Chronic IllnessChronic Illness

Lisa B. Flatt, RN, MSN, CHPNLisa B. Flatt, RN, MSN, CHPN

Chronic IllnessChronic Illness

• Chronicity – last indefinitely

• Medical care – treating symptoms vs. curing

ModelsModels

• 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. AcuteChronic vs. Acute

• Chronic – lasting

• Acute – short term with end in sight

Adjustment PatternsAdjustment Patterns

• Kubler Ross – stages -- LOOK IT UP

• Change lifestyle

• Change location/environment

• Acceptance of limitations

• Modifications

DisabilityDisability

• 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 IssuesChronic 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 AdjustmentFactors 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

AssumptionsAssumptions

• 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…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….And more….

• Socioeconomic factors– Unemployment– Cost– Health insurance or lack of– Food and healthy eating

And more….And more….

• Environmental factors– Structural– Transportation– Occupational hazards– Safety issues– Patient safety needed equipment/lifts

PsychologicalPsychological

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

Review…Review…

• Alternative and complementary therapies

• Right to Health Care

• ??What kind of and how good is it???

Model of Chronic IllnessModel 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 ActsDevelopmental 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 ProcessNursing 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