1. Chronic Illness
Lisa B. Flatt, RN, MSN, CHPN

2. Chronic Illness Chronicity – last indefinitely
Medical care – treating symptoms vs. curing

3. Models Chronic Illness Trajectory Model Pretrajectory phase – wellness
Trajectory phase – onset of symptoms
Stable phase – start treatment
Unstable phase – changes in treatment/decrease in improvement or management
Acute phase – Sick hospital
Crisis phase – life-threatening
Comeback phase – get a little better
Downward phase – moving towards death
Dying phase – actively dying

4. Chronic vs. Acute Chronic – lasting
Acute – short term with end in sight

5. Adjustment Patterns Kubler Ross – stages -- LOOK IT UP
Change lifestyle
Change location/environment
Acceptance of limitations
Modifications

6. Disability Limitations Face discrimination
Limitations at home and work
ADA of 1990 protection
Deal with environmental conditions that we don’t think about - curbs

7. Chronic Illness Issues
Self-care – ADL assistance
Deterioration of Health – progressively grow worse – ie. COPD
Quality of life – decreases, increased problems – such as financial, depression
Caregiver Dimension – family steps in – if there is one – dramatic changes in family life and dynamics

8. Factors Influencing Adjustment
Gender roles – caregiver is male or female
Age – is there a spouse/SO still there, adult children
Age – ability to continue with their disability
Preferences – who they want to help – relationship with their HCP’s
Spiritual/religious/cultural beliefs
Support
Physical condition at start
Role insufficiency- loss of job, changes

9. Assumptions People want to return to their previous state
Intrarole conflict – inability of client to meet new demands of new role
Interrole conflict – cannot perform expected or previous role
Hiding symptoms are normal
“Want to pass”

10. And more…
Culture – Chinese (oldest male cares for parents) Middle Eastern – women caregivers hard to be sick and step down Different rituals
Some cultures remove from society
Different interpretations of quality of life
Response to chronic illness and why you became ill in the first place

11. And more…. Socioeconomic factors Unemployment Cost
Health insurance or lack of
Food and healthy eating

12. And more…. Environmental factors Structural Transportation
Occupational hazards
Safety issues
Patient safety needed equipment/lifts

13. Psychological Depression Anger Isolative Stigma to be ill Dependence
Clingy
Want to be normal
Learned helplessness

14. Review… Alternative and complementary therapies Right to Health Care
??What kind of and how good is it???

15. Model of Chronic Illness
133 million Americans have a chronic illness
This number will increase 1% a year until 2030
CDC – CV disease, cancer, diabetes
Medicare/medicaid/private insurance/HMO
Ethical and legal implications – Patient advocate

16. Developmental Disabilties Acts
1975 – mental disorders
1980- advocacy program
OBRA (omnibus reconciliation act) 1990 – right to refuse treatment
PSDA (patient self determination act) 1991 – inform of rights and have signed papers
Advanced and DNR

17. Nursing Process Assessment – adl’s; advocacy; ethical and legal aspect
Analysis – collaboration, establish diagnosis and goals
Planning – plan short term realistic goals for illness “caregiver will state plan for respite”
Implementation – intervene for person, simple measures
Evaluation – effectiveness of interventions determine further needs