Research Article: Participation of patients with chronic illness in nursing care: An Iranian perspective

The increasing number of chronically ill people has served as an impetus for the promotion of patient participation in nursing care. However, little is known about patient participation in Iran. The aim of this study was to identify the factors that are relevant to patient participation and the nature of that participation, as experienced by chronically ill patients and registered nurses in Iran. Grounded theory was used as the method. Twenty‐two participants were recruited by using purposeful and theoretical sampling. The data were generated by semistructured interviews and participant observations. Constant comparison was used for the data analysis. This study indicated that participation is an interactive process between nurses, patients, and family members in the caregiving context. Participation occurred when the caring agents worked together. The core category of “convergence of the caring agents” emerged. The subcategories emerged as the levels of participation and included “adhering”, “involving”, “sharing”, and “true participation”. The factors related to the caring agents and caregiving context could be considered as predictors of the level of participation when caring for these patients.     

Health care interpreters: A physiotherapy perspective

Communication is the greatest barrier in health care provision for people of non-English speaking backgrounds. The New South Wales Health Standard Procedures stipulate that the Health Care Interpreter Service must be used in consultations with clients who cannot fully comprehend English. This study explored the attitudes, thoughts, and feelings of physiotherapists toward health care interpreters and their service. Interviews and observations were conducted at three different hospitals. Six physiotherapists were interviewed in total. The results showed physiotherapists did not collaborate with health care interpreters for all consultations with clients of non-English speaking backgrounds. Physiotherapists were found to be largely negative in their attitude toward the health care interpreter service. Suspicion and distrust of interpreters, time constraints, and the perceived cost of the service were major themes identified in the interviews. Physiotherapists need to be aware that failure to collaborate with interpreters may result in litigation should there be reason to contest the validity of treatment consent or warnings given.     

Managed care and chronic illness: an overview

The growth in managed care raises a number of issues with respect to people with chronic illness. One issue is whether HMOs enroll their fair share of people with chronic illness. Another issue is how to address the fears among people with chronic illness or disabilities who are faced with requirements to join managed care plans.     

Health care access: a consumer perspective

This article describes the use of action research as an information base for policy formulation by a collaborative partnership in Spokane, Washington. Health and social service providers recognized access to care by uninsured persons as a major community issue. Little was known from the consumers' perspective about factors limiting access. No benchmarks existed against which to measure progress. Investigators collected mailed surveys from 475 residents of six Spokane neighborhoods and 97 persons participated in 12 focus group sessions. Income, education, and ethnicity were primary factors affecting perceptions of degree to which medical, dental, and mental health needs were being met. Many residents were unable to obtain needed health care; low-cost dental and mental health services were named as their highest priorities. Quality of care, relationships with providers, immediacy of access, and cost were important concerns. Major barriers were cost, length of time before one could get an appointment, lack of comfort with providers, and having to miss work for appointments. Consumer input is critical in understanding local issues in health care. Action research that combines qualitative and quantitative data enhanced practice/policy decisions through assuring ownership of the research and immediate use of findings by involved agencies.     

Stigma in childhood chronic illness: a well sibling perspective

The purpose of this study was to describe how well siblings view potential stigma in childhood chronic illness. Results of interview of 27 siblings are discussed using three major categories: revealing of the chronic illness to others, responses to the ill child, and impact of the illness on daily living.     

Meeting a primary care challenge in the United States: chronic illness care

Leading health care experts in the United States have stated that the greatest primary care challenge today is meeting the complex needs of patients with chronic illness/long-term conditions or impairment.To address this challenge, there is a need for health care system redesign that requires a multidisciplinary team approach, including active participation from professional nurses. In particular, it is essential for advanced practice nurses to provide leadership in health systems design for which they are specifically trained and experienced. In this article, the primary care challenge related to chronic illness care management is addressed. Future implications for community-based, chronic illness care delivery and the education of future health care providers with a focus on advanced practice nurses will also be discussed.     

Living with chronic illness: social support and the well spouse perspective.

Progressive neurologic disease has a significant impact on family members, particularly those living with and caring for a homebound adult. Focus groups were conducted with women who were the primary caregiver for their disabled husband. The women described themselves as being restricted to the home by caregiving requirements. Multiple sclerosis was a critical personal hardship for them, involving persistent struggle that often resulted in anger and frustration. Because of the social isolation created by their caregiving responsibilities, these women depended on their disabled husband for support. Yet, never having time away from the husband strained the marital relationship and threatened the supportive nature of the relationship. The women in this study found it necessary to have personal time and space away from their husband. They created space for themselves by setting apart a place in the home that was theirs or by declaring time out for themselves. These strategies helped them avoid or reduce negative outcomes of the social support received from their husband.     

Intensive short-term home care for chronic illness

The revised Medicare regulations offer home health nurses new opportunities to try different visit plans, including more visits. Providing intensive services for a relatively short period of time early in the service period can offer long-term benefits for patients and their families as well as overall cost savings for the insurer.     

Finding common ground: patient-centeredness and evidence-based chronic illness care

Health outcomes for patients with major chronic illnesses depend on the appropriate use of proven pharmaceuticals and other therapeutic technologies, and effective self-management by patients. Effective chronic illness care then bases clinical decisions on the best, rigorous scientific evidence, or evidence-based medicine. Effective support for patient self-management includes efforts to increase patient participation in care and collaborative goal-setting and planning of treatment. These interventions appear somewhat consistent with recent conceptualizations of patient-centered care. The consistent delivery of proven therapies and information and support for self-management requires practice systems organized for that purpose. The Chronic Care Model is a compilation of those practice system changes shown to improve chronic care. This paper explores the concept of patient-centeredness and its relationship to the Chronic Care Model. We conclude that the Model is both evidence-based and patient-centered and that these can be properties of health systems, and not just of individual practitioners.     

Psychophysiological processes of stress in chronic physical illness: a theoretical perspective

This paper proposes a theoretical framework and conceptual model for clinicians and investigators working with people who have a chronic physical illness. The framework is based upon nursing theory and classical propositions from psychology and physiology. The major premise of the model is that individuals with limited psychosocial attributes and a preponderance of unmet basic needs are more likely to perceive events as threatening and experience a maladaptive stress response, such as heightened symptoms and acute exacerbations of their illness. Conversely, those with strong attributes and a perception of need satisfaction are more likely to view events as challenging, thus avoiding symptomatic discomfort and enhancing personal growth. Implications for nursing practice and research are addressed.