Chronic Illness and Rehabilitation

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Chronic Illness and Rehabilitation Rehabilitative practices in chronic illness are particularly important in helping patients to cope with their health conditions. The main objective of rehabilitation is to promote functionality, recovery and quality of life by trying to restore or improve compromised function.

This paper discusses on the rehabilitation of stroke patients, the nurse’s role in the management of their conditions and the relevant changes in the healthcare system to improve care delivery in patients with chronic illnesses and disability.

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Case Study MM, a 60 year old woman was rushed to the emergency room after collapsing before having dinner with her family. The family was having a get together when she lost consciousness and was immediately rushed to the emergency department. Getting there, the patient was awake but confused and had difficulties with her speech. She had complained of having slurred speech, numbness and tingling in one of her extremities five days ago but had resolved within a few minutes. She has significant health history of hypertension and diabetes.

The patient was admitted into the acute stroke department and her vitals taken. At the time, her blood pressure was at 163/95 and her blood sugar levels were 9.8mmol/L. From her previous symptoms, it became apparent that the patient had transient ischemic attack but had neglected it, increasing her risk for getting stroke. Her head CT scan showed the presence of a thrombus in her left internal carotid artery causing infarction of the left anterior hemisphere.

There was no evident brain hemorrhage. This confirmed that the patient was having stroke and was immediately placed on intravenous recombinant tissue plasminogen activator and aspirin antiplatelet therapy. After her condition had stabilized, she was transferred to a stroke rehabilitation unit.

Stroke Rehabilitation In most individuals who suffer stroke, their muscles cease to function normally. Stroke rehabilitation is necessary for such individuals to help them restore the normal functioning of their muscles as well as relearn the skills lost. In cases of permanent disability, the patient is taught how to compensate for it using parts that are still functional. This is essential in promoting better quality of life for such patients and also helping them to live independently post-stroke (Le

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Danseur, 2020). The rehabilitating process is often individualized to meet the personal needs of the patient. This is because the severity of damage caused by stroke as well as the recovery time of individuals varies greatly.

Stroke results in physical, cognitive and psychological side effects that need to be addressed during rehabilitation. Common physical side effects include plasticity, visual impairment, muscle weakness, dysphagia, fatigue, pain, seizures, paralysis, and loss of control over body movements. Cognitive side effects include memory loss, aphasia, sensory loss, vascular dementia and apraxia. Psychological side effects associated with stroke includes pseudobulbar affect, post-stroke depression, anxiety and grief among others (Le Danseur, 2020).

Based on the post stroke complications, there are different types of rehabilitative therapies depending on the goal of therapy. This includes physical therapy, cognitive therapy and psychiatric therapy. Physical therapy is done to improve physical functioning and involves approaches such as constraint induced therapy, motor skill exercises, mobility training and range of motion therapy. The choice of approach is dependent on the desired goal such as improving mobility, easing muscle tension and improving muscle strength and coordination among others.

Cognitive therapy is done to improve cognitive functions and includes approaches such as speech therapy, psychological evaluations, occupational therapy and pharmacological treatment with antipsychotics.

Nursing Roles in Managing Patients with Chronic Conditions Nurses are essential members of the interdisciplinary healthcare team responsible for the diagnosis, treatment and management of chronic illnesses. The chronic nature of a disease demands long term care and management to prevent chronic disease related complications as

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well as to promote the wellness of the patient (Christiansen & Feiring, 2017). In most instances, the patients interact more with their nurses than with other interdisciplinary care team members, making them pivotal in the successful implementation of health interventions.

The roles of nursing in the care of chronically ill patients can be categorized into education, provision of quality care, influencing healthy lifestyle practices and coordinating patient care among others. On education, nurses are able to provide patients with meaningful information on how to improve their overall health, prevent complications and identify signs of worsening health, tips to use in cases of emergencies and other relevant information concerning their conditions. Through education, nurses are in a position to influence healthy lifestyle behaviors and discourage lifestyles that increases their risk of complications. The same way, they can link patients to groups where they can get relevant support for their illnesses (Le Danseur, 2020).

In the provision of quality care, nurses are committed in ensuring safety and quality in achieving better health outcomes. This includes the use of evidence based nursing interventions, preventing complications, administering medications and assessing patients among others.

However, the roles of nurses in the provision of direct patient care is dependent on the extent of their scope in practice, which tends to differ in different states and nations. Last, nurses play important role in coordinating patient care especially between different members of the care team. They are in a position to communicate with other care providers and design effective approaches that are specific to patient needs. They are also in close contact with the patient and their family, allowing their involvement in care (Christiansen & Feiring, 2017).

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In rehabilitation set ups, nurses contribute majorly into patient care. They assess for the patient’s need for rehabilitation, the type of rehabilitation suitable for the patient and implement rehabilitative practices. They work alongside other care providers in monitoring the patient’s progress and promoting recovery. Nurses also ensure that holistic care is provided for better outcomes. Preventive care is prioritized considering the risk for such patients to have subsequent stroke attacks.

Changes in the Healthcare System to Improve Care Delivery in Older Adults with Chronic Illness and Disability As the numbers of older adults continues to increase, so does the burden of chronic diseases on the health system increases. Older adults are likely to be diagnosed with multiple chronic conditions, requiring long term care and management. The impact of chronic diseases on the healthcare system is felt through its demand of resources, need to prevent chronic disease related complications and the longevity of care. This is particularly worrying, especially in the current health system that has placed more emphasis on emergency and acute care (Salmond & Echevarria, 2017).

To improve care in older adults with chronic conditions, there is need for change in the approach to health prevention and promotion, utilization of community resources, access to care and the quality of primary care services. Health prevention and promotion among the old population ensures better quality of life as it translates to lower incidences of chronic illnesses, early diagnosis and less disease-related complications. Incorporating health prevention and promotion strategies to everyday care of adults should therefore be adopted.

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Community resources are underutilized in the current health system despite their massive benefits on the prevention, treatment and management strategies. Community resources are resourceful in providing social support, wellness and recovery programs which are crucial for treatment and health promotion. Utilizing community resources will also help decongest health facilities as the elderly can be treated and managed from such centers (Berens, Blazo & Peacock, 2020).

Improving access to care and the quality of care provided to every person has a positive influence on their health outcomes. Lack of access to care is a major contributor to cases of late diagnosis and poorly controlled chronic diseases. The same way, poor quality of care leads to poor outcomes as preventable complications are likely to occur. Improved access to quality care will improve the treatment and management of chronic conditions, lessening their impact on the healthcare system (Salmond & Echevarria, 2017).

Conclusion Chronic conditions and disabilities can potentially result in situations where a patient will require rehabilitative care. In stroke patients, most of them require post-stroke rehabilitation to restore their physical, psychological and cognitive function from the impact of stroke. Nurses do play important role in providing care to persons with chronic illnesses. Improving the healthcare system will help reduce the occurrences of chronic illnesses and promote better chronic disease management, especially in the elderly who are at higher risk.

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References Berens, J. C., Blazo, M., & Peacock, C. (2020). Transitioning to adult care. In Handbook of Clinical Adult Genetics and Genomics (pp. 59-69). Academic Press.

Christiansen, B., & Feiring, M. (2017). Challenges in the nurse's role in rehabilitation contexts. Journal of clinical nursing, 26(19-20), 3239-3247.

Le Danseur, M. (2020). Stroke rehabilitation. Critical Care Nursing Clinics, 32(1), 97-108.

Salmond, S. W., & Echevarria, M. (2017). Healthcare transformation and changing roles for nursing. Orthopedic nursing, 36(1), 12.