Patients Suffering from Chronic Illnesses - Essay Example

Running Head: Living With Arthritis Living with Arthritis Name Institution Date ARTHRITIS Introduction Patients suffering from chronic illnesses should be encouraged and trained to lead and maintain quality life. Their condition does not make them less human and thus should enjoy living fulfilled life. This case study will discuss arthritis, the different types, principles of care for the chronically ill, maintaining quality life and providing continuity of care within a multidisciplinary team setting. Arthritis is a collection of conditions that damage. There are more than 100 types of arthritis caused by different things such as degenerative changes, trauma, metabolic disturbances etc. Arthritis mostly affects the elderly but can also affect children and those in other age groups. Over 70% of North Americans suffering from arthritis is above 65 years. Arthritis is found in women more than it is in men. In USA 46 Million people are estimated to have arthritis while 2,576,000 people in Australia 2001 are suffering from the same (ABS 2001 National Health Survey, Australia’s Health, 2004). These figures are very high and call for attention on the prevention of arthritis. The condition like any other has negative impacts on the monthly income of a family as well as the economic status of a country. This is owed to the fact that it reduces the working capacity of individuals and results to use of extra money from the family income for medical checkups. In addition, time is wasted as the patients miss other functions so as to visit a doctor. It is such effects that have directed researches to engage themselves in scientific researches to at least try and come up with a possible solution (Silman & Hochberg, 2004). All types of arthritis are characterized by swelling, stiffness and pain. The pattern of pain is different depending on the location and the arthritides (Silman & Hochberg, 2004). Of all the types of arthritis Rheumatoid is the most common. Disregarding the type, the ordinary symptoms are swelling, pain, and joint stiffness. Some types like rheumatoid and lupus affect other body organs with different symptoms such as malaise, weight loss, muscle aches, difficulty moving the joints, fever, and inability to walk or use the hand among others. Different types of arthritis affect different parts and different age groups. Osteoarthritis affects the elderly with an estimated 30% of females acquiring it by the time they are 65 years. Osteoarthritis has an effect on the larger joints like hip, knee and the back. It is obtained from daily tear and wear of joints. It starts with the cartilage and finally eroding into each other of the opposing bones. At the on set minor pain is experienced while walking and later the pain is continuous even at night. The pain can be too much to an extent of preventing one from doing any activity. It mainly affects the pelvis, back and spine which bears weight. The factors that expose one to osteoarthritis are obesity, sedentary lifestyle, repetitive joint use and former joint trauma (WHO, 2002). This condition is incurable but can be prevented from worsening by physiotherapy to strengthen muscle, weight loss and use of painkillers. Lupus is another type of arthritis characterized by hair loss, lung fibrosis, skin rush, photosensitivity, kidney problems and emotional liability. Gout is caused by evidence of uric acid in the joint causing swelling and later lead to dysfunction (Couper, 2003). The last type and the most common type of arthritis are rheumatoid. The cause is unknown and is incurable but drugs are used to ease pain. In this case the immune system attacks the body tissues. The immune system does not only attack the joints but also other parts of the body. The cartilage and the joint lining are damaged leading to wearing away of two opposing bones. It affects joints in the wrists, fingers, elbows and knees. The disease is regular and leads to deformity. It affects people aged from 20 years and above. In children the symptoms include fever, skin rash and disability (Silman & Hochberg, 2004) Implication of arthritis When the arthritis progress it causes deformities of fingers or wrist joint because of loss of cartilage and it may be impossible to move. Severe arthritis makes the nerve to be trapped in the wrist causing carpal tunnel syndrome. After some time the fingers loss muscles and sensation and one cannot use them (Silman & Hochberg, 2004). Generally arthritis has no cure and cannot be completely prevented but care can be taken to reduce the risk by losing weight, physical exercise and eating healthily. It is also advisable to take early diagnosis which enhances better prognosis. CASE STUDY A young lady called Bella aged 35 was diagnosed with rheumatoid arthritis (RA). It began with a slight but persistent pain in the joints. When she went to the hospital, she was tested and diagnosed with rheumatoid arthritis. The main symptoms of RA include joint pain, morning stiffness among others. This particular lady, called Bella, started experiencing some pain in the wrist and knee joint which for some time she ignored. Later she started experiencing pains in her elbows and fingers. Bella was treated using medicine and advised to be positive about her condition because this will help in managing the disease. Despite the advice given Bella found it hard to come into terms with her problem. She feared that the disease will deform her and will thus have to be dependant and more so her children will suffer as she cannot take care of her. Key Issues The fact is that Bella is suffering from Rheumatoid Arthritis which is incurable and if care is not take it can progress leading disability. The main issue is that Bella has not taken her condition positively, she fears for her life and that of her family incase she acquires a disability. To help Bella lead a normal quality life and manage her condition several things need to be put in place. There is a need to establish teams of professional from different disciplines that will help her manage her condition, Wagner EH (2000:567). The team will include a rheumatologist, a dietician, a physiotherapist, a counselor, orthopedic, nurse and a physiotherapy. This team will help Bella change her attitude and life style which will help her manage her condition. The team will apply the principles of care for chronic illness to help Bella lead a positive life. Principle of Care There are seven main principles in the care of patients who are chronically ill which are basic in offering sufficient care and the right services. They are the principles that should be considered when setting up and managing a health care service for those chronically ill. It is evident that chronic diseases are poorly managed and health workers are not adequately trained. These principles therefore help to determine ones understanding on caring for patients and how to put in order a practice or a service. These principles are thus discussed in this paper in regard to caring for patients with rheumatoid arthritis (Couper, 2003). The first basic principle in caring for patients with rheumatoid arthritis is commitment. When taking care of Bella the team should understand that in whatever strategy they apply, handling her as a person is very vital. The commitment that the doctor shows towards her creates trust. The doctor’s commitment helps the patient to be fully and independently committed. The commitment should not only come from the doctor but also from all other stakeholders. Incase of a complication, the doctor plays the role of diagnosis and medical prescription. Since the doctor’s role does not include, monitoring the patient’s continuous behavior, this is left the nurse. The nurse monitors the patient’s conditions, reminds him/her when to take the medicine, educates on cleanliness issues (Wagner, 2000). The role of the dietitian is making a diet plan for the patient and giving nutritional counseling to Bella. Her recovery does not basically depend on the medical prescription, but also how well she is able to apply a healthy diet. A counselor will help Bella accept her condition and live positively with arthritis (Balint, 1964). On the other hand, a physiotherapist is very important in helping the patients to do exercises. This is important in ensuring that the patient does not loss hiss ability to move. These personnel cannot work as individuals if they are to help Bella. Team work has been found to be more effective than individual work. Commitment draws a medical practitioner into continuity, which is the most fundamental aspect in managing care for the rheumatoid arthritis patients. The above has been viewed as a continuous therapeutic association and as a on the go, sustainable follow-ups. The continuity is as a result of commitment founded on understanding and mutual trust. The continuity coupled with commitment helps the care taker to understand the concerns, aspirations and the needs Bella. Continuity simply means an ongoing and sustainable follow ups and supporting them every time. Patients with rheumatoid require assessment regularly to determining any complication. Continuity is also necessary as it save money and time because new care providers repeat investigations incurring cost on the patient. They also take time reading previous reports and understanding the patient (Stewart et al, 1999). Collaboration between the patient and the doctor is necessary on different levels (Von et al, 1997). The difference between chronic illness care and other care is that in chronic, the patient should be involved to manage themselves. Bella should be trained and helped to take cake of herself. This can be done by setting realistic goals together In regard to self care and life style. The two parties set up the responsibilities and the roles. Setting goals together and developing a plan of action to achieve mutual targets are helpful steps in managing rheumatoid arthritis. The bottom line is to have a common mental picture and working together towards making it real (Wagner et al, 2001). Bella should adhere to treatment with the understanding, support and continuous monitoring of the doctor. Collaboration does not involve obeying the orders of the doctor but carrying out what they have both agreed. It is very important to work in collaboration and concert with the team members. These members include rheumatologist, dieticians, occupational and physiotherapists, nurse, social workers among others. The team is effective in managing the disease as they bring in board variety of knowledge. Collaboration also involves the family of Bella and other patients suffering from the same illness. They come together and become a group giving care to each other. To help Bella live positively and take care of herself, she should be helped to comprehend her illness fully, complication and management. Tools such as computer programs, leaflets and videos can be used. This will help her know how to take care of herself in relation to physical exercise, diet and medication. It also requires the care giver to understand the patient, her needs, concerns, aspirations and fears without which management can’t be successful. Change is requisite in chronic illness. Bella must change in regards to taking treatment regularly. Rheumatic disease necessitates lifestyle modification such as diet and physical exercise. The change should not be seen as just helpful but basics for disease management. Change is vital for preventing complications, helping them adapt to impairment and promote the best possible health. The team of care givers should help her change based on her priorities not on what is good to them. She needs to understand when she needs to consult a clinician, but as she acquires responsibility and knowledge and she is in a position to control the illness, she will rarely need a clinician. She should be able to go for a month without going to a doctor on maintenance treatment, with time go for three months and even six months without going to the clinician (Hugo J. & Couper, 2005:64-78). In every chronic disease there are management guidelines that help in making decision. Bella and the multidiscilinary team should follow those guidelines to enhance management of the illness and positive living. There is need far an individualized plan but this should not lead to neglecting guidelines that are acceptable. There is always a notable improvement when the clinical guidelines are followed. In addition to the principles above, it is also very important that Bella’s medical reports are well recorded and kept well. The sessions and the issues handled should be neatly kept in records and what to be addressed in the next meeting. The notes kept on Bella should be on the basis of problem medical reports. A flow chart in form of a sheet or a card can be used on recording things such as the blood pressure, blood sugar weight, the different test etc. this records help in monitoring her progress. According to the seven principles of care as explained by (Couper, 2003) the clinician is responsible for follow the guidelines and obtaining the needed information. On the other hand Bella has a duty to make sure that she understand the illness, change accordingly in behavior and lifestyle and life positively thus taking control of the illness. In addition there is need for a joint responsibility for the clinician, Bella and other members of the team in ensuring continuity and collaboration. McWhinney describes this as mutual commitment (McWhinney, 1997). According to (World Health Organization, 2002) the team helping Bella should assess any complaint or concern that she could be having. The complaint could be new or ongoing. This ensures that they are addressing her agenda’s and meeting her need. The team also ought to assess the patient’s clinical status, how much is the illness under control. They should also assess how much Bella has adhered to the treatment and lastly whether there is any complication. In conclusion it is worth noting that suffering from a chronic illness is not a death sentence. There is still a reason to live and life a happy life but it all depend on the approach. If the above principles are used, Bella should be in a position to lead a normal fulfilled life, taking care of herself and her family. All the discussed stakeholders should put their combined efforts together to support Bella. Reference Couper, I. (2003).Reflections on the Care of the Chroni­cally Ill, SA Fam Pract 45(1):6-8 Silman AJ, & Hochberg MC,(2004). Epidemiology of the rheumatic diseases, 2nd ed. Oxford Press. WHO. (2002).Innovative Care of Chronic Conditions: Building blocks for action. Global Report. World Health Organisation, Von Korff, M. Gruman J, Schaefer J, Curry SJ, Wagner EH. (1997). Collaborative management of chron­ic illness. Ann Int Med. Wagner,E.H, Austin,B.T, Davis C, Hindmarsh M, Schaefer J, Bonomi A. (2001). Improving chronic illness care: Translating evidence into action. Health Af­fairs. Hugo, J. & Couper, I. (2005). The consultation: a juggler’s art. 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