THE PROBLEMS OF MANAGING CHRONIC CONDITIONS
Chronic conditions have implications for everyday living and management problems for individuals and their families as well as for society at large. Most importantly, individual efforts should be directed at preventing chronic conditions since many chronic conditions can be traced, at least in part, to unhealthy lifestyles or behaviors such as smoking and overeating. Thus, changes in lifestyle can result in the prevention of some chronic conditions, or at least a delay in their onset until a later age. Because of the tendency of some people to resist change, however, bringing about alterations in people’s lifestyles is one the major challenges facing nurses today.
Once a chronic condition has occurred, the focus shifts from disease prevention to managing symptoms and staying well by avoiding complications (eg, eye problems in the diabetic) and the development of other acute illnesses (eg, pneumonia in a person with chronic obstructive lung disease). Quality of life, often over-looked by health professionals in their approach to care of people with chronic conditions, is also important. Health-promoting be-haviors, such as exercise, are essential to quality of life even in peo-ple who have chronic illnesses and disabilities because they help to maintain functional status (Stuifbergen & Rogers, 1997). See Nursing Research Profile 10-1 for more information.
Although coworkers, extended family, and health care profes-sionals are affected by the problems of people with chronic ill-nesses, the problems of living with chronic conditions are most acutely experienced by patients and their immediate families. It is they who feel the greatest impact with lifestyle changes that di-rectly affect quality of life. Nurses provide direct care, especially during acute episodes, but they also provide the teaching and se-cure the resources and other supports that enable people to inte-grate their illness into their lives and have some quality of life despite their illness (Michael, 1996). To understand what nurs-ing care is needed, it is important to comprehend the issues that people with chronic illness and their families contend with and manage, often on a daily basis. The challenges of living with chronic conditions can be summarized as follows:
· Alleviating and managing symptoms
· Psychologically adjusting to and physically accommodating disabilities
· Preventing and managing crises and complications
· Carrying out regimens as prescribed
· Validating individual self-worth and family functioning
· Managing threats to identity
· Normalizing individual and family life as much as possible
· Living with altered time, social isolation, and loneliness
· Establishing the networks of support and resources that can enhance quality of life
· Returning to a satisfactory way of life after an acute debili-tating episode (another myocardial infarction or stroke) or reactivation of a chronic condition
· Dying with dignity and comfort