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Assignment-Models of Health Care. - Copy

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  Plan of Care for HIV/AIDS patients in Kiruhura District; Case Study.Abstract; This paper is dichotomy of the different Health Care delivery models used in the Health Care industry and especially the Chronic illnesses like HIV and AIDS or the services for the elderly. A look into the impact, the scale and magnitude of HIVAIDS on individuals, societies and states has compelled the !riter of this paper to seek to understand ho! HIVAIDs services are delivered in "iruhura District #asing on the $iomedical and $iopsychosocial models. %tili&ing the Activities of Daily 'iving(AD') model as compared to the $iomedical model is  paramount and therefore tested . A care plan for *epha(not his real name), a +'HIV !ho lacks #asic needs for himself and his other - Children !as formulated #ased on the  $iopsychosocial model. An assessment to his a#ility to perform his daily activities like routine !ork, pick his medication preparing food for his children !as performed #ased on the  Instrumental Activities of Daily 'iving scale (IAD') and the Integrated anagement of Adult and Adolescent illnesses model(IAI)!ith a goal of reversing his condition to normal.  A paradigm shift from the #iomedical model that focuses only #iological factors to a more holistic one/the $iopsychosocial model that focuses on $iological, sociological, +sychological and Spiritual factors that e0plains the disease path!ay or a path!ay to reduce the disease is the ans!er to HIVAIDS care and is here#y advocated for use in "iruhura District  Introduction:ac!"round; Globally, HIV/AIDS has caused devastating effects on Human capital, States and societies. It haslead to overhelming challenges to families, communities, Governments and Health systems. !amily"s economic capacity as and is retarded because of loss of or#ing capacity that is due to less or#ing hours either because individuals spend most hours sic# or are loo#ing after the sic# hence lo production capacity, $hildren and other individuals in homes have missed the  basic needs because the meager resources that ould be utili%ed are being spent to pay for medical bills. Hospitals and Health facilities have been overhelmed ith the groing number of people in need of hospitali%ation and this necessitated increasing the number of Human &esources for Health to meet the groing number of patients. Additional monies ere needed to  purchase enormous supplies that are needed to meet the demand of health facilities. Social structure has been greatly affected as individuals lost their dear ones, their bread inners leavinga large group of dependants'(V$s,)odos that is often times not productive either due to illhealth or they spend most of the time loo#ing after the sic#. Governments have lost good  professionals ho ould steer development in the most critical times. Health systems have not *+-+   been spared as the number of patients has increased superseding the ones anticipated'this depleted resources yet the infrastructure ards0 has remained the same. 1his therefore, calls for a multidisciplinary approach to HIV/AIDS care as opposed to a single approach that is mostly  practiced by many (rgani%ations.And the need to provide holistic health care to people 2iving ith HIV and AIDS32HIV0 is groing day by day in order to meet their physical, psychological, social and spiritual needs. 4nli#e the late 5+s and early 6+s hen e ere treating acutely ill AIDS patients, today ere managing a chronic illness here HIV/AIDS $lients live in societies ith their family members and are engaged in routine activities li#e any normal person ould do. 1his #ind of lifestyle has necessitated a paradigm shift in thin#ing and designing the best interventions that ould meet their needs' from an acute illness here the need is to regain his/her health to a chronic illness hose need is more broad to include physical, psychological, spiritual and social needs. 7ut it is also idely #non that in the +th century and today, in hat is termed as #$odern 8 times, the most common model of health care by health care professionals in the medical field is the bio$edical  model. A model here most health care professionals in their routine practice aim at Diagnosing and 1reating the 3atients ith a goal of curing the disease or disability. It focuses purely on 7iological factors as causes of illness and e9cludes or ignores the influence of Socio, 3sychological or :nvironmental or even 3olitical factors on a persons" health. It is the most dominant health care model and is considered a modern ay of healing as it considers #"ood health%  as freedom from physical pain, disease or defect Article; by )illiams, revised by$. )illborn and edited by A. <oseph ++=0. In contrast, some fields of medicine >ursing, 3sycaitry and $ounseling0 have advocated for a different #ind of model that is more comprehensive and one that loo#s at biological, sociological ,3sychological and spiritual factors as some of the areas that influence or lead to ill health ' iopsychosocial $odel that focuses on a holistic care approach. 3roponents of this model 7iopsychosocial model0 li#e Dr. George 2. :ngel, -60 have ?uestioned the use of 7iomedical model and in ++, he argued that to ma#e a proper diagnosis and subse?uently treat this person ade?uately you need to loo# at his/her social, psychological history and consider his/her :nvironmental factors. 1hese help you to design the best pathay to treatment of the cause or underlying causes of illness. 1herefore, to be able to meet all the needs of 32HIV as Health care professional in a  predominantly 7iomedical model period, Iam also affirming George"s argument of investigating a persons" social, psychological and biomedical history in order to design the best treatment plan.Additionally, the )orld health (rgani%ation )H(0 definition for Health as a @ state of complete physical, ental, spiritual and socio !ell#eing of an individual not merely the a#sence of disease or infirmity1   also affirms Dr. George"s argument. It puts it clear that attaininggood health re?uires one to be physically, 3sychologically, Socially and spiritually sound all *+-+  together not in parts. 1herefore in an attempt to provide ?uality Health care, health care  professionals need to focus on ones physical, social, psychological factors as causes of disease and as a state of ellness if attained. &elating the above to health care models the 7iomedical model and the 7iopsychosocial model0 and the )H( definition, it is paramount that Health care professional begin providing a holistic $are that ta#es into account an individual"s 3sychological, 3hysical, social and Spiritual needs ith an aim of attaining total independence to one"s self since it is the most desired state of affairs that all of us aspire to attain. An individual should be able to perform his/her daily activities independently ith no support. !ailure to reach this level of independence calls for an assessment of one"s level of inability as this assists health care or#ers to plan for the best intervention needed 2oper et, al, -65+,-65,-66+,-6650. 1o contribute to the argument of the need to dramatically shift from the disease based care to a holistic care of 32HIV, e need to understand further the impact of HIV and AIDS on families, societies and Governments. )e itnessed since late 5+s , early 6+s and today that HIV/AIDS caused catastrophic harm to individual, families and societies. In its acute form of the 5+s and early 6+s, Hospitals ere overhelmed as the number of patients that needed hospitali%ation roseto alarming levels yet Health care systems ere not prepared to handle the groing number. Death rate as so high and Health $are systems aimed at treating and controlling opportunistic infections. 1he most common intervention as 3revention and this is the time hen 4ganda came up strongly ith the A7$ strategy that brought don the HIV prevalence. In the late 6+s '+++ and ++B/, the advent of $are and 1reatment, e itnessed some stabili%ation of the epidemic and the Health care systems managed chronic patients as opposed to acutely ill ones of the 6+s. Death rate reduced, 32)A continued living in societies and families and the 32)A needed to continue living as other normal people are. 1o attain this need therefore, it calls for a 3aradigm shift in service delivery'from acute care model that aims at curing disease or illness to a $hronic $are model that aims at providing total health through a  Holistic approach that considers all aspects of an individualmental, Social, Spiritual and 3hysical0. 1his Health care model must be able to asses a person 2iving ith AIDS"32)A0 ability to perform her/his Daily Activities. Against this bac#ground therefore, a $ase Study aimed at analy%ing different HIV/AIDS $are *odels practiced elsehere and Ciruhura District in particular ith a goal of finding the best $are model for 32)A is hereby ritten. An evaluation of these models based on the needs available by 32)A and the e9isting Health $are system to identify the best  fit    care $odel  that can be adopted by the District to greatly improve the ?uality of life of 32)A. 1his paper shall analy%e the use of 7iomedical and the 7iopsychosocial models but focus on the Activities of Daily 2ivingAD20 and >ursing model by >ancy 2oper'2ogan and 1ierney. *+-+  1he  ob&ecti'e  of this case study is to find out ho best can the services of 32)A be delivered in a resource limited setting li#e Ciruhura district and ith a goal of improving the ?uality of life of 32)A. 1his paper shall briefly loo# at the HIV and AIDS $are practices at the = A&1 centers in Ciruhura District&ushere Hospital, Ca%o H$ IV and !amily Health &esource $enter0 based on the io$edical  and iopsychosocial  models of Health $are. A sample $are plan shall be formulated that may be adopted by all the A&1 $enters if they ish to. The overall goal of this paper is to identify the Care model that meets the HIV/AIDS patient’s needs similar to the one mentioned below as;  2 *epha a !ido!er !ith - children !ho has #een attending an A3T clinic at 3ushere  Hospital an 456 that runs a HIVAIDS programme for 7 years. *epha defaulted on clinic appointment and his meedication for no! 8months, he is lost to follo!up since he moved a!ay from that area to a far area in search of casual !ork to ena#le him take care of his Children and no! he is found very ill and cared for #y his eldest son. His needs no! involve edical,  +sychological, Social and Spiritual1. HIV/AIDS (iterature re'ie): 1he 4>AIDS report +--0, mentions Sub Saharan Africa here 4ganda lies, as a region heavily burdened ith HIV/AIDS epidemic. It is a region here 6E.B*illion0 of the orlds HIV/AIDS live contributing to -E of the orlds ne infections yet only6 million access lifelong A&14>AIDSF +--0. 1he regionsub'Saharan Africa0 is still grappling ith huge numbers+E0 of people dying from AIDs related illnesses'points above the $aribbean hichis the second and 6points above >orth America.4>AIDSF+--0. In 4ganda, it is estimated that -.million people are living ith AIDS and only =++,+++E0 individuals are on A&1 but the country"s target is ++,++++E0 individuals4AISF+--0. 1he *(H/A$3 report+-+0 estimated that there ere -=+,+++ ne infections in a year reflecting == ne infections per day. 1he same report indicates that there ere B,+++ deaths per year reflecting - deaths per day *+,.- $nibuses of dead people due to AIDS . 1he above Global and >ational figures indicate an alarming situation that needs a dramatic ay of thin#ing and designing of interventions. &eversing this trend to reasonable figures is the most desired state. 1he recent scientific developments that effective A&1 and Safe *edical *ale $ircumcision reduce HIV transmission by 6E and +E respectively, it is possible that e can achieve this state. 1his paper shall aim at formulating the best service delivery practices $are 3lan0 to 32)A programmes and to engage the e9isting Health care programmes to adopt this  plan. *+-+  1he 4ganda data reveals that, biomedical, 7ehavioral and sociological factors are #non to fuel the HIV/AID situation. 1hese are further disaggregated as $ross generation se9, multiple concurrent se9ual partnerships, :arly initiation of se9, *other to $hild 1ransmission of HIV, Se9ually 1ransmitted Infections S1Is0 and Alcohol are the most #non drivers of the epidemic in 4ganda. 1he above factors loo#ed into the conte9t of 7iopsychosocial model of health care delivery, can significantly contribute to the reversing of the HIV/AIDS impact.1herfore, a $are model that target those factors #non to fuel the HIV/AIDS epidermic 7iomedical,psychological and social0 can provide a best anser to reversing the HIV and AIDS impact. A 7iopsychosocial model of HIV and AIDS $are is therefore being advocated for use. It is from these evidences shon above and belo, dran from the recent 4ganda AIDS Indicator surveys and various reports that sho the impact, magnitude, the scale and scope of the scourge that I advocate for 3sychosocial model of Health $are in HIV/AIDS care programmes.   !or e9ample data from the AIDS indicator surveys++B/  +--/-0 indicate regional variations in some indicators #non to fuel the disease as indicated belo.A comparison of  regions of Campala and South )estern adds more insights to this paper.  *+-+
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