Chronic Illness, Persons and Their Families

By Marisol Jane T. Jomaya MAN - I

ILLNESS a state in which a person s physical, emotional, intellectual, social, developmental or spiritual functioning is diminished or impaired compared with previous experience. not synonymous to disease includes the disease process and the effect of functioning and well being in all dimensions. i.e. CANCER, LEUKEMIA

Types of Illness:1. ACUTE ILLNESS short duration and is severe, symptoms appear abruptly are intense and often subside after a relatively short period of time.

2. CHRONIC ILLNESS persists usually longer than 6 months and can also affect functioning in any dimension. The client may fluctuate between maximal functioning and serious health relapses that may be life threatening.

A chronic disabling disease interferes with ongoing life adaptations by making the performance of routine tasks more challenging. (Mechanic 1995)

y *** Chronic illness is the leading health problem

in North America for older adults and children. Issues surrounding its acceptance and management are complex and overwhelming.

PREVALENCE AND CAUSES OF CHRONIC ILLNESS/CONDITIONS

Chronic conditions have become the major cause of health related problems in developed and developing countries giving these countries the dual burden of trying to eradicate infectious diseases while learning to manage chronic conditions.

Longer life spans because of advances in technology

and pharmacology, improved nutrition, safer working conditions and greater access for some people to health care.

Improved screening and diagnostic procedures,

enabling early detection and treatment of diseases.

Prompt and aggressive management of acute

conditions, such as myocardial infarction and AIDS related infectionsy The tendency to develop single or multiple chronic

illnesses with advancing age.

y Modern lifestyle factors such as smoking, chronic

stress and obesity, that increase the risk for chronic illnesses, such as pulmonary disease, hypertension and cardiovascular diseases.

ILLNESS BEHAVIOR it involves how people monitor their bodies, define and interpret their symptoms, take remedial actions and use the health care system.Affected by personal history, social situations, social

norms and the opportunities or constraints of community institutions. Can be used as coping mechanisms view illness as release from responsibilities or view illness as added stressors or burden

VARIABLES I FL E I G ILL ESS AND ILLNESS BE AVI RINTERNALPERCEPTION OF SYMPTOMS If client believes symptoms disrupt their normal routine they are more likely to seek health care assistance than if they do not perceive the symptoms to be disruptive NATURE OF ILLNESS Clients with acute illness are more likely to seek health care assistance and comply readily with therapy. On the other hand, clients with chronic illness with symptoms which may not be cured but only partially relieved may not be motivated to comply

EXTERNALVISIBILITY OF SYMPTOMS SOCIAL GROUP/SOCIAL SUPPORT Client reacts more positively when there is social support and at the same time practicing positive health behavior.

CULTURAL BACKGROUND Culture teaches the person how to be healthy, how to recognize illness and how to deal with it. Ethnic differences can influence decisions about health care and the use of diagnostics as well as health services.

ECONOMIC VARIABLE Because of financial constraints, client delays treatment and attempt to carry out daily activities.

ACCESSIBILITY TO HEALTH CARE SYSTEM Economic variable and seeking health care service are interrelated factors. For many clients entry into the system is complex and confusing. ** Illness is never an isolated life event. Client and family must deal with the changes resulting from the illness and treatment

CHARACTERISTICS F CHRONIC ILLNESSManaging chronic illness involves more than

managing medical problems. Associated psychological and social problems must also be addressed.Chronic illnesses usually involve many different phases

over the course of a person s lifetime. There can be acute periods, stable and unstable periods, flare ups and remissions.

Keeping chronic conditions under control requires

persistent adherence to therapeutic regimens. One chronic disease can lead to development of other chronic conditions.

Chronic illness affects the whole family. Family life can

be dramatically altered as a result of role reversals, unfilled roles, loss of income, time spent managing illness, decreases in family socialization activities and the costs of treatment.

The major responsibility for the day to day

management of illness falls upon the shoulders of chronically ill people and their families. The home rather than the hospital is the center of care.The management of chronic conditions is a process of

discovery.Managing chronic conditions is a collaborative

process.The management of chronic illness is expensive.

Chronic conditions raise difficult ethical issues for the

patient, health care professionals and the society. Living with chronic illness means living with uncertainty.

PHASES OF CHRONIC ILLNESS1.PRETRAJECTORY PHASE -is a stage wherein a person is at risk for developing chronic conditions because of genetic factors or lifestyle behaviors which increases susceptibility to chronic illness. 2. TRAJECTORY PHASE -is characterized by the onset of symptoms or disability associated with a chronic condition.

3. STABLE PHASE -indicates that symptoms and disability are being managed adequately. 4. UNSTABLE PHASE -is characterized by an exacerbation of illness symptoms, development of complications or reactivation of an illness in remission.

5. ACUTE PHASE - is characterized by sudden onset of severe or unrelieved symptoms or complications that require hospitalizations for their management.

6. CRISIS PHASE -is characterized by a critical or life threatening situation that requires emergency treatment or care.

7. COMEBACK PHASE -is the period in the trajectory marked by recovery after an acute period. 8. DOWNWARD PHASE - marks the worsening of the condition. Symptoms and disability continue to progress despite attempts to gain some control through the treatment and management regimen.

9. DYING PHASE - is characterized y the gradual or rapid decline in the trajectory despite efforts to halt the disorder or slow the decline through illness management; it is characterized by failure of life maintaining body functions.

IMPACT OF ILLNESS IN CLIENT AND FAMILY1.BEHAVIORAL AND EMOTIONAL CHANGES Short term, non life threatening illness evokes few behavioral changes in the functioning of the client and the family. Severe illness, particularly one that is life threatening , can lead to more extensive emotional and behavioral changes such as DABDA Hopelessness/powerlessness

2. IMPACT ON BODY IMAGE Body image is the subjective concept of physical appearance. Some illnesses result in changes in physical appearance and clients and families react differently to these changes.When a change in body image occurs the following

phases is undergone.SHOCK, WITHDRAWAL, ACKNOWLEDGEMENT,

ACCEPTANCE, REHABILITATION

4. IMPACT ON FAMILY ROLES When an illness occurs, parents and children try to adapt to the major changes resulting from a family members illness. ROLE REVERSAL is very common. It leads to stress, conflicting responsibilities or direct conflict over decision making.

3. IMPACT ON SELF CONCEPT Self concept is a mental self image of strengths and weaknesses in all aspect of personality.It depends in part of body image and roles as well as

other aspects of psychology and spirituality.Important in family relationships or relationship with

significant others. A client whose self concept changes because of illness may no longer meet family expectations, leading to tension or conflict.

5. IMPACT ON FAMILY DYNAMICS Family dynamics is a process by which the family functions, makes decisions, give support to individual members and copes with everyday changes and challenges.

y If a parent in a family becomes ill, family activities and

decision making often come to a halt as the other family members wait for the illness to pass, or they delay action because they are reluctant to assume the ill person s roles and responsibilities.

INTERVENTIONSA. EMPOWERMENT The purpose of the nurse client relationship is to maintain and restore control to clients.Empowerment is a social process of identification and

support of an individual s abilities to attend to one s needs to problem solve and to activate necessary resources to control one s own life.

HEALTH COACHING DISCHARGE PLANNING COLLABORATION SELF MANAGEMENT CONTROL

SELF

DETERMINATION ESTABLISHING A

SENSE OF MASTERY CLIENT AND FAMILY

EDUCATION HEALTH SYSTEM

NAVIGATION ADVOCACY

DECISION MAKING ANTICIPATORY GUIDANCE CULTURAL COMPETENCE

PROMOTING HOME AND COMM NITY BASED CAREy TEACHING PATIENTS SELF CARE One of the goal of nursing in the 21st century is to

prevent chronic conditions and care the people affected by them. Promotion of healthy lifestyle, encouraging the use of

safety and disease prevention measures and prevention should begin early in life and continue throughout the life span.

Patient and family teaching is one of the most

significant aspect of nursing care and may make the difference in the ability of patients and their families to adapt to chronic health conditions.

CONTINUING CARE Chronic Illness management is a collaborative process between a patient, family, nurse and other health care professionals. Collaboration is not limited to hospital settings, rather it is important in all settings and throughout the illness trajectory.

y Management at home

Nurses should think beyond the individual level to the

community and global levels. In terms of illness prevention and health promotion, this entails wide ranging efforts to assess people for risk factors for chronic illness.

REFERENCES y Fundamentals of Nursing, 7th edition,Potter and Perryy Fundamentals of Nursing, Kozier y Brunner and Suddarth s Textbook of Medical

Surgical Nursing, Brunner/Suddarthy Chronic illness impact and intervention,

Larsen/Morof Lubkin

yEND