NURSING 7124 Management Of Chronic Illness

Introduction:

Renal diseases are is one of the most commonly discovered chronic health adversities which involves a number of concerns that are associated with not just pharmacological care but also demands considerable self-management activities (Kramer et al. 2018). It causes gradual loss of function of the kidney of the patient, hence, there is need for acute self-care or self-management that emerge for such patients due to the lack of the kidneys being able to complete their daily functionality. This summary essay will attempt to discuss the challenges identified by three online discussion posts and suggest strategies to overcome the barriers.

Discussion of challenges and strategies to overcome:

With respect to the appendix 1, it discussed the fact that the challenges in the self-management priorities and along with that, the self-management education plans given to the patients with kidney damage has considerable barriers. The extremely short duration of the self-management education and training is the main contributing factor for the challenges in patients or their family carers not clearly understanding the need for lifestyle modifications, dietary habits and fitness regime. The discussion post provided the strategy of offering steering promotion platforms to the suitable target group, although there are other possible strategies as well (Reid et al. 2011). Enhancing the duration of the clinical interaction between the patients and their care providers during patient educational session or discharge planning with smartphone based teaching can be effective (Hayashi et al. 2017). Another strategy, as discussed by Dinh et al. (2016), is the teach back method, which will encompass asking the patients or their family members to repeat back the content of the education plan which will ensure clear demarcation of whether the patients have understood it completely.

As per the appendix 2, the lack of health literacy among the populace, especially those belonging to the lower socio-economic gradient, has limited access to health care and health promotion, and I completely agree with the school of thought. In order for the self-management planning and training to work effectively for the patients in consideration, it is very important for the target group to at least have a basic idea of preventative or health promotional behaviours (Joboshi and Oka 2017). Along with that, the discussion post of appendix 2 has also mentioned that the hyperkalaemia is a health concern which is not given enough prioritization in the health promotional planning. Both of these factors act cumulatively against proper self-management activities being integrated in the patents with hyperkalaemia or kidney disorders (Fried, Kovesdy and Palmer 2017). First and foremost strategy is adequate training of the health care staff on the importance of hyperkalaemia to improve health literacy of the populace. It is crucial for the local and global health authorities to focus on enhancing the accessibility of health care as well to ensure better accessibility, better literacy and better self-management of the diseases (Kazawa et al. 2015).

With respect to the discussion post appendix 3, the small set patient centred conferences based on self-care activities around the home care based self-management can be difficult. The collective decision making, the effective and impartial participation from both the patient nd the collaborating care providers is important which is often not taken into consideration which impacts their self-management abilities as well. In this case, a very important strategy that can be incorporated in this context is incorporating different motivational interviewing and collective decision making that encourage self-care modalities (Crown and Vogel 2017).

As discussed in the appendix 4, Cinacalcet being withdrawn from the pharmaceutical benefit scheme has enhanced the cost of care for the patients immensely. Which has led to reluctance to continuing the medication or taking the alternative surgical option which is associated with greater risks. There is need for local and national government action on making the medicine subsidized on the basis of demand supply statistics, although the there are other strategies that can be taken as well, along with more cost-effective management of the disease is mandate. There is need for more emphasis of the care services to encourage the patients to engage in non-pharmacological self-management activities such as controlled water intake as per the discussion post (Burnier et al. 2014). As discussed by Kramer et al. (2018), other potassium lowering therapies can be also considered in management of hyperkalaemia. Dietary modification that limit the daily intake of potassium has also been proven as a considerably important strategy for hyperkalaemia self-management (Clark-Cutaia 2018).

Appendix 5 discusses the impact of communication and transport related difficulties in accessing the care facilities and self-management of the renal disorders of the patients. The transportation barrier acts like considerable restriction for the health care staff to carry out community education due to the lack of resources availability and the complication in reaching the patient populations, which affects the patient population residing in remote and rural areas. One very important strategy as discussed in the post with respect to Shahady (2006) can be the incorporation of mobile health trucks in the patient education and self-management training facilities along with community education as per the discussion post. Although, the aid of tele-health facilities can also be taken to improve the health literacy of remote patient populations (Toh, Pawlovich and Grzybowski 2016).

Appendix 6 discusses a very important aspect associated with self-management of chronic diseases, which is the language barrier. Summarizing the discussion post, it has to be mentioned that for the Australian migrant population the language barrier restricts the effective communication between the patients and the care providers. I would like to add that this challenge is also pertinent for the first people of Australia, where the cultural appropriateness and language barrier is a very important challenge for implementing health literacy and self-management. In this case, the strategy discussed in the post had been taking the aid of advanced technology in the mobile phones and Google translator (Jungner et al. 2018). Along with that, taking the assistance of technology to develop language appropriate instruction pamphlets can also prove to be beneficial (Hawley and Morris, 2017).

Reflection and conclusion:

On a concluding note, I would like to mention that this had been an extremely beneficial experience for me which has not only helped me identify the challenges predominating the lack of adequate self-management for patients with renal disorders; but this exercise has also helped me evaluate the analyse the challenges, link them with my own best understanding of the scenario and suggest evidence based strategies that can be easily implemented in practice to overcome these barriers. I sincerely hope that the knowledge and expertise gained from this activity will help me implement safe and effective evidence based practice in future.

References:

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Clark-Cutaia, M.N., 2018. Perceived Barriers to Adherence to Dietary Sodium Recommendations in Hemodialysis Patients. Nephrology Nursing Journal, 45(2).

Crown, S. and Vogel, J.A., 2017. Enhancing Self-Care Management of Interdialytic Fluid Weight Gain in Patients on Hemodialysis: A Pilot Study Using Motivational Interviewing. Nephrology Nursing Journal, 44(1).

Dinh, T.T.H., Bonner, A., Clark, R., Ramsbotham, J. and Hines, S., 2016. The effectiveness of the teach-back method on adherence and self-management in health education for people with chronic disease: a systematic review. JBI database of systematic reviews and implementation reports, 14(1), pp.210-247.

Fried, L., Kovesdy, C.P. and Palmer, B.F., 2017. New options for the management of chronic hyperkalemia. Kidney International Supplements, 7(3), pp.164-170.

Hawley, S.T. and Morris, A.M., 2017. Cultural challenges to engaging patients in shared decision making. Patient education and counseling, 100(1), pp.18-24.

Hayashi, A., Yamaguchi, S., Waki, K., Fujiu, K., Hanafusa, N., Nishi, T., Tomita, H., Kobayashi, H., Fujita, H., Kadowaki, T. and Nangaku, M., 2017. Testing the feasibility and usability of a novel smartphone-based self-management support system for dialysis patients: a pilot study. JMIR research protocols, 6(4).

Joboshi, H. and Oka, M., 2017. Effectiveness of an educational intervention (the Encourage Autonomous Self-Enrichment Program) in patients with chronic kidney disease: A randomized controlled trial. International journal of nursing studies, 67, pp.51-58.

Jungner, J.G., Tiselius, E., Wenemark, M., Blomgren, K., Lützén, K. and Pergert, P., 2018. Development and evaluation of the Communication over Language Barriers questionnaire (CoLB-q) in paediatric healthcare. Patient education and counseling.

Kazawa, K., Takeshita, Y., Yorioka, N. and Moriyama, M., 2015. Efficacy of a disease management program focused on acquisition of self-management skills in pre-dialysis patients with diabetic nephropathy: 24 months follow-up. Journal of nephrology, 28(3), pp.329-338.

Kramer, H., Jimenez, E.Y., Brommage, D., Vassalotti, J., Montgomery, E., Steiber, A. and Schofield, M., 2018. Medical Nutrition Therapy for Patients with Non–Dialysis-Dependent Chronic Kidney Disease: Barriers and Solutions. Journal of the Academy of Nutrition and Dietetics.

Reid, C., Hall, J., Boys, J., Lewis, S. and Chang, A., 2011. Self management of haemodialysis for End Stage Renal Disease: a systematic review. JBI Database of Systematic Reviews and Implementation Reports, 9(3), pp.69-103.

Shahady, E.J., 2006. Barriers to care in chronic disease: how to bridge the treatment gap. Depression, 46.

Toh, N., Pawlovich, J. and Grzybowski, S., 2016. Telehealth and patient-doctor relationships in rural and remote communities. Canadian Family Physician, 62(12), pp.961-963.