Chronic Illness and Palliative Care - Essay Example

Running Head: Chronic Illness and Palliative Care (Arthritis Case Study) Student’s Name: Instructor: Course Code and Name: Institution: Date the Assignment is due: Chronic Illness and Palliative Care (Arthritis Case Study) Introduction To start this case study, it is worth to note that any patient suffering from any kind of disease needs care and medical assistance (Saunders, 1989). This is true for curable conditions as well as incurable conditions. 26 years old David Krashen was diagnosed with rheumatoid arthritis (RA) two years ago, on the very season that he was hoping to make it to the NBA trials in New Jersey. It had began with a persistent though slight pain in the knee joints every after a training session and joint stiffness whenever he woke up in the morning. He went to the team’s doctor who referred him to a specialist in his home area. That was where he was tested and positively diagnosed with rheumatoid arthritis. David was one among the millions of arthritis patients, diagnosed with the chronic disease at the prime of his youth. A patient with a permanent disease like cancer, arthritis or any other of the so called, chronic illnesses requires specialized care. The patient needs to be helped, encouraged and even trained to manage the condition so that he or she can lead a quality life irrespective of the permanent condition (Saunders, 1989). Having such a permanent condition deems a person no less of a human being, a human being with the right to an enjoyable, fulfilled life. On that understanding, this essay paper constitutes a detailed description of arthritis as a chronic illness, its types, causes and symptoms, before elaborating on principles of care an arthritis patient needs to maintain a quality life especially focusing on the principles of continued palliative care in a multidisciplinary team setting. Background Information on Arthritis Arthritis, such as the strain diagnosed in David Krashen, is a leading chronic disease in the world today. The term chronic illness is used to refer to any illness that is permanent/incurable or long lasting, examples of chronic illnesses include arthritis, asthma, cancer, diabetes, cardiovascular disease etc (Schofield, Smith & Black, 2008). The Centers for Disease Control and Prevention reports, that we have over 133 million individuals in the world who are currently living with a chronic disease (World Health Organisation, 2010). WHO, statistics indicate that chronic illnesses are the ranking cause of death across the globe today (World Health Organisation, 2010). The fact that the disease cannot be permanently cured means that the patient has to live with the disease, thus delimiting the quality of his or her life greatly. Such diseases develop consequent to such factors as heredity, lifestyle choices, metabolic anomalies and even adverse environmental factors. A year after the diagnosis, David Krashen left the league and lost all hopes of joining NBA because the condition had progressed to severely limit his physical movements even when out of the pitch. Young and ambitious, the condition had cost him a life in the glorious National Basketball Association (NBA), a source of income, the company of friends, a truckload of dreams and a robust health he had always taken forgranted. Arthritis causes extreme physical disability and is most common among the adult population. Traditionally, Arthritis was regarded as a disease for the elderly. Today however, cases of arthritis even in children have become common (Springhouse, 2005). It is however more prominent in women than in women, as numerous North American government research studies have documented. Over 40% of Americans were suffering from Arthritis in 2008, translating to about 32 million people. WHO estimates that 50% of the global adult population has had a brush with arthritis (World Health Organisation, 2010). By 1997, arthritis was costing Americans over $50 billion annually. A 2001 ABS National Health Survey in Australia established that 2.6 million people were suffering from Arthritis in the continent (Springhouse, 2005). Arthritis is incurable and even unpreventable. The most one can do is to reduce the risks of developing the condition by exercising regularly, losing weight and eating healthily. Early diagnosis also enhances the prognosis of a patient. The advent and development Arthritis is marked by joint inflammation, which eventually develops until joint movements are inhibited completely (Couper, 2003). Arthritis progression ends up deforming the fingers or wrist joints after the cartilage is damaged, thus making it impossible to move. Nerves are also affected by the development of the carpal tunnel syndrome in which fingers loss their muscles and their ability to sense. The arthritis patient experiences debilitating pain, limited movement, and a reduction his or her societal participation, all adding up to an altered quality of life (Macleod, 2005). The most common symptoms of arthritis include severe joint pain, limited joint movements where the pain is felt, inflamed ligaments, muscles and cartilage, joint stiffness, redness, swelling and warmth at the inflamed joint, fever, weight loss, gland swelling, fatigue, fatigue, general body weakness, poor digestion, overeating, constipation and unwillingness to commit to a physical activity. Doctors have identified over 100 distinct kinds of arthritis, identified on the basis of the body part inflicted. The most arthritis kind however is the osteoarthritis kind, which triggers grave wear and tear of the cartilage. The second most common kind is rheumatoid arthritis, an inflammation of joints resulting from overactive immune systems (Couper, 2003). Besides joints however, we have some kinds of arthritis that afflict tissues and organs in the body. David Krashen’s joint pain became unbearable sometimes until he was bedridden for most of the last one year. By the time he contacted a palliative care center late last year, Krashen was deeply depressed and contemplative of suicide. Alternative and Complimentary Approaches to Pain Control The primary means of elevating pain in an arthritis patient is using medication. Health professionals prescribe certain medications to help improve the quality of life for the patient, the drugs being administered by a health practitioner such as nurses or being self administered (Basford, 1998). While an arthritis patient with an advanced condition needs close attention of professionals, a physician or other health professionals will not always be available. At other times, the professionals may not be available when required. The absence of such a professional doesn’t mean that the requisite care should not be availed to the patient. At such times, it will be advisable to use alternative strategies to control pain (Schofield, Smith & Black, 2008). Taking of pain medication is also addictive and can in a way threaten the health of a patient in the long term. A reduced dosage of medication coupled by other complimentary approaches help reduce such dangers (Herzlinger, 2007). Some patients are also allergic to the drug treatment and cannot take the medication continually (Schofield, Smith & Black, 2008). Other patients have preexisting conditions such as diabetes, hypertension, ulcers etc, which may prevent such patients from taking medication (Portenoy, 1993). The available alternative and or complimentary approaches to pain control include massage, meditation, herbal treatment, nutrition therapy and pain therapy (Schofield, Smith & Black, 2008). Coping with Arthritis Pain David Krashen ended up being depressed by the excruciating pain of living with arthritis. He could not even leave his bed for extended periods of time, something that he had never done before when he had been on a start laden track towards NBA stardom. The intensity of pain suffered by arthritis patients can make life bleak and stressful such that many like Krashen always contemplate suicide (Morton, 2005). Sometimes, pain control is not achieved since the healthcare providers are not aware of its existence in some patients (McCaffery, 1989). The main barriers to quality pain management include patient’s reluctance to report the pain, unwillingness to distract the health practitioners, fear that the condition is worsening, desire to be perceived as a good patient, fear of drug addiction, concerns on side effects bourn by pain medication, the expensive cost of the pain treatment etc (McCaffery, 1989). Today however, increased appreciation of the necessity to manage pain in arthritis patients has resulted to better pain assessment and control measures being taken to improve the quality of the patient’s life (McCaffery, 1989). This is important because arthritis is very, very painful and has no cure such that the patient would have to live with that pain for the rest of his or her life (Ali, 2003). David Krashen is now on prescription drugs and can easily attend other treatment options without the stress of excruciating pain. Multidisciplinary Team, Follow up and Communication Multidisciplinary Team According to Morton (2005), the term multidisciplinary team refers to a collection of professionals who are specialized in different types of care that encompass the spiritual, physical, and spiritual needs of the patient. As Morton (2005) notes, such comprehensive teams make it possible to approach palliative care from every angle such as offering pharmacologic interventions for pain relief, giving targeted therapies, inducing disease remission, minimizing drug side effects, establishing a perfect patient-clinical relationship, being loving and empathetic, encouraging the patient towards self-management and self-help, involving family, work associates and friends etc. Establishing such a multidisciplinary team involves bringing health care professionals, friends and families together to form a team of care givers. Approaching care giving as a team work helps maximize care continuity and ensure cohesiveness of the care and avoid unduplicated effort or left our care needs. Healthcare Professional Responsibility When he finally sought palliative care, he needed additional physicians, specialist nurses and assorted health professionals (psychologists especially) to help him recover and start living again. These professionals were converged from various disciplines, each charged with the responsibility of providing specialist services to him. Krashen is now under a multidiscipline team that ensures maximal continuity, comprehensiveness and cohesiveness of the care given. Today we have outpatient clinics, hospitals and homes offering palliative arthritis care. Such institutions usually employ rheumatologists, dieticians, physiotherapists, counselors, orthopedic nurses and other healthcare professionals. The responsibility of the healthcare professionals begins with the identification of each patient’s needs, goals, problems, expectations, health practices and beliefs. Secondly, the healthcare professionals must help the patient accept his or her arthritic condition so that he or she can initiate lifestyle changes to help him or her cope with the condition comfortably (Basford, 1998). The third step is to develop a written care action plan that focuses on the patient’s needs, and the strategies to meet them during the care. All problems and weaknesses or barriers are also identified and strategies to overcome them detailed. Such include pain management using medication. The health professionals must also motivate the arthritis patient to pursue the achievement of the care objectives himself or herself. It is also the responsibility of the healthcare professionals to mobilize support teams from friends, family, hospital staff and the community based health professionals to help the patient pull through comfortably (Koenig, George and Titus, 2004). It is the healthcare professionals who must also teach the patients on the appropriate use of pain medication, working of the injured joints etc in a bid to make the patient develop a self-management behavior that helps him or her fight depression (Coleman & Newton, 2005). Follow Up Besides providing a one-time care for the patient, probably when the condition is most complex and painful, it is also important that the arthritis patient be given continued follow up since that condition is never going to heal. David Krashen has to attend weekly clinics for a few minutes so that his physician, psychologist and dermatologist can access the condition progression, drug side-effects and level of pain. Follow up is an important component of palliative care especially for home based out-patients who only come to the clinics when the condition deteriorates. Communication Arthritis should never be treated in ignorance. The first time that Krashen was diagnosed with arthritis, he was ignorant of the condition and that is why he went into depression and let the condition deteriorate. Nevertheless, when he was informed and educated on the condition, he immediately initiated a care strategy that has helped him start his life anew. The important part of care is making the patient aware of the care program in such a way that he or she participates in the care program from an informed point of view (Wagner, 2001). Such effective patient-clinical communication accrues when the patient is informed about the routine data and how he or she can enter the data personally from home or even when in the clinic (Korff, 1997). Effective communication is indicated by patients like Krashen who can now complete summary reports for his care progress (Huber, 2006). Some facilities use videoconferencing to build communication between the patients and their healthcare providers (Huber, 2006). Some professionals use multiple learning channels and modes such as posters, websites, books and videotapes to help the patient understand arthritis in a way that he or she knows what to do and when (Coleman & Newton, 2005). Supportive System and Palliative Care Krashen’s prognosis was depressing since the arthritis had been diagnosed in after a long while as he ignored the symptoms. By the time it was discovered, it was already complex and the joints and ligaments had already been severely damaged. To make matters worse, after diagnosis, he went into a melancholic period, fell prey to depression and lost hope of living. That means he did not seek appropriate care. The initial lack of social, health and palliative care services had made him approach death far too fast and painfully than was necessary. Caring for an arthritis patient is not an ad hog endeavor. The aim of palliative care is centered on providing the best quality of life to the patient through an assortment of treatments that although they wouldn’t cure the condition, they help the patient to live comfortably (World Health Organisation, 2010). The care given must necessarily address all the patient’s problems ranging from the physical, spiritual, and even emotional. This care extends even beyond the patient to his or her loved ones. David Krashen had just been married before the diagnosis and his wife, mother and brother had a very hard time coming to terms with the predicament. Their suffering, grief and bereavement almost equaled that of Krashen. That means that they too have had to undergo extensive counseling not only to accept the condition but also on how best they can take care of Krashen. Conclusion Chronic illnesses such as arthritis are a burden to the patient, family and friends. In cases like that of David Krashen, arthritis can be the end of a promising career, a disruption of income generation, a cause of depression and a destructing agent for one’s self esteem. Arthritis can easily rob a quality life from an individual (Balint, 1964). The fact that the condition cannot be completely prevented or cured does not mean however, that such an individual will become a sad case of a slow painful death (Balint, 1964). With proper medication, pain management, sound dieting, exercises and therapy, the patient can still enjoy a relatively happy and active life. Palliative care here becomes essential since it collects professionals from a multidisciplinary setting and brings them together in a team that comprehensively provides all a patient’s need ranging from physical, to spiritual, medical to psychological (Balint, 1964). A proper support system and palliative care must include proper communication, pain management, counseling, love and care, qualified medical intervention and a holistic approach to overseeing a patient’s needs. References Ali, V. (2003). interventional management of chronic pain. Nurse2 Nurse, 3; 4, 18-19. Balint, M. (1964). The doctor, his patient and the illness. Edinburgh: Churchill Living­ Stone. Basford, J.R. (1998). Physical Agent: Rehabilitaion medicine. Philadelphia: Lippencott-Raven. Coleman, M.T. & Newton, K.S. (2005). Supporting self-management in patients with chronic illness. American Family Physician, 72(8), 1503-270. Couper, I. 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Health Af­fairs. World Health Organisation (2010). Palliative Care. Retrieved 12th April 2010, from http://www.who.int/cancer/palliative/en/ Read More