N109: Foundations in Nursing Practice

N109: Foundations in Nursing Practice Study Guide adopted course of treatment. • Downward phase: This phase is characterized by progressive deterioration in mental and physical status. The goal of this phase is to accept the prognosis and address concurrent issues. • Dying phase: This phase refers to a period of weeks, days, or hours preceding death. Thegoal of this phase is to accept the impending death and ensure a peaceful death. 3.3 Chronic Care Model Dr. Edward Wagner identified issues in providing care for people with chronic illness through primary care. These issues include: • Primary care is set up to respond to acute illness, and does not anticipate the needs of chronically ill patients. • Chronically ill patients are not adequately informed about their conditions and are not supported in self-care of their conditions beyond the office. • Physicians are too busy to educate and support patients with chronic illness to stay healthy. Because of these issues, Wagner developed the Chronic Care Model (CCM). The essential elements of the CCM are the community, the health system, self-management support, delivery system design, decision support, and clinical information systems. The CCM replaces physician-centered office care with a team of professionals who collaborate with the patient about his care; this model tends to result in healthier patients, more satisfied providers, and cost savings. 3.4 Adjustment Patterns The individual and family will go through a period of time during which they are trying to discern what adjustments to the home and family must be made to accommodate the chronic illness. During this time, they will also be learning to accept the chronic condition and dealing with any stigma that may be associated with it. This is a unique process for each individual and family and is influenced by many factors. Some of these factors include the patient’s personality, if he has any unresolved anger or grief from the past, how sudden and to what extent the illness causes lifestyle changes, resources available, current stage in family and life cycle, as well as previous experiences with illness and stress. 3.5 Problems Associated with Chronic Illness In addition to the effects of the chronic illness itself, the individual with a chronic illness may also experience other issues commonly associated with chronic illness. In the patient and family dealing with chronic illness, the nurse must also assess for the following issues: • Access to healthcare: If the chronically ill person is poor or in a rural or underserved area, access to quality healthcare may be an issue that the nurse must address in the plan of care. Access to care may also be affected by the individual's ability to get to appointments and afford the care and medications needed.

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