212
Unit 3
Applying concepts from the nursing process
health literacy to engage effectively with the health system and
manage their own care (ADHA, 2009a).
Despite the importance of teaching the patient and family,
the nurse must recognise that patients recently diagnosed with
serious chronic conditions and their families may need time
to understand the significance of their condition and its effect
on their lives. Teaching must be planned carefully so that it
is not overwhelming. Furthermore, it is important to assess
the impact of a new diagnosis of chronic illness on a patient’s
life and the meaning of self-management to the patient
(Kocaman et al., 2007). Interventions that enhance chronic
illness self-management have demonstrated improved patient
outcomes (Carrier, 2009).
The nurse cannot assume that a patient with a long
standing chronic condition has the knowledge necessary to
manage the condition. Learning needs change as the trajectory
phase and the patient’s personal situation change. The nurse
must also recognise that patients may know how their body
responds under certain conditions and how best to manage
their symptoms. Contact with patients in the hospital, clinic,
nursing centre, home or long-term care facility offers nurses
the ideal opportunity to reassess patients’ learning needs
and to provide additional teaching about an illness and its
management.
As previously noted, one of the major deficits of care of
chronically ill people is the fragmentation of services. In
order to avoid this, chronic illness management must be a
collaborative process between the individual, family, nurse and
other healthcare professionals. Collaboration is not limited
to hospital settings; rather, it is important in all settings and
throughout the illness trajectory. General practitioners have a
major role in the management of chronic illness as they often
act as a patient’s case manager. In some instances, this role may
be allocated to a specialty nurse such as those nurses working
with heart failure or COPD patients.
Most chronic conditions can be managed in the home
but may require the input of a range of independent services.
Nurses in all settings should be aware of the resources and
services available in a community and should make the
arrangements (before hospital discharge if the person is hospi
talised) necessary to secure those resources and services. When
appropriate, home care services are contacted directly. Case
management models adopted by community nurses are partic
ularly beneficial in managing chronic illness where multiple
services are involved to improve health outcomes (Hunter,
2012).
Care for special populations with
chronic illness
When providing care and teaching, the nurse must consider
a variety of factors (e.g. age, gender, culture and ethnicity,
cognitive status, the presence of physical and sensory limita
tions) that influence susceptibility to chronic illness and the
ways people respond to chronic disorders. Certain populations,
for example, tend to be more susceptible to certain chronic
conditions.
Chronic conditions are experienced at a higher rate in
Indigenous communities in both Australia and New Zealand.
In Australia, Indigenous peoples experience chronic condi
tions at 36% more than the general population. There are
higher mortality rates for diabetes (14 times the rate), kidney
illness (10 times) and heart illness (3 times) (AIHW, 2010a;
Health
InfoNet
, 2012). The Ma¯ori population of New Zealand
had higher rates for diabetes, cardiovascular illness, asthma and
COPD. The level of disability for Ma¯ori was approximately
four times higher compared with Europeans and for Pacific
Islander peoples (NZMOH, 2012c).
Populations at high risk for specific conditions can be
targeted for special teaching and monitoring programs. People
of different cultures and genders tend to respond to illness dif
ferently; being aware of these differences is extremely import
ant (Drew, 2008; McMurray, 2007). For cultures in which
people rely heavily on the support of their families, families
must be involved and made part of the nursing care plan. As
Australia and New Zealand become more multicultural and
ethnically diverse, and as the general population ages, nurses
need to be aware of the relationship between culture, age and
chronic illness management, and so be prepared to adapt the
care they give accordingly. They also need to be aware of how
they may be influenced by their own culture (Stein-Parbury,
2009).
The outcomes of chronic illness in many cases are pain, dis
ability and even death. The terms chronic conditions and dis
ability are often used interchangeably according to the context
and implications to the individual (Lubkin & Larsen, 2013).
The next section discusses the issues related to disability in
more detail.
Disability
Definition of disability
According to the WHO,
disability
is an umbrella term for
impairments, activity limitations, participation restrictions and
environmental factors, and
impairment
is a loss or abnormality
in body structure or physiological function, including mental
function. A person’s functioning or disability is viewed as a
dynamic interaction between health conditions (i.e. illness,
disorders, injuries, trauma) and contextual factors (i.e. personal
and environmental factors) (WHO, 2012). In Australia, a
broad definition of disability is applied in conjunction with
the WHO’s International Classification of Functioning (ICF).
Disability is seen as ‘a multidimensional concept relating
to impairment in bodily structure or function, limitation in
activities, restriction in participation and the affected person’s
environment’ (AIHW, 2006, p. 71). New Zealand, however,
defines disability as ‘a long term limitation in the ability to
carry out one or more activities’ (NZMOH, 2005, p. 95). Other
terms used to describe people with disabilities that are not
universally accepted or understood are ‘people who are phys
ically challenged’, and ‘people with special needs’. Another
approach to disability is described by Lutz and Bowers (2005),
who stated that none of the existing definitions adequately
addresses disability in everyday life. They defined disability as
a multifaceted, complex experience that is integrated into the
lives of people with disabilities. The degree of the integration
is influenced by three disability-related factors: (1) the effects
of the disabling condition, (2) others’ perceptions of disability,
and (3) the need for and use of resources by the person with
a disability.
Therefore, a person is considered to have a disability—
such as a restriction in performance or function in everyday
activities—if he or she has difficulty talking, hearing, seeing,
