CASE STUDY

Critical Analysis & Clinical Decision Making

Critical Analysis & Clinical Decision Making

Introduction

Case Presentation

In this case study the patient had an antenatal appointment at the 34th week. The baby was felt in a breech position. Ultrasound confirmed that the baby was present in breech position. Our patient was insisting to have vaginal breech birth because she was afraid of Lower segment caesarean section. Doctors were insisting to perform the Lower segment caesarean section due to the Low Birth Weight of a child and also due Intra Uterine Growth restriction. Another reason was the woman was smoking throughout the period of pregnancy. Finally it was decided by the gynaecologists to perform the Lower segment caesarean section. The midwife was supporting the patient, because she is not practiced the breech vaginal birth, doctors tried to scare the patient by the views of midwife and made her agree for Lower segment caesarean section. The patient in this case study was afraid about the procedure of Lumbar puncture (in order to give spinal analgesia) and requested general. The patient and child were physically well after birth at 38 weeks. Although the patient was emotionally upset because she desired the vaginal birth.

Discussion

History of COCE

The concept of COCE were started from North America in the aearly 1960s. Since that time several conceptual and theoretical definitions have come up in the literature. The initial attempt to for operationalizing the COCE (continuity of care) was found to be reported in the year 1967 (Pugh & MacMahon, 1967). The context of institutional care resulted in a definition targetted on readmissions of patients to and transforms between psychiatric setting . Consequent operational work has also demonstrated the context of service delivery. During the period of deinstitutionalization the concept or ideology was shifted to incorporate follow-through on community relations after discharge or referral and community-based care aspects—movement of client in reaction to requirement, communication among providers, patient-caregiver relationship stability, and efforts to retrieve patients who were lost to treatment (Pugh & MacMahon, 1967).

COCE

Continuity of health care also known as continuum of care is to what extent the care is linked and coherent, in turn based on the information flow quality, care coordination and interpersonal skills. Continuity of health care refers different things to different caregivers, and can be of various types, which are (Anonymous, 2006):

Information Continuity

It incorporates data on previous events which is utilized to provide care is adequate to the current circumstances of patients.

Personal Relationships Continuity

It means to recognize the ongoing relationship among care providers and patients and providers is the undergirding that links care over time and bridges discontinuous events.

Clinical Management Continuity

Before the initiation of planning or important discussion, continuity type should be agreed, in order to prevent misinterpretation. Flawless care means an optimum condition where continuity is present in the health care setting despite of the presence of several transitions (Anonymous, 2006).

When the medical errors were analysed, it revealed the various gaps in the continuity of health, still very few accidents occurred due to the ...