week 1: chronic illness trajectory

chronic illness trajectory

• persistent changes in mental, physical, and spiritual health status, requiring long-term management

chronic disease

• long-duration >3 months

• long latency period, clinical course

• multi-factorial etiology

• no definitive cure

• changes over time

chronic disease definition

• refers to a diagnosis categorized in the biomedical system according to its etiology, pathophysiology, signs, symptoms, and potential treatment strategies

• necessitates long-term strategies

chronic illness

• an alteration in health or function

• lasts for an extended period of time >6 months or longer

• duration of the individual’s life

chronic illness definition

• lived experience of long-term health disturbances, whether related to communicable or non-communicable disease, conditions, syndromes, or disorders, and how individuals cope with the disruption of the illness

attributes

• care transitions

• self-care management

• health-related quality of life

• uncertainty

care transitions

• a proactive plan of care with goals

• patient- and family-centered

• dynamic → always changing, revised as needed

• plan of care shared with care team → developed and shared across providers and patient’s support system

• created, documented, executed, and updated with every patient

• comprehensive → includes community and nonclinical services with health care services that incorporations the patients’ needs, preferences, and resources to achieve the patient’s goals

• most likely to benefit identified

care transition example

• LTC → exacerbation → ICU → medsurg → rehab → home health

self-care management

• a dynamic process in which individuals actively manage chronic illness

• health provider interventions support behavioral skills to manage conditions independently including medications, equipment, health monitoring, and engagement in self-care decision making

• managing new dx

health-related QOL

• pertaining to life satisfaction and life concerns

• may change over time

• impacted by health and illness

• affecting individual and family

• know the patient’s baseline

• look at patient satisfaction with functional ability but make sure patients are able to express lived experiences and take into account

uncertainty

• the inability to determine the meaning of illness-related events, occurring when the decision-maker is unable to assign definite value to objects or events, or is unable to predict outcomes accurately

• unpredictable nature of chronic illness can create uncertainty → a subjective experience influenced by the ambiguity of an illness; complexity of treatment; communication with healthcare providers about the severity of a conditional or the erratic nature of the illness trajectory

• prevents or delays coping; increases emotional and psychological distress

• makes it harder to adjust to chronic illness

Corbin Strauss Model of Chronic Illness

• onset

• stable

• acute

• comeback

• crisis

• unstable

• downward

• dying

onset

• signs and symptoms are present

• diagnostic period

• figure out what’s going on with the patient

stable

• illness course and symptoms controlled by treatment regimen

• person maintains everyday activities

acute

• active illness with severe and unrelieved symptoms or complications

• hospitalization may be required for management

• what they were on before wasn’t helping, may need to increase dosage of meds

• the patient’s symptoms can be controlled by a prescribed regimen

comeback

• gradual return to an acceptable way of life

• feeling better, stable again, acceptable

crisis

• life-threatening situation occurs

• emergency services are necessary

• stroke or a heart attack

unstable

• unable to keep symptoms or disease control under control

• life becomes disrupted while patient works to regain stability

• hospitalization not required

• our role is to help assist clients to gain greater control over their s/sx and help with everyday activities

• could include palliative care

downward

• gradual and progressive deterioration in physical or mental status

• accompanied by increasing disability and symptoms

• continuous alterations in everyday life activities

• nothing is helping, towards end of life

• assist with care planning, palliative care, and support

• more frequent flare ups occurring to the point where the body is dying and it’s not able to function optimally anymore

dying

• patient has to relinquish everyday life interests and activities, let go, and die peacefully

• immediate weeks, days, hours proceeding death

seven tasks of people experiencing chronic illness

1. prevent and manage crisis

2. carry out prescribed treatment regimen

3. control symptoms

4. reorder time → need to eliminate activities

5. adjust to changes in course of disease

6. prevent social isolation

7. attempt to normalize interactions with others