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Lecture 3

Week 3 Chronic Illness Models of Care.rtf

18 Pages

Course Code
NURS 2280
Shauna Houk

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Chronic Illness 5R’s – patient, drug, dose, route , time Plus 5 Rights 1.Right Reason 2.Right Response 3.Right Documentation 4.Right Education 5.Right to Refuse What is Chronic care Model?  Developed early 1990’s by Dr John Wagner  Identifies essential elements of a health care system that encourage high-quality chronic disease care  Foster productive interactions between informed patients who take an active part in their care and providers with resources and expertise.  Used by HCP and organizations in the delivery of care Elements of Chronic Care Model a.Community b.The health system c.Self-management support d.Delivery system design e.Decision support f.Clinical information systems Additional Considerations  Patient Safety (in Health System)  Cultural competency (in Delivery System Design)  Care coordination (in Health System and Clinical Information Systems)  Community policies (in Community Resources and Policies)  Case management (in Delivery System Design) Requires a paradigm shift in HCP thinking, how we deliver care and health care system=$$$$, time, social support Models of Care for Chronic Disease Management: Hospice care lacking 1. Home Care o Largest growing practice area o High level of acuity o Elderly and those with CD most frequent users o RN Role: case manager, direct care provider 2. Hospital Care o Acute illness o Episodic admissions with exacerbations o RN Role: direct care provider, clinical leader, unit manager 3. Rehabilitation Care o Individualized care to achieve optimal level function o Focuses on: Physical Mental Spiritual Social Economic o RN Role: direct care, case manager 4. Long term care o Provides residential, skilled and non skilled care to individuals with chronic illness, disabilities, and functional decline (ie. age, disease) o RN Role: oversees care and delegates tasks, care manager 5. Palliative care o End of life care o Setting goals and priorities o Managing psychosocial needs and physical symptoms o RN Role: direct care provider, case manager, Chronic Illness Behaviour o First described 1929 Henry Sigerist-“special positions of the sick” o Influences of behaviour- poverty, demographic status, past experience o Impact of illness behaviour  Loss of Self  Moral Work  Devalued Self  Lack of role norms Adaptive responses (Moos & Holahan, 2007)  Managing Symptoms  Managing treatment  Forming relationships with health care providers  Managing emotions  Maintaining a positive self-image  Relating to family members and friends  Preparing for an uncertain future Challenges External to the individual:  HCP expect people to take the “sick role”  Healthcare system supports a “fix and cure”  Ineffective teams  Social stigma  Social isolation Social Stigma: Definition and Facts o Defined: “Something that disqualifies an individual from full social acceptance” o It is socially constructed o It affects people differently o Leads to feelings of devaluation and discrimination o Promotes coping mechanisms of secrecy and withdrawal o Rejection and social isolation lead to decreased self-esteem Aspects of Stigma o Those prone to stigma lack a fully developed sense of personal identity o Culture may determine stigma oReligion may play a role in stigma oDisability and disease Who does Stigma CommonlyAffect?  Mentally ill  Infectious diseases (HIV/AIDS)  Terminal diseases (cancer)  Alcoholism, Drug related problems Chronic Disease as Stigma What are some societal values? How does Chronic illness fit into this picture?  Youth  Attractiveness  PersonalAccomplishment  Strong  Productive  Physically Healthy Physical Perfectio n Health Care Delivery to decrease the Effects of Stigma  Shift from Cure to Care  Mutual participation  Power is divided equally b/t provider & client  Aparticipatory relationship decreases some of the stigma of the disability  Enhances self-worth & adherence to regimes  Distinguish b/t non-acceptance vs non-participation  Do not overestimate the physical limitations imposed by the disability Shift from Cure Vs Care- Caring should be demonstrated by valuing and assisting those with chronic illnesses.Accepting the characteristics of chronic illness such as long term course of action, relapses and multiple treatment modalities. The client is responsible for long-term disease management and the HCP is responsible for helping the client help himself or herself. Treating a client as a partner in establishing goals demonstrates one’s acceptance of the individual as valuable and demonstrates respect for that person. When health care providers make decisions regarding tre
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