Prevention May Be More Expensive than Cure - Assignment Example

Asthma deaths continue to occur despite a greater awareness of the disease within the public sphere (Hannaway, 2004, p. 256). Asthma is a disease of the bronchial tubes, where constriction causes a person to lack an adequate intake of oxygen. The symptoms are well known among the public, and include coughing, wheezing and episodes of shortness of breath (someone, date, page). This paper will discuss the issue that, to date, despite sufferers, non-sufferers and health professionals having greater awareness of the disease, continued increases in morbidity rates from asthma occurs. Firstly, a brief revision of factors that may influence morbidity rates to remain high will be outlined. Secondly, a reflective discussion of my own experience with asthma sufferers in as a practice nurse working in a GPs surgery shall be presented. Finally, a conclusion shall synthesise the main points of the paper, and clearly state how issue is reflected in my area of clinical practice. Presently, Western societies experience easy access to health information and education as compared to the past. For example, the internet provides an abundance of information resources and access to public health services, council libraries are open to the public, and contemporary media and advertising strive to 'educate' their consumers on product labels. Large scale efforts of primary care workers at using behavioural modification methods, and encouraging sufferers to adopt healthier lifestyles, such as avoiding pollution, or not smoking around children, have been largely unsuccessful. However, although it is ultimately the sufferer who decides whether to adopt a healthier lifestyle, it appears that factors exist which hinder their access to health information, as well as that of their families, and perhaps also the primary care workers who deliver services to them (Morris, 2001, p. 48). Socio-economic status of the sufferer has traditionally been cited as the dominant factor affecting health and wellbeing. Inequalities in access to economic resources results in dramatic differences in life chances (Fulcher & Scott, 1999, p. 588). For example, one may not own a computer, or is unable to afford an Internet connection, so is unable to source health information. Alternatively, unfamiliarity with using a PC may negate a person's interest of using a public library's facilities. Another dominant factor is the cultural beliefs of the sufferer, which may constrain a sufferer from using contemporary medications. Research has indicated that non-compliant sufferers contribute to high morbidity rates of asthma. This may be due to religious affiliation, or from a mistrust of medications that are not traditionally associated with one's cultural upbringing. Other factors that can inhibit access to health information include: social isolation, such as can be experienced by elderly or the physically disabled; geographical location that constrains attendance to health promotion programs; the sufferer experiencing other health issues that they consider 'more important' than asthma; personality characteristics that influence a person's decision to deny the diagnosis of asthma; or peer pressure to not attend health education, or to avoid use of medication in some social contexts. Social constructions that contribute to high morbidity rates of asthma include asthma not being conceptualised as a life-threatening disease. Especially, an absence of symptoms such as wheezing are often interpreted as meaning the absence of the disease all together. Hence, sufferers may fail to recognise danger signals. Alternatively, asthma tends to be conceptualised as solely a childhood experience. The fact that the disease can develop at any time across the lifespan does not appear to be well known to the public, as such many older sufferers may believe that their age provides them with immunity from the diseases more serious effects. It is also recognised that the unnecessary morbidity rates of asthma are due to primary care workers under-use of a preventative care approach (Butler, 2001, p. 166). For example, Butler (2001) reports one study indicating that only 5 out of every 35 patients who presented to their GP the week prior to hospital admission had received appropriate prophylactic changes to their medication. It appears that some doctors fail to appreciate the urgency of an asthmatic episode (Barnes, Hilton & Levy, 2000, p. 43). Reflective Discussion Drawing on my own clinical practice experience I am concur with the Hannaway (2004, p. 263) that the key to managing the asthma is through patient education. As such, this requires time on the part of the health care providers (Hannaway, 2004, p. 263). Although, my experience supports claims that effective consultation and inclusive participation of the sufferer requires adequate resources to be available (Pattison, 2001, p. 203). What I have found difficult is the acceptance of non-compliant patients, such as the asthmatic smoker, and I often question myself as to whether they are really entitled to health treatment in the future, due to their self-infliction of the disease. However, I am aware of my ethical obligation to 'first do no harm', and to uphold their human right to not heed health information. It is also apparent to me that all stakeholders in the issue of asthma morbidity must be unwilling to accept that current high levels are 'normal'. Further, it is evident in my practice that, as found by (Hyland, 1998, p.185), a patient is more likely to pay attention to their symptoms, and to take their medication, when they perceive asthma as a serious illness. As such, the patient needs to be provided with continual updates on the disease, such as avoidance of particular allergens or the importance of immunisations, to extend their knowledge and understanding of prevention and treatment. It is also important that information and education take a one-to-one approach between the patient and the service provider. Essentially, effective communication is vital so the shared meanings of language by which we communicate with our patients must align with their understandings at this time, to ensure their confidence in what is required of them to do (Fulcher & Scott, 1999, p. 284). Ultimately, the patient should be provided with a written asthma management plan. As a primary service provider I have come to understand that it is necessary that I remain flexible in role as I am also required to take on other roles, such as teacher and mentor. I am also more aware of the importance to liaise with other health service providers, such as school nurse or community nurse, as good communication with other health professionals can help me to add to and improve my own clinical practice. This will extend my knowledge of what to do, and when to do it, when I am confronted with the diversity of asthmatic episodes that can occur. I have also cultivated the practice of not feeling threatened by the need to sometimes refer my patients on when I recognise that secondary care may be necessary. Conclusions It is evident that a range of personal, social and health professional factors influence an asthma sufferer's awareness an access to health information that subsequently impacts on morbidity rates. In my practice it is evident that organisational decisions need to be abided to ensure that effective and efficient asthma care is provided within the primary care setting. For example, evaluation of patient education; the language used by which to communicate health information; and health workers attitudes towards collaboration, as well as attitudes toward referrals for secondary care of patients. As such, policy changes need to be made within primary care settings in regards to patient education and care procedures delivered by health professionals. References Barnes, G. Hilton, S. Levy, M (2000) Asthma at your fingertips Class Publishing: London Butler, J (2001) Prevention may be more expensive than cure in Working for health Heller, T (ed) Sage Publications: London Fulcher, J. Scott, J (1999) Sociology Oxford University Press: Oxford Hannaway, P (2004) What To Do When the Doctor Says It's Asthma Fair Winds: Gloucester, USA. Hyland, M (1998) Asthma management for practice nurses Churchill Livingstone: Edinburgh Morris, D (2001) Post modern illness in Working for health Heller, T (ed) Sage Publications: London Pattison, S (2001) User Involvement and participation in the NHS in Working for health Heller, T (ed) Sage Publications: London Read More