Collegian
Volume 17, Issue 2 , Pages 43-45, July 2010

Nurses addressing the challenges of chronic illness: From primary to palliative care

Centre for Cardiovascular & Chronic Care, Curtin University, Australia

Institute of Nursing Science, Faculty of Medicine, University of Basel, Switzerland

The Johns Hopkins University School of Nursing, USA

published online 11 June 2010.

Article Outline

 

The 20th century has heralded unprecedented technological advances in health care and also considerable social change (Koh et al., 2010). Introducing innovative practices in prevention and treatment has decreased mortality for many conditions, previously causing premature death. These welcome advances in health outcomes have paradoxically created a new set of problems and challenges — equally as complex and challenging as those of previous centuries (Daar et al., 2007, Wagner, 1998).

Globally, as life span lengthens, health care systems are facing the challenges of providing services to increasing numbers of people with chronic illnesses. Many of these individuals are older and facing a range of social challenges. These people and their families are living with an uncertain future and experiencing increasing demands physically, emotionally and financially (Koh et al., 2010, Parekh and Barton, 2010). In this setting the support from health professionals, particularly nurses, is important to ensure optimal health outcomes.

The need for coordination, communication and support for self-management is not just the case for non-communicable diseases but for infectious diseases and cancer as well. In this Special Edition of Collegian, Phillips and Currow (2010) make a compelling case for considering cancer as a chronic condition given the increasing survival rates. Recent and evolving epidemiological transitions underscore the importance of nurses critically analysing the way in which they work and how they interact with patients, communities and policy makers (De Geest, 2009, Hill et al., 2007).

The way in which we engage with our environment has also changed over recent decades, impacting not only on chronic conditions but also the presentation and spread of many infectious diseases (Harper & Armelagos, 2010). Conditions relating to the physical environment and significant changes in nutrition and exercise are also emerging (Delfino et al., 2010) and recognition of the psychological stressors of living in the modern world is apparent (Graham, 2010). Many people now live for an extended period with a number of chronic and complex conditions. How bemused would many of our forebears be if they realized that one of the most challenging problems in the 21st century would be obesity (Gill et al., 2009)?

Australia is in a setting of health care reform in response to recognising the burden of a health care system buckling under the pressures of increased demands (Australian Institute of Health and Welfare, 2009). A range of factors, including system, provider and patient factors contribute to the challenges in providing chronic care but also the solutions (Dennison et al., 2007). Nurses are well placed to drive this reform agenda. However, achieving these improvements will take commitment, introspection and importantly collaboration with our colleagues and patients. Moreover, a team approach to patient rather than physician centered care is critical to success. Importantly, the composition of the team needs to be designed to meet the priorities and needs of the patient and their family.

Addressing the challenges in nursing is essential to overcoming the unmet needs in the health care system as a whole. Nurses are the largest segment of the health care workforce, and their skills and availability can directly impact on the safety, quality, and efficiency of our health care system. In this issue, Hickman, Rolley, and Davidson (2010), suggest strategies that can be applied to the acute care setting to make it more conducive to meeting the needs of individuals with a chronic illness, while Sayers and DiGiacomo (2010) discuss the importance of considering the role of nurse educators in workforce reform. As increasing numbers of people live for longer periods with potentially life limiting illnesses, we cannot escape effective planning for the end-of-life care and integration of a palliative approach to promote symptom management and decrease the burden on individuals and their families. Ensuring nurses have the necessary skills and competencies is critical. In this issue, Ramjan and colleagues describe the processes of curriculum reform and address the need to integrate a palliative approach across the nursing curriculum (Ramjan, Costa, Hickman, Kearns, & Phillips, 2010).

Chronic conditions are not just a condition of ageing as they are evident across the life span. For example, childhood asthma is a condition of considerable significance (Vuillermin et al., 2010). In this issue, Brown and colleagues discuss the importance of engaging parents in the management of asthma (Brown, Gallagher, Fowler, & Wales, 2010). An apparent yet poorly addressed area of chronic care is the transitional needs of children moving to adolescence with a chronic illness (Henderson et al., 2010, Rapley and Davidson, 2010). This is an important consideration for the future to ensure that this challenging transition is smooth.

Emerging challenges, such as dealing with increasing numbers of elderly individuals with chronic conditions, compel health professionals and consumers alike to reframe and reconsider how we view and manage chronic conditions. Previously often a passive partner in health care, we are now motivating and challenging patients to join with us in managing their condition. Potempa and colleagues present a model of primary care for older adults with chronic health conditions that focuses on their active engagement in health care. This article underscores that interventions in chronic illnesses need to focus on behaviour change and theoretically and conceptually congruent principles (Potempa, Butterworth, Flaherty-Robb, & Gaynor, 2010).

Increasing evidence suggests that in order to improve health care outcomes there needs to be an intersection between policy, practice, research and educational initiatives. This presents a challenge to nurses to ensure that our interventions in primary, secondary and tertiary care are evidence based and accessible to all populations. Sadly, increasingly health inequity is a problem of our modern world (Joshi, Jan, Wu, & MacMahon, 2008). In Australia, the health reform agenda is striving to achieve more equitable distribution of services. Developing the primary care sector and the nursing role are considered integral to this approach. Halcomb and colleagues have tracked the uptake of enabling policy initiatives and funding models to promote the nursing role (Halcomb, Davidson, & Brown, 2010). It is encouraging to see the favourable trajectory and the potential of the nursing role in general practice.

Although chronic disease has been the focus of research and concern in the developed world for several decades, it is only in recent decades that this challenge has been recognised in emerging economies (Mary Schooling, Lau, Tin, & Leung, 2010). In this issue Sindhu and colleagues describe an innovative model that is a potential solution that is appropriate to a regional Thai community, through harnessing local networks and promoting communication and continuity of care (Sindhu, Pholpet, & Puttapitukpol, 2010). As members of a global community, we as nurses are compelled to collaborate with our colleagues internationally to develop innovative solutions (De Geest, 2009).

Accordingly, peak professional bodies, including the Royal College of Nursing, Australia have recognised the growing challenge of chronic disease and the special role that nurses play in health care reform. This Special Edition of Collegian seeks to bring together a series of papers that address the crucial role nurses can play in the reconfiguring the health care system to better meet the needs of individuals, their families and communities. We trust that they will stimulate thought and debate and further discussion in the journal. More importantly, we look forward to papers that describe interventions that are improving patient care and outcomes.

Back to Article Outline

References 

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PII: S1322-7696(10)00032-6

doi:10.1016/j.colegn.2010.05.001

Collegian
Volume 17, Issue 2 , Pages 43-45, July 2010

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