Promoting Home and Community-Based Care
Since chronic conditions are so costly to individuals, families, and society, one of the major goals of nursing in the 21st century should be the prevention of chronic conditions and the care of people with them. This requires promoting healthy lifestyles and encouraging the use of safety and disease-prevention measures, such as wearing seat belts and obtaining immunizations. Preven-tion should also begin early in life and continue throughout the life span.
Patient and family teaching is one of the most significant as-pects of nursing care and may make the difference in the ability of patients and their families to adapt to chronic health conditions. Well-informed, educated patients are more likely than unin-formed patients to be concerned about their health and do what is necessary to maintain it (De Ridder, Depla, Severens & Malsch, 1997). They are also more likely to manage symptoms, recognize the onset of complications, and seek health care early: knowledge is the key to making informed choices and decisions during all phases of the chronic illness trajectory.
Despite the importance of teaching the patient and family, the nurse must recognize that patients recently diagnosed with serious chronic conditions and their families may need time to grasp the significance of their condition and its effect on their life. Teach-ing should be planned carefully so that it provides information that is important to the patient’s well-being at the time without being overwhelming.
The nurse who cares for patients with chronic conditions in the hospital, clinic, or home should assess each patient’s knowledge about the illness and its management; the nurse cannot assume that a patient with a long-standing chronic condition has the knowl-edge necessary to manage the condition. A patient’s learning needs change as the trajectory phase and his or her personal situation changes. The nurse must also recognize that patients may know how their body responds under certain conditions and how best to manage their symptoms (Gallo & Knafl, 1998). Contact with patients in the hospital, clinic, or home offers nurses the ideal opportunity to reassess patients’ learning needs and to provide ad-ditional information about an illness and its management.
Chronic illness management is a collaborative process between patient, family, nurse, and other health care professionals. Col-laboration is not limited to hospital settings; rather, it is impor-tant in all settings and throughout the illness trajectory (Corbin Cherry, 2001). Keeping an illness stable over time requires careful and continued monitoring of symptoms and attention to management regimens. Detecting problems early and assisting patients to develop appropriate management strategies can make a significant difference in outcomes.Most chronic conditions are managed in the home. Therefore, care and teaching during hospitalization should focus on what thepatient needs to know about the condition in order to manage once discharged to home. 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 patient is hospitalized) necessary to secure those resources and services. When appropriate, home care services are contacted directly. The home care nurse will reassess how the patient and family are adapting to the chronic condition and its treatment and will con-tinue or revise the plan of care accordingly.
Because chronic conditions occur worldwide and the world is increasingly interconnected, nurses should think beyond the in-dividual level to the community and global levels. In terms of ill-ness prevention and health promotion, this entails wide-ranging efforts to assess people for risk factors for chronic illness (eg, blood pressure and diabetes screening, stroke risk assessments) and group teaching related to illness prevention and management.
The nurse should also remind the patient with a chronic ill-ness, and the patient’s family, about the need for ongoing health promotion and the screening recommended for all people, as the chronic illness and disability often become the priority to the ex-clusion of other health-related issues.
When providing care and teaching, the nurse must consider a va-riety of factors (eg, age, gender, culture, and ethnicity) that in-fluence susceptibility to chronic illness and the ways patients respond to chronic disorders. Certain populations, for example, tend to be more susceptible to certain chronic conditions. Popu-lations at high risk for specific conditions can be targeted for spe-cial teaching and monitoring programs. People of different cultures and genders tend to respond to illness differently; being aware of these differences is extremely important (Bates, Rankin-Hill & Sanchez-Ayendez, 1997; Becker, Beyene, Newsom & Rodgers, 1998; Thorne, McCormick & Carty, 1997). For cul-tures in which patients rely heavily on the support of their fami-lies, families must be involved and made part of the nursing care plan. As the United States becomes more multicultural and eth-nically diverse, and as the general population ages, nurses need to be aware of how an individual’s culture and age facilitate or hin-der chronic illness management, and nurses should be prepared to adapt the care they give accordingly (Becker, Beyene, Newsom &Rogers, 1998; Jennings, 1999; Rehm, 1999).
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