Chronic Illness And Nursing Practices

Afza.Malik GDA

Chronic Illness as Nursing Challenge 

Chronic Illness And Nursing Practices

Nursing And Chronic Illness,What Is Criteria Of Chronic Illness,Traditional Approach To Chronic Illness,Research Contribution In Improvement of Quality of Life.

Nursing And Chronic Illness

    The practice of nursing has long been identified with the care and comfort of the chronically ill. It is apparent, however, that the health care delivery system, in general, has not adequately responded to the changing needs of the population, particularly in terms of the increasing numbers of chronically ill adults. 

    Currently, in the United States, by age 70, a majority of the US population copes with the effects of at least one chronic illness (Nesses, 2002). 

    Blandon and colleagues. (2001) reported that when asked what they thought were the most important health problems facing the nation, over 80% of respondents identified three chronic illnesses: cancer, human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), and heart disease as the top three.

What Is Criteria Of Chronic Illness

    Chronic illness includes a broad spectrum of diseases that differ significantly from one another in their underlying causes, modes of treatment, symptoms, and effects on a person's life and activity. 

    Chronic illness refers to diseases that are caused by nonreversible pathology; are characterized by a slow progressive decline in normal physiological function; are permanent with cure unlikely; and require long-term surveillance, leaving residual disability (Huw, Coates, & Bore, 2001). Families are drained physically, emotionally, and financially. 

    There is often upheaval of relations among the patient, family, and other members of society. Overall, chronic illnesses vary greatly in their developmental course. Some conditions improve over time, some stabilize, and others are progressively degenerating and debilitating. 

    From the societal perspective, living with a chronic illness is a major source of health care utilization. In the United States, chronic diseases account for three quarters of health care costs (Vineland, 2003). Specifically, Druss and colleagues (2001) indicated that almost half of US health care costs in 1996 were borne by persons with one or more of five chronic conditions: mood disorders, diabetes, heart disease, asthma, and hypertension. 

    In addition, the nonmedical costs are substantial due to lack of productivity. Druss and colleagues (2002) reported that the most expensive chronic illness at a population level was ischemic heart disease; at the per capita level it was respiratory malignancies. 

    The conditions with the greatest disability (including bed days, missed workdays, and rare impairments in activities of daily living and instrumental activities of daily living) relative to expenditures were mood disorders. chronic obstructive pulmonary disease, and arteriopathies.

Traditional Approach To Chronic Illness

    The traditional approach to studying chronic illness has been limited, focusing on the medical model. A new health para a dogma care oriented model of illness has emerged. The concept of health is more readily measured in terms of maximizing physical, psychological, social, and spiritual well-being. 

    In this paradigm, a holistic health-focused model has become accepted with a resulting change towards care of the whole person as well as the family. In addition, in chronic disease management, all clinical decisions need to be individualized, because they usually involve choices between possible outcomes that may be viewed differently by different patients. 

    Vineland (2003) recognized that a constant tailoring of care to the actual needs of individual patients as well as the complexity and long duration of the disease are the distinguishing features of chronic case management. 

    Another related framework that has emerged is the self and family management in chronic illness (Grey, Knave, Gillis, & McCorkle, in press). Pollock (1987) provided an initial review of nursing research related to adaptation to chronic illness. 

    More recently, Fitzpatrick and Goeppinger (2000) edited ten chapters that reflected a variety of chronic illnesses and a full range of interventions to manage them. Valuable contributions to increase our understanding have come from first-person accounts of patients' experiences (Thorne & Patterson, 2000). 

    Other noteworthy efforts have been expanded to families, including ethnically diverse families (Chesla & Run greangkulkij, 2001). Other important contributions have focused particularly on nursing interventions. 

    For example, Frich (2003) concluded that nursing interventions for patients with diabetes can improve psychosocial and health outcomes in terms of facilitating adherence to regimens or behavior changes (greater self-care skills), patient satisfaction, good clinical outcomes (reduction in plasma glucose , decreased blood pressure and cholesterol), and cost savings.

Research Contribution In Improvement of Quality of Life

    Research related to improving the quality of life for people with chronic illness should be a national priority given that people are living much longer and better with conditions that used to be fatal. The existing literature is limited in several critical ways. 

    Much of the research in chronic illness addresses a particular illness or disability. Findings may be applied too narrowly or too inclusively to illnesses with markedly different demands. 

    The landscape of chronic illness is diverse and complex, presenting a vast range of symptoms and trajectories, accomplished by a variety of demands over the natural history of the diseases. Research to date has focused on only specific phases of the trajectory of specific diseases, and not on the unfolding of illness related to developmental tasks over the entire course of an illness. 

    The impact of chronic illness on the patient, well family members, and key caregivers differs and depends on when an illness strikes in the family and on each member's, individual development. 

    Many complex management interventions are eventually aimed at improving or maintaining the patient's independent participation in society. Outcome measures covering this dimension are rarely applied. In order to capture these complex relationships, designs that include mixed methods will be essential.

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