Textbook of Medical-Surgical Nursing 3e

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Unit 3   Applying concepts from the nursing process

Level 3 High complexity Care coordination

Prevention activities

Level 2 High risk Disease/care management

Figure 10-2  Levels of healthcare for people with chronic disease. (Redrawn from National Health Priority Action Council. (2006). National Chronic Disease Strategy (Fig. 1, p. 4). Canberra: Australian Department of Health and Ageing. Viewed April 2013 at www. health.gov.au/internet/main/publishing.nsf/ Content/7E7E9140A3D3A3BCCA257140007AB32B/$File/ stratal3.pdf. (Copyright Commonwealth of Australia, reproduced by permission.))

Level 1 70–80% chronic disease population Self-management support

composed of the elements illustrated in Figure 10-3 and has the following objectives: • Prevent and/or delay the onset of chronic illness for individuals and population groups • Reduce the progression and complications of chronic illness • Maximise the well-being and quality of life of individuals living with chronic illness and their families and carers

• Reduce avoidable hospital admissions and healthcare procedures • Implement best practice in the prevention, detection and management of chronic illness • Enhance the capacity of the healthcare workforce to meet population demand for chronic illness prevention and care into the future (NHPAC, 2006). In 2009, the National Preventative Health Taskforce released the National Preventative Health Strategy that focuses on the preventative causes, smoking, alcohol over­ consumption and obesity, which underpin many chronic conditions. Characteristics of chronic conditions In all illnesses, but even more so with chronic conditions, the illness cannot be separated from the person (Fig. 10-4). People with chronic illness must contend with it daily. Characteristics of chronic illness include the following: • Managing chronic illness involves more than treating medical problems. Associated psychological and social problems must also be addressed, because living for long periods with illness symptoms and disability can threaten identity, bring about role changes, alter body image and disrupt lifestyles. These changes require continuous adaptation and accommodation, depending on a person’s age and situation in life. Each decline in functional ability requires physical, emotional and social adaptation for patients and their families (Lubkin & Larsen, 2013). • Keeping chronic conditions under control requires persistent adherence to therapeutic regimens. Failure to adhere to a treatment plan or to do so consistently increases the risk of developing complications and accelerating the illness process. However, the realities of daily life, including the impact of culture, values and socioeconomic factors, affect the degree to which people adhere to a treatment regimen. For example, approximately 40% to 60% of individuals do not adhere to their prescribed medications and this risk increases as the number of medications increases. Managing a chronic

H e a l t h p r o m o t i o n

Ongoing monitoring

Early detection

End-of-life care

Assessment

Self-management support Multidisciplinary care planning and review

Person, carer and family

Rehabilitation

Psychosocial support

Evidence-based

clinical management

P r e v e n t i o n a n d r i s k r e d u c t i o n Care coordination

Figure 10-3  Core elements of the continuum of chronic disease prevention and care. (Redrawn from National Health Priority Action Council. (2006). National Chronic Disease Strategy (Fig. 2, p. 8). Canberra: Australian Department of Health and Ageing. Viewed April 2013 at www.health.gov.au/internet/ main/publishing.nsf/Content/7E7E9140A3D3A3BCCA257140007AB32B/$File/ stratal3.pdf. (Copyright Commonwealth of Australia, reproduced by permission.))