Prevention and Control of Chronic Diseases - Essay Example

?Griffith Gold Coast campus School of Nursing and Midwifery 8011NRS: Chronic Illness and Palliative Care Case Study: Chronic Asthma and Principles of Care Assignment 1/ Semester One/2011 Course Convener: Student's name: I.D. Number: Word Count: 2250 (9 pages) Due date: Introduction Chronic disease care is a vital for geriatrics. The increased number of chronic disease among elder people draws an attention to the urgent need to find the most appropriate ways to deliver effective care. This case study is about a patient with chronic asthma disease. From the provided scenario, some general information has been obtained about the client, however, further health assessment is need by the nurse practitioner in order to assess and evaluate the client's need as well as developing an appropriate care plan. The discussion in this paper will be based on the principles of care of a patient with a chronic illness which is asthma in attempts to explore three main concepts, living with asthma and patients quality of life; the client's empowerment through self-management care and the continuity of care in a multidisciplinary team approach with a palliative care setting. According to the definition provided by the World Health Organization (1990), "Palliative care is the active total care of patients whose disease is not responsive to curative treatment. Control of pain or other symptoms and psychological, social and spiritual problems in this context are of paramount importance" (pp. 804). Regarding shared values and ethics in palliative care, ethike is a Greek word from which the word ethics is derived. Ethos is a value which one has and consistently applies to one's life. Within the palliative care setting, there are three aspects of patient care that need special attention: the realms of the palliative care patient; the realm of the palliative care nurse; and the realm of the palliative care team. The realm of the palliative care patient is mainly concerned with the patients' well-being even though he or she is in the end stages of terminal illness. The patient is still given treatment, in most instances, for what ails him or her, but the patient is prepared to die at any moment. In this case, the ailment being treated is asthma. The Client’s General Information Scott is a 47-year-old manager of a cotton farm in a rural area of the Queensland State. Scott was diagnosed with asthma at age of six years. There are some factors such as dairy products; shellfish; electrical storms and dairy dust that trigger his asthma attacks. Scott is married, but his wife left him three months ago and his condition gets worse and the house does not have the same standard as before. In his effort to find alleviation of the symptoms of asthma, Scott attends his 45 to 49 year old health assessment for the first time. The Patient's Diagnosis Scott was diagnosed with asthma at age of six years. His asthma is a chronic condition. Recently, Scott is complaining of bad asthma attack which stopped him to attend his work as usual. Additionally, Scott has psoriasis and the history of having it is unknown. However, the nurse practitioner should conduct a thorough health assessment in order to gain furthers details about the diagnosis of both disease, treatment, and the way of self management that is followed by Scott in order to control over his condition. Measuring the severity level of asthma is determined by the physician by asking the client to have a lung function test (LFT), which a breathing test that identify whether the person is having asthma and its severity. Another test that can be done easily by the patient is spirometry, which is an instrument that is considered to be the most accurate test to determine asthma (Department of Health and Aging, 2010b). Living With Asthma Asthma is a chronic inflammatory disease of the airways and lung. It is characterized by wheezing, coughing, chest tightness and shortness of breath. There are some of the risk factors that contribute to trigger asthma attack such as colds and flu, air pollution, tobacco smoke and occupational allergens (Department of Health and Aging, 2010 a). According to the Australian Institute of Health and Welfare (2010a), the symptoms of asthma are wheezing, shortness of breath, tightness of the chest as a result of widespread narrowing of the patient's airway. Usually, the symptoms of asthma are revisable and the severity of the attack ranges between mild, intermittent symptoms leading into few health problems for the patient, to severe wheezing and breathlessness. Few people living with asthma has severe adverse effect on their quality of life and might threat their lives. Though the underlying causes of asthma are not understood very well, there are some factors that might trigger the development of asthma. The following factors are known to be triggers of asthma: viral infection, exercise, exposure to allergens (dust, pollens, mould spores, animal dander), irritants (such as tobacco smoke, air pollution, food additives), occupational exposure if irritants, fumes and dust (AIHW, 2010a). Due to these factors, Scott is in recurrent asthma attacks evidenced by Scott's report of being unable to work for six months. As Scott is living in a cotton farm and his house is not kept clean after his wife's leaving, it is well understood that Scott have been exposed to some of the above mentioned triggers such as dust and occupational irritants in the cotton farm. Asthma impacts the quality of life of the individuals as those people are more likely to restrict their activities in order to minimize the symptoms' impact by taking days off work (AIHW, 2010a) and this is what happened to Scott. Physical Impacts of Asthma On the health assessment, Scott reported that his condition is getting worse and could not cope with his duties at work do to deterioration in his health status. In addition, Scott reported that his home does not have the same standard as before, because his wife left him three months ago. As a result, Scott is suffering from recurrent asthma attack and was not eating appropriately in which his body is affected by asthma attack and psoriasis. According to Stumbles, Andrus, McLellan and von Garnier (2008) diet plays a vital role in chronic condition of asthma. The patient with asthma must avoid any kind of food allergy because it causes more irritation and swelling of the airway and leads to less air aspiration and expiration. All of this may lead to decrease the level of the oxygen in the blood, which is important for the mobility and the activities that are needed by the patient. As a result lacking of oxygen in the body is the main reason for activities restriction in patients with asthma. Stumble et al. (2008) stated that loss of energy due to poor oxygenation secondary to difficulty in expiration which result in inability to do activities of daily living, at school or work and sometimes patient faces difficulty in talking because of the struggling to exhalation and inhalation processes. Psychological Impacts of Asthma Having a chronic disease, this makes many challenges that affects Scott's life for long and needs a great deal of help to overcome. Scott needs to make adjustments in order to adapt with his chronic asthma disease and his other stressors such as being living alone after his wife left him, and the occupational arrangement in the cotton farm which is a source of his asthma triggers as well. Scott may not be able to adjust to all of the changes in his life so easily and to accept his condition as life lasting which often leads to ongoing stress resulting in chronic depression. Scott reported that his wife has left him for three months subsequently his eating was not well since that. In addition, Scott reported that the house is not kept the same standard as before and this might contribute to the presence of asthma triggers at home such as dust and also report of being sick for the last six months. At work place, many times Scott was unable to work because of his recurrent asthma attacks which result in taking several days off work. There is no further information about the psychological impact of asthma on Scott. As a result, the nurse practitioner should assess Scott for further details in order to discover how much asthma affects his life. This is because depression (may occur to Scott) is considered to be one of the leading factors of lowering an individual's quality of life and thus should be kept at the minimal level. Moreover, it is advisable to refer Scott for counseling session using multidisciplinary approach in order to reduce any anxiety of fear related to his condition and his status at home and workplace (AIHW, 2010a). Multidisciplinary Care and Self-Management Multidisciplinary care is a person-centered care that includes assessment, planning, monitoring and review as well as self-management encouragement, and client education (Ehrlich, Kendall, Muenchberger & Armstrong, 2009). Ehrlich et al. (2009) claimed that the person-centred care based upon some principles such as advocacy, client's involvement, encourage social and psychological support, empowerment, protect the client's right and confidentiality, the provided care is matched with the clients' needs, addressing their cultural and or spiritual needs. For clients with chronic condition, it has been emphasized by the Australian Federal Government that something must be done in order to help these chronically ill patients. This approach is a team-based care that benefits both the outcomes of both the health care professionals and patients with chronic conditions (Yates, Wells & Carnell, 2007). According to Cioffi, Wilkes, Cummings, Warne and Harrison (2010) stated that evidences shows that the multidisciplinary team approach includes improvement in measurements of the chronic diseases, adhesion to the guidelines for each chronic condition, support self management programs and this approach is based on client-focused education. Furthermore, Coster and Norman (2009) also supported the idea of increasing the demand on educational interventions that assist in helping the patients with chronic condition to better manage their own disease or condition. In order to improve Scott condition, the above approach should be implemented by the nurse practitioner. This can be done by referring him to other health care professionals in the health care settings and community institutions. Active involvement of the patient in his care plan is vital for successful management of the desired care, reduce the symptoms and prevent unnecessary hospitalization (Coster & Norman, 2009). Providing Scott with appropriate referral and health education about self-management will empower him by giving him the chance to decide his care in his own. Quality of Life According to Australian Institute of Health and Welfare (2010b) the health of people with asthma is worse than those people without it. In addition, people with asthma reported absenteeism of work more than normal people. In order to improve the quality of life of people living with asthma and other respiratory diseases such as Chronic Obstructive Pulmonary Disease (COPD), it is recommended to implement a multidimensional assessment that addresses the problem related to the airway, co-morbidities, risk factors and skills of management. This assessment and care for such patients needs developing effective systems of health care and guidelines for clinical practice as well as improving health outcomes through research agenda (Gibson, McDonald & Marks, 2010). In the response to the national framework of chronic disease, asthma has been given an attention by the government at all level. For example, in Queensland state, there are many actions were taken in order to detect and control over asthma as it is one of the major disease affect the health and the quality of life of many Australians. Accordingly, 'Asthma management Program' has been developed in an attempt to reduce the impact of asthma and linked chronic respiratory condition such as COPD (Department of Health and Aging, 2010b). In addition, there are other program has been established for this purpose such as the followings; 'Community Support Program', 'Asthma Management Program', 'Asthma child Adolescent Program', GP and Allied Health Professional Asthma and respiratory Education Program, Australian State and territory Asthma Foundations'. All of the above program has its own goals and objectives, but their main and common concern is supporting patients with asthma and their families in order to improve self-management of asthma condition, support families and health careers to manage and link respond to asthma and increases the awareness among communities of asthma control as well as improve the access to the health care services concerned with diagnosis, assessment and management of asthma s well as improve the quality of life of Australian people over all the country. The Queensland government has established the 'Asthma Foundation of Queensland' for all Queenslanders in order to improve their quality of lives by supporting people and families living with asthma (Asthma Foundation of Queensland, 2010). As Scott is living in Queensland in a rural area, this program covers his living area. Conclusion Chronic diseases affect many people's lives. However asthma is one of the major conditions of chronic illnesses that affect the quality of many people generally in the world and specifically in Australia. Due to the increased number of chronic disease, the Australian government attempts to control over them by initiating a national chronic diseases program. In response to the national chronic disease programs, the Queensland government has developed its health care system and community services in order to meet the needs of patients with asthma and any other respiratory diseases. As a nurse practitioner, a thorough health assessment is in demand to evaluate and assess the health status of patients with chronic diseases such as asthma. An appropriate health assessment assists the health care professionals to determine the appropriate health care for such patients. With these professionals’ help, patients with chronic illnesses like asthma will be able to receive the care they need. REFERENCES Asthma Foundation of Queensland. (2010). Asthma Queensland. Retrieved March 25th, 2011, from http://www.asthmaqld.org.au/content/?id=2. Australian Institute of Health and Welfare. (2010a). Asthma. Retrieved March 31st, 2011 from http://www.aihw.gov.au/asthma-and-chronic-respiratory-diseases/. Australian Institute of Health and Welfare. (2010b). How does asthma affect quality of life? Retrieved March 31st, 2011 from http://www.aihw.gov.au/asthma-quality-of-life/ Cioffi, J., Wilkes, L., Cummings, J., Warne, B., & Harrison, k. (2010). Multidisciplinary teams caring for clients with chronic conditions: Experiences of community nurses and allied health professionals. Contemporary Nurse, 36(1-2), 61-70. Coster, S., & Norman, I. (2009). Cochrane reviews of educational and self-management interventions to guide nursing practice: A review. International Journal of Nursing Studies, 46 (28), 508-528. Department of Health and Aging. (2010a). Asthma. Retrieved March 29th, 2011 from http://www.health.gov.au/internet/main/publishing.nsf/content/health-pq-asthma-index.htm. Department of health and Aging. (2010b). Asthma: Asthma Management Program. Retrieved April 1st, 2011, from http://www.health.gov.au/internet/main/publishing.nsf/content/asthma-manage. Erhrlich, C., Kendall, E., Muenchberger, H., & Armstrong, K. (2009). Coordinated care: What does that really mean? Health and Social Care, 17(6), 619-627. Gibson, P. G., McDonald, V. M., & Marks, G. B. (2010).Asthma in older adults. The Lancet, 376(9743), 803 – 813. Stumbles, P., Andrus, P., McLellan, S., & von Garnier, C. (2008).Chronic asthma. In E. Chang & A. Johnson (Eds.), Chronic illness and disability: Principles for nursing practice (pp. 269-286). Chatswood, N.S.W: Churchill Livingstone Elsevier. World Health Organization (1990). Technical report series. Geneva: WHO. Yates, R. Wells, L., & Carnell, K. (2007). General practice based multidisciplinary care teams in Australia: Still some unanswered questions. A discussion paper from the Australian general practice network. Australian Journal of Primary Health, 13 (2), 10-17. Read More