NUR460 Week 1: Persistent Illness PDF

**[Week 1: Persistent Illness ]** In terms of study tips: - Focus on the lectures/slides and recall the activities and discussion from seminar. - For theories/frameworks/models covered (e.g., shifting models of illness/wellness, care coordination framework, uncertainty theory), st...

**[Week 1: Persistent Illness ]** In terms of study tips: - Focus on the lectures/slides and recall the activities and discussion from seminar. - For theories/frameworks/models covered (e.g., shifting models of illness/wellness, care coordination framework, uncertainty theory), study them by thinking about how you could apply the components of the theories to your nursing practice. For instance, you might want to review the components of a theory, like the care coordination framework which is reviewed in detail in the required reading for week 2, and think about the actions/interactions you could undertake to provide coordinated care. - Review the challenges faced by people with persistent and complex illness and the strategies you could incorporate into your nursing care to improve outcomes and care coordination. - You do not need to know any statistics (e.g., epidemiology). - You also don\'t need to know the specifics around the transition timeline (e.g., what should be done at certain ages).  What you should know, are the benefits of an organized transition program, some/many of the actions/activities that should be accomplished during the transition process and how you might incorporate them into your care coordination (like we discussed in seminar). **Chronic Illness:** refers to health conditions that persist over extended periods and that are often associated with participation and activity limitations - **Loss of self** is a primary source of suffering for people with chronic illness - Chronic illness contributes substantially to: - Morbidity: rates of disease in a population - Mortality: the rates of deaths in a population - Chronic illness is significantly higher among Canada's indigenous people - Common conditions: diabetes, hep C, HIV, heart disease, HTN **Acute and Chronic Illness** - Acute illness on top of chronic illness is common - Comorbidity: 2 or more disorders not directly related, one condition can make the other one worse - Acute + chronic - Ex: Pneumonia + MS - Must understand underlying chronic illness in order to treat acute illness - Multimorbidity: 2 or more chronic medical conditions in the same person, may not be related - Chronic + chronic - Ex: Diabetes + asthma + osteoporosis - Associated w dec QoL, polypharmacy, and multi + complex medical regimens - Demands high standard of nursing skills - Optimal health is a challenge to achieve - Can result in complex self care needs, limits mobility, multiple HCP appts (challenging and time consuming lack of engagement, not following prescriptions properly) - May lead to inc use of ER **Factors contributing to Chronic Illness** - Key determinants of health - Risk factors - Modifiable - Nonmodifiable - Role of genetics - Genetic testing can lead to preventative strategies (sooner you know, sooner you can treat or prevent it) - Role of aging - More likely to have at least 1 chronic condition - 50% of the world age 80+ have 3 or more chronic illnesses - **Factors to consider with Chronic Illness** - Associated disability - Medical -- disability to be medically correct - Social- disability is a socially created disease, not an inherent attribute to individuals - Biopsychosocial -- WHO says this is best bc it allows both to be true - If environment is adjusted to meet individual needs, then no limitation to QoL will be experienced - Psychosocial dimensions - The sick role: pts are victims of their chronic illness - True about pts who are seen and treated - Treat them as human beings, listen to their stories, respect their choices for tx - Self-efficacy: critical bc they are managing their condition on their own - Health-related hardiness (HRH): when ppl experience high lvls of stress without falling ill - Mood disorders: can trigger depression, 1/3 exp depression, not all psychological -- often d/t inflammation - Fatigue: most distressing symptoms ppl can have w chronic illness, v frustrating, can lead to misunderstanding by others - Stigma: pt may be labeled by their tx and illness - May influence error in delivery of care - Can cause unequal power balance between us and the pt - QoL and HRQL: perceptions of physical and mental health status and key variations of health status - Living with chronic illness - Loss of self is a primary source of suffering for people with chronic illness - Normalization and/or covering - Pts are the expert pt -- they know more about their illness than we'll ever know -- **listen to your pt** - Ask yourself: am I treating the pt the way I want to be treated? - Chronic illness and caregiving - Caregiver burden  **Shifting Perspectives Model of Chronic Illness** A diagram of a process Description automatically generated - Ongoing continuously shifting process - **Illness in the foreground** - Focus: loss, sickness, burden associated - Happens during initial diagnosis or exacerbation of illness - **Wellness in the foreground** - Person creates harmony b/w identity and their disease - Nurses role: educate pt, help them understand their disease and how to self-manage - Can be done through supportive environment - Identify illness' unique patterns of response - Help pt make connections with others to share their stories to find support - Nurses need to be aware of emotional distress that occurs when there is acute + chronic or exacerbation - Can lead pt to lose control, feel lonely, pain, loss of dignity - **Treat the person, treat them as a person, do not just treat the illness** - Recognize pt strength, listen to their stories, we can help them return to wellness as this will help us think of an incorporate better strategies to manage their illness **Chronic illness and optimizing health outcomes** - Self-management: patients are in control - Related to better overall physical results, mental results and QoL - Nurses responsible for developing partnership w pts through open, caring, ongoing, mutually responsive convos - Compliance vs adherence - Adherence: pt agrees with healthcare team's tx plan - Instead of saying pt non-compliant -- find out WHY - Coping with chronic illness - Nursing care - Partnership between nurse and pt (and caregivers) - Be alert to potential barriers to successful self-management - Use effective teaching methods (ex. Teach-back) - SDOH can affect successful self-management **What patients with chronic illness want from the health care system** - Access to information concerning: - Diagnosis and its implications - Available treatments and their consequences - Potential impact on the patient's future - Continuity of care and ready access to it - Coordination of care, particularly with specialists - Infrastructure improvements (scheduling, wait times, prompt care) - Ways to cope with symptoms such as pain, fatigue, disability, and loss of independence - Ways to adjust to disease consequences such as uncertainty, fear and depression, anger, loneliness, sleep disorders, memory loss, exercise needs, nocturia, sexual dysfunction, and stress