Chronic Illness Lisa B. Flatt, RN, MSN, CHPN

Chronic Illness Chronicity – last indefinitely Medical care – treating symptoms vs. curing

Models Chronic Illness Trajectory Model Pretrajectory phase – wellness Trajectory phase – onset of symptoms Stable phase – start treatment Unstable phase – changes in treatment/decrease in improvement or management Acute phase – Sick hospital Crisis phase – life-threatening Comeback phase – get a little better Downward phase – moving towards death Dying phase – actively dying

Chronic vs. Acute Chronic – lasting Acute – short term with end in sight

Adjustment Patterns Kubler Ross – stages -- LOOK IT UP Change lifestyle Change location/environment Acceptance of limitations Modifications

Disability Limitations Face discrimination Limitations at home and work ADA of 1990 protection Deal with environmental conditions that we don’t think about - curbs

Chronic Illness Issues Self-care – ADL assistance Deterioration of Health – progressively grow worse – ie. COPD Quality of life – decreases, increased problems – such as financial, depression Caregiver Dimension – family steps in – if there is one – dramatic changes in family life and dynamics

Factors Influencing Adjustment Gender roles – caregiver is male or female Age – is there a spouse/SO still there, adult children Age – ability to continue with their disability Preferences – who they want to help – relationship with their HCP’s Spiritual/religious/cultural beliefs Support Physical condition at start Role insufficiency- loss of job, changes

Assumptions People want to return to their previous state Intrarole conflict – inability of client to meet new demands of new role Interrole conflict – cannot perform expected or previous role Hiding symptoms are normal “Want to pass”

And more… Culture – Chinese (oldest male cares for parents) Middle Eastern – women caregivers hard to be sick and step down Different rituals Some cultures remove from society Different interpretations of quality of life Response to chronic illness and why you became ill in the first place

And more…. Socioeconomic factors Unemployment Cost Health insurance or lack of Food and healthy eating

And more…. Environmental factors Structural Transportation Occupational hazards Safety issues Patient safety needed equipment/lifts

Psychological Depression Anger Isolative Stigma to be ill Dependence Clingy Want to be normal Learned helplessness

Review… Alternative and complementary therapies Right to Health Care ??What kind of and how good is it???

Model of Chronic Illness 133 million Americans have a chronic illness This number will increase 1% a year until 2030 CDC – CV disease, cancer, diabetes Medicare/medicaid/private insurance/HMO Ethical and legal implications – Patient advocate

Developmental Disabilties Acts 1975 – mental disorders 1980- advocacy program OBRA (omnibus reconciliation act) 1990 – right to refuse treatment PSDA (patient self determination act) 1991 – inform of rights and have signed papers Advanced and DNR

Nursing Process Assessment – adl’s; advocacy; ethical and legal aspect Analysis – collaboration, establish diagnosis and goals Planning – plan short term realistic goals for illness “caregiver will state plan for respite” Implementation – intervene for person, simple measures Evaluation – effectiveness of interventions determine further needs