HLTENN044 Introduction to Chronic Disease PDF

HLTENN044 IMPLEMENT AND MONITOR CARE FOR A PERSON WITH CHRONIC HEALTH PROBLEMS Introduction to Chronic disease Diploma of Nursing HLT54121 Image sourced from https://www.needpix.com/photo/download/1186669/anatomy-female-muscles-skeleton-tissue-organs-internal-organs-endoskeleton-bone - Free to us...

HLTENN044 IMPLEMENT AND MONITOR CARE FOR A PERSON WITH CHRONIC HEALTH PROBLEMS Introduction to Chronic disease Diploma of Nursing HLT54121 Image sourced from https://www.needpix.com/photo/download/1186669/anatomy-female-muscles-skeleton-tissue-organs-internal-organs-endoskeleton-bone - Free to use and share WARNING This material has been reproduced and communicated to you by or on behalf of Swinburne University of Technology in accordance with Section 113P of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Do not remove this notice. Acknowledgement of Country We respectfully acknowledge the Wurundjeri People of the Kulin Nation, who are the Traditional Owners of the land on which Swinburne’s Australian campuses are located in Melbourne’s east and outer-east, and pay our respect to their Elders past, present and emerging. We are honoured to recognise our connection to Wurundjeri Country, history, culture, and spirituality through these locations, and strive to ensure that we operate in a manner that respects and honours the Elders and Ancestors of these lands. We also respectfully acknowledge Swinburne’s Aboriginal and Torres Strait Islander staff, students, alumni, partners and visitors. We also acknowledge and respect the Traditional Owners of lands across Australia, their Elders, Ancestors, cultures, and heritage, and recognise the continuing sovereignties of all Aboriginal and Torres Strait Islander Nations. This unit of competency describes the skills and the knowledge required in contributing to the care of the client with chronic illness by performing nursing interventions that support the clients‘ needs and assist in maintaining an optimal lifestyle. What words would you use to describe a chronic disease or condition? Chronic Diseases • develop slowly over time. • last for more than three months. • generally have no cure How m any chronic diseases can you think of? Chronic conditions include • noncommunicable conditions • persistent communicable conditions • long-term mental disorders • ongoing physical/structural impairments https://www.youtube.com/wat ch?v=UTSf09Huz70 Chronic disease is the leading cause of death world wide even where infectious diseases are widespread. Guess w hich chronic diseases in Australia are the leading causes of death? Death statistics in Australia | Finder https://www.aihw.gov.au/reportsdata/australias-health AUSTRALIA’S HEALTH PRIORITIES Australia currently has 9 National health priorities Can you guess what they might be? How many of them are a chronic disease? INCREASE IN CHRONIC CONDITIONS DUE TO…. 1.  infant mortality 2.  life expectancy 3. Lifestyles of unhealthy behaviours: • Tobacco use • Prolonged and unhealthy nutrition • Physical inactivity • Excessive alcohol • Unsafe sexual practices • Unmanaged psychological stress •  illicit drug use RISK FACTORS FOR CHRONIC DISEASES - WHO Modifiable risk factors • Poor nutrition • Lack of exercise • Tobacco use Nonmodifiable risk factors • Age • Heredity Intermediate risk factors Chronic disease • Hypertension • Raised blood glucose • Abnormal lipids • Obesity • Cardiovascular diseases • Cancer • Chronic respiratory diseases • diabetes LEADING CAUSES OF DEATH IN AUSTRALIA 2018 1. Ischaemic heart disease 2. Dementia 3. Stroke 4. Lung cancers 5. Chronic obstructive pulmonary disease 6. Colo-rectal cancers 7. Diabetes 8. Lymph/blood cancers 9. Chronic kidney disease 10. Prostate cancer 11. Heart failure 12. Influenza & pneumonia 13. Pancreatic cancer https://www.aihw.gov.au/reports/australias-health/causes-of-death COMMON CHRONIC CONDITIONS IN AUSTRALIA THAT CONTRIBUTE TO PREMATURE MORTALITY AND MORBIDLY • • • • • • • • • • arthritis asthma back problems cancer chronic obstructive pulmonary disease (COPD) diabetes mellitus heart, stroke and vascular disease kidney disease mental and behavioural conditions Osteoporosis What proportion of Australians do you think has one or more chronic conditions? What proportion of Australians over the age of 65 do you think have one or more chronic conditions? Can you guess the top 3 chronic conditions? CONTINUUM OF CHRONIC DISEASE No management: suffer full and debilitating effects Positive management: optimum level of health/life PRIMARY LEVEL OF PREVENTION Generalised health promotion activities as well as specific actions that prevent or delay the occurrence of the disease • • • • • • • Protecting oneself against environmental risks such as air and water pollutions Eating nutritious food Protecting oneself against industrial hazards Obtaining immunisations Undergoing genetic screenings Eliminating the use of alcohol and cigarettes Practising safe sex SECONDARY LEVEL OF PREVENTION Involves activities that emphasise early diagnosis and treatment of an illness that is already present, to stop the pathological process and enable the person to return to their former state of health as soon as possible • • • Having screenings for diseases such as hypertension, diabetes & glaucoma Obtaining physical examinations and diagnostic tests for cancer Obtaining specific treatment for illness (e.g. the treatment of streptococcal infections of the throat will prevent secondary infections involving the heart & or kidneys) TERTIARY LEVEL OF PREVENTION Focuses on stopping the disease process and returning the affected person to a useful place in society within the constraints of any disability • Primarily revolves around rehabilitation • Obtaining medical or surgical treatment of an illness • Enrolling in specific rehabilitation programs for cardiovascular problems, head injuries and strokes • Joining work training programs following illness or injury • Educating the public to employ rehabilitated people to the fullest possible extent. ISSUES REPORTED IN MANAGING CHRONIC ILLNESS • a fragmented system, with providers and services working in isolation from each other rather than as a team • uncoordinated care • difficulty finding services they need • at times, service duplication; at other times, absent or delayed services • a low uptake of digital health and other health • technology by providers to overcome these barriers • difficulty in accessing services due to lack of mobility and transport, plus language, financial and remoteness barriers • feelings of disempowerment, frustration and disengagement. CHRONIC ILLNESSES Have irreversible pathologies Encompasses not only physical health but have social, emotional, psychological and financial impacts Involve an interdisciplinary team of professionals & non-professionals caregivers Require long periods of supervision, observation & care Demand responsibility from the clients RESPONSE TO CHRONIC ILLNESS DEPENDS ON… The point in the life cycle at which the onset of the illness occurs The type & degree of limitations imposed by the illness The visibility of impairment and disfigurement The pathophysiology causing the illness The relationship between the impairment and functioning in the social roles. Pain and fear CHRONIC DISEASE MODELS Chronic care model (CCM) • Advocates for a structural change from reactive to proactive. Greater focus on nurses, social workers and self-management. Emphasis on patient centred and evidence based care in the community (excludes health promotion and health prevention) Improving chronic illness Care (ICIC) • Integrate medical science with redesigned health care delivery systems so chronic patients in any setting can receive prompt diagnoses and care. Innovative Care for Chronic Conditions (ICCC) • Developed by WHO. Supports a paradigm shift from acute to chronic. Includes management of political environment, building integrated health care, aligning policies focussing on health, using health care workers more effectively, centre care on patient and family, community support, emphasis on prevention CHRONIC DISEASE MODELS Stanford model • Uses the Chronic Disease Self-Management Program to provide participants with skills to enhance medical treatment and reduce costs such as: solving problems, making decisions, utilizing resources, forming a patient -provider partnership, making action plans for health behaviour change and self-tailoring Transitional Care Model (TCM) • the coordination and continuity of healthcare as patients transfer between different locations or different levels of care within the same location including hospitals, subacute and post-acute nursing facilities, the patient’s home, primary and specialty care offices, and long-term care facilities. Based on a comprehensive plan of care and the availability of healthcare practitioners who are well-trained in chronic care and have current information about the patient’s goals, preferences, and clinical status. Essential for persons with complex care needs. • https://www.youtube.com/watch?v=XIG1ZQFxTvs PHASES OF ADJUSTMENT TO LIVING WITH A CHRONIC DISEASE CRISIS PHASE • Looking for treatment • May turn to drugs or alcohol • Blaming • Fear, anxiety Nursing intervention: • Assist them to manage physical and psychological symptoms PHASES OF ADJUSTMENT TO LIVING WITH A CHRONIC DISEASE STABILISATION PHASE • Awareness that the condition is chronic • Friends and family may retreat • May feel isolated Nursing intervention: Assist the person to develop goals around what they can do and help them achieve them PHASES OF ADJUSTMENT TO LIVING WITH A CHRONIC DISEASE RECONSTRUCTION PHASE • Learning to live with the consequences of the disease • More control • Renewed sense of self INTEGRATION PHASE • Accepting that the disease has provide positive life experiences • Sense of pride in achievement Management of people with a chronic illness Assessment • Holistic – What does this mean? • Multidisciplinary Planning and implementing care • Independence should be the main goal Evaluation THE STAGES-OF-CHANGE MODEL Precontemplation People in this stage are not thinking seriously about changing and tend to defend their current behaviours. Contemplation People in this stage are able to consider the possibility changing their behaviours but feel ambivalent about taking the next step. Preparation Sees the 'cons' of continuing behaviours as outweighing the 'pros' and they are less ambivalent about taking the next step. They are usually taking some small steps towards changing behaviour. They believe that change is necessary and that the time for change is imminent. Action Actively involved in taking steps to change their behaviour and making great steps towards significant change. Ambivalence is still very likely at this stage. May try several different techniques and are also at greatest risk of relapse. THE STAGES-OF-CHANGE MODEL Maintenance Able to successfully avoid any temptations to return to using behaviour. Have learned to anticipate and handle temptations to use and are able to employ new ways of coping. Can have a temporary slip, but don't tend to see this as failure. Relapse During this change process, most people will experience relapse. Relapses can be important for learning and helping the person to become stronger in their resolve to change, but can also be a trigger for giving up in the quest for change. https://www.youtube.com/watch?v=Twlow2pXsv0 How would knowledge about this model assist you as a nurse? REFLECTION • Does anyone in your family or friends suffer from a chronic disease? • What impacts does it have on their lives? • How can you as a nurse help the person deal with chronic illness? FAMILY AND CHRONIC ILLNESS Illness brings about changes in both the individual and their family Maureen is an 68 year old woman who had a stroke last year which has left her with right-sided weakness resulting in impaired mobility and a reduced ability to perform ADLs. She requires support with meal preparation and showering and dressing. Prior to the stroke she helped her daughter who is a single mother by looking after her pre-school child and 3 other grand children before and after school so that her daughter could work. She loved to cook and garden and keep a tidy house. Her husband who previously worked full-time now only works in the morning so that he can care for her a keep her company in the afternoons. What are the financial, social, emotional, physical, psychological impacts on Maureen and her family? THE NURSES ROLE AND FAMILY CENTRED CARE •Perform a comprehensive nursing assessment to enable planning of client centred care • The health care team, client and their family must be involved in problem solving and decision making • Give support and information to ensure understanding of disease management and how to prevent acute episodes • It is important for nurses to recognise both the actual and potential health problems of chronic health clients •https://www.youtube.com/watch?v=rWrd 9RhSD1E Case study (FROM CHANG PG17) Mr Aboud 56,works as a psychologist. He appears to be in good health and lives life to the full, but discloses that he has been diagnosed with type 2 diabetes. Mr Aboud reports that his diet is high in carbohydrates and fats and his professional responsibilities limit his capacity to exercise. He is concerned that diabetes will cause his apparent good health to deteriorate and he wonders about his need to comply with suggested management strategies. • 1. What questions would a nurse ask to assess the impact that diabetes has on Mr Aboud? • 2. List the potential impact of this disease socially, emotionally, physically, psychologically and financially for Mr Aboud • 3. Is it possible for people to normalize diabetes in their lives. How? • 4. What positive outcomes could Mr Aboud experience as a result of his diabetes? • 5. What nursing interventions would help Mr Aboud achieve optimal health? SOCIAL IMPLICATIONS • • • • • • • isolation Change in friendships Reduced ability to socialise Change in alcohol intake Physical changes that affect sporting ability Depression and loss of desire to socialise Affect of changed social ability on relationship with partner • Embarrassment and fear of rejection EMOTIONAL AND PSYCHOLOGICAL IMPLICATIONS Change in relationships with partner, family and friends; change of body image, change of role in family, loss of ability to make decisions, loss of self care ability etc can lead to……. • • • • • • Grief Anger Depression Low self-esteem Anxiety Denial FINANCIAL IMPLICATIONS • Loss of income (basic needs – food, electricity, housing) • Role of bread-winner? • Mortgage • Sick leave entitlements • Children: school fees/holidays • Change in lifestyle • Affordability of medical costs? • Medication • Changes to home PHYSICAL IMPLICATIONS • • • • • Disability Inability to perform ADLs Rapid / slow deterioration of associated body systems Inability to participate in enjoyable activities Boredom Does a chronic illness have a link to an acute illness? http://www.diffen.com/difference/Acute_vs_Chronic REFERENCES: Australian Government : AIHW https://www.aihw.gov.au/reports/australias-health/causes-of-death Australia's health 2020 - Australian Institute of Health and Welfare (aihw.gov.au) WHO (2017) Investing in NCDs prevention and control saves lives and money . July 11. sourced at Investing in NCDs prevention and control saves lives and money – YouTube Koutoukidis,G., Stainton,K.(2020)Tabners Nursing Care : Theory and Practice. 8th edition. Ontario Ministry of Health and long term care. Bestincorporatehealth.com Sourced at : https://www.bing.com/images/search?view=detailV2&ccid=G6ZcUsWx&id=E6CDE4BBF7364BD7D4C5ED04858D923243A2C75D&thid=OIP.G6 ZcUsWxwVAElEWWzQQ05wHaFj&mediaurl=https%3a%2f%2fth.bing.com%2fth%2fid%2fR.1ba65c52c5b1c15004944596cd0434e7%3frik%3d XceiQz Primary, Secondary and Tertiary Prevention (2015) sourced at: http://www.iwh.on.ca/at-work/80 Wallace, S,.( 2020) Death statistics sourced at : Death statistics in Australia 2022 | Finder WHO / Integrated chronic diseases preventions and control. Sourced at : https://www.who.int/chp/about/integrated_cd/en Dr Wendy Guess (2015)Improve Your Life Using the Stages of Change (Transtheoretical) Model - Dr Wendy,Nov 5. sourced at : Improve Your Life Using the Stages of Change (Transtheoretical) Model - Dr Wendy Guess - YouTube Bryeanne Berryman ( 2018) NMIH301 Nursing Care of People with Chronic Conditions - Assessment 2 May 20 . sourced at : NMIH301 Nursing Care of People with Chronic Conditions - Assessment 2 - YouTube HLTENN044 2022