngectomecs will work to improve on the patient’s welfare. Betty is given enough counseling as George’s condition could affect them negatively. They will be given opportunity to express emotions, fears and questions. Pain will be assessed and appropriate action taken to achieve pain control. Cohen J. (2002, 910)

Planning Support

Assessment of needs for further emotional support will be done and referred to District Nurse, Macmillan Nurse or GP as necessary

Assessing psychosocial needs to help determine the level of care needed and refers made to social services or mental health team as necessary

Nutritional assessment will be done and dietetic referral made if necessary,

Make speech therapy referral for pre-operative visit.

Assess the psychosocial needs to determine the level of care needed or refer to social services, mental health team as necessary.

Further Appointments.

 Laryngectomy discharge and continuing support will be offered.

Discuss with the multidisciplinary team patient family district nurse to set a discharge date. This will enable the nurse arrange for pre-discharge visits.

Need for social support refer to social services

Assess the need for trachea equipment and further dietetic support by liaising with dietitian.

Knowledge Clarity.

Ensure patient and family can perform trachea care, operate equipment, self medicate and have contact phone numbers in case of any problems.

Assess patient’s and family’s need for further information about surgery outcomes and postoperative radiotherapy.

Speech Therapy

Ensure patient has a suitable method of communication like communication chart, literacy skills, answer phone and prosthesis.

Following primary surgical voice restoration ensure adequate voice is achieved, a cleaning regime is established and a contact number provided.

Further Appointments           

Ensure a follow up of the speech therapy is arranged.

Combined head and neck clinic

ENT outpatients

 George’s feedback can help the interprofessional team learn some lessons of how people perceive cancer and how they can adjust to solve such cases in future. At the initial stage of diagnosis patients find the information overwhelming and this stage the inter-professionals should be very keen when disclosing this information. There are worries that they are going to die and they need to be consoled accordingly. They worry of what will happen to those they leave behind especially their spouses. Good explanation on the procedures to be taken helps patients to be at ease. Effective dissemination of information makes the procedure easy for the patients. Bezzina P., Keogh J. & Keogh M. (1998, 40)

            Long waiting to see the doctors can be reduced by ensuring that allocation of appointments is done according to the people demands. Patients do experience pain which can be reduced by establishment of pain killers and appropriate measure to reduce the chances for risks in infections. Appropriate measures should be carried out so that parking is provided for patients coming for appointments. The costs should be reasonable so that additional costs are not imposed on desperate patients. Consolation by the inter-professional teams works to help people take up the surgery. Constant check ups by nurses at home helps to establish the patient’s progress. Social support group is very important in helping people adjust to their new lifestyles and enjoy life again.

            Learning points from this module include the knowledge that patients have diverse needs and should therefore be handled at a personal level. Effective communication with patients enables complex situations to be solved amicably and at ease. The patients ought to be handled with care especially if they are vulnerable to see to it that more harm than good is not imposed. People have different perceptions regarding health and disseminating the honest information regarding disease will work to help patients adapt appropriately to diseases when they strike. Interprofessional approach to handle patients is important as it ensures diverse needs are attended to appropriately. Warenstein M. (2001, 50)

             The ultimate call of nursing is to provide medical care services to ensure patient’s survival and wellness. The role of the nurse will be to improve quality of care offered, preventing and managing chronic diseases while ensuring costs are well contained and access is equitable. The nurse can ensure that the patient’s needs are addressed by explaining any queries the patient or their family members could be having regarding the care given or conditions that arise. Interprofessionalism will improve the communication and trust between different professions allowing for improved and collaborative skills. Pollard K, Sellman D & Senior B. (2005, 70)

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