Chronic diseases present a particularly complex challenge for patients. These conditions cannot usually be healed swiftly, so they are not curable in the short term. Therefore, they will stay with a patient for many years, and the condition will last a lifetime for some.
In the US, 60% of adults live with a chronic disease. Some of the most commonly found chronic diseases are heart disease, arthritis, asthma, and hyperthyroidism.
A holistic approach to chronic disease care
In a primary care setting, nurses at varying levels of seniority are engaged with managing chronic diseases. Depending on the limits of their licensure, they carry out tasks that help patients to manage their symptoms and live a full life. Their work can make a difference by controlling the signs that a patient experiences and slowing the progression of the disease. This allows the patient to feel better and, as a result, to be more in control of their condition. For the best results, nurses take a holistic approach. They focus not just on the state but also on the person’s overall health and continued improvement.
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How are chronic diseases initially managed?
After an initial diagnosis, patients are referred to a consultant who will decide on the right treatment plan for their disease. To do so, the consultant will need to gain a deeper understanding of a patient’s general health, which ensures that additional problems do not occur further into the treatment. It is often the case that people suffer from more than one health condition, which can impact one another. Understanding this aspect of a patient’s well-being allows the doctor to manage the disease more effectively. There will also be a period of testing out medications, as some will counteract others or cause an adverse reaction.
Lifestyle changes, appropriate medication, and knowledge are key to managing a chronic illness and slowing its progress. As part of this early-stage examination, a physician will usually look at a patient’s lifestyle to see whether environmental factors or their diet are exacerbating their chronic condition. For instance, being around airborne irritants, such as fumes or strong odors, can make asthma attacks more frequent, while smoking can worsen a heart condition.
How do nurses improve the health outcomes of chronic disease patients?
Effective chronic disease management involves more than finding the right medication and treating a patient’s symptoms. This form of long-term care involves organizing screenings, scheduling check-ups and monitoring the patient regularly. Nurses are key in helping patients control their chronic conditions and reduce their symptoms.
A nurse coordinates each aspect of a person’s treatment if they have to visit more than one department or consultant and will also educate the patient about their condition. This patient-centered method can lessen the effects of an ailment and improve the patient’s quality of life. Doing so lowers their need for regular medical interventions, reduces their health costs, and helps take pressure off a busy hospital.
Offering a patient self-management support
According to research, self-management of a chronic condition can positively impact clinical outcomes. Self-management includes teaching patients about their condition and giving them the skills to manage it well. To manage their illness and general health well, patients need the right information and support from their nurses. The end goal of self-management is patient empowerment, as it gives people living with a long-term condition more agency in their treatment, among other things.
Nurses will also work with the wider health team to find solutions for a patient’s health problems. They will then present the information and help the patient make an informed choice about their care. They will also encourage patients to find a support network outside the medical setting. This could include friends, family, work colleagues or patient groups, online forums, and national societies. Finally, nurses can advise people on living with their condition. Many chronic ailments challenge daily tasks or outings, so nurses will be ready to talk patients through this difficult topic. Establishing which activities are most important and which can be delegated to others can offer relief.
Why does self-management work?
Over a year, patients spend very little time with their healthcare team, but they can take care of themselves independently with the right tools. By involving patients in their care, nurses can improve their outcomes, but there are many other reasons for doing so. Primarily, it cuts down on the number of visits to a health professional that a patient has to make, saving them money and reducing their travel time. Additionally, when a patient understands their diagnosis and why they are experiencing symptoms, it can reduce their anxiety about the condition. Furthermore, this knowledge allows them to correctly identify when their symptoms are worsening and what needs to be done.
Transitioning a patient from hospital to home
Not all patients are diagnosed with a chronic condition during a visit to a physician’s office after a period of mild symptoms. Some are rushed to the hospital or admitted after a seizure or collapse at home, so they spend time as an inpatient. Discharge planning is crucial for appropriately managing the patient’s future care and avoiding readmissions. As well as caring for people in the hospital after a diagnosis, nurses will assist with their transition to becoming an outpatient and moving back home.
Most people with an initial course of inpatient treatment will need further appointments with other practitioners. In discharge planning, a nurse will arrange the referrals for each service, from physical therapy to home care and telephone meetings. To do this, they collaborate with the team around their patient. This could include other nurses, doctors, consultants, and surgeons. Doing so ensures that everyone knows the discharge plan and agrees it is sufficient. Furthermore, nurses will contact the patient’s family to talk about the project and confirm what role they will be playing in the patient’s care moving forward.
Preparing an inpatient for their move home
Most patients will have family members who become involved with their care and treatment following the discharge. Nurses work with these people to teach them the procedures to monitor the patient’s chronic illness and keep them well. This could include reading a glucometer if the chronic disease is diabetes or taking blood pressure if hypertension is an issue. As well as advising the family, nurses ensure the patient has all the information sheets they need and any devices they will use at home – such as monitors or wearables. Nurses will also establish the patient’s follow-up appointment schedule. They will confirm that the patient has a copy of any referral letters and knows where to go and what to bring.
Nurses who manage the discharge of a chronic illness patient have a key role in their aftercare. They connect their treatment with what they will get as an outpatient. They also ensure that the patient and their family are confident in the move and informed about the condition to limit recovery times and prevent readmission.
Helping patients with chronic illnesses manage their medication properly.
Nurses are skilled at building trust with their patients, meaning they are in the ideal position to get people to take their medication properly. Considering that medication is often vital to a patient’s well-being-, it could be a surprise that many people either don’t take it correctly or neglect their treatments altogether. This happens for various reasons, from a fear of side effects to the complexity of a treatment that includes multiple pills to a loss of symptoms (which makes some people think they are cured). Whatever its root cause, medication nonadherence is a serious issue, causing 100,000 deaths each year and resulting in $100bn in medical costs.
How nurses encourage adherence to medication
Part of this process is education because when patients understand how their medication works and why they need it, they are more likely to take it. Encouraging the patient to ask questions and creating discussions around medication can also be useful, as this allows them to share their concerns with the nurse early on. Nurses will also detail why the drug is key to treating chronic illness and the risks of forgetting to take it. When people are clear about these issues and the information has been provided by a health professional, they are more likely to take their treatment seriously. Furthermore, nurses can show patients how to save money on their monthly medication bills. They might suggest discount plans or coupons, generic alternatives, or ordering online.
Although patients are keen to get well in the early stages of a chronic illness, they may become fatigued with taking medications in later months and years. This is especially true when the dosing schedule is high or involves secondary actions, such as taking with or after a meal or a full glass of water. In these instances, nurses can find ways to simplify the schedule that a patient has to follow. They might seek alternative drugs that can be taken together at one time of day so that the patient finds their treatment less time-consuming and intrusive. Anything that reduces the chance of a missed dose is helpful.
To support their efforts, nurses will praise a job well done. Some patients have genuine difficulty remembering their dose, so positive reinforcement can encourage them to keep at it.
Supporting patients with medical monitoring technology
Recent research suggests that wearables may play an integral role in chronic disease management, and nurses in this field are often responsible for promoting patient engagement with these devices. Along with monitoring a patient’s health remotely, wearables can support self-management practices and improve outcomes. They can measure a person’s breathing rate, blood sugar level, and ketones to ensure they are healthy.
Although useful, encouraging patients to accept wearables and other medical technology can be a struggle. Frequently, patients say that the device they have been given is difficult to use, while others input data incorrectly and make errors because they struggle to deal with the interface. To overcome these barriers, nurses listen to their patients’ concerns and seek solutions.
Nurses can deal with these issues by spending time with each patient and showing them how to use their devices correctly. They can also provide updated literature on the device so that the patient has something to refer to when they are at home. Wearables are excellent early warning systems for patients with chronic illnesses, so keeping people on board with their use is an important part of nursing.
Scheduling regular appointments
Chronic diseases are monitored and reviewed regularly, even if the patient is feeling well. A practice nurse often manages these appointments at the patient’s clinic or physician’s office. They are a crucial part of chronic illness management because a face-to-face meeting can identify new symptoms or changes in symptoms. This can necessitate the establishment of a new regime of treatment or a referral to the hospital for further tests.
Before these reviews, a nurse will ensure that the patient has been invited for blood tests and has had their other measurements taken. This includes their blood pressure, weight, and other statistics relevant to their condition. By gathering this information in advance, the nurse can consider the implications before their patient arrives and ensure that any pressing issues are discussed.
Nurses can also carry out assessments over the phone, which is often seen as a better way to review people with chronic conditions. It means that they do not have to go to the hospital, but more importantly, it lowers their risk of acquiring an infection during their visit. Telephone assessments are often used with wearables, as nurses can use the information from these devices to inform the guidance they give to a patient. As a result of these appointments, nurses can also order lab tests or make referrals to ensure that the patient’s condition is kept in check.
Setting goals for a patient’s behavioral changes
One of the most challenging aspects of managing a person’s chronic illness can be persuading them to change their behavior. Whether the nurse pushes patients to quit smoking, change their diet, or get more exercise, they can be met with resistance. Often, it’s because the patient is not ready to change or because they do not see why they have to change. This could be due to several factors.
In these situations, nurses remain empathetic and non-judgmental. They listen to the patient’s concerns or the barriers they mention but also point out that the end goal cannot be reached without change. In doing so, nurses show their patients how their behavior impacts their illness and possibly makes the symptoms more pronounced. Finally, they will work with a patient to set achievable goals and devise a timetable for change.
Nurses play an essential role in chronic illness management.
Both nurse practitioners and registered nurses provide chronic disease management care in various medical settings. Frequently, they work to support their patients independently, but they will also collaborate with a wider care team to achieve the best possible outcome. As well as offering clinical support, they work as an advocate. This often involves advising their patients on self-managing a chronic condition, ensuring that medications are taken correctly, and arranging follow-up appointments to review their progress. The work of each nurse is often life-changing for patients. It allows them to take control of their ailment, manage their symptoms and begin to feel healthier.