Choose a chronic illness from the below list and critically discuss how you would support selfmanagement of your client/patient living with this chronic illness in the Community.
Asthma is generally a chronic respiratory tract disease which involves an interaction of obstruction in airflow, hyperresponsiveness of bronchi and inflammation. The severity of above interaction varies from patient to patient. Technically, the bronchial tubes of the lungs get inflamed and they become swollen, which in turns results in tightening of the bronchial muscles. Therefore, airflow through these bronchial tubes becomes difficult and shows symptoms like coughing, difficulty in breathing, wheezing and tightness of the chest.
Many changes occur due to obstructive airflow through bronchial tubes. These changes are as follows:
In asthma, the main physiological event occurs is narrowing of airway leading to obstruction in airflow(Asthma: pathophysiology, causes and diagnosis, 2014). In acute asthma, the narrowing of smooth muscles occurs rapidly due to some external stimuli such as allergens or some irritants.
Pathophysiology and Self-Management of Chronic Asthma
Bronchoconstriction due to allergens is mediated by the release of Ig-E dependent mediators which are released by mast cells. These mediators include histamine, prostaglandins, tryptase and leukotrienes which are responsible for contraction of bronchial smooth muscles. Further, in addition to above mediators other stimuli such as cold air, exercise and irritants may be responsible for airflow obstruction. The mechanisms governing the response of airway to the above factors are not well defined, but it appears that the main mechanism is related to inflammation of the airway(Bachert & Zhang, 2012). The other factor which may also responsible for precipitating asthma complications is stress.
Although the mechanisms for this is not clearly established yet. But it may be due to increased production and release of pro-inflammatory cytokines.
When asthma becomes severe by time due to inflammation, other complications also begins such as hypersecretion of mucus, edema, and formation of mucus plugs in the airway.
One of the reasons for hyperresponsiveness of airway may asthma. The mechanisms which are responsible for above pathology are dysfunctional neuro-regulation, inflammation, and structural changes.
In some patients suffering from asthma, airflow obstruction may be reversible to some extent(Cardinale, Giordano, Chinellato & Tesse, 2013). The permanent structural modifications can occur. These changes are due to progressive lung dysfunction which is not prohibited by or can be reversed by current therapy. Airway remodeling includes an activation of several structural cells, with permanent changes that enhance the airflow obstruction and airway hyperresponsiveness. This leads to patient decreased response to therapy. The structural changes discussed above can be the sub-basement membrane thickening, airway hypertrophy of smooth muscles and hyperplasia, subepithelial fibrosis, proliferation of blood vessels and dilation, and mucus hypersecretion(Henderson, 2008).
The following are the important points which should be always taken into consideration by nurses during health management of asthma patients:
Nurses should put emphasis on long-term therapy which is ongoing.Nurses should take care of patients with moderate as well as severe asthma require inhaled anti-inflammatory therapy on daily basis to decrease asthma episodes.Discuss with the patient and concerned physician to prepare a management plan for asthma as per the needs of the patient.During every visit, review management plan of each patient and their medication.
At every visit, nurses should ask patients about the medicines they are taking and make sure that they are not taking beta blockers(Mogasale & Vos, 2013). For patients susceptible to aspirin, tell them not to take any kind of NSAID’s. The NSAID’s can lead to severe asthma episode.Teach the patient about the correct use of metered-dose inhalers and nebulizers. Ask the patient to demonstrate the same. If needed, again teach the patient about the procedure.Nurses play an important role in healthcare by helping patients to make decisions and learn about specific actions to be taken to control asthma. Nurses should deliberately plan and involved in educating their patient so as to increase the probability that patients will stick to the recommended actions(Lehrer, Mullol, Agredo & Alobid, 2014).
Health promotion is a process of increasing the control of people over there health. It includes a wide range of environmental and social interventions. Health promotion is linked by values e.g Ottawa charter awareness and empowerment. The Ottawa charter, it is the name given after international conference on health promotion held on November 1986 in Ottawa, Canada. The principles which were included under Ottawa charter for health promotion are personal skill development, strengthening the community, the creation of supportive environment and reorganize health service. These principles of health promotion were discussed at an 8th global conference held in Helsinki in 2013(Albuterol multidose dry powder inhaler efficacy and safety versus placebo in children with asthma, 2016). Campbell and Gibson state that for the promotion of health and enhancement of individual’s skills in order to resolve their issues, meet their needs and locate their resources for better control over their survival, the most important thing which is required is ‘Empowerment’.
In the case of an asthmatic patient, the aim of empowerment would be the betterment of the patient’s condition as asthma is incurable, making patients responsible for their health and focus on the opportunities that are available in their communities. The role of nursing within this context is to promote health and provide education on inhaler therapy technique used by asthma patient(Kowalski, 2010).
According to Marmot et.al improvement in education on asthma would increase awareness, knowledge and help the patient to make healthier choices. There are various theoretical models on health promotion which focus on health related decisions like Rosenstock Health belief model. This is the best-known model for health promotion. Health belief model was modified in 1980, it explained a reason behind a failure to use health services by the people.There is an another model named shiing perspectives model of chronic illness that indicate a pathway for health professionals on improvement and supporting individuals suffering from chronic illness(Londoño & Schulz, 2015). Whitehead developed a Florence Nightingale's model which states that “ the nurse, the client, and the environmental factors are in balance”. If the environmental factor is out of balance the patient spends unnecessary energy. So, the role of the nurse is to maintain the balance of the patient with environmental factors which encourages healing.
Chronic asthma manifestations and symptoms such as wheezing, cough, and dyspnea significantly affect the daily life of family members or carers. According to a survey in children asthma and their carers, about 33% of their carers left work in one year due to their the asthma of child. The work lost and burden on the family members is directly associated with the severity of asthma. Carers of patient’s with uncontrolled asthma are likely to have high chances to bear work loss approximately more than 5 days a week as compared to carers of patient’s having controlled asthma(Ellis, 2012).
People suffering from chronic illness need more health services which increase their interaction with the health system. If the system and organizations fail to provide culturally competent healthcare, there is a higher risk of negative health results. Americans, Africans and other minorities have less interaction with the physicians which results in lower satisfaction with their care(Nygårdh, Malm, Wikby & Ahlström, 2011). There is lower interaction among Asian Americans and Latinos with physicians. Lower patient- physician interaction is associated with dissatisfaction system. Latinos, Asian Americans, and African Americans in comparison to whites believe that they would have received better services if they belong to different ethnicity or race. Various reports have shown that African Americans, they feel more disrespectful when they were treated as compared to other different minority groups. Individual behavior, values, and beliefs about well being and health services are affected by various factors such as nationality, ethnicity, race, socioeconomic status, occupation, physical & mental status and language (Morrison, Mair, Yardley, Kirby & Thomas, 2016). Cultural competence is broadly defined as the ability of the organization to integrate and understand these factors for better delivery of healthcare services. The goal of the culturally efficient health care system is to provide better health care services irrespective of ethnicity, nationality, race, English proficiency and cultural background.
There are various strategies to improve patient-physician interaction for better health services:
Providing training to improve skills, increasing knowledge, and cultural awareness.
Introduce various cultural specific tools into the healthcare system(Nunes, Pereira & Morais-Almeida, 2017).To increase operation hours.Include community and family members in making healthcare decisions. Recruit minority staff.
For better cultural competence in the healthcare system, professional should be taught about how to provide better services in culturally competent manner. There are various training courses, teaching methods which vary greatly in content from four-hour seminar to months academic course.
Key DO’s and DONT’s must provide to healthcare professionals for a particular group. It is nearly impossible to know everything about each culture completely. Training courses must be provided which are universal.
Some key points for a better understanding of people from different cultural background(Evans-Agnew, 2017):
Physician or health care provider must be polite, non-confronting and predictable with patients and their family members.They do not ask questions or make assumptions.They do not get inattentive if the patient does not make eye contact.They must use an interpreter if a patient is from different cultural background.Healthcare providers or physicians must learn how to greet Non-English speakers.They must use visual aids if there is a language problem.
The main principle of the concept is to make patient informed about choices and helps them in making their decisions. For further elaboration, Patient empowerment is the concept which involves control over the daily conditions of the patients(Sills, Ginde, Clark & Camargo, 2010). Patients attain necessary knowledge, self-awareness, and skills to make their quality of life better. The concept of patient empowerment includes following key points:
There are main three parameters which are important at the initiative stage of patient empowerment i.e education, health literacy, provision for information for self-management and making right decisions.The concept includes strategies for both patients and healthcare professionals.
Implementation of strategies is categorized into three levels i.e micro level which is initiative level, a meso level which is implementation at some regional level and macro level which includes implementation at the national level or another higher level(Anderson & Funnell, 2010).
Several patients suffering form uncontrolled asthma, despite the frequent availability of effective therapy options. Nursing practitioners have a unique role and opportunity as frontline healthcare professionals and patient educators to recognize and analyze chronic asthma. Nursing practitioners also have to determine the necessary actions to facilitate patients and maintain the check on symptom control. With the implementation of the above-discussed points such as patient empowerment, cultural safety, and health management, the role of Nursing practitioners in asthma management will become more critical. Nursing practitioners are best suited for the duties of primary purveyors of asthma awareness, promoters for the partnership of healthcare system and patients for optimization of their health, and also plays an important role in ongoing monitoring to make sure for consistent achievement of therapeutic objectives for asthma management and control.
Albuterol multidose dry powder inhaler efficacy and safety versus placebo in children with asthma. (2016). Allergy And Asthma Proceedings. https://dx.doi.org/10.2500/aap.2016.37.4015
Anderson, R., & Funnell, M. (2010). Patient empowerment: Myths and misconceptions. Patient Education And Counseling, 79(3), 277-282. https://dx.doi.org/10.1016/j.pec.2009.07.025
Asthma: pathophysiology, causes and diagnosis. (2014). Clinical Pharmacist. https://dx.doi.org/10.1211/cp.2014.20066997
Bachert, C., & Zhang, N. (2012). Chronic rhinosinusitis and asthma: novel understanding of the role of IgE ‘above atopy’. Journal Of Internal Medicine, 272(2), 133-143. https://dx.doi.org/10.1111/j.1365-2796.2012.02559.x
Cardinale, F., Giordano, P., Chinellato, I., & Tesse, R. (2013). Respiratory epithelial imbalances in asthma pathophysiology. Allergy And Asthma Proceedings, 34(2), 143-149. https://dx.doi.org/10.2500/aap.2013.34.3631
Ellis, J. (2012). The impact of lung cancer on patients and carers. Chronic Respiratory Disease, 9(1), 39-47. https://dx.doi.org/10.1177/1479972311433577
Evans-Agnew, R. (2017). Asthma Disparity Photovoice. Health Promotion Practice, 152483991769103. https://dx.doi.org/10.1177/1524839917691039
Henderson, W. (2008). Secretory Phospholipase A2and Airway Inflammation and Hyperresponsiveness. Journal Of Asthma, 45(sup1), 10-12. https://dx.doi.org/10.1080/02770900802569751
Kowalski, M. (2010). Medical Therapy in Chronic Rhinosinusitis. Current Allergy And Asthma Reports, 10(3), 153-154. https://dx.doi.org/10.1007/s11882-010-0100-8
Lehrer, E., Mullol, J., Agredo, F., & Alobid, I. (2014). Management of Chronic Rhinosinusitis in Asthma Patients: Is There Still a Debate?. Current Allergy And Asthma Reports, 14(6). https://dx.doi.org/10.1007/s11882-014-0440-x
Londoño, A., & Schulz, P. (2015). Influences of health literacy, judgment skills, and empowerment on asthma self-management practices. Patient Education And Counseling, 98(7), 908-917. https://dx.doi.org/10.1016/j.pec.2015.03.003
Mogasale, V., & Vos, T. (2013). Cost-effectiveness of asthma clinic approach in the management of chronic asthma in Australia. Australian And New Zealand Journal Of Public Health, 37(3), 205-210. https://dx.doi.org/10.1111/1753-6405.12060
Morrison, D., Mair, F., Yardley, L., Kirby, S., & Thomas, M. (2016). Living with asthma and chronic obstructive airways disease: Using technology to support self-management - An overview. Chronic Respiratory Disease. https://dx.doi.org/10.1177/1479972316660977
Nunes, C., Pereira, A., & Morais-Almeida, M. (2017). Asthma costs and social impact. Asthma Research And Practice, 3(1). https://dx.doi.org/10.1186/s40733-016-0029-3
Nygårdh, A., Malm, D., Wikby, K., & Ahlström, G. (2011). The experience of empowerment in the patient-staff encounter: the patient's perspective. Journal Of Clinical Nursing, 21(5-6), 897-904. https://dx.doi.org/10.1111/j.1365-2702.2011.03901.x
Sills, M., Ginde, A., Clark, S., & Camargo, C. (2010). Multicenter Study of Chronic Asthma Severity Among Emergency Department Patients With Acute Asthma. Journal Of Asthma, 100913044443056-9. https://dx.doi.org/10.1080/02770903.2010.504878