Disability and Chronic Illness in Nursing - Essay Example

Disability And Chronic Illness In Nursing This is the case study of an Australian story 'The Beautiful Mind'. This is the story of Melissa Holland a nurse, whose life is disrupted by a tragic plane crash. Melissa suffered with frontal brain damage, shattered vertebrae, and ankle and elbow damage. Melissa spent many months in the hospital and lots of years in rehabilitation learning the basic skills. Melissa amazed everyone with her courage and progress to better health; she is now keen to re enter her profession that she loved so much. As a nurse who suffered head injuries, Melissa will have a better understanding towards patients with such disabilities. (A Beautiful Mind: 21-3-2005). Taking Melissa's case, lets discuss the various aspects of chronic illnesses. Chronic pain is not very responsive to narcotics and analgesics; it is more restrictive to different therapies of pain. Only a few patients can define an injury or pain as the cause of the illness, which is much lesser than the psychological feelings of depression and trauma, which such patients undergo. All these side effects may be the main cause for the chronic pain. (T.J. Murray, Chronic Pain Study). Chronic pain is an important social and medical problem for many reasons. It is very distressing to patients, as it affects their life and even their employment, and not very responsive to treatment. Chronic pain is associated with large financial, as in the case of Melissa, who did not get any sort of compensation or insurance for her treatment. In spite of its regularity and large costs, it becomes very difficult to understand and manage a patient, and ultimately becomes a cause of stress and confusion to everyone concerned with the patient. Chronic pain becomes the main cause of irritation for everyone - the patient, his or her family and friends, the employers, the insurance and payment agencies, and their physicians. As the patients don't respond to treatment, the physicians try to find a cause for the illness. Annually around billion dollars are measured in the lost time and output, compensation and legal hassles, medical treatments and other personal costs for the patients suffering. Though not all patients become chronic, patients with chronic pain Although less than ten percent of all pain patients go on to become chronic, the chronic pain patients come up to around more than half of the total cost of compensation for the pain, and stand for an rising group of very distraught and suffering people. (T.J. Murray, Chronic Pain Study). It is very difficult to understand and assess people with chronic illness, and difficult to fairly take care and compensate such people. The patient can only experience the pain in such chronic illnesses, it is difficult for anybody to assess the pain, an outsider can only experience it, as the patient says the pain is there. Chronic pain is defined as constant pain for more than 6 months when normal healing should have been expected. Some of the steps, which can be taken to ensure better care for chronic patients, are Recognition of the emotional, physical, behavioral and psychological factors involved in patients with chronic pain. Educating physicians, nurses and other health care professional of the nature and management of patients with chronic pain. Adopting a proper rehabilitation program for chronic pain like, better care for trauma and pain, recognizing the characteristics and behavior of pain, stressing the need for improved activity and physical movement, even in the case of pain, accepting the aim to return to work early. (T.J. Murray, Chronic Pain Study). Apart from the illness, people like Melissa have to face the social stigma, associated to such disabilities. Scholars of the disability policy describe four different models of disability: A right model of disability which considers disability as the outcome of a sin, a medical model of disability which considers disability as a fault or sickness, which can be cured by medicines, a rehabilitation model, an outcome of the medical model, which considers the disability as a insufficiency that ought to be fixed by a helping or rehabilitation professional and the disability model, under which, the problem is defined as a ruling attitude by professionals and others, the tendency for people to generalize all persons with disabilities missing the large disparity within the disability community. (Deborah Kaplan, World Institute of Disability). The first model is the oldest and less common in these days. There are many communities that relate disability with sin and disgrace and disability is often linked with guilty feelings. For patients with any disability, this model is particularly troublesome. This model has been related to shame on the entire family with a disabled family member. There are many instances where the families have kept the disabled family member in isolation, not letting them meet anyone, keeping them out of school and barred from any chance of playing a role in the society. In many circumstances, this model has resulted in general social isolation and self-hatred. In the medical model, if a patient is cured, than these problem will not arise. In the medical model disability can be defined as the inability of a person to work. The rehabilitation is mostly similar to the medical model, only that it considers a disabled person to receive the services of a rehabilitation specialist who can give the patient, therapy, counseling or treatment. The disability model identifies social inequity as the most major problem experienced by persons with disabilities, and as the root cause of many of the problems faced by patients that are regarded as central to the disability under the other models. (Deborah Kaplan, World Institute of Disability). Another issue related to the definition of disability is the identity of disability. There are many people who come into the group of disabled persons, but do not consider themselves as disabled. They're maybe many reasons for a person to not identify himself as disabled, even though considered as disabled by others. The main reason being disability carries a stigma, which people don't want to be associated with. For people who are newly disabled and children with disabilities, it takes some time for them to digest the fact that they are members of a stigmatized group. Newly disabled people may have the label of disability that is common among non-disabled people. (Deborah Kaplan, World Institute of Disability). People with disabilities may fear that if they identify themselves as being disabled, others may see them only as disabled and fail to recognize their other abilities. There are many disabled people who do not think they are disabled but face discrimination. The nature of discrimination towards disability is that it time and again has very little to do with the individual's potential and true characteristics. The underlying social stigma and stereotypes are the cause of the discrimination, more than the disability itself. It is known that the disability as such is not the cause at all, but the reaction of people to the disability is the main cause. A few strategies that can be followed to avoid the stigma attached with disability. Different social and legal activities can be taken that challenge the statements behind the disability discrimination. The main aim is to eliminate the stigma. The decision to not be associated with those who have been stigmatized tends to be responsible for the stereotypes and discrimination. (Deborah Kaplan, World Institute of Disability). Lets consider the role of a nurse in the health care system. Nurses play a key role in health care delivery in different settings like hospitals, schools, homes, workplace etc. Nurses teach how to prevent diseases and promote wellness to the patients. They are able to provide expert, capable care during chronic illness, and offer support and consideration to patients and families. In some cases nurses become the main source of support for the patient and her family. (Guides to Careers in Healthcare, 2004). Nurses look upon patients and their families as essential members of the care team and believe it is very important for patients to be educated and concerned in their care so that they understand their treatments. Because nurses generally spend more time with patients than they do with other members of the healthcare team, nurses are ideally positioned to support for the patients needs and privileges. (Guides to Careers in Healthcare, 2004). A good nurse should have proper critical-thinking skills, thorough knowledge of patho-physiology and other sciences, and the capability to develop and put into practice different nursing involvements that improve a patient's health. (Guides to Careers in Healthcare, 2004). In Melissa's case nurses working closely with disabled people can play an advocating role to help overcome the disabling effects on patients with head injuries. Patients may become extremely depressed and it is important to recognize the reason why it occurs in order to determine the conditions in which anti-depressants may or may not help. Anti-depressants may be useful for depression, and possibly other mood swings such as emotional problems, but are not likely to be helpful where medical features of the brain injury itself imitate depression. (Prof Lynne Turner-Stokes, (2004, p.4) The Royal College of Physicians). The main reasons for depression occurring in patients with head injuries are An emotional reaction to the sudden inception of disability and the changes associated with the disability, which may include physical, financial, professional, and relationship losses. A direct result of the brain injury leading to changed imbalance within the brain resulting in mood swings in the patient. A tendency to go into depression with suicidal feelings. Loss of energy, a decreased appetite and changed sleeping habits. Poor concentration in the patient and inability to make decisions (Prof Lynne Turner-Stokes, (2004, p.4) The Royal College of Physicians). The nurse, who takes care of the patient in the rehabilitation center, helps the patients with brain injury and chronic disease in achieving good health, and adapting to a changed lifestyle. The nurse at the rehabilitation center provides care for the patient. The main focus of nursing care is on: Maintenance of the patients health Providing proper nutrition Making the patient look towards a positive objective Impairment of the skin reliability Various bowel and bladder problems Impaired physical movement The patient's incapability of taking care of herself. Altered sleeping pattern Chronic illness and disability Impaired cognition Improper oral communication and understanding Improper sexual functioning. (Treatments for Traumatic Brain Injury, Rehabilitative Center Treatment). The main goals followed by health care professionals, for rehabilitation of a patient with head injuries are 1. Stabilize the health and healing therapy issues related to brain injury and the other disabilities. 2. Preventing any secondary complications. Some of the problems include sores due to pressure, pneumonia and other complications. 3. To restore the patient's lost functional capabilities. The functional changes possibly include, limited ability to move, use the bathroom, difficulty to talk, eat and feel. 4. The staff will also provide the patient with necessary adaptive devices or approaches to improve her functional independence. 5. The staff begins to interact with the patient and her family regarding the changes that might be required when the patient goes home. (Treatments for Traumatic Brain Injury, Rehabilitative Center Treatment). Each day, the nurse helps the patient to participate in different healing therapies. In the beginning, the patient requires the assistance of the nurse for even very simple activities like: getting out of bed, eating, brushing teeth etc. The patient also may require the help of a nurse as there is every risk of the patient falling from the cot, the patient may also try to go out of the hospital and go home. Usually such patients will be in a confused and dreamy state. It is the responsibility of the nurse to review, observe and interpret critical physiologic or other body functions and inform the physician of changes. The nurse should repeat the observations at regular intervals and provide the necessary information to the family. The patient has to be observed regularly for any signs of pain. In the most critical time of a patient's life, nurses are with the patient and offer continuous support to the patient. A nurse is there for a person when he is born, when he is ill and when he dies. Every person shares her most intimate moments with a nurse, and trusts the nurse completely to carry out painful procedures. Nurses are at the beck and call of a patient throughout the day. The nurse acts as a soul mate to a patient when the patient is afraid or lonely. The nurse feeds and bathes the patient. The nurse teaches the patient about self- care, while working with the patient. The nurse educates the patient and her family about the right diet and nutrition, the amount of sleep and rest required by a patient, how to maintain proper hygiene, and other aspects to lead a healthy life. (The role of the nurse on the Health care team). The advocacy of a nurse can be seen in: giving moral support to the patient, speaking on behalf of a patient, and acting as a mediator when necessary. This advocacy forms a part of the way of caring for the patient; this helps in developing a bond between the nurse and the patient, by which the patient has a feeling of trust and support towards the nurse. This shows that nurses have a special and dignified place in the health care system, which make them the most reliable persons for a patient. (The role of the nurse on the Health care team). Being a nurse herself, all these feelings towards a patient and her experience in dealing with such situations helped Melissa to recover quickly. Melissa's experience with disabled patients, must have given her the grit and determination to get well soon and join back the profession, which she adored. We hope that many more youngsters join the nursing profession and serve the disabled people like Melissa did. References ABC Home radio television news, A Beautiful Mind [online]. (Updated 21 March 2005). Available from: http://www.abc.net.au/austory/content/2005/s1328042.htm. [Cited 7 February, 2007]. T J Murray, Dalhousie University, Chronic Pain Study [online]. Available from: http://www.wcb.ns.ca/chresch.htm [cited 7 February, 2007]. Prof Lynne Turner-Stokes, The Royal College of Physicians 'Clinical Effectiveness and Evaluation Unit, Concise guidance for the use of anti-depressant medication in adults undergoing recovery or rehabilitation following acquired brain injury[online]. Available from: http://www.bgs.org.uk/Publications/Publication%20Downloads/ABI-Clinical1-1.doc, [cited 7 February, 2007]. Treatments for Traumatic Brain Injury, Rehabilitative Center Treatment [online]. Available from: http://www.traumaticbraininjury.com/content/treatmentsfor /rehabilitativecentertreatment.html, [cited 7 February 2007]. Guides to Careers in Healthcare, The Role of the Nurse as part of the Health Care Team [online]. Available from: http://www.pfizercareerguides.com/default.aspt=article&b =nursing&c=nurseOverview&a=nurseRole [cited 7 February, 2007]. Deborah Kaplan, World Institute of Disability, The Definition of Disability - Perspective of the Disability Community [online] Available from: http://www.peoplewho.org/debate/kaplan.htm [cited 7 February, 2007]. The role of the nurse on the Health care team [online]. Available from: http://www.wpro.who.int/internet/files/pub/85/1-6.pdf [cited 8 February, 2007]. Read More