NURS2038 Illness Prevention and Management Study Guide 2024 S2.pdf

NURS2038 Illness Prevention and Management 2024 S2: Study Guide 1 NURS2038: Illness Prevention and Management...

NURS2038 Illness Prevention and Management 2024 S2: Study Guide 1 NURS2038: Illness Prevention and Management Study Guide Semester 2, 2024 NURS2038 Illness Prevention and Management 2024 S2: Study Guide 2 Topic Key Content Lecture Chronic Illness Chronic Illness - Week 1 “A chronic illness/disease is a health condition that is persistent or otherwise long-lasting in its effects or a disease that progresses with time. The social and economic consequences of chronic disease can impact on peoples’ quality of life. The term chronic is generally applied when the course of the disease lasts for more than three months.” While some chronic conditions can be cured, generally the focus of care is on preventative management and care. The Australian Institute of Health and Welfare commonly reports on 10 major chronic conditions Asthma Back pain Cancer Cardiovascular disease Chronic obstructive pulmonary disease Diabetes Chronic kidney disease Mental health conditions Osteoporosis *focus on these ones, not the ones from the ABS provided in week 3 lecture. Disease = pathophysiology of a condition Illness = “the human experience of a disease (how it is perceived, lived with responded to by individuals, their families, and healthcare professionals)” 47% (1 in 2) of Australians report having at least 1 chronic condition from the ‘top 10 most prevalent conditions’ Week 3 NURS2038 Illness Prevention and Management 2024 S2: Study Guide 3 Week 1 Chronic illness accounts for 1 in every 2 hospitalisations Chronic illness/ disability can affect all dimensions of a person’s life - physical, psychological/ social, spiritual and environmental Care provision must be holistic & culturally sensitive Care must be relevant to the person (person centred) who has the chronic illness and their family Care providers must take a ‘whole of life’ approach, with understanding of risk factors that contribute to chronic illness Principles of Chronic Care: Equity: Absence of unjust, avoidable or remediable differences among groups of people Collaborative partnerships: The partnership between providers, patients, and their families in shared decision-making, coordination, and cooperation Access: The opportunity or ease with which consumers or communities are able to use appropriate services in proportion to their needs Evidence-based: An approach to care that integrates the best available research evidence with clinical expertise and patient values Accountability and Transparency: the process of holding people responsible, open and honest access to truthful information Shared responsibility: An approach in which responsibility for health goals is shared among community stakeholders Sustainability (strategic planning and responsible management of resources): allocating resources appropriately, and developing a healthcare plan that has longevity NURS2038 Illness Prevention and Management 2024 S2: Study Guide 4 Person-centred: a practice in which patients actively participate in their own medical treatment, care is focused on the needs of the individual. Ensuring that people's preferences, needs and values guide clinical decisions, and providing care that is respectful of and responsive to them The nurse’s role in chronic illness management Week 2 Leveraging the principles of chronic illness management, the nurse’s role is to Early identification of risk support for behaviour modification Optimising evidence-based care Facilitating self-management Primary Healthcare Is cost-effective, efficient, care approach to preventing and/or managing health risks, enhance quality of life Week and affect enduring change. Primary health care uses person-centred care to address physical, mental and 1/week social well-being. 6 Rather than being reactive and dealing with a problem when it arises, focus on regular maintenance and quality education to prevent issues arising. Principles of Primary Health care: Access: The ability of individuals to obtain and utilize healthcare services when needed. This includes factors such as availability, affordability, and geographic proximity of services to ensure everyone can receive the care they require. NURS2038 Illness Prevention and Management 2024 S2: Study Guide 5 Equity: The principle of fairness in healthcare, ensuring that individuals have access to the care they need based on their specific circumstances, rather than everyone receiving the same level of care. It focuses on reducing health disparities across different populations. Empowerment: (see below) A process designed to facilitate self-directed behaviour change by encouraging a focus on strengths and abilities. Empowerment allows patients to build capacities to gain access, networks and/or a voice, to gain control over their health decisions. Health Literacy: (see below) Health literacy is the skills, knowledge, motivation and capacity of a person to access, understand, appraise and apply information to make effective informed decisions about their health. Community Participation: The involvement of individuals and communities in decision-making processes, planning, and implementation of health interventions or programs that affect their well-being. It promotes a sense of ownership and relevance to local health needs (note this does not refer to the socialisation of the socially isolated. The focus is on planning and development of health programs). Cultural Sensitivity: Awareness and respect for the cultural differences, beliefs, values, and practices of individuals and communities when delivering healthcare services. It involves adapting care to meet the unique cultural needs of patients. Cultural Safety: Providing an environment in healthcare where individuals feel respected, valued, and safe, free from discrimination or harm due to their cultural identity. It requires healthcare providers to challenge power imbalances and ensure care is responsive to cultural diversity. Intersectoral Collaboration: Cooperation and coordination between various sectors (e.g., health, education, housing, social services, and government) to address the broader determinants of health and improve public health outcomes. It emphasises integrated approaches across multiple fields to solve complex health problems. NURS2038 Illness Prevention and Management 2024 S2: Study Guide 6 Health Promotion: The process of enabling individuals and communities to increase control over and improve their health by addressing broader social, environmental, and behavioural determinants. Health promotion includes initiatives such as education campaigns, public policies, and community-based interventions. Appropriate Technology: The use of technology that is well-suited to the specific social, economic, and cultural contexts of the population it is intended to serve. In healthcare, this means using tools and solutions that are affordable, accessible, and sustainable for a particular community, such as telehealth in rural areas. Health Literacy Health Literacy - Health literacy is the skills, knowledge, motivation and capacity of a person to access, Week 2 understand, appraise and apply information to make effective informed decisions about their health. Outcomes associated with high health literacy: Better adherence to treatments and medications Better at monitoring own health and safety Better understanding of instructions Higher levels of self-care and management Make informed health decisions and select appropriate treatments Improved quality of life Reduced health costs More likely to engage in preventative services Empowered to proactively participate in health decisions Live healthier lifestyles Health education is “any combination of learning experiences designed to help individuals and communities improve their health, by increasing their knowledge or influencing their attitudes” Health education can be delivered in two different ways: Planned – structured, organised and prescheduled, often focused on an identified need. NURS2038 Illness Prevention and Management 2024 S2: Study Guide 7 Opportunistic – spontaneous, informal and often provided throughout routine provision of care as it relates to an episode of care. 8 factors that affect learning: Education level Economic circumstances Language spoken Attention Readiness to learn/motivation Family and community support Emotional factors (fears, insecurities) Health condition (fatigue, discomfort) Prior to planning and implementing health education it is important to first assess a person’s health literacy Self-management Self-Management is the ability of individuals and their support networks to promote and maintain health, and Week 2 prevent disease, or cope with illness or disability. Empowerment Empowerment is a process designed to facilitate self-directed behaviour change by encouraging a focus on Week 2 strengths and abilities. Empowerment allows patients to build capacities to gain access, networks and/or a voice, to gain control over their health decisions. The role of the nurse in fostering empowerment is: Serve as facilitator and expert resource Ensure patients have knowledge and resources to make informed health decisions Assist patients to achieve goals and overcome barriers through education Provision of ongoing self-management support Encourage patient self-reflection NURS2038 Illness Prevention and Management 2024 S2: Study Guide 8 Disempowering behaviour includes: talking more than listening, evaluating more than understanding, advising more than informing, making assumptions, judgemental body/verbal language and belittling behaviour, providing only the options that suits the nurse, or making decisions for the clients without consulting them Disempowerment may cause ongoing patient dependence or withdrawal from healthcare Stages of readiness The Readiness to Change Model, also known as the Transtheoretical Model (TTM), consists of five stages of Week 2 to change model/ change. These stages reflect an individual's readiness to modify behaviour, often used in contexts like health Transtheoretical behaviour changes (e.g., quitting smoking, weight loss, or managing chronic conditions). The stages are: Model 1. Precontemplation: The person is not yet considering change and may not be aware of the problem or the need to change. 2. Contemplation: The person is aware of the problem and is thinking about making a change but has not yet committed to action. 3. Preparation: The person is getting ready to change and may take small steps toward making the change within the near future. Sourcing resources, knowledge and skills occurs in anticipation of change. 4. Action: The person actively takes steps toward making the change and modifying their behaviour. 5. Maintenance: The person has successfully changed their behaviour and is working to sustain the change and avoid relapse. A sixth stage is anticipated: NURS2038 Illness Prevention and Management 2024 S2: Study Guide 9 6. Lapse and relapse: Lapse is a one-off return to behaviour that doesn’t lead to old patterns of use A lapse can present an opportunity for self-discovery and learning that will promote meaningful change Relapse involves a return to previous patterns of behaviour People can cycle through these stages’ multiple times, and they may not always be linear. The 5 A’s model for The 5As model of behaviour change is a structured framework used in healthcare to help individuals Week 2 behaviour change adopt healthier behaviours. It is particularly useful in managing chronic conditions, promoting lifestyle changes, and preventive healthcare. The 5As stand for: 1. Assess: Evaluate the patient’s readiness, willingness, and ability to change. This step gauges where the patient stands in terms of motivation and barriers to making a change. 2. Advise: Provide clear, personalized advice about the need for behaviour change. This should be direct and based on evidence, emphasizing the health benefits of changing behaviours and the risks of not doing so. 3. Agree: Collaboratively set goals base on patient interest and confidence in their ability to change the behaviour 4. Assist: Offer support in developing a plan to change. This might involve helping the patient set realistic goals, providing resources, offering counselling, or referring them to additional services. 5. Arrange: Set up follow-up appointments or plans to track progress. Regular monitoring, encouragement, and adjustments to the plan are essential for maintaining the behaviour change over time. The 5As model provides a systematic approach to guiding patients through the process of behaviour change, supporting them at every stage. This also requires the nurse to: Establish a rapport so clients have opportunities to express concerns freely Provide objective information about patient health and what they need to do to address their concerns Use appropriate education strategies and confirm understanding, e.g. teach back NURS2038 Illness Prevention and Management 2024 S2: Study Guide 10 Ensure patient follow-up Comorbidity and Co-morbidity - The presence of two or more chronic conditions in a person at the same time. Comorbidity Week 3 Multimorbidity means that one 'index' condition is the focus of attention, and others are viewed in relation to this. Multimorbidity - The presence of two or more (unrelated) chronic conditions in a person without any of conditions holding priority over the others (definition provided in lecture, though conditions may be related and still considered multimorbid, eg. CVD and CRD). Burden of Disease Burden of disease measures the impact of living with illness and injury and dying prematurely. Week 3/Week Burden of disease is measured using disability-adjusted life years (DALYs) 5 One DALY is 1 year of ‘healthy life’ lost due to illness and/or death—the more DALYs associated with a disease or injury, the greater the burden Modifiable and Modifiable risk factors are behaviours or characteristics that individuals can change or control to reduce their Week non-modifiable risk risk of developing chronic illnesses. These factors are directly influenced by lifestyle choices, behaviours, or 3/week factors environmental exposures. Addressing modifiable risk factors can help prevent or manage chronic conditions. 4/week Common (but not all) modifiable risk factors include Smoking, Nutrition, Alcohol, Physical inactivity 7 Non-modifiable risk factors are aspects of an individual's health or circumstances that cannot be changed or controlled. These factors may increase the likelihood of developing chronic diseases but are beyond a person's ability to alter. Understanding non-modifiable risk factors helps healthcare providers assess an individual's risk for certain conditions and guide preventive measures. These may include genetics/family history, age, cis- gender or ethnicity. NURS2038 Illness Prevention and Management 2024 S2: Study Guide 11 Social Social determinants of health are the non-medical factors that influence health outcomes. These Week Determinants of include the conditions in which people are born, grow, work, live, and age, and the wider set of forces and 3/week Health systems shaping the conditions of daily life. 6 Some common SDH are: 1. Social gradient 2. Stress 3. Early life 4. Social exclusion 5. Work 6. Unemployment 7. Social support 8. Addiction 9. Food 10. Transport Motivational Motivational Interviewing is a strategy to encourage behavioural change, with the health professional working Week 4 Interviewing in partnership with individuals and families to offer non-judgmental information and strategies to facilitate positive change. This is a technique used to facilitate empowerment, but it is not the same as empowerment. Make sure you know the subtle difference between the two. It uses the following stages: 1. Engaging: Establishing a trusting, collaborative relationship with the patient by actively listening and showing empathy. NURS2038 Illness Prevention and Management 2024 S2: Study Guide 12 2. Focusing: Narrowing down the conversation to the specific behaviour or issue the patient wants or needs to change. 3. Evoking: Eliciting the patient’s own motivations for change by exploring their feelings, values, and ambivalence about the behaviour. 4. Planning: Collaboratively developing a concrete plan for change that is based on the patient’s readiness and commitment. A common communication technique used in motivation interviewing is the OARS model: Open-ended questions to engage person in conversation (increases participation) Affirm a person’s strengths and progress Reflect on person’s situation – helps person see a way forward/ missing ‘piece of the puzzle’ Summarise to confirm understanding Chronic Illness A health strategy is a plan that guides the actions and goals of a healthcare organisation or system. It can help Week 4 / management improve the quality, efficiency, and effectiveness of healthcare services, as well as address the challenges and week 7 / programs opportunities in the changing healthcare environment. These are usually developed at a federal or state level week 9 and identify key areas of priority, funding and resources available and outcome measures. They do not provide specific interventions or programs, as these need to be developed by local health networks and communities to meet the specific needs of the community. To support those living with chronic illness the Australian government has a range of illness management programs. These include: Medicare Benefits Schedule NURS2038 Illness Prevention and Management 2024 S2: Study Guide 13 Pharmaceutical Benefits Scheme National Disability Insurance Scheme National Health & Medical Research Council (NHMRC) Person-centred Person-centred care - The practice in which patients actively participate in their own medical treatment in Week 6 care close cooperation with their health professionals. Person-centred care considers the patient’s (and their family’s) goals, values and preferences when developing a health care plan Rural and remote People living in rural and remote areas have higher rates of hospitalisations, deaths, injury Week 6 healthcare People living in rural and remote areas have poorer access to and are less likely to utilise primary health care services, than people living in urban areas. Generally, people living in rural and remote areas have: lower formal education (less likely to have completed year 12 and/or tertiary studies) lower income work in agricultural or manual labour employment be more likely to be unemployed Have higher cost of living Have higher risk of engaging in risky health behaviour Have higher risk of domestic violence Have reduced access to health care including diversity of providers Shorter life expectancy Higher levels of disease and injury Health technology eHealth refers to “cost-effective and secure use of information and communications technologies in support of health and health-related fields, including health-care services, health surveillance, health literature, and health education, knowledge and research” (WHO, n.d.) NURS2038 Illness Prevention and Management 2024 S2: Study Guide 14 Telehealth refers to “the use of electronic information and telecommunications technologies to support long- distance clinical health care, patient and professional health-related education, public health and health administration” (HRSA, n.d.) Health Inequity & ‘Health inequities are differences in health status or in the distribution of health resources between different Week 7 Vulnerability population groups, arising from the social conditions in which people are born, grow, live, work and age.’ These inequities have significant social and economic costs both to individuals and societies. ‘Vulnerability is the degree to which an individual, population...is unable to anticipate, cope with, resist, and recover from the impact of disease and disasters’. Vulnerable populations are groups of people who experience a disproportionate burden of disease, due to barriers to accessing adequate health care, that can lead to differences in health outcomes and life expectancy. These populations have a higher risk of developing chronic conditions. Some vulnerable populations in Australia include: First Nations persons Culturally and linguistically diverse persons People living in rural, regional and remote areas Sexuality and gender diverse people (LGBTQI+) People in low socioeconomic groups People living with mental illness People living with disability Homeless Ageing Children Women Refugees NURS2038 Illness Prevention and Management 2024 S2: Study Guide 15 Stigma Stigma refers to a negative set of beliefs, perceptions, or attitudes that society or individuals hold toward a Week 7 person or group, often based on characteristics such as illness, disability, race, gender, or behaviour. Stigma leads to discrimination, marginalisation, and social exclusion, which can affect the mental, emotional, and physical well-being of those who are stigmatised. In healthcare, stigma can prevent individuals from seeking treatment or support due to fear of judgment or rejection. Illness Behaviour Illness behaviour is any activity, undertaken by a person who feels ill, to define the state of his health and to Week 8 discover a suitable remedy. It is ddefined by the shifting of priorities and unfolds over time as people struggle to achieve some accommodation or management over their chronic illness Stages of illness behaviour: These 5 stages of illness behaviour are Symptoms experience. Assumption of the sick role. Medical care contact. Dependent client role. Recovery and rehabilitation Illness behaviour can be influenced by: individual personality family Educational factors Economic factors Psychological and Personal factors Social factors NURS2038 Illness Prevention and Management 2024 S2: Study Guide 16 Adaptation to Adaption to Health refers to the phenomenon that individuals, over time, adjust to a deterioration in their Week 8 Health health and may lead to an increase in reported levels of quality of life, even if the health status has not improved Advocacy Advocacy - Promoting patient safety and quality care. Week 8 This includes; protecting patients, provision of quality care and interpersonal relationship as well as educating patients. Additionally, advocacy gives patients a voice in situations or settings where they could possibly be ignored or disregarded illness trajectory Illness trajectory describes the course or progression of chronic illness as experienced over time. Week 9 The four defining **illness trajectories** describe patterns of decline experienced by individuals with chronic illness or terminal conditions. These trajectories help predict the course of a disease and guide appropriate care and management. Here are the four illness trajectories, along with examples: 1. Sudden Death/Short Decline: - Trajectory: Sudden and unexpected death occurs with little to no warning, often in individuals who appear healthy or have stable conditions. - Example: A person experiences a fatal heart attack or stroke without prior significant decline in health. 2. Organ Failure/Episodic Decline: - Trajectory: Marked by periods of gradual decline punctuated by episodes of acute exacerbations, with partial recovery between episodes. Patients often experience an unpredictable decline in health over time, eventually leading to death. - Example: A patient with chronic heart failure or chronic obstructive pulmonary disease (COPD) who experiences periodic flare-ups requiring hospitalisation, followed by partial recovery. NURS2038 Illness Prevention and Management 2024 S2: Study Guide 17 3. Frailty or Progressive Decline: - Trajectory: A slow, gradual decline in physical and cognitive function over a prolonged period, often seen in elderly patients or those with chronic degenerative diseases. This trajectory is marked by increasing disability and dependency. - Example: An elderly person with Alzheimer's disease or advanced frailty who experiences a gradual loss of independence and function over several years. 4. Chronic illness with recovery: - Trajectory: Individuals with a chronic condition may experience long periods of stability, with intermittent flare-ups or exacerbations that require treatment, followed by recovery or return to baseline function. This trajectory involves ongoing management but does not necessarily lead to a steady decline. - Example: A person with multiple sclerosis (MS), who may experience periods of remission after an exacerbation, or a person with a spinal cord injury who slowly regains some functional capacity as spinal shock subsides (which can take up to two years), who learns to manage their condition through avoiding complications such as pressure injuries and dysreflexia. There is another illness trajectory not included in the lecture (so don’t memorise this one): Terminal Illness - Trajectory: Characterised by a steady decline in physical function over a relatively short period (Thus distinguishing it from prolonged decline trajectory), with a clear terminal phase. This trajectory is common in illnesses where death is expected after a defined period of illness. - Example: A patient with advanced cancer who experiences gradual decline and worsening symptoms, leading to death within months. Understanding these trajectories allows healthcare providers to tailor interventions, offer appropriate timely interventions, plan and organise interventions in anticipation of needs preventing delays in care, and better communicate with patients and their families about prognosis and planning. NURS2038 Illness Prevention and Management 2024 S2: Study Guide 18 Case Scenario Betty Batfish is a 58-year-old lady who lives with her husband in Mt Lawley. Betty is overweight and drinks ‘a Week 1 Practice couple of wines on the weekend’. Betty is employed as a chef at a popular restaurant. Betty has a busy social life and enjoys ’fancy dinners with my friends’. Betty has recently been diagnosed with T2DM. Though she was prescribed Metformin, Betty doesn’t like taking any medication because ‘taking tablets makes me feel old’. Discuss the different dimensions of Betty’s life as they have been affected by her diagnosis. Points for consideration: 1. Biophysical Dimension: Betty’s diagnosis of T2DM directly affects her metabolic health. Being overweight is a significant risk factor for the progression of diabetes and its complications, such as cardiovascular disease, neuropathy, and vision problems. Her reluctance to take medication could potentially worsen her blood sugar control and increase her risk of long-term complications. It is also important to consider her weight and diagnosis of T2DM may not be exclusive to diet and exercise. There could be stressors in her life leading to cortisol release that will increase chronic blood sugars, she may have genetic risk factors, she may have been previously required to take high doses of corticosteroids for another condition – there are a range of other biophysical elements and it is important not to make assumptions about causes of her diabetes. Stress will disrupt sleep which can further increase risk of diabetes, and weight or metabolic problems. Part of our holistic approach needs to consider assessment of all these factors. Betty enjoys socialising, including frequent fancy dinners and alcohol consumption. These lifestyle factors, particularly diet and alcohol intake, can affect her ability to manage T2DM, as these activities likely include high-calorie, high-carbohydrate meals and alcohol that can spike blood glucose levels as it is a carbohydrate. Alcohol can also inhibit insulin function. These are areas where Betty gets enjoyment and quality of life, so we need to consider the importance of these lifestyle features in our health plan with Betty. 2. Psychosocial and Emotional Dimension: NURS2038 Illness Prevention and Management 2024 S2: Study Guide 19 Betty’s resistance to taking medication because it makes her “feel old” reflects a psychological struggle with her diagnosis, especially as it relates to her identity and perceptions of ageing. Feeling "old" might make her reluctant to fully engage in her treatment, affecting her long-term health outcomes. Betty’s busy social life, which revolves around food and alcohol, may feel threatened by her diagnosis. Managing her diabetes may require changes in her social interactions, potentially affecting her relationships or sense of enjoyment when dining out with friends. Receiving a diagnosis of T2DM can be emotionally challenging. Betty may be experiencing denial, frustration, or fear, especially if she sees the need for lifestyle changes as an unwanted disruption to her life. Betty’s husband and social circle will play a crucial role in supporting her management of T2DM. If they are not aware or supportive of the changes Betty needs to make (like moderating alcohol consumption and making healthier food choices), it may be difficult for her to implement effective changes. Betty’s identity as someone who enjoys “fancy dinners with friends” is deeply intertwined with her social life. Adapting to a new way of managing her diabetes might mean rethinking how she engages with her friends socially, which could lead to feelings of isolation or loss if not handled sensitively. 3. Occupational Dimension: As a chef, Betty’s occupation is directly tied to food and cooking. Managing T2DM might pose a challenge in her work environment, where she is constantly surrounded by food and may have to make changes to her diet. Her job may make it harder for her to maintain a healthy eating routine or avoid tempting foods. The restaurant industry is known for its high levels of stress, irregular hours, and physically demanding work. Stress can impact blood sugar levels, and irregular work hours might make it harder for Betty to maintain regular meal times and glucose monitoring. 4. Health Literacy and Empowerment: Betty may not fully understand the importance of Metformin in managing her condition or how T2DM affects her body long-term. Addressing health literacy will be key to helping her feel empowered in making informed choices about her medication and lifestyle changes. NURS2038 Illness Prevention and Management 2024 S2: Study Guide 20 Empowering Betty to take ownership of her health by providing education on diabetes management, the role of diet, exercise, and the potential consequences of poorly controlled diabetes is essential. This could also involve giving her the autonomy to make small, achievable changes that align with her personal goals and lifestyle. 6. Cultural and Environmental Dimension: Betty’s food habits and social interactions are closely linked to cultural expectations, particularly around dining and social drinking. Working within this cultural framework, rather than against it, is important in supporting her to make sustainable changes without feeling like her social life is being sacrificed. Living in Mt Lawley, an urban area, Betty likely has good access to healthcare services, healthy food options, and recreational facilities, which can facilitate her diabetes management. However, she may need guidance on navigating these resources in a way that integrates well with her busy lifestyle. Primary Healthcare and Chronic Illness Management Approach: Using a person-centred approach to care, it’s crucial to address each of these dimensions in a holistic manner. Betty’s care plan should incorporate her unique life circumstances and preferences to help her manage her T2DM effectively: - Health Education: Provide tailored education about T2DM, including how small dietary changes can still allow her to enjoy social occasions. Help Betty understand how Metformin works and how it supports her overall health rather than making her feel "old." - Behavioural Support: Use motivational interviewing techniques to explore Betty’s ambivalence about taking medication and making lifestyle changes, helping her set small, achievable goals that align with her values. - Social and Community Support: Encourage Betty to involve her social network, including her husband and friends, in her health journey. This might include finding healthier alternatives for dining out or moderate alcohol consumption strategies that don’t take away from her enjoyment. NURS2038 Illness Prevention and Management 2024 S2: Study Guide 21 - Self-Management Tools: Equip Betty with self-management skills, such as blood glucose monitoring, meal planning strategies, and ways to manage stress and fatigue in her busy work and social life. Fred Fish is 47 year old male who left school at age 16 to work as a bricklayer. Fred lives alone, but his best Week 2 mate Barney lives next door. Fred has ‘a few’ beers most nights and smokes a vape ‘only when I drink’. Fred has no health history but rarely goes to the doctor or dentist ‘as I am never sick’. Fred eats mostly takeaway meals ’because they taste good’. Fred has recently been told he has COPD. Fred gets the letters mixed up when he tries to explain this to Barney, ‘I have CODP’ Call Of Duty Please? CODP, COPD? My lungs are not right.’ Fred has been told he should see a respiratory therapist and quit smoking, but Barney says that’s probably not necessary. How does Fred’s health literacy affect his ability to manage his chronic illness? Points for consideration: 1. Understanding His Diagnosis: - Fred struggles to remember or correctly articulate his condition, referring to it as "CODP" instead of COPD. This confusion shows a lack of comprehension about what COPD is, how it affects his lungs, and what the condition entails. Without a clear understanding of his diagnosis, Fred is less likely to take appropriate action to manage his illness. 2. Following Medical Advice: - Fred has been advised to see a respiratory therapist and quit vaping, yet he does not appear to understand the importance of following this advice. His friend Barney, who dismisses the need for medical care, further NURS2038 Illness Prevention and Management 2024 S2: Study Guide 22 complicates Fred’s ability to take his condition seriously. Poor health literacy can make Fred more likely to trust informal advice from friends rather than professional healthcare recommendations. 3. Managing Lifestyle Changes: - Fred’s daily habits—drinking beer, vaping, and eating mostly takeaway meals—are inconsistent with managing COPD. Effective COPD management often requires lifestyle changes, such as quitting smoking, reducing alcohol intake, improving diet, and engaging in physical activity. Fred’s low health literacy may prevent him from recognising the significance of these changes or knowing how to implement them. 4. Engaging with Healthcare Providers: - Low health literacy might make Fred hesitant to visit doctors or specialists, as seen in his pattern of rarely going to healthcare appointments. He may find it difficult to communicate with healthcare providers or ask the right questions about his condition. As a result, Fred might not fully understand the advice given to him or feel empowered to manage his illness. 5. Medication Adherence: - Should Fred be prescribed medications or inhalers, his ability to understand dosage instructions, the importance of adherence, and potential side effects could be compromised by his low health literacy. Without clear understanding, Fred may fail to use medications properly, worsening his COPD symptoms. 6. Self-Management of Symptoms: - Managing COPD requires awareness of symptoms like shortness of breath and recognising exacerbations. Fred's low health literacy might prevent him from identifying early warning signs or knowing when to seek medical help, increasing the risk of complications. 7. Access to Reliable Information: NURS2038 Illness Prevention and Management 2024 S2: Study Guide 23 - Fred’s confusion about his diagnosis and reliance on Barney’s dismissive advice suggest that he may struggle to access or evaluate reliable health information. Without proper guidance, Fred might continue making decisions based on incorrect or incomplete information. Strategies to Improve Fred’s Health Literacy and COPD Management: - Simplified Communication: Healthcare providers should use plain language and visual aids to explain COPD, its symptoms, and management strategies, ensuring that Fred understands his condition. - Teach-Back Method: Asking Fred to repeat what he has learned in his own words can help confirm his understanding and correct any misconceptions. Care needs to be taken not to do this in a patronising way. - Support Networks: Engaging Barney in Fred's care might be beneficial, but educating both Fred and Barney together about COPD and its management could help reduce misinformation. - Access to Resources: Providing Fred with clear, easy-to-read materials or videos about COPD and self- management strategies might help him grasp the importance of seeing specialists, quitting vaping, and making dietary changes. - Smoking Cessation Support: Since Fred vapes when he drinks, introducing him to tailored smoking cessation programs that address his lifestyle could encourage him to quit. Though again, if Fred understands his condition and his health literacy is improved, and he continues to vape as this is where he draws his enjoyment in life, then this is an informed decision and we cannot force or impose value systems on him. Question 1. Discuss the challenges of managing this chronic illness in such a remote location. Week 6 Question 2. What healthcare strategies can be leveraged to assist some remote manage her chronic illness? Question 3. What technology can be used to assist someone remote in managing her chronic illness? Points for consideration: Managing chronic illness in a remote location presents unique challenges, including: NURS2038 Illness Prevention and Management 2024 S2: Study Guide 24 1. Limited Access to Healthcare Services: - Remote areas often have fewer healthcare facilities and specialists, making it difficult for patients to receive timely care, regular check-ups, or specialist consultations, which are crucial for chronic illness management. 2. Delayed Diagnosis and Treatment: - Limited access to diagnostic tools and specialists may result in delayed diagnosis or inappropriate treatment, which can worsen chronic conditions or lead to complications. 3. Access to Medication and Supplies: - Patients in remote areas may experience delays or difficulties in accessing medications, medical supplies, or specialised equipment (such as glucose monitors for diabetes or inhalers for COPD). 4. Lack of Specialist Care: - Remote areas often lack specialists, such as endocrinologists, cardiologists, or respiratory therapists, who are essential for managing complex chronic conditions. 5. Transportation Issues: - Long distances to healthcare facilities or lack of reliable transportation may prevent individuals from accessing care regularly, especially in emergencies or when specialised services are needed. 6. Social Isolation: - Social isolation in remote areas can affect mental health and motivation, making it harder for patients to stay engaged in self-management of their chronic illness. It may also limit access to peer support groups. 7. Health Literacy: - Individuals in remote areas may have lower health literacy, making it harder to understand their chronic condition, its progression, and the importance of following treatment plans. NURS2038 Illness Prevention and Management 2024 S2: Study Guide 25 Healthcare Strategies to Assist Someone in a Remote Location with Chronic Illness: 1. Telehealth and Telemedicine: - Telehealth services can connect patients with healthcare providers for consultations, monitoring, and follow-up care without the need for travel. Regular telemedicine appointments can help monitor the progression of the chronic illness, adjust medications, and provide health education. 2. Outreach Programs: - Mobile health units and outreach programs can bring healthcare services directly to remote areas, offering regular check-ups, screenings, and vaccination services, which are critical for chronic illness management. 3. Community Health Workers: - Training and deploying community health workers or nurse practitioners in remote areas can provide patients with local healthcare support, health education, and medication management while reducing the need for frequent travel to urban centres. 4. Care Coordination: - Establishing a care coordination model, where a primary care provider in the remote location works closely with specialists in urban areas, ensures continuous and comprehensive care for patients with chronic conditions. 5. Health Education Programs: - Developing health literacy programs in remote communities can empower individuals to better manage their chronic conditions by improving their understanding of medication, symptoms, and lifestyle changes. 6. Chronic Disease Management Programs: - Implementing community-based chronic disease management programs, which focus on self-management support, regular monitoring, and education, can help patients stay engaged in managing their condition. NURS2038 Illness Prevention and Management 2024 S2: Study Guide 26 Technology to Assist in Managing Chronic Illness in Remote Locations: 1. Telehealth and Telemedicine Platforms: - Telehealth platforms allow patients to consult with healthcare professionals via video or phone, reducing the need for travel. This is particularly useful for routine follow-ups, chronic disease management, or specialist consultations. 2. Remote Patient Monitoring Devices: - Devices such as wearable fitness trackers, blood pressure monitors, glucose meters, or pulse oximeters allow patients to track key health metrics at home. Data from these devices can be shared with healthcare providers in real time, enabling early intervention if necessary. - For example, a patient with diabetes could use a continuous glucose monitor (CGM) to track blood sugar levels, which could be monitored by their healthcare team remotely. 3. Mobile Health Apps: - Health apps can assist with medication reminders, tracking symptoms, or providing educational content about managing chronic illnesses. These apps can also serve as platforms for telehealth visits or for receiving daily tips on self-management strategies. 4. Medication Delivery Services: - Online pharmacies and medication delivery services can ensure that individuals in remote locations receive their medications regularly, helping them stay adherent to their treatment plans. 5. Digital Health Coaching: - Remote health coaching services, accessible via mobile apps or online platforms, can provide patients with personalised advice, motivation, and strategies for managing their chronic illness, ensuring they stay on track with lifestyle changes or medication adherence. NURS2038 Illness Prevention and Management 2024 S2: Study Guide 27 6. Wearable Technology: - Smartwatches and fitness trackers equipped with heart rate monitors or oxygen saturation sensors can help patients monitor their condition daily and send alerts to their healthcare providers if abnormal readings occur. Frank Flounder is a 36-year-old male First Nations Person who lives in Albany. Frank completed year 12 and Week 8 works in construction. Frank lives with his wife Frieda and they have 2 children. Frank has a close group of friends and coaches the local under 19’s AFL team. Frank does not drink alcohol nor smoke, but he overweight and does regularly consume take-away fried food which he admits to eating 4-5 times a week. Frank has had type 2 diabetes, which he has managed well for 5 years. Frank’s GP has recently retired, and Frank missed his last appointment, Frank attends Albany ED to get a new script for his insulin and overhears nurses talking about him. The nurses make racist remarks and suggest that Frank does not look after his own health. How can this healthcare experience affect Frank? What are potential long-term repercussions of this interaction? What could be done differently in this situation? Points for consideration: Impact on Frank could include: - Frank may feel hurt, ashamed, and disrespected by the comments, which can lead to feelings of isolation, distrust, and reduced self-esteem. Hearing racist remarks may evoke anger, frustration, or anxiety, especially when coming from healthcare professionals who are supposed to provide care and support. - Frank’s trust in the healthcare system may be severely diminished. This interaction could cause him to feel alienated from seeking healthcare, leading to avoidance of medical settings due to fear of being judged or mistreated based on his identity as a First Nations person. NURS2038 Illness Prevention and Management 2024 S2: Study Guide 28 - Although Frank has managed his Type 2 diabetes well for five years, the nurses’ suggestion that he doesn’t take care of his health might make him question his own health management efforts. This can lead to discouragement and reduced motivation to maintain his self-care practices. - As a First Nations person, Frank’s cultural identity might be further marginalised by this experience, as the remarks he overheard reinforce negative stereotypes and perpetuate systemic racism in healthcare. This can harm his sense of belonging and contribute to feelings of cultural disenfranchisement. What are the potential long-term repercussions of this interaction? - Frank may avoid future healthcare visits, delay necessary treatments, or fail to follow up with health services, resulting in poorer management of his diabetes and increased risk of complications. Avoidance of care can lead to worsening health outcomes, not just in terms of diabetes but for any future health concerns. - If Frank delays getting regular check-ups, or seeking means to obtain his insulin, his diabetes could become poorly managed over time. This may increase the risk of developing complications such as cardiovascular disease, neuropathy, or kidney disease, which are common in people with poorly controlled Type 2 diabetes. - The psychological impact of this negative experience, combined with possible social isolation, can contribute to mental health issues such as depression, anxiety, or feelings of hopelessness. Long-term exposure to racism has been linked to poor mental health outcomes in marginalised communities. - As a respected community member and AFL coach, Frank’s experience may affect his ability to engage fully in these roles. A loss of confidence in the healthcare system and his own health management could impact his energy, motivation, and willingness to stay involved in these meaningful social and cultural activities. He may also develop mistrust in the wider community and self-consciousness about his racial identity, which could lead him to social withdrawal. What could be done differently in this situation? - The healthcare staff should undergo cultural safety and cultural sensitivity training to understand the importance of treating First Nations people with respect, acknowledging their cultural needs, and addressing the systemic racism that impacts their health experiences. Staff should be educated about the detrimental NURS2038 Illness Prevention and Management 2024 S2: Study Guide 29 effects of racist behaviour and trained to provide person-centred, compassionate care. Unfortunately, this is only effective if a staff member has self-insight to their own prejudices and a desire to learn more. - Nurses and other healthcare providers should approach Frank with a person-centred approach, focusing on his health needs without judgment or assumptions. This includes respectfully listening to his concerns, acknowledging his successful management of diabetes for five years, and supporting him in accessing the care he needs without bias. - Healthcare organisations must adopt a zero-tolerance policy for racism and other discriminatory behaviours. Clear protocols should be in place to report and address racist comments or actions to ensure a safe, inclusive environment for all patients. This needs to include a safe avenue for Frank to raise his concerns with feedback provided to Frank on the ongoing improvements to this service to address his concerns. An apology from the healthcare provider should also be provided to reassure Frank that this standard of care is not acceptable or tolerated. - Healthcare services should actively engage with First Nations communities to foster trust and provide culturally appropriate care. Having Indigenous liaison officers or health workers available could help bridge communication gaps, ensure cultural safety, and provide support to individuals like Frank. - The healthcare team could have supported Frank by expressing empathy and appreciation for his efforts in managing his diabetes and helping him navigate the transition from his retired GP to a new healthcare provider. Offering clear guidance and scheduling follow-up appointments would demonstrate respect and commitment to his long-term health. - Frank’s healthcare should encompass a holistic approach, recognising the social, emotional, and cultural aspects of his life. Providers should encourage discussions about his diet and lifestyle habits (e.g., consuming take-away food) without judgment, helping him find sustainable ways to improve his health while respecting his autonomy, values and personal circumstances. Greg Groperfish is 44-year-old male who left school at age 15 to work as a farm-hand on a remote property Week 9 100km outside of the closest small rural town. Greg has a very high level of fitness due to in his job. There are nine other farm workers that live within 300 metres of Greg’s house, whom Greg thinks of as ”my family”. Greg NURS2038 Illness Prevention and Management 2024 S2: Study Guide 30 drinks a carton of beer every Friday night and smokes 2-3 cigarettes a day “but yeah, I do smoke more on Friday’s when I am having a drink with the family”. Greg has a medical history of gout, fatty liver disease and mild hypertension. Greg does not currently take any regular medications. Greg visits his GP and you, (the Primary Health Care Nurse) once every year “doesn't matter if I need it or not, I always make sure I get my bits checked, every year without fail!”. At his most recent visit Greg has been diagnosed with Chronic Obstructive Pulmonary Disease (COPD). How can you, the Primary Health Care Nurse work in partnership with Greg to assist him in managing his chronic illness? Points for consideration: 1. Building Trust and Open Communication: - Establish rapport: Greg already has a habit of visiting the GP annually, showing that he values his health. Acknowledge and support his commitment to regular check-ups, reinforcing the importance of this partnership in managing his COPD. - Non-judgmental communication: Approach Greg’s smoking and drinking habits without judgment, ensuring that he feels comfortable discussing these behaviours openly. This will foster trust and create a foundation for discussing health changes. 2. Health Education and Empowerment: - Educate Greg about COPD: Explain in simple, clear language what COPD is, how it affects the lungs, and the potential long-term consequences if not managed. Use diagrams or models if helpful, considering Greg’s rural background and preference for practical, hands-on learning. Prior to education it is important to first assess his health literacy and what he already knows, ensure what is communicated is individually tailored to his needs so as to not patronise him nor overwhelm him, and consider a multimodal approach to teaching that will reinforce key points and align with his learning style and health literacy. NURS2038 Illness Prevention and Management 2024 S2: Study Guide 31 - Provide information on smoking and alcohol’s impact: Gently educate Greg on how smoking exacerbates COPD and how alcohol (especially in large quantities) can contribute to his other health conditions, like gout and fatty liver disease. Focus on facts rather than pushing him toward immediate cessation, allowing Greg to reflect on his choices. - Discuss symptom management: Teach Greg how to recognise the early signs of COPD exacerbation (e.g., increased shortness of breath, coughing, wheezing) and explain when it’s necessary to seek medical help. 3. Goal Setting and Collaborative Care Planning: - Set small, achievable goals: Work with Greg to set manageable goals for improving his health (SMART goals). For instance, he might decide to reduce his smoking to one cigarette a day or limit his alcohol intake. Since Greg smokes more while drinking, reducing his alcohol consumption on Fridays could naturally lead to smoking less. Given Fred finds enjoyment in this social behaviour, switching to low alcohol or low carbohydrate beers may help reduce this risk rather than attempting to remove his enjoyment altogether. - Actionable health behaviours: Discuss activities Greg can maintain or add to his daily routine to improve lung health, such as walking or engaging in breathing exercises. Given his physically demanding job, capitalise on his high level of fitness and explain how physical activity can support lung function. - Create a personalised care plan: Tailor Greg’s COPD management plan to fit his lifestyle. This plan should include scheduling follow-up visits, monitoring his lung function, and making lifestyle adjustments at his own pace. Ensure that Greg is fully involved in creating the plan to empower him to take ownership of his health. 4. Smoking Cessation and Alcohol Reduction: - Explore smoking cessation options: Offer smoking cessation support without pressure. Present Greg with different options, such as nicotine replacement therapies (NRT), behavioural counselling, or apps designed to reduce smoking. Acknowledge that quitting or reducing smoking might take time. - Encourage gradual alcohol reduction: Discuss ways Greg could moderate his Friday drinking habits, such as alternating alcoholic drinks with water, reducing the number of beers, or setting a limit on how much he consumes with his “family.” Frame this as part of managing both his COPD and his existing conditions like gout and fatty liver disease. NURS2038 Illness Prevention and Management 2024 S2: Study Guide 32 -consider involvement of his “family”/friends in his plan. If he is able to discuss with them his health concerns, they may be an invaluable support for him. The friendship group may be able to amend their social practices to help reduce the temptation and risk for Frank, and may also benefit from improved health. Having a social ‘team’ of people undergoing lifestyle change can be motivating and help individuals hold accountability for their goals. 5. Monitoring and Follow-up: - Establish regular check-ins: Since Greg visits once a year, suggest increasing the frequency of visits to monitor his COPD more closely, especially in the initial stages. Offer telehealth or phone consultations, if necessary, given the rural location, to keep the appointments accessible. - Symptom monitoring tools: Provide Greg with tools or apps to track his symptoms (e.g., a symptom diary or a spirometer if available), allowing him to monitor his lung health and identify patterns in flare-ups. 6. Accessing Healthcare in a Remote Area: - Discuss local healthcare resources: Help Greg understand the importance of consistent COPD management and provide information about any local or rural healthcare services, such as mobile health units or specialist outreach programs. - Telehealth services: Given his rural location, suggest telehealth services that might allow Greg to connect with respiratory specialists or receive health education without needing to travel long distances. 7. Leveraging Greg’s Social Support System: - Engage his social network: Recognise the importance of Greg’s “family” of co-workers. Encourage Greg to involve them in his health journey, whether by supporting his goals to cut back on smoking and drinking or engaging them in healthier social activities. Social support can be a significant motivator in chronic illness management. - Educating Greg’s support system: If Greg is comfortable, offer to provide health education to his co-workers about how they can support his COPD management, potentially creating a healthier environment for everyone. NURS2038 Illness Prevention and Management 2024 S2: Study Guide 33 8. Addressing Other Chronic Conditions: - Holistic care approach: While focusing on COPD, ensure that Greg’s other health conditions (gout, fatty liver disease, hypertension) are also considered in his management plan. For instance, reducing alcohol consumption will benefit both his liver and his lungs. - Encourage dietary changes: Work with Greg to explore healthier food options, emphasising how his diet can impact both COPD and his other conditions. Help him find alternatives to frequent takeaway fried food that are still convenient and satisfying. 9. Long-Term Self-Management: - Empower Greg with self-management skills: Provide Greg with the knowledge and tools he needs to manage COPD long-term, including lifestyle advice, symptom tracking, and recognising the need for timely medical intervention. - Peer support or local groups: If available, connect Greg with support groups for people with COPD, whether in-person or online, to share experiences and gain motivation for better self-management. Further Revision For the above case studies – what are some techniques or strategies you could use to help improve health outcomes? Explain what these techniques are and what the benefits of them are. 1. Motivational Interviewing (MI) - What it is: Motivational Interviewing is a collaborative, person-centred communication technique used to strengthen a person’s motivation and commitment to change by exploring and resolving ambivalence. It is a non-confrontational approach that helps patients articulate their reasons for change and empowers them to take ownership of their health decisions. NURS2038 Illness Prevention and Management 2024 S2: Study Guide 34 - Benefits: MI encourages patients to voice their own goals and motivations, making behaviour change more sustainable. It is especially useful for conditions like smoking cessation, weight management, and chronic disease self-management. MI respects the patient’s autonomy and fosters long-term engagement in their health. 2. Collaborative Partnerships - What it is: This approach involves working alongside the patient as an equal partner in their healthcare. It emphasises shared decision-making and mutual respect, allowing patients to contribute to the creation of their care plans based on their values, preferences, and lifestyle. - Benefits: Collaborative partnerships ensure that patients feel empowered and in control of their care, which can increase their commitment to managing their health. When patients are actively involved in decision- making, they are more likely to adhere to treatment plans and make informed, lasting lifestyle changes. 3. Person-Centred Care - What it is: Person-centred care focuses on treating the patient as a whole person rather than just their illness. It considers the individual’s personal, social, and cultural contexts and involves tailoring healthcare interventions to their unique needs and circumstances. - Benefits: This approach fosters a deeper connection between healthcare providers and patients, leading to greater satisfaction and better adherence to treatment plans. By prioritising the patient’s experiences, values, and preferences, person-centred care can improve health outcomes and enhance overall well-being. 4. Advocacy - What it is: Advocacy in healthcare involves healthcare providers or others (such as family members) acting on behalf of the patient to ensure their needs are met, especially in situations where patients may face barriers to care or discrimination. Advocacy can also involve helping patients navigate complex healthcare systems and access necessary resources. NURS2038 Illness Prevention and Management 2024 S2: Study Guide 35 - Benefits: Advocacy ensures that patients receive equitable and appropriate care, particularly in populations that may face health disparities or stigma (e.g., First Nations people, people with disabilities). It helps remove barriers to care, improves patient access to necessary services, and promotes social justice in healthcare. 5. The 5As Model of Behaviour Change - What it is: The 5As (Ask, Advise, Assess, Assist, Arrange) is a framework used to guide healthcare providers in supporting patients through behaviour change: - Ask: Identify and assess the patient’s behaviour. - Advise: Provide clear, personalised advice for behaviour change. - Assess: Evaluate the patient’s readiness to change. - Assist: Provide tools, support, and strategies to help the patient make changes. - Arrange: Plan follow-ups to monitor progress and provide ongoing support. - Benefits: The 5As model is a systematic and supportive approach to behaviour change. It helps ensure that patients receive continuous care and encouragement, making it easier for them to adopt and maintain healthier behaviours. 6. Stages of Readiness to Change (Transtheoretical Model) - What it is: This model describes the stages individuals go through when contemplating and making behaviour changes: - Precontemplation: The individual is not yet considering change. - Contemplation: The individual is aware of the need for change and is thinking about it. - Preparation: The individual is getting ready to take action. - Action: The individual is actively taking steps to change behaviour.