Chronic Illness
Lisa B. Flatt, RN, MSN, CHPN
Chronic Illness
• Chronicity – last indefinitely
• Medical care – treating symptoms vs.
curing
Models
• Chronic Illness Trajectory Model
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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
Chronic vs. Acute
• Chronic – lasting
• Acute – short term with end in sight
Adjustment Patterns
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Kubler Ross – stages -- LOOK IT UP
Change lifestyle
Change location/environment
Acceptance of limitations
Modifications
Disability
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Limitations
Face discrimination
Limitations at home and work
ADA of 1990 protection
Deal with environmental conditions that we
don’t think about - curbs
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
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
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”
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
And more….
• Socioeconomic factors
– Unemployment
– Cost
– Health insurance or lack of
– Food and healthy eating
And more….
• Environmental factors
– Structural
– Transportation
– Occupational hazards
– Safety issues
– Patient safety needed equipment/lifts
Psychological
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Depression
Anger
Isolative
Stigma to be ill
Dependence
Clingy
Want to be normal
Learned helplessness
Review…
• Alternative and complementary therapies
• Right to Health Care
• ??What kind of and how good is it???
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
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
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