Clients with Chronic Illness and Their Families - Coursework Example

with Chronic Illness and Their Families 2009 OUTLINE: A) Nursing chronically ill and role of a nurse B) Changes in chronically ill patients and care provided C) Interventions and approaches to chronically ill patients D) Family of a person with a chronic illness For centuries nurses have been caring for dying and suffering, providing support to their families. Nurses providing end-of-life care should possess a mix of skills: be expert clinicians, patients advocates and educators. Nursing as a ‘person-centered activity’ (Thomas, 2005) places a patient at the centre of healthcare. Chronically ill patients deserve much more attention as they are particularly sensitive to effects of nursing care being completely depended on the health care system. (Thorsteinsson, 2005) Nursing service is different from other services provided as it assumes the highest degree of vulnerability of its clients. The basis of end-of-life care is managing symptoms and boosting quality of life rather than concentrating on treatment procures, which in many cases is useless for chronically ill patients. Long term care also supposes relief from pain and suffering and restoring functional capacity of a patient. As chronic illness effects physical, emotional and spiritual well-being of a patient and his/her family, the care for those with chronic conditions is a complex and challenging task. The majority of chronically ill are older adults, which require managing of disease, avoiding complications and contributing to healing capacity of a patient as well as achieving optimal quality of life. (Moss et.al., 2003) Considering that chronically ill elders over 65 years they have special spiritual needs including spiritual support, need for love and trust, which contribute to the sense of spiritual well-being and thus to positive quality of life. The role of a nurse is in providing creative spiritual care to guarantee satisfaction of a chronically ill patient with a life. It is not acceptable to get spiritual aspect of care out of view when caring for a dying patient. (OBrien 2002, p.269) Dying patients and their families face many challenges in copying with stress of pending death. The humanistic nursing theory of Paterson and Zderad supposes provision of spiritual care for terminally ill. Stepnick and Perry offers a model of transitional phases of dying, which supposes that dying patients share the same characteristics at the face of death. They suggest strategies, including listening and open communication, preparing dying patient to the final stages of the illness. (OBrien 2002, p.269) Palliative care supposes sensitive practices, which manage physical, emotional and spiritual needs of the patients. The task of a palliative nurse is to provide a complex care for better control of an illness being a complementary activity to traditional nursing practice. A nurse has to not only manage the symptoms like nausea or pain, but be able to create a safety trustworthy relationship with a client. (Quaglietti, Blum and Ellis, 2004) It is important to set relationship of trust between a patient and a nurse as it facilitates adherence to treatment plan by a patient and one’s awareness of its significance. The effective communication in health care setting is of utmost importance for positive outcomes of the treatment process. It’s really a challenge for a care provider to be concentrated wholly on a patient with his specific problems, considering every detail, understanding person’s background and interpreting different meanings in everyday situations. (Kitson, 1999 in Thomas, 2005) Inadequate communication between patients and care providers results in the failure to achieve whole-person patient care. To avoid such impediments clinicians should make use of contextual knowledge, share it with other providers and preserve relationships with both the patient and other care providers engaged in the process. Chronic physical illness produces the emotional trauma as a person loses not only customary level of functioning but sees no future. It is natural to have feelings of fear, anger and depression at this situation. The emotional stress is hard to survive and the task of a nurse is to assist a person through these emotional changes. Meeting physical needs of chronically ill patients conveys a sense of welfare to these individuals. Helping them to get dressed, take a bath and groom themselves promotes self-respect and a sense of well-being. Promoting self-care allows developing motivation in ill patients and their families to work out the problems themselves. That’s why health care personnel should teach chronically ill people of physiological ramifications of their position and the way to cope with them. Roy Adaptation Model can be applied to nursing chronically ill patients where a nurse is responsible for directing patient’s energy into getting well. The Model defines the purpose of nursing, which is ‘to promote adaptation of persons in each of the adaptive modes in situations of health and illness.’ Thus the center of nursing activity is a patient with its needs and adaptive responses to the environment. (Marriner-Tomey & Alligood, 2006) That’s why some kind of interaction should exist between a health care provider and a patient. Patients are reinvented in healthcare as partners in the process. For the partnership it is required to work a certain degree of communicative concordance. (Mock, 2001) Effective communication is a must for good care-taking process: it allows to identify patients problems more accurately, benefit to patient’s satisfaction with the care and thus results with diminished anxiety and depression, understanding the problem, adhering to treatment options and following recommendations on behaviour change. One of the most difficult tasks in professional-patient communication is ‘finding the appropriate words to express what may be ineffable feelings, uncertain conditions and experiences.’ For example, when professionals feel precluded from advising and patients are looking for advice, the letter can be masked as giving information. (Candlin, 2000) Such basic communication skills as attending and listening make the communication between the care-taker and the patient effective. These skills are particularly important when communication happens between a care-taker and a cancer-diagnosed patient. Attending refers both to physical and psychological participation of a care-taker. Effective attending puts the care-taker in a position of an active listener and can be achieved by facing a patient, adopting a bodily posture of openness and availability indicating complete involvement. Listening refers to the ability of the care-taker to capture and understand both verbal and nonverbal messages the patients communicate. Listening to and understanding the patient’s verbal messages involves perception of a mix of experiences, behaviour and feelings the patient communicates about. Understanding nonverbal messages such as bodily behaviour (posture, and gestures), facial expressions, voice-related behaviour, general appearance and physical appearance is important for their correct interpretation. Empathy makes a patient acknowledge that he/she is accepted. For health care providers it means to effectively hear a patient, encourage him/her to share thoughts and feelings. It also means provider’s readiness to address the medical, psychological and social needs of the patient. Key tasks in communication with patients include (Maguire & Pitceathly 2004): Eliciting (a) the patients main problems; (b) the patients perceptions of these; and (c) the physical, emotional, and social burden of the patients problems on the family. Tailoring information to what the patient wants to know; checking his or her understanding Eliciting patients’ feedback on the information and his or her main concerns Maximising positive outcomes of treatment by making sure that the patient will follow a treatment plan and advice about changes in lifestyle. Unfortunately, care-takers often fail to elicit the complaints and concerns of patients. They are reluctant to get information about patients perceptions of their problems and its impact on physical, emotional, and social state of a patient. No care is taken to patients’ requests and to their understanding of treatment recommendations resulting in non-adherence to treatment plan. Until recently, little attention has been paid to ensure that care-takers acquire skills required for effective communication with the patients. Thus psychosocial issues haven’t been considered and no partnership relations established between a caretaker and a patient. Very often caretakers have been reluctant to inquire about the social and emotional influence of the illness on the patient and family fearing this produces distress that they cannot handle. Their fears are about increasing patients distress, taking too much time, and threatening their own emotional well-being. Consequently, their response to emotional cues is that of blocking further disclosure. (Maguire & Pitceathly 2004) Communication skills should be integrated in the treatment process in a natural way. Skilled care-takers are good listeners using empathy to assist the patient to come to grips with their problems. The communication skills to be used depend on the patient, the patient’s needs and the problem situation. For example, when talking about breast cancer, nurses have to consider psychological aspects of this life-threatening disease. The diagnosis of breast cancer is a stressful situation for a woman, and here the task of a nurse is to provide psychological consultation. Stressful treatment and changes in the body image have a profound effect on the way a patient feels about herself and her close relationships. Men often say they experience feelings of helplessness and fear and do not know how to support their women. Therefore it’s important for them to communicate their fears with health professionals, primarily breast care nurses, who should be aware of this and provide opportunities for them to discuss these issues. More and more studies show that strong relationships are crucial in dealing with life-threatening illnesses and show the huge role of friends and family in woman’s treatment. (Fox, 2005) Some chronic illness can be a grueling burden for family members who find themselves in situation of increased risks for depression and disease. It is the case of family members with Alzheimers disease. The greatest struggle, which caregivers face, is difficult behavior of AD person. Patients behavioral disturbances increase with high level of criticism and overexpressed emotions of a caregiver. Distress makes caregivers intolerant toward the patients. Although it is impossible to track any relationship between caregivers distress and delusions, it is obvious that caregiver’s factors determine patients’ outcomes. The better understanding of this relationship may help both caregivers and patients. (Riello, 2002) The family of chronically ill patient goes through a number of stages adapting to new conditions and developing new roles. During the challenging stage the conflict between family members and health care professionals is common as the former try to gain control over health care of the ill person. In the collaborative stage family becomes a part of health care team, gaining self-confidence and being less reliant on health care professionals. (Lubkin, & Larsen, 2005) Heath care providers can prevent negative events during some stages using Family Empowerment Interventions model, the goal of which is "to recognize, promote, and enhance a familys ability" to cope with the conditions of an ill family member and sustain family life. Nurses understanding behavioral and counseling techniques are considered to be the best team members to guide family caregivers. It is a nurse who helps to develop coping strategies based on family resources and needs. The central task of a nurse is to promote confidence of the family to cope. (Lubkin, & Larsen, 2005 p. 267) Effective care-taker-patient communication is an integral part of good clinical care. Caring for a patient who has cancer can be a daunting task. If done with empathy and sensitivity it can create an important bond between a care-taker and a patient. There is not one right formula for caretaking, but appreciation and responsiveness to the patients verbal and non-verbal signals are core skills, which should be developed. REFERENCES OBrien, E. M. (2002) Spirituality in nursing: standing on holy ground. Ed.2, Sudbury, MA: Jones & Bartlett Publishers Candlin C. N. (2000). Reinventing the patient/client: new challenges to Healthcare communication. Lecture Cardiff University. Fox, Clare. (2005). Sexuality and Breast Cancer. Retrieved 26 Apr., 2009 from http://www.sjhospice.org.uk > Kitson A (1999). The essence of nursing. Nursing Standard, 13 (23), 42-46. Lubkin I. M. and P. D. Larsen (2005). Chronic illness: impact and interventions. Ed. 6, Sudbury, MA: Jones & Bartlett Publishers. Maguire, P. & Pitceathly, C.  (2004). Key communication skills and how to acquire them Cancer Research UK Psychological Medicine Group, Christie Hospital NHS Trust, Manchester. Marriner-Tomey, A. and M. R. Alligood. (2006). Nursing theorists and their work. Ed. 6, Elsevier Health Sciences. Mock K. D. (2001). Effective clinician-patient communication. Physician News’ Digest. Retrieved 26 Apr., 2009 from http://www.physiciansnews.com/law/201.html. Moss, D., T. Davies, A.McGrady, I. E., Wickramasekera. (2003). Handbook of Mind-body Medicine for Primary Care. Thousand Oaks, Calif.: Sage Publications Quaglietti, S., L. Blum, V.Ellis. (2004). The Role of the Adult Nurse Practitioner in Palliative Care. Journal of Hospice and Palliative Nursing. 6(4), 209-214 Riello R., C. Geroldi, O.Zanetti, F. Giovanni. (2002). Caregiver’s distress is associated with delusions in Alzheimers patients. Behavioral Medicine.  28 (3), 92-98.   Thomas L. (2005). Nursing Ambitions: Protecting the basic principles of nursing against the challenges of constant change. Lecture Cardiff University Thorsteinsson, L. Sch. (2002). The quality of nursing care as perceived by individuals with chronic illnesses: the magical touch of nursing. Journal of Clinical Nursing, 11, 32-40 Read More