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• Chronic illness is a lived experience influencing wellness behaviors based on individual and family values, shaped by demographic, socioeconomic, technological, cultural, and environmental variables. This experience remains unique to the individual and family.

Chronic Disease Key Points

• The top 4 Noncommunicable Diseases (NCDs) are cardiovascular diseases (heart disease and stroke), cancer, diabetes, and chronic respiratory diseases.
• Mental health diseases are also significant.
• 75% of global deaths link to NCDs.

Impact of Chronic Disease

• More than 50% of the world's population lives with some form of chronic disease.
• High mortality is an indicator, and the economic costs are trillions of dollars.

Chronic Disease in the US

• Chronic disease affects the quality of life and increases healthcare costs due to the need for increased treatment and long-term care, leading to increased disease and death rates.

Chronic Disease Globally

• There is an increase in noncommunicable diseases like hypertension (HTN), diabetes, and obesity, due to lifestyle changes. Healthcare is not fully prepared to handle chronic illnesses, leading to increased mortality.
• A great deal of money is needed for chronic individuals in the healthcare system

Influences Impacting Chronic Health Conditions

• Major risk factors for NCDs include tobacco use, unhealthy diet/nutrition, excessive alcohol use, physical inactivity, and air pollution.

Factors Increasing Chronic Disease Incidence

Cultural Factors:

• Stigma surrounds mental health conditions in some cultures.
• Diets high in processed foods, high in fat and low in fruits lead to diabetes. Some may have cultural barriers to exercise.

Environmental Factors:

• Air pollution increases the risk for COPD.

Biologic Factors:

• Increased inflammation leads to rheumatoid arthritis (RA).
• There may be high genetics links to DMT2 or sickle cell disease.

Technologic Factors:

• Advancements like continuous glucose monitors help manage chronic conditions like diabetes.

Socioeconomic Factors:

• Those in lower socioeconomic statuses have higher rates of chronic health conditions due to limited access to care, poor nutrition, and living in polluted areas.

Demographic Factors:

• Racial and ethnic minorities, such as African Americans, have an increased risk for HTN and diabetes due to economic status and access to healthcare.
• There is an increase in noncommunicable disease in younger populations.

Needed Nursing Competencies

• Clinical expertise is needed with knowledge of the disease process of COPD, diabetes, and health decline/failure.

Attitudes and Values Related to Chronic Health Conditions

• Stigma around conditions, particularly less visible ones like mental health and autoimmune diseases, can cause isolation.
• Empowerment, acceptance, awareness, empathy, and compassion are very important.
• Cultural norms shape how chronic conditions are understood and treated and independence is also important.
• Many patients value holistic well-being, emphasizing symptom management and emotional health over mere survival, alongside cost-effectiveness, access, and equity.

Societal Factors Related to Chronic Health Conditions

• NCDs negatively affect overall health and make individuals more vulnerable.
• Examples include diabetes, respiratory issues, and heart disease, as well as HTN's impact on stroke, heart disease, diabetes, and kidney failure.
• The financial cost of NCDs impacts both individuals and the economy.
• Poverty limits access to healthcare, causing people to be unable to work and education is not reached.

Core Competencies for Health Professionals

• Visibility and commitment to action are needed for political action, including funding for primary prevention, like the Affordable Healthcare Act.
• Affordable and accessible healthcare should be provided for everyone through preventive care, robust screening, treatment, and accessible knowledge/education.
• Patient-centered care is crucial, involving evidence-based practice, informatics, and quality improvements, utilizing interdisciplinary teams.

Impact of ACEs on Chronic Health Conditions

• Adverse Childhood Experiences (ACEs) are potentially traumatic events in childhood (0-17 years), such as violence, neglect, abuse (physical, sexual, psychosocial), and family member suicide attempts or death.
• Other factors include family substance misuse, instability, homelessness, food insecurity, and changing care providers, such as foster care.
• School nurses and social workers are helpful for children, but unaddressed situations can lead to toxic stress increasing early death, mortality, and chronic illness.

ACEs Scoring

• An ACE score can be calculated by counting the different types of traumatic events a person experienced during childhood (before 18 years old).

Impact of ACEs on Chronic Illness

• High ACE scores are linked to various health issues, including mental health disorders and heart disease due to the long-term effects of trauma and stress
• Higher scores showing a childhood marked by multiple traumatic experiences.

ACEs Study Stats

• ACEs are common, with about 61% of adults across 25 states reporting at least one ACE and nearly 1 in 6 reporting four or more types of ACEs.
• Up to 1.9 million cases of heart disease and 21 million cases of depression could be potentially avoided by preventing ACEs.

Groups at Risk

• Women and several racial/ethnic minority groups were at greater risk for having experienced 4 or more types of ACEs.

Costs of ACEs

• ACEs are costly, with economic and social costs to families, communities, and society totaling hundreds of billions of dollars each year.
• By preventing ACEs, large numbers of health conditions reduce, and ACEs are costly economically and socially.

Preventing ACEs

• Strengthening economic supports to families.
• Promotion of social norms that protect against violence and adversity.
• Ensuring a strong start for children and teaching them new needed skills.
• Connect the youth to caring adults and activities.
• Intervening to lessen immediate and long-term harms.

Addressing Long Term Harms

• Proper screening tools / standardized tools and after-school programs/clubs are needed.
• Assess for support systems– family or friends around the child.

What is Stigma?

• Stigma is a mark of shame, a response to any attribute that devalues a person's social identity, co-occurring with labeling, stereotyping, cognitive separation, status loss, social rejection, and discrimination.

Conditions Most Likely to Be Stigmatized

• These conditions would include mental health conditions (Bipolar Disorder, Schizophrenia), obesity (which displays a visible condition with avoidable risk factors), HIV/AIDS (a condition not visible to most people with avoidable risk behaviors), and physical disability (cerebral palsy, Down syndrome, Parkinson's)

Client Stigma Impact

• Family reactions impact the stigma experiences through negative feelings, shunning, and feelings of isolation.
• Stigma is felt through how there are impacted feelings in the community.

Stigma in Obesity

• Isolation, feelings of shame, judging on eating or exercise, and harsh judgements are made.

Stigma w/ Mental Health Illnesses

• Disbelief occurs, family just blew off symptoms, men not wanting to get help and label in community

Stigma w/ HIV/AIDS

• Some are supportive while others condemn, communities may respond negatively, and judgement occurs.

How are Persons with Chronic Illness Socially Marginalized?

• People with chronic illnesses face stigma and misunderstanding of their condition, challenges at work, and issues with healthcare.

Is someone with Schizophrenia just a Schizophrenic

• The term schizophrenic is often used as a label but reflects a reductionist view of the individual.

Why is Stigma Complex?

• Stigma is complex because it is population targeted.

Inter-related Types of Stigma

• Structural stigma: type of stigma that occurs when somebody does not fit into structural norms, such as healthcare, policies, and social inequality.
• Public stigma: refers to negative attitudes and beliefs toward someone held by general population/community.

Self stigma:

• Internal feelings of a person that they are not good enough
• Is the Internal of the person (stressful / shame). It influences decisions to seek help and impacts health outcomes.
• “Stigma Complex” becomes Multidimensional

Taking A Stand

• HCW's can take stand against stigma by keeping patient confidentiality/privacy, correcting false language, speaking out against negative language/behaviors, suggestion/providing useful resources and promote diversity while avoiding stereotypes.

Communication and empathy importance

• Communication strategies help people that are experiencing stigma with active listening, showing empathy, normalizing conversations about chronic health conditions, respect privacy/confidentiality, educating the patient/raising awareness and removing self-stigma.

Stigma: Discrimination factors

• Discrimination occurs through personal discrimination or structural discrimination, creating architectural barriers and funding barriers, not to mention treatment barriers.
• Personal Discrimination – Loss of privilege, opportunity or equal access occurs.

Quality of Life Definition

• WHO defines QOL "as individual's perception of their position in life in the context of culture and values system in which they live and in relation to their goals, expectations, standards, and concerns.”

What is Health Related Quality of Life?

• Physical/disease of QOL that Focuses on life quality impacted by physical and mental disease. Cella (1995) described it as "the extent to which one's usual or expected physical, emotional, and social well-being are affected by a medical condition or its treatment”.

Domains of Quality of Life

QOL Domains:

• Physical Health
• Psychological Health
• Level of Independence
• Social Relationships
• Environment
• Spirituality, Religion, and Personal Beliefs

Measuring Quality of Life:

• This measurement is made through measuring functional ability and individual experience.
• It is difficult to measure, for ever, because it has a different outlook on QOL - multidimensional and highly subjective concept

Why is it important to measure Quality of Life?

• Measuring quality of life (QOL) is important because it provides a holistic understanding of well-being beyond traditional metrics such as income or physical health. QOL acknowledges more than is just their physical health as it integrates emotional, social, and environmental factors into a comprehensive view of life satisfaction.

Quality of Life Measurement tool

• Holistic Understanding: Captures physical, emotional, social, and environmental well-being. Patient Centered Care: Improves treatment planning by addressing patients' overall needs. Informed Decision-Making: Guides healthcare providers, policymakers, and individuals. Identifies Disparities: Highlights inequities to address marginalized populations. Evaluates Interventions: Tracks the effectiveness of treatments or public health program
• Subjectivity measures: Subjectivity: Varies greatly between individuals, making standardization difficult. Limited accuracy- Mainly subjective

Compare and contrast Quality of Life

• Healthy Days- Measures perceived physical and mental health over the past 30 days and assesses adequate health over that period.
• Best used for Public health surveys, community health assessments. Has 4 domains: pain, sad/depressed, anxiety, sleep
• WHOQOL-BRIEF- Measures overall QOL across physical health, psychological, social relationships, and environment within context of values systems and intended population.
• Health promotion requires individual measurements

Nursing regarding Quality of Life

• Nursing implications pertaining to QOL require care that should be individualized, focus on wellness, empower the individual, achieve health behaviors and be home-based: Visiting patient with telehealth and determine patient needs as goals.

Adherence defined

• Adherence is the goal for clients on long term treatments where they must have motivation
• Def: The extent to which a person's behavior corresponds with agreed recommendations from a health care provider

Adherence v. Compliance

• Adherence is the key: Compliance matches Prescriber's recommendations.
• Compliance has Paternalistic approach while adherence has a partnership approach.

Adherence factors

• Adherence factors include the understanding of where the patient is coming from, while keeping in mind any personal/social factors (transportation, money or social life problems). It also includes prior health behaviors.

Why Should You Adhere

• To stay healthy the patient is always involved in decisions made and regimens are negotiated with alternative therapies explored. This requires honesty and trust in the treatment relationship.

What is Unintentional or Intentional Nonadherence

• If there is no Followthrough with a treatment, it can be considered nonadherence.
• The goal of nonadherence is to create individualized treatments based on patients.

Models to Guide Changes

• HBM/Health Belief Model/ Behavior changes are key aspects
• TTM/Transtheoretical Model of Change/ Stages/ Intervention matching.
• HPM/Health Promotion Mode/ Influenced by individuals

Factors to Enhance Nursing Adherence

• Education and coaching regarding health literacy and numeracy.
• Also provide Ethnocultural interventions that Respect cultural beliefs, values, and practices.
• Always provide care in patient's native language
• Nursing must focus on Patient-Related Factors

Grief and Loss

• Exploration of grief comes from the loss of something or someone, while taking into account cultural needs.
• Actual loss involves the loss of the individual.
• Anticipatory includes losses such as the loss of a job or independence.

Characteristics related to Loss

• Anticipatory grief occurs before an event and might experience it twice.
• Disenfranchised grief involves grief that is not socially recognised such as when there is a terminated pregnancy.

Kubler-Ross Grief Model

Kubler-Ross Grieving model involves stages of grief, starting with denial> anger>bargaing and ending in acceptance.

Factors affecting grieving process

• Must take note on nature loss of loss and have the patience to teach new tools for the loss or find new resources.

Characteristics of factors affecting grieving process

• Characteristics of factors affecting this is the need to take into account the loss, take note of number of losses, age and gender as each factor is different.

Nursing Implication regarding dying persons

• Nursing must ask about their current medical history and provide/assist when possible in those last days.

Nursing interventions

• Provide judgment free care and education and facilitate collaborative meetings with the Chaplin of social wokers.
• This involves helping the person with all self and environment changes that occur with medical conditions.