Case Scenario
Discuss about the Chronic rheumatoid arthritis self management.
The impact of any health condition is daunting on the lifestyle and living condition of the patient that is suffering through the disease. However, in case of different chronic conditions, the detrimental; impact on the patient is far more deliberating (Nelson et al., 2014). A chronic disease condition can be defined as the disease that persists for a long period of time. On a more elaborative note, it has to be mentioned that any disease condition that has persisted for more than three months can be called chronic. One of the most characteristic features of a chronic condition is the fact that a chronic condition cannot be cured and hence the patients will need to live with the chronic condition for the rest of his or her life (Pergolizzi et al., 2013).
It has to be mentioned here that the management of the chronic conditions has been reported to be a multifaceted issue and there are several challenges that persist in the optimal management and care delivery for a patient suffering with a chronic condition (Zwar et al., 2017). However, the self management strategies have developed as the most effective measure to provide best possible intervention program to the patients suffering with a particular chronic disease condition. The concept of self management can be defined as the umbrella term that integrates the domains of self care with optimal disease management as well (Merolli, Gray & Martin-Sanchez, 2013). This assignment will attempt to discuss the case of a patient suffering from a chronic condition and attempt to develop a self management plan to address her care needs effectively.
There are a variety of different chronic conditions that can have a deliberating impact on the living condition of the patient, such as arthritis, asthma, cancer, COPD, diabetes, and a few communicable diseases such as the hepatitis C and HIV (Bashshur et al., 2014). However, for this case study we are focusing on the case of a patient who had been suffering from chronic arthritis for past 5 years along with a few related co-morbidities. In order to protect the privacy and confidentiality of the patient, she will be called Emily in the assignment. The patient is a 78 year old woman living with her husband in a three story house, south of Melbourne, in a suburban area. She had two daughters; both of them lived abroad for their careers. Along with that, it has to be mentioned that the patient had been taking insulin for diabetes along with metformin. The patient had also been taking two oral medications for her hypertension including clevidipine and lisinopril. Her past medical conditions include hypertension, diabetes and she had also been admitted to the health care facility for a hyperglycemic attack a year ago and she had been struggling with weight management as well and had visited a nutritionist in the past as well. The psychosocial history of the patient reveals the fact that she had been a librarian in a local school but has retired at the age of 65. Emily had loved her job as she is a reading enthusiast, and she had been very depressed and down after she had to retire. The interview with the patient revealed the fact that the patient felt extremely bored and listless sitting idle at home all day and even though her husband enjoyed lounging and watching TV the entire day, Emily felt that she did not feel content with lounging all day watching Netflix. Furthermore, psychosocial investigation about the patient revealed the fact that she used to go for strolling to the nearby park however, recently the pain in her knee has increased considerably and she cannot move around much anymore without assistance. The patient had stated the fact that she had been visiting the facility to get her chronic pain managed and she also admitted that she had not been able to climb the stairs at all in the past couple weeks and had been woken up from her sleep by the pain in her knees at nights. Hence, analyzing the subjective and objective data that has been gathered by the patient in the patient assessment it can be clearly stated that the patient had been suffering from chronic arthritis associated pain in her knee due to which she had been admitted to the facility. However, the patient had other related co-morbidities as well which will need to be included in the self management plan prepared for the patient as well (Wigg et al., 2013).
Chronic Disease Management Model
As mentioned above, the management of chronic diseases is often very difficult due to the various complexities associated with the disease and other confounding factors associated with the patient, such as the age of the patient, mental health status, behavioral patterns, familial and social relationships, and lastly personal wishes or expectations (Stellefson et al., 2013). Hence, in order to develop a care plan or a management plan that addresses each of the care needs, a chronic disease management model is required. The chronic disease management plan that can be utilized in the context of Emily, the patient in the case study, is the chronic care model (CCM). This model had been developed by Wagner in 1990s and the primary purpose behind the model is to provide the health care professionals with the opportunity to develop a care program that emphasizes on the aspect of self management of the patient (Kadu & Stolee, 2015).
CCM (Kadu & Stolee, 2015)
The aim of the concept of self management in the health care is to provide the patients with a sense of empowerment and control while they struggle with chronic co-morbid disorders. The chronic care model integrates the self management into the care planning procedure effectively. The objectives set for this model is to enhance the knowledge and ability of the patients to manage their own health conditions and create an environment where all the different domains of the health care facility can support the patient while they themselves take active decisions and manage their care needs or issues. The chronic care model has six particular sectors or factors and each of the factors together provides a framework for the nurse to provide care and illness management keeping the patients and their control over the program at the centre of the program (Gee et al., 2015).
The first element is the delivery system design which is the first step of the care planning. In this step the nursing professional will need to focus on the creating a multidisciplinary team for the patient and collaborate with care providers belonging to different domains with respect to the care needs of the patient. For Emily, the practicing nurse will need to collaborate with orthopedic physician, diabetic expert, nutritionist, cardiac expert, therapist, and fitness expert. The second element is the self management support, which is the most important aspect of care planning procedure. In this case, the practicing nurse will have to collaborate and assist Emily and her family to develop different skills and knowledge to overcome the i.ssues that are arising due to her different health conditions. Here the practicing nurse will also have to provide her with self management tools, referrals and community resources for her to take control of her osteoarthritis, diabetes and hypertension. The next two elements of the model are decision support and clinical information system, that integrates two very important aspects of health care delivery, evidence based practice and health informatics. Here the nurse will introduce Emily with the personal health records and tele-medicine tools so that Emily can avail the assistance of the evidences and resources in managing her condition (Bashshur et al., 2014). The next two elements of the model are the community and resources and policies, where the nurse will actively encourage the patient for community engagement activities and be able to use the policies and benefits that Emily is eligible to in order to take control of the chronic illness and track her own progress effectively (Kadu & Stolee, 2015). Hence, it can be stated that the chronic care model is one of the most effective framework for the nurses to assist the patients with chronic illness management and can also assist in development of self management plan.
|
Goals(overarching goal) |
Short-term/long-term goals |
Strategies/Interventions |
Tasks/Actions |
By Whom? |
Evaluation (to reflect expected outcomes – how will you assess/measure progress) |
Timeframe |
|
|
Outcome Indicators |
Outcome Measures |
||||||
|
Taking ownership of health needs with respect to health system organization |
Short term goals: Recognizing and managing body responses, completing health related tasks. Long term goal: Becoming an expert. |
Emily will need to monitor the body responses to the illness issues that she had been having Next she will need to collaborate with the practice nurse and carry out program planning with the rest of health care system or multidisciplinary team for better illness management of the chronic arthritis (Thorstensson et al., 2015). For the pain management, Emily will be given both pharmacological and non-pharmacological measures. However, as a part of her self management plan she will have to take initiative to take medications properly and regularly and perform non-pharmacological treatments regularly. Lastly, according to the CCM, self-management is facilitated by emphasizing on the importance of the central role played by patients in their illness management. Hence, on a long term basis, the patient will have to set goals, perform decision making, problem solving, Planning, prioritising and pacing, and developing confidence and self-efficacy (Kroon et al., 2014) |
Carry out pain assessment with the practice nurse Participate in the care planning procedure to decide the possible pain management techniques and follow up care. Maintain journals and personal health records for following the care plan Participate in the care planning procedure, collaborate actively ion goal setting and problem solving. |
Emily |
Emily is better in control of her symptoms and her disease |
Emily can understand carry out pain assessment and is in control of pharmacological and non-pharmacological interventions |
1-2 weeks |
|
Performing health promotion activities with respect to self management support |
STG: Changing health behaviours to minimize illness impact LTG: Performing health promotional activities |
According to CCM, self management requires the patient to have a central role in disease management. Hence Emily will need to bring changes in her sedentary lifestyle such as exercise and dietary changes (Dziedzic et al., 2013). |
Participating in counselling session with nurse to understand the impact of her lifestyle and health behaviours and be able to change them Participate in health promotional activities, exercise plans and community engagement activities (Sperber et al., 2013). |
Emily |
Emily understand need for lifestyle changes and takes up health promotional behaviours |
Emily quits her sedentary lifestyle, takes up exercise programs and engages in community inclusion programs. |
1-2 months |
|
Adjusting, with respect to decision support |
STG: Adjusting to the illness LTG: Adjusting to new self |
According to CCM, evidence based assistance provided to patients with chronic disease management helps them adjust with the disease and new life with the chronic disease (Ory et al., 2013). Share relevant literature and case examples to help Emily come to terms with the chronic arthritis. |
Help Emily make sense of the illness by sharing literature evidence with her. Help Emily Identify and confronting change and loss associated with her arthritis and mobility restrictions. Examine her health beliefs, expectations and values (Free et al., 2013). Help her clarify and re-establish roles and deal with any stigma |
Community practicing nurse |
Emily adjusts to her illness and her new self with the burden of her chronic condition |
Emily understand the impact of chronic osteoarthritis and its connection with diabetes and hypertension on her life and how she can overcome the issues and live with it. |
1 month |
|
Integrating illness into daily life with respect to clinical information system and self management support |
Modifying lifestyle to adapt to disease |
Developing information system and integrating the technological aspects of health such as personal health records will help Emily reorganize her everyday life with respect to the illness and its management (Clark, Gong & Kaciroti, 2014). |
Creating a consistent health routine Obtaining assistance with activities of daily living Controlling environment and keeping track of progress |
Emily |
Emily integrates information system to better manage her illness |
Emily keeps control of her personal health records and participates in all activities |
1-2 month |
|
Activating resources with respect to community resources and policies |
STG: Obtaining and managing social support LTG: Identifying and benefiting from all available resources and policy informations |
Community resources and policies can be of extreme help to the elderly patients suffering with chronic co-morbidities (Dziedzic et al., 2013). Hence Emily will need to be introduced to the different community resources and policies that Emily can be benefitted from along with her husband. |
Implementing evidence based practice in order to share policy information with Emily. Explain about the policies to her in a manner she understands (Gee et al., 2015). Share details of important community resources with her and help her decide the most plausible community support she is willing to take. Include her husband on the process and encourage Emily to take the final decision. Arrange meetings and visits to community support executives to help Emily make the decision |
Nurse practitioner |
Emily has clear idea of the policies and community resources. |
Emily knows the policy schemes such as aged care schemes and disability insurance schemes that can benefit her and she decides upon a suitable community support for her recovery after discharge. |
1-2 weeks |
Conclusion:
A chronic disease can have a deliberating impact on the living condition of a patient and in case the patient is elderly, the restrictive impact of the chronic disorders is far more discerning. In the essay, the case of Emily, an elderly woman suffering with chronic condition osteoarthritis along with a few related comorbidities was highlighted.. In order to provide a plan that is effective for her and integrative of self management practices, a chronic disease management model had been used. The essay had used the chronic care model by Wagner and has attempted to align the different steps of the model with the self management plan. This has helped to integrate all different aspects of providing chronic disease management with emphasis on empowerment an d decision making control to the patient in order to manage the impact of the illness and integrate the coping strategies with her life
References:
Bashshur, R. L., Shannon, G. W., Smith, B. R., Alverson, D. C., Antoniotti, N., Barsan, W. G., … & Ferguson, S. (2014). The empirical foundations of telemedicine interventions for chronic disease management. Telemedicine and e-Health, 20(9), 769-800.
Clark, N. M., Gong, M., & Kaciroti, N. (2014). A model of self-regulation for control of chronic disease. Health Education & Behavior, 41(5), 499-508.
Dziedzic, K., Nicholls, E., Hill, S., Hammond, A., Handy, J., Thomas, E., & Hay, E. (2013). Self-management approaches for osteoarthritis in the hand: a 2× 2 factorial randomised trial. Annals of the rheumatic diseases, annrheumdis-2013.
Free, C., Phillips, G., Galli, L., Watson, L., Felix, L., Edwards, P., … & Haines, A. (2013). The effectiveness of mobile-health technology-based health behaviour change or disease management interventions for health care consumers: a systematic review. PLoS medicine, 10(1), e1001362.
Gee, P. M., Greenwood, D. A., Paterniti, D. A., Ward, D., & Miller, L. M. S. (2015). The eHealth enhanced chronic care model: a theory derivation approach. Journal of medical Internet research, 17(4).
Kadu, M. K., & Stolee, P. (2015). Facilitators and barriers of implementing the chronic care model in primary care: a systematic review. BMC family practice, 16(1), 12.
Kroon, F. P., van der Burg, L. R., Buchbinder, R., Osborne, R. H., Johnston, R. V., & Pitt, V. (2014). Self?management education programmes for osteoarthritis. The Cochrane Library.
Merolli, M., Gray, K., & Martin-Sanchez, F. (2013). Health outcomes and related effects of using social media in chronic disease management: a literature review and analysis of affordances. Journal of biomedical informatics, 46(6), 957-969.
Nelson, A. E., Allen, K. D., Golightly, Y. M., Goode, A. P., & Jordan, J. M. (2014, June). A systematic review of recommendations and guidelines for the management of osteoarthritis: the chronic osteoarthritis management initiative of the US bone and joint initiative. In Seminars in arthritis and rheumatism (Vol. 43, No. 6, pp. 701-712). Elsevier.
Ory, M. G., Ahn, S., Jiang, L., Smith, M. L., Ritter, P. L., Whitelaw, N., & Lorig, K. (2013). Successes of a national study of the chronic disease self-management program: meeting the triple aim of health care reform. Medical care, 51(11), 992-998.
Pergolizzi, J. V., Raffa, R. B., Taylor, R., Rodriguez, G., Nalamachu, S., & Langley, P. (2013). A review of duloxetine 60 mg once?daily dosing for the management of diabetic peripheral neuropathic pain, fibromyalgia, and chronic musculoskeletal pain due to chronic osteoarthritis pain and low back pain. Pain Practice, 13(3), 239-252.
Sperber, N. R., Bosworth, H. B., Coffman, C. J., Lindquist, J. H., Oddone, E. Z., Weinberger, M., & Allen, K. D. (2013). Differences in osteoarthritis self-management support intervention outcomes according to race and health literacy. Health education research, 28(3), 502-511.
Stellefson, M., Chaney, B., Barry, A. E., Chavarria, E., Tennant, B., Walsh-Childers, K., … & Zagora, J. (2013). Web 2.0 chronic disease self-management for older adults: a systematic review. Journal of medical Internet research, 15(2).
Thorstensson, C. A., Garellick, G., Rystedt, H., & Dahlberg, L. E. (2015). Better management of patients with osteoarthritis: development and nationwide implementation of an evidence?based supported osteoarthritis self?management programme. Musculoskeletal Care, 13(2), 67-75.
Wigg, A. J., McCormick, R., Wundke, R., & Woodman, R. J. (2013). Efficacy of a chronic disease management model for patients with chronic liver failure. Clinical Gastroenterology and Hepatology, 11(7), 850-858.
Zwar, N., Harris, M., Griffiths, R., Roland, M., Dennis, S., Powell Davies, G., & Hasan, I. (2017). A systematic review of chronic disease management
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