7892310_Complex Care-Revised-Revised (1).edited

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1 Complex Care: An Analysis of Ben’s Complex Health Requirements Student’s First Name, Middle Initial(s), Last Name Institutional Affiliation Course Number and Name Instructor’s Name and Title Assignment Due Date

2 Complex Care In Australia, 33% of people have complex healthcare needs (Kabir et al., 2022). Asante et al. (2022) cite that in the last half-decade, the figure of people in the country with three or more chronic illnesses has grown by over 2.4%. Death rates are going up, healthcare costs are rising, and more people are going to emergency rooms because of this trend (Kabir et al., 2022). This paper uses Ben as a case study to examine the problems of caring for someone with complicated healthcare needs. Ben has many health problems, such as pain in his lower back from a spine injury, PTSD, depression, and social problems like being alone and having financial issues. The study discusses the challenge of caring for Ben's multiple issues and looks at his nursing care management plan to find parts that fail to work together. Ben Classification as Complex Patient: An Analysis of Ben’s Complex Health Requirements Nicolaus et al. (2022) define patients with complicated health needs as people who have more than one long-term illness and those who may have difficulty functioning and take more than one medicine or other treatment concurrently. Apart from needing comprehensive care to deal with their complex health issues, complex patients are marked by an urgent need for health interventions (Davidson et al., 2022; Nicolaus et al., 2022). As per Arena et al.’s (2023) contention, a critical criterion for identifying patients with complex healthcare needs is assessing the number of they have utilized specialized care, such as emergency services. This contention aligns with Hudon et al.’s (2021) findings, where a significant proportion of patients (about 35%) were frequent users of emergency health services. In most cases, patients with complex healthcare needs have tailored care plans incorporating interventions targeting specific health conditions (Nicolaus et al., 2022; Toomey et al., 2021). Ben's situation aligns with these

3 conditions because he suffers from L4-L5 spinal fusion -which signifies a critical musculoskeletal injury leading to long-term pain and decreased mobility (Toomey et al., 2021). Apart from the physical health issue, Ben suffers from PTSD and depression, which complicate the treatment approach. Ben's unemployment increases the complexity of his condition because of the proven association between social issues and physical and psychological well-being. According to Hudon et al. (2021), complex health needs must be identified promptly to reduce the risk of adverse health outcomes and the high cost of emergency interventions. Furthermore, Hudon et al. (2021) mention that social and psychological issues may interfere with the usual care process, requiring constant and often expensive adjustments. Health complexity delineates the gap between a patient’s healthcare needs and the capacity of healthcare services to address such requirements (Hudon et al., 2021; Corbett et al., 2022). Accordingly, Hudon et al. (2021) found that patients with complex needs often try to address this gap by utilizing services such as emergency departments, which increases healthcare costs and predisposes them to poor health outcomes, including death. Emerging Nursing Care Barriers Patients with complex health issues are likely not to experience the full benefits of regular care because of interferences caused by social and psychological issues. For example, social issues are empirically linked to poor psychological outcomes- such as unemployment, and the emergence of emotional problems, such as depression (Hua & Ma, 2022; Lee et al., 2022). Furthermore, Rosignoli et al.’s (2022) and Kollerup et al.’s (2023) study indicate the relationship between mental, physical, and emotional health, highlighting that a problem affecting one domain of an individual’s health influences their overall well-being. It is helpful to use the biopsychosocial model to comprehend better Ben's complicated illness and the obstacles it poses

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4 to nursing care. A tailored healthcare intervention is necessary to break the relationship between Ben's health problems. Ben may not be able to experience the full benefits of his present healthcare options due to his numerous health issues, particularly if he fails to get the individualized attention and recommendations he needs where he is. Ben is unable to follow nurse intervention due to the intricacy of his health condition. For instance, physical health difficulties, such as L4-L5 spinal fusion, may cause pain and functional limits. These two, according to Shahid et al. (2022), support Peng et al.'s (2022) argument that patients are less likely to adhere to physical exercise and physiotherapy therapies. Beyond that, Ben has psychological and social challenges that could make it harder for him to get the high-quality integrated treatment he needs. According to recent studies (Lee et al., 2022; Toomey et al., 2021), people experiencing financial problems due to unemployment and the resulting mental health concerns are likely to experience limited access to healthcare. Additionally, Hua and Ma (2022) present mental health issues as hindrances to effective nursing care, primarily where patients' behaviors and physical symptoms are wrongly attributed to mental health issues, preventing clinical efforts to identify underlying causes. Multiple Chronic Conditions: Barrier to Effective Care Delivery Multi-morbidity is when a person has two or more long-term illnesses, making diagnosing and treating complicated patients difficult (Davidson et al., 2022; Nicolaus et al., 2022). Having more than one sickness is often seen as a challenge since it significantly influences various aspects of healthcare. As per Suls et al.’s (2019) analysis, Individuals with complex healthcare issues often fall victim to diagnosis overshadowing, a situation where health practitioners assume that a patient’s behavior is a consequence of mental health issues, thereby failing to explore underlying biological causes. The case scenario applies to Ben, where low

5 involvement in physical activities and low productivity may be attributed to PTSD and depression without factoring in his physical illness (chronic lower back pain). Additionally, patients with complex healthcare needs are at a high risk of medical errors, non-adherence, and adverse health effects associated with medical interactions. In support of this argument, Kaneko et al. (2022) and Bierman (2019) found that a significant proportion of patients suffering from multiple health conditions experience issues upholding their medical regimen and that those taking different medications that were prescribed on different occasions had at least one experience with drug interactions. Complications in drug schedules have also been highlighted as a critical issue affecting the effectiveness of care delivery to patients with complex health needs. For instance, Kaneko et al. (2022) describe a case in which patients suffering from mental, physical, and social illnesses had trouble adhering to their drug regimens. Difficulties cited by Berk et al. (2023) and Lee et al. (2022) included such things as problems of returning for drug refills, forgetting to take medication, or simply opting not to because they did not want to experience the side effects. Poor integration between health provider services creates disco- ordinated and fragmentary care (Rosignoli et al., 2023; Bourne et al., 2022). Health practitioners often fail to coordinate their treatment plans, which leads to conflicting treatments and low- quality healthcare for people with complex needs (Davidson et al., 2022; Aramrat et al., 2022). Ben's Nursing Care Plan Patients with numerous health issues require comprehensive care that is achievable through a multidisciplinary approach. Nonetheless, a critical issue concerning the coordination of health professionals arises when caring for patients with complex healthcare requirements, which may lead to fragmented care plans (Bourne et al., 2022; Kollerup et al., 2023). A tension exists between the management of chronic lower back pain and depressive symptoms because

6 increased physical activity can exacerbate lower back pain and cause injuries (Heywood et al., 2022). Ben wants his chronic lower back pain reduced so he may resume his active activities. Ben desires that his persistent lower back pain go away so that he will be able to do physical work without any problems. Another goal is to increase exercise and physical activity, which is intended to help in controlling both PTSD and depression symptoms. Participating in physical activities is often linked to better mental health, but excessive exercise can worsen lower back pain (Singh et al., 2022; Bourne et al., 2022; Kollerup et al., 2023; Shaygan et al., 2022). Permitting Ben to perform manual tasks without hindrance, cited as an objective for managing lumbar discomfort, may undermine the objective of enhancing physical activity. Furthermore, the newly initiated medications, namely Sertraline, Ibuprofen, Panadeine Forte, and Oxycodone, bring about further complications. These medications might cause side effects, such as weariness, and negatively affect physical activity and productivity (Bourne et al., 2022; Shaygan et al., 2022). The Soporific properties of certain medications may undermine the objective of enhancing physical activity and participation in pleasurable pursuits. In addition, Ben's care plan exhibits a contradiction in terms of managing depression, specifically the objective of "reducing or eliminating the need for medication to control symptoms," which clashes with the recent commencement of Sertraline, an antidepressant. SSRIs, such as Sertraline, have been proven to be efficacious in treating acute depression and improving the overall functioning of patients (Shaygan et al., 2022). As per Zainal’s (2023) discussion, care decisions should be hinged on variables such as patient preferences and be guided by the nursing principles of nonmaleficence and benevolence (Heywood et al., 2022; Varela & Melvin, 2023). Conclusion

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7 Delayed identification of patients with compound healthcare requirements often increases the danger of adverse health outcomes and the use of emergency department services. Ben is a patient with complex healthcare requirements because he experiences co-occurring physical, mental, and social health issues. Patients with complex healthcare requirements are often challenging to manage and require complex nursing care plans involving multidisciplinary efforts. Ben's health problems are highly intertwined, presenting a need for a comprehensive, patient-centered care plan. This paper argues that Ben will likely not experience the full benefits of nursing care because of healthcare access issues arising from his financial position. Being a patient with complex healthcare needs, he is predisposed to poor health outcomes because his medical complexities may interfere with usual care delivery. As highlighted in previous parts of this paper, mental health conditions such as PTSD and depression may cause health practitioners to overlook Ben’s physical health issues. Furthermore, this paper highlights conflicting elements in Ben’s treatment plan. For example, the paper outlines antidepressants that may cause drowsiness as a factor that conflicts with the goal of increasing Ben’s physical activity. Additionally, the paper identifies the objective to increase Ben’s physical activities as a factor that conflicts with Ben’s physical health needs because it may cause injuries to his lower back.

8 Reference Aramrat, C., Choksomngam, Y., Jiraporncharoen, W., Wiwatkunupakarn, N., Pinyopornpanish, K., Mallinson, P.A.C., Kinra, S. and Angkurawaranon, C. (2022). Advancing multi- morbidity management in primary care: a narrative review. Primary health care research & development , 23 , e36. doi: 10.1017/S1463423622000238 Arena, A. F., Mobbs, S., Sanatkar, S., Williams, D., Collins, D., Harris, M., ... & Deady, M. (2023). Mental health and unemployment: a systematic review and meta-analysis of interventions to improve depression and anxiety outcomes. Journal of Affective Disorders . Doi: 10.1016/j.jad.2023.05.027 Berk, M., Köhler‐Forsberg, O., Turner, M., Penninx, B. W., Wrobel, A., Firth, J., ... & Marx, W. (2023). Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology, mechanisms, and management. World Psychiatry , 22 (3), 366-387. doi: 10.1002/wps.21110 Bierman, A. S. (2019). Preventing and managing multi-morbidity by integrating behavioral health and primary care. Health Psychology , 38 (9), 851. dio: 10.1037/hea0000787 Bourne, R. S., Jennings, J. K., Panagioti, M., Hodkinson, A., Sutton, A., & Ashcroft, D. M. (2022). Medication-related interventions to improve medication safety and patient outcomes on transition from adult intensive care settings: a systematic review and meta- analysis. BMJ quality & safety , 31 (8), 609–622. doi: 10.1136/bmjqs-2021-013760

9 Corbett, T., Lee, K., Cummings, A., Calman, L., Farrington, N., Lewis, L., ... & Bridges, J. (2022). Self-management by older people living with cancer and multi-morbidity: a qualitative study. Supportive Care in Cancer , 30 (6), 4823–4833. doi: 10.1007/s00520-022- 06892-z Davidson, A. R., Kelly, J., Ball, L., Morgan, M., & Reidlinger, D. P. (2022). What do patients experience? Interprofessional collaborative practice for chronic conditions in primary care: an integrative review. BMC Primary Care , 23 (1), 1-12. https://doi.org/10.1186/s12875- 021-01595-6 Heywood, S. E., Connaughton, J., Kinsella, R., Black, S., Bicchi, N., & Setchell, J. (2022). Physical therapy and mental health: a scoping review. Physical Therapy , 102 (11), pzac102. doi: 10.1093/ptj/pzac102 Hua, Z., & Ma, D. (2022). Depression and perceived social support among unemployed youths in China: investigating the roles of emotion-regulation difficulties and self- efficacy. International Journal of Environmental Research and Public Health , 19 (8), 4676. https://doi.org/10.3390/ijerph19084676 Hudon, C., Bisson, M., Dubois, M. F., Chiu, Y., Chouinard, M. C., Dubuc, N., ... & Vanasse, A. (2021). CONNECT -6: a case-finding tool to identify patients with complex health needs. BMC Health Services Research , 21 (1), 1-9. https://doi.org/10.1186/s12913-021- 06154-4 Kaneko, H., Hanamoto, A., Yamamoto-Kataoka, S., Kataoka, Y., Aoki, T., Shirai, K., & Iso, H. (2022). Evaluation of Complexity Measurement Tools for Correlations with Health-

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10 Related Outcomes, Health Care Costs and Impacts on Healthcare Providers: A Scoping Review. International Journal of Environmental Research and Public Health , 19 (23), 16113. dio: 10.3390/ijerph192316113 Kollerup, M. G., & Laursen, B. S. (2023). Exploring hospital nurses’ transitional medication management for older patients with multi-morbidity: An ethnographic study. Nordic Journal of Nursing Research , 43 (1). https://doi.org/10.1177/205715852110617 Lee, G. B., Etherton-Beer, C., Hosking, S. M., Pasco, J. A., & Page, A. T. (2022). The patterns and implications of potentially suboptimal medicine regimens among older adults: a narrative review. Therapeutic advances in drug safety , 13 . doi: 10.1177/20420986221100117 McGorry, P. D., Mei, C., Chanen, A., Hodges, C., Alvarez‐Jimenez, M., & Killackey, E. (2022). Designing and scaling up integrated youth mental health care. World Psychiatry , 21 (1), 61- 76. dio: 10.1002/wps.20938 Mitchell, C., Zuraw, N., Delaney, B., Twohig, H., Dolan, N., Walton, E., ... & Yousefpour, C. (2022). Primary care for people with severe mental illness and comorbid obstructive airways disease: a qualitative study of patient perspectives with integrated stakeholder feedback. BMJ open , 12 (3), e057143. oi: 10.1136/bmjopen-2021-057143 Nicolaus, S., Crelier, B., Donzé, J. D., & Aubert, C. E. (2022). Definition of patient complexity in adults: A narrative review. Journal of Multi-morbidity and Comorbidity , 12 , 26335565221081288. doi: 10.1177/26335565221081288

11 Peng, M.S., Wang, R., Wang, Y.Z., Chen, C.C., Wang, J., Liu, X.C., Song, G., Guo, J.B., Chen, P.J. and Wang, X.Q. (2022). Efficacy of therapeutic aquatic exercise vs physical therapy modalities for patients with chronic low back pain: a randomized clinical trial. JAMA Network Open , 5 (1), e2142069-e2142069. doi: 10.1001/jamanetworkopen.2021.42069 Rosignoli, C., Ornello, R., Onofri, A., Caponnetto, V., Grazzi, L., Raggi, A., ... & Sacco, S. (2022). Applying a biopsychosocial model to migraine: rationale and clinical implications. The journal of headache and pain , 23 (1), 100. doi: 10.1186/s10194-022- 01471-3 Shaygan, M., Sheybani Negad, S., & Motazedian, S. (2022). The effect of combined Sertraline and positive psychotherapy on hopelessness and suicidal ideation among patients with major depressive disorder: a randomized controlled trial. The Journal of Positive Psychology , 17 (5), 655-664. https://doi.org/10.1080/17439760.2021.1913636 Singh, S., Shri, N., & Dwivedi, L. K. (2022). An association between multi-morbidity and depressive symptoms among Indian adults based on propensity score matching. Scientific Reports , 12 (1), 15518. doi: 10.1038/s41598-022-18525-w Skou, S.T., Mair, F.S., Fortin, M., Guthrie, B., Nunes, B.P., Miranda, J.J., Boyd, C.M., Pati, S., Mtenga, S. & Smith, S.M. (2022). Multi-morbidity. Nature Reviews Disease Primers , 8 (1), 48. doi: 10.1038/s41572-022-00376-4 Spink, A., Wagner, I., & Orrock, P. (2021). Common reported barriers and facilitators for self- management in adults with chronic musculoskeletal pain: a systematic review of

12 qualitative studies. Musculoskeletal Science and Practice , 56 , 102433. doi: 10.1016/j.msksp.2021.102433 Suls, J., Green, P. A., & Boyd, C. M. (2019). Multi-morbidity: Implications and directions for health psychology and behavioral medicine. Health psychology , 38 (9), 772. doi: 10.1037/hea0000762 Toomey, D., Reid, D., & White, S. (2021). How manual therapy provided a gateway to a biopsychosocial management approach in an adult with chronic post-surgical low back pain: a case report. Journal of Manual & Manipulative Therapy , 29 (2), 107-132. doi: 10.1080/10669817.2020.1813472 Varela, A. J., & Melvin, A. (2023). The theatre of depression: a role for physical therapy. Physiotherapy Theory and Practice , 39 (7), 1325-1341. doi: 10.1080/09593985.2022.2041136 Zainal, N. H. (2023). Is combined antidepressant medication (ADM) and psychotherapy better than either monotherapy at preventing suicide attempts and other serious psychiatric adverse events for depressed patients? A rare events meta-analysis. Psychological medicine , 1-16. doi: 10.1017/S0033291723003306 Kabir, A., Tran, A., Ansari, S., Conway, D. P., & Barr, M. (2022). Impact of multi-morbidity and complex multi-morbidity on mortality among older Australians aged 45 years and over: a large population-based record linkage study. BMJ open , 12 (7), e060001.

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13 Asante, D., Rio, J., Stanaway, F., Worley, P., & Isaac, V. (2022). Psychological distress, multi- morbidity, and health services among older adults in rural South Australia. Journal of Affective Disorders , pp. 309 , 453–460.

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