1. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 34 Living in Harmony With Chronic Conditions

2. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Introduction Illness as a difficult life situation Effect of chronic illness on the older adult Gerontological nurses need to understand the unique challenges and goals for older patients living with chronic conditions Goal is to maintain a high-quality, satisfying life and not be controlled by the disease

3. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chronic Conditions and Older Adults Impact of medical technology on aging Eighty percent of older adults have at least one chronic disease Incidence of chronic disease is higher with advancing age Impact on quality of life (QOL) Nursing diagnoses

4. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Goals for Chronic Care Healing –Implies the mobilization of the body, mind, and spirit to control symptoms

5. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Goals for Chronic Care—(cont.) Maintain or improve self-care capacity Manage the disease effectively Boost the body’s healing abilities Prevent complications Delay deterioration and decline Achieve the highest possible quality of life Die with comfort and dignity

6. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Goals for Chronic Care—(cont.) Nurse role –Facilitate the healing process –Guide individuals to achieve their maximum potential and highest attainable QOL –Create a therapeutic human and physical environment –Educate, empower, reinforce, affirm, validate, and remove barriers

7. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement True or False? Chronic condition care activities should be focused down a curative path.

8. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False Because chronic diseases cannot be cured, it would be inappropriate to direct care activities down a curative path. Rather, healing is of the utmost importance.

9. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Goals for Chronic Care—(cont.) Maintain or improve self-care capacity Manage the condition effectively Boost the body’s healing abilities Prevent complications Delay deterioration and decline Achieve the highest possible QOL Die with comfort and dignity

10. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement True or False? Successes in chronic care are measured differently from those in acute care.

11. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True The success and progress of goals of chronic care must be measured differently from acute care. Determinants of success are different from those of acute care but are no less important.

12. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment of Chronic Care Needs Assessment and reassessment of self-care and caregiving abilities –Individual –Family/caregiver The family is the patient Care needs must be reviewed and validated with the patient and family members to develop goals for care Community resources

13. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Maximizing the Benefits of Chronic Care Selecting an Appropriate Physician –Knowledgeable specialist –Factors that promote a positive physician ‒ patient relationship –Preparation for office visits

14. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Maximizing the Benefits of Chronic Care—(cont.) Using a chronic care coach –Shared experience with a buddy or coach –Provision of support and assistance –Role of the chronic care coach Feedback and positive reinforcement, support, encouragement, and assistance

15. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement True or False? A chronic care coach can be a spouse, child, friend, or someone with a similar condition who cares about and has regular contact with the patient.

16. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True The person who is facing life adjustments related to a chronic condition can benefit from a buddy or coach who can provide support and assistance. A chronic care coach can be a spouse, child, friend, or someone with a similar condition who cares about and has regular contact with the patient.

17. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Maximizing the Benefits of Chronic Care—(cont.) Increasing knowledge –Informed patients are able to manage and prevent complications –Knowledge helps empower the patient Organizations Newspapers Libraries Internet

18. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Maximizing the Benefits of Chronic Care—(cont.) Locating a support group –Assist in obtaining information –Fellowship with other individuals who have the same needs –Support groups can be located through: Telephone directories Local agency on aging National organization headquarters

19. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Maximizing the Benefits of Chronic Care—(cont.) Making smart lifestyle choices –Compliance with treatment plan –Dietary practices –Regular exercise –Stress management –Assertiveness –Development of a healing attitude and mind set

20. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Maximizing the Benefits of Chronic Care—(cont.) CAM therapies –Utilization of the body’s capacity to heal itself –The patient is in charge of the healing process –Need to discuss therapies with the health care provider

21. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Maximizing the Benefits of Chronic Care—(cont.) Complementary and Alternative Therapies for People with Chronic Conditions Acupressure Acupuncture Aromatherapy Ayurvedic medicine Biofeedback Chiropathy Guided imagery

22. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Maximizing the Benefits of Chronic Care—(cont.) Herbal medicine Guided imagery Herbal medicine Homeopathy Hydrotherapy Hypnotherapy Light therapy Massage therapy

23. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Maximizing the Benefits of Chronic Care—(cont.) Meditation Naturopathic medicine Nutritional supplements Osteopathy Progressive relaxation Qigong Sound therapy

24. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Maximizing the Benefits of Chronic Care—(cont.) T’ai chi Therapeutic touch Yoga

25. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Factors Affecting the Course of Chronic Care Difficulty of sustaining treatment measures Need for: –Regular reinforcement and support –Periodic contact and reevaluation of capacity Motivation Factors influencing a patient’s ability to manage their illness

26. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Factors Affecting the Course of Chronic Care—(cont.) Defense mechanisms and implications –Reactions to lifestyle changes, frustrations, and losses –Reactions as defense mechanisms: Denial Anger Depression Regression

27. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following reactions, as a defense mechanism for coping with a chronic condition, demonstrates regression? a. Independently discontinuing medications b. Having a violent outburst c. Refusing to engage in self-care activities d. Abandoning self-care behaviors

28. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer d. Abandoning self-care behaviors Regression, as a coping mechanism, includes becoming increasingly dependent unnecessarily and abandoning self-care behaviors.

29. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Factors Affecting the Course of Chronic Care—(cont.) Psychosocial factors –Can impact degree to which the patient lives effectively –Altered self-concept –Need support and encouragement as they adapt to their chronic condition –Goal is to achieve optimum psychosocial health

30. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Factors Affecting the Course of Chronic Care—(cont.) Impact of ongoing care on the family –Need to assess the entire family Potential effects of the caregiving role Sacrifices and compromises Disruption to health Need to realistically evaluate caregiving responsibilities and identify options for care

31. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Factors Affecting the Course of Chronic Care—(cont.) Need for institutional care –Statistics –First choice is generally caregiving in the home –Families need support and assistance from the nurse when the decision for assisted living or nursing home care is needed

32. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chronic Care: A Nursing Challenge Need for specialized nursing knowledge and skills –Management of multiple medical problems –Skilled assessment and planning –Individualized promotion of self-care capacity –Monitoring of family health