Volume 41 Issue 3 (September 2009)
Care for The Chronically Ill:
A Challenge Also for Nursing! (p 229-230)
One of the greatest health care challenges of the 21st century worldwide will be caring for the burgeoning number of persons living with chronic illness (World Health Organization [WHO], 2002). Nurses can face this challenge by adding to the evidence base through research, by adapting their educational programs to changing patient needs, and by incorporating principles of chronic care models into clinical practice. The Journal of Nursing Scholarship (JNS) can serve as a platform for information exchange within the international nursing community.
What is meant by the challenge of chronic illness? Chronically ill patients are a diverse population: some live with cardiovascular disease, others with cancer, blindness, congenital diseases, or any of a host of disorders. However, all share common characteristics: none can be healed, all depend on lifelong treatment and follow-up, and all need to develop their self-management skills to improve their health outcomes and avoid acute exacerbations of their illnesses (WHO, 2002). Whereas chronic illness was responsible for less than 50% of the global burden of disease in 1990, it is expected to account for more than 70% by 2020 (British Medical Journal, 2002).
Care for the chronically ill is a major driver of health care budgets (Nolte & McKee, 2008); and although the risk of chronic illness increases with age, it occurs over the entire life span (e.g., children with congenital heart disease or asthma). Bodenheimer, MacGregor, and Stothart (2005) argued that nurses can be the leaders in providing care to this growing patient group; but the increasing burden of chronic illness demands that we rethink the way we provide care (WHO, 2002).
Adequate care for the chronically ill differs substantially from the care provided in our predominantly acute care driven health care system, with their limited attention to patient self management, prevention and continuity of care (WHO, 2002). More optimal care models for the chronically ill have been described, i.e., the Chronic Care Model (Bodenheimer, Wagner, & Grumbach, 2002) adapted by the WHO to the "Innovative Care for Chronic Disorders" framework (WHO, 2002). Central to these models is the planning of care as a close interplay between layers of the health care system, starting with connected, prepared, informed, and motivated patients, families, health care teams, and communities. They also promote care continuity, encourage quality through leadership and incentives, organize and equip health care teams, support self management and problem prevention, develop and encourage the use of information systems, and create positive policy environments (WHO, 2002). Models developed for diabetes or heart failure provide excellent examples of how changing care systems drive health care improvement (Nolte & McKee, 2008; Sochalski et al., 2009); and increasing evidence associates evidence-based models of chronic illness care with improved outcomes (Nolte & McKee, 2008).
Further, the success of any chronic illness care model depends on interdisciplinary collaboration. It requires health care providers who share certain core competencies (i.e., patient centered care, partnering, quality improvement, information and communication technology, public health perspective; Pruitt & Epping-Jordan, 2005; WHO, 2005). These competencies should be integrated into health care professions' curricula as well as guiding post-graduate training.
The impact of chronic illness, already major, can only increase, calling for action at all levels. Although various countries have begun to invest in care systems more conducive to chronic illness care, their efforts cannot yet match the challenge ahead. We welcome input from the nursing community regarding chronic illness care, and look forward to publications on this issue in JNS!
Sabina De Geest, RN, PhD, FAAN, FRCN
Editorial References
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Letters to the Editor
I was very impressed with Susan Gennaro's editorial "What the World Needs Now" and her final determination that "efficiency" is the one thing that would really help the world. That so mirrored my growing conviction that leaning "waste", that is, identifying and dropping non-value added process steps, out of our health care processes, is the secret to decreasing patient risk, decreasing work place stress, and increasing capacity in all of our health care systems. It could also decrease cost, or at least avoid additional costs, that would otherwise accrue from increased capacity. I applaud Ms Gennaro's willingness to share her non-traditional thinking in how she came up with "efficiency" as the answer!! I vote for her for President...o.k., if not that, then at least for the directorship of our Health & Human Services!!!!!
Elaine J. Huggins, RN, MSN, CPHQ Vandenberg AFB, CA Elaine.Huggins@Vandenberg.af.mil |
The world needs efficiency? Efficiency means to centralize health care which limits availability of health care to remote rural and poorer areas of the world. Efficiency means a good monetary return for care. Efficiency means the bottom line more important that the mission of health.
Efficiency means that there is more intervention with natural processes like childbirth and death. This increases the cesarean section rate and encourages assisted suicide. Efficiency takes away individual freedoms and the dignity of the person.
Efficiency means that no one will get that extra time to learn health promotion and self care. No child can need that extra attention to feel safe. No one can be born or die at an inopportune time. No one can take that fourth day to grieve. Human beings become cogs in a machine, parts to move down the line. Efficiency is production not nursing.
What the world needs is love. Not namby-pamby dewy eyed infatuation but a love that respects personhood and their rights to care from start of life to its end, the love that calls each person to healthy lives, the love that is self giving and in service to others, the love that leads us to companion others with compassion in their joys, their sufferings, and their losses. That is the loving care that is nursing. We can be efficient, to be sure. Nursing gives dignity, freedom, and that love that the world needs most.
Mary C. Herendeen, SFO, BSN, CHPN
Kendallville, Indiana
Xi-Nu Chapter at Large
Fort Wayne, Indiana
Susan, On this bright sunny summer morning in the Nation's Capital we woke to the news of questionable election results in Iran and the promise of enriched uranium in North Korea. One can really be left with a "What can I do to make the world a better place?" question in a big hurry.....but with few good answers. As luck would have it, I picked up my new JNS and read your editorial. You are right. What one good person can do, especially one clinical nurse researcher, is to keep-on-keeping-on with the development of efficient, evidence-based, models of practice that will have widespread, perhaps international, impact. That IS what one person can do to make a difference. Thank you for your editorial. Today (as many days), YOU made a difference...just wanted to let you know. Kathy
Kathleen F. Gaffney, PhD, RN-CS, F/PNP
Professor
College of Health and Human Services 3C4 School of Nursing George Mason University Fairfax, VA 22030-4444
Research: Health Promotion for Mothers & Young Children | |
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