1 of 31

Course: Medical Surgical Nursing

Topic: Care of Clients with Chronic Illness and Comorbidity

The Nurses International Community

Contact info: info@nursesinternational.org

2 of 31

COPYRIGHT

NI Privacy Policy and Terms of Use.

Contact info: info@nursesinternational.org

3 of 31

Module Goals

Learners will be able to:

Define “chronic illness.”
Outline the impact of chronic illness on health and quality of life, including physical, social, and mental health.
Discuss the nursing care of clients with disability.
Discuss the challenges of caring for clients with multiple comorbidities.

Contact info: info@nursesinternational.org

4 of 31

Definition of Chronic Illness

Health conditions that last 1 year or more and require ongoing medical attention or limit the activities of daily living.

Centers for Disease Control and Prevention, CDC], 2022

Contact info: info@nursesinternational.org

5 of 31

Examples of Chronic Diseases

Human immunodeficiency virus/acquired immunodeficiency syndrome
Cardiovascular disease
Diabetes mellitus
Amputation
Blindness
Arthritis
Asthma
Cancer
Cystic fibrosis
Obesity
Tobacco use and exposure
Joint disorders

CDC, 2013

Silva et al., 2017

Contact info: info@nursesinternational.org

6 of 31

Impact of Chronic Illness on Health

and Quality of Life

Quality of life:

An individual's’ perceptions of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns.

World Health Organization [WHO], 1996,

as cited in Megari, 2013

Contact info: info@nursesinternational.org

7 of 31

Impact of Chronic Illness on Health

and Quality of Life

Living with a chronic disease is challenging as it interferes with physical, mental, and social functions and thus greatly affects a person’s quality of life.

One in three adults lives with multiple chronic conditions and accrues a disproportionate health and cost burden.

Hajat & Stein, 2018

Contact info: info@nursesinternational.org

8 of 31

Impact of Chronic Illness on Health and Quality of Life:

Physical Health

Three in five global deaths are attributed to four major noncommunicable diseases:

Cardiovascular disease,
Cancer
Chronic lung diseases
Diabetes

(Wang et al., 2016, as cited in Hajat & Stein, 2018)

Individuals with chronic illness are more likely to experience everyday problems when they have physical limitations and perceive their health as poor (Houtum et al., 2015).

Contact info: info@nursesinternational.org

9 of 31

Impact of Chronic Illness on Health and Quality of Life:

Psychosocial Health

Mental health is a state of mental well-being that enables the individual to cope with the stresses of life, realize their abilities, learn and work well, and contribute to their community.

It underpins individual and collective abilities to make decisions and build relationships.

WHO, 2022b

Contact info: info@nursesinternational.org

10 of 31

Impact of Chronic Illness on Health and Quality of Life:

Psychosocial Health

Being chronically ill is a continuous process of balancing the demands of the illness and everyday life.

People with chronic illness may encounter additional problems in daily life, for instance, problems related to living independently.

Houtum et al., 2015

Contact info: info@nursesinternational.org

11 of 31

Impact of Chronic Illness on Health and Quality of Life:

Psychosocial Health

A chronic disease disrupts an individual's life and impacts well-being due to

A sense of a loss of control over one’s life.
Increased negative experiences and outcomes associated with managing chronic disease.

Megari, 2013

Contact info: info@nursesinternational.org

12 of 31

Impact of Chronic Illness on Health and Quality of Life:

Psychosocial Health

Potential limitations that challenge access to healthcare:

Individuals with comorbidities may face challenges in adhering to treatment regimens.

Clients on antipsychotic therapy are at risk for chronic illnesses due to adherence issues.

SAMHSA, 2016

Contact info: info@nursesinternational.org

13 of 31

Critical Thinking Question

Give three examples of how chronic illnesses might disrupt a person’s life.

Contact info: info@nursesinternational.org

14 of 31

Nursing Care of Clients with Chronic Illness

Coordination of care:

It may be complex and across multiple settings.

Successful management requires the client’s participation in their care.

(U.S. Department of Veteran Affairs, 2017)

Nurses develop trusting relationships to engage and motivate clients.

Contact info: info@nursesinternational.org

15 of 31

Nursing Care of Clients with Chronic Illness:

Management

Patient education

Enhances client self-efficacy, coping, and self-management skills.

Teaches about disease processes.

Goal is to promote self-care over extended periods.

Chan, 2021

Contact info: info@nursesinternational.org

16 of 31

Nursing Care of Clients with Chronic Illness:

Management

An integrated approach

Targets risk factors of chronic diseases
Integrates primary, secondary, and tertiary prevention, health promotion, and related programs.

Nurse roles:

Care coordinators
Case managers

Chan, 2021

Contact info: info@nursesinternational.org

17 of 31

Nursing Care of Clients with Chronic Illness:

Treatment

Chronic diseases

Leading cause of death globally
Associated with 63% of the 57 million deaths in 2008

The majority of these deaths are attributed to

Cardiovascular diseases
Cancers
Chronic respiratory diseases
Diabetes

Alwan et al., 2011,

as cited in Sav et al., 2015

Contact info: info@nursesinternational.org

18 of 31

Nursing Care of Clients with Chronic Illness:

Treatment

Modalities to treat chronic illnesses:

Surgery
Physical therapy
Psychological therapy
Radiotherapy
Medication therapy

Sav et al., 2015

Contact info: info@nursesinternational.org

19 of 31

Critical Thinking Question

What is meant by the following statement?

“Self-efficacy is an important factor that influences patients’ ability to self-manage symptoms of their chronic diseases.”

Contact info: info@nursesinternational.org

20 of 31

Challenges of Caring for Clients

with Multiple Comorbidity

Dependence and disability affect quality of life:

Early interventions may help prevent the progression to dependence (Coronado-Vazquez et al., 2020)

Challenge for nurses:

Continuity and coordination increase the complexity of care
Increased ethical concerns related to autonomy
Poor staffing in long-term facilities
Fewer resources in low-income communities
Population is aging with a longer life expectancy

(O’Connor et al., 2018)

Contact info: info@nursesinternational.org

21 of 31

What Would the Nurse Do?

List the organizations in your community that support clients with chronic illnesses.

List a website that supports clients with chronic illness.

List a national association that supports clients with chronic illnesses.

Contact info: info@nursesinternational.org

22 of 31

Red Flags

People with serious mental health conditions are at high risk of experiencing chronic physical conditions.
People with chronic physical conditions are at risk of developing poor mental health (Canadian Mental Health Association, 2022).
Mental health is a basic human right. It is crucial to personal, community, and socioeconomic development (WHO, 2022b).
The prevention and treatment of chronic illness, especially when involving multiple medications, can become challenging (Sav et al., 2015).

Contact info: info@nursesinternational.org

23 of 31

Cultural Considerations

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Health beliefs: In some cultures, talking about a possible poor health outcome will cause that outcome to occur.
Health customs: In some cultures, family members play a large role in healthcare decision-making.
Ethnic customs: Differing gender roles may determine who makes decisions about accepting and following treatment recommendations.

Agency for Healthcare Research and Quality [AHRQ], 2020

Contact info: info@nursesinternational.org

24 of 31

Cultural Considerations (Continued)

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Religious beliefs: Faith and spiritual beliefs may affect health-seeking behavior and willingness to accept treatment.
Dietary customs: Dietary advice may be difficult to follow if it does not fit the foods or cooking methods of the family.
Interpersonal customs: Eye contact or physical touch may be acceptable in some cultures but inappropriate or offensive in others.

AHRQ, 2020

Contact info: info@nursesinternational.org

25 of 31

Cultural Considerations (Continued)

Socioeconomic status
Family patterns
Gender roles and responsibilities
Marriage patterns
Sexual behavior
Preventive patterns
Pregnancy and birth practices
Body image
Nutrition
Dressing/wearing habits
Personal hygiene

LibreTextsMedicine, 2021

Housing arrangements
General health regulations
Professions
Religion
Habits
Culture-induced stress
Status of immigrants
Substance use
Leisure time habits
Pets
Self-healing strategies and therapies

Contact info: info@nursesinternational.org

26 of 31

Cultural Considerations: Examples

The individual’s cultural beliefs about health, attitudes, behaviors, past experiences, and treatment practices play a vital role in improving health and preventing/treating diseases.

Cultural variables can be motivational factors in health-disease relationships.

LibreTextsMedicine, 2021

Contact info: info@nursesinternational.org

27 of 31

References

Agency for Healthcare Research and Quality (AHRQ). (2020). Health literacy universal precautions toolkit, 2nd edition. U.S. Department of Health and Human Services, National Institutes of Health. https://www.ahrq.gov/health-literacy/improve/precautions/tool10.html

Almirall, J., & Fortin, M. (2013). The coexistence of terms to describe the presence of multiple concurrent diseases. Journal of Comorbidity, 3(1), 4-9. https://doi.org/10.15256/joc.2013.3.22

Bernell, S., & Howard, S. (2016). Use your words carefully: What is a chronic disease? Frontiers in Public Health, 4(159), 1-3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4969287/pdf/fpubh-04-00159.pdf

Canadian Mental Health Association. (2022). Connection between mental and physical health. https://ontario.cmha.ca/documents/connection-between-mental-and-physical-health/#:~:text=The%20associations%20between%20mental%20and,of%20developing%20poor%20mental%20health

Centers for Disease Control and Prevention. (2013c). Preventing chronic diseases and reducing health risk factors. https://www.cdc.gov/nccdphp/dch/programs/healthycommunitiesprogram/overview/diseasesandrisks.htm

Contact info: info@nursesinternational.org

28 of 31

References

Centers for Disease Control and Prevention. (2022). About chronic diseases. https://www.cdc.gov/chronicdisease/about/index.htm

Chan, S. (2021). Chronic Disease Management, Self-Efficacy and Quality of Life. Journal of Nursing Research, 29(1), e129. https://doi.org/10.1097/jnr.0000000000000422

Coronado-Vazquez, V., Canet-Fajas, C., Ramírez-Durán, M. V., Gómez-Salgado, J., Robles-Romero, J. M., Fagundo-Rivera, J., & Romero-Martín, M. (2020). Nursing care ethical implications regarding chronic patients at hospital discharge. Healthcare, 8(21), 167. https://doi.org/10.3390/healthcare8020167

Hajat, C., & Stein, E. (2018). The global burden of multiple chronic conditions: A narrative review. Preventive Medicine Reports, 12, 284-293. https://doi.org/10.1016/j.pmedr.2018.10.008

LibreTextsMedicine. (2021). Cultural factors affecting health and disease. https://med.libretexts.org/Bookshelves/Nursing/Nursing_(Ulutasdemir)/04%3A_Transcultural_Nursing/4.02%3A_Cultural_Factors_Affecting_Health_and_Disease

Contact info: info@nursesinternational.org

29 of 31

References

Megari, K. (2013). Quality of life in chronic disease patients. Health Psychology Research, 1(e27), 141-148. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4768563/pdf/hpr-2013-3-e27.pdf

O’Connor, S., Deaton, C., Nolan, F., & Johnston, B. (2018). Nursing in an age of multimorbidity. BMC Nursing, 17(49), 1-9. https://doi.org/10.1186/s12912-018-0321-z

Sav, A., King, M. A., Whitty, J. A., Kendall, E., McMillan, S. S., Kelly, F., Hunter, B., & Wheeler, A. J. (2015). Burden of treatment for chronic illness: A concept analysis and review of the literature. Health Expectations, 18(3), 312-325. https://doi.org/10.1111/hex.12046

Silva, C. G. d., Sena, L. B., Rolim, I. L. T. P., Sousa, S. d. M. A. d., & Sardinha, A. H. d. L. (2017). Nursing care for patient with chronic health conditions: An integrative review. Revista de Pesquisa: Cuidado é Fundamental Online, 9(2), 599-605. https://nbn-resolving.org/urn:nbn:de:0168-ssoar-53345-4

Substance Abuse and Mental Health Services Administration. (2016). Adults in poor physical health reporting behavioral health conditions have higher health costs. https://www.samhsa.gov/data/sites/default/files/report_2107/ShortReport-2107.html#:~:text=Adults%20aged%2018%20to%2064,with%20higher%20health%20care%20expenditures

Contact info: info@nursesinternational.org

30 of 31

References

U.S. Department of Veteran Affairs. (2017). Role of nurses in managing chronic conditions. https://academyhealth.org/sites/default/files/VA_FORUM_Fall_2017.pdf

van Houtum, L., Rijken, M., & Groenewegen, P. (2015). Do everyday problems of people with chronic illness interfere with their disease management? BMC Public Health, 15(1000). https://doi.org/10.1186/s12889-015-2303-3

Van Wilder, L., Pype, P., Mertens, F., Rammant, E., Clays, E., Devleesschauwer, B., Boeckxstaens, P., & De Smedt, D. (2021). Living with a chronic disease: Insights from patients with a low socioeconomic status. BMC Family Practice, 22, 233. https://doi.org/10.1186/s12875-021-01578-7

World Health Organization. (2022a). Health and well-being. https://www.who.int/data/gho/data/major-themes/health-and-well-being#:~:text=The%20WHO%20constitution%20states%3A%20%22Health,of%20mental%20disorders%20or%20disabilities

World Health Organization. (2022b). Mental health: Strengthening our response. https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response

Contact info: info@nursesinternational.org

31 of 31

Please go to

My Learning Experience

to provide feedback on your experience.

Thank you, and come back soon!

Contact info: info@nursesinternational.org