Nursing Adults with Long Term Conditions

Jane Nicol, Lorna Hollowood

• Publisher: Learning Matters
• Year: 2019
• ISBN:
  9781526470959
• Edition: 3
• Topic: Medicine
• Subtopic: Nursing

With the number of people living with long term conditions set to increase, ensuring nurses are equipped with the knowledge and skills required to care for this group of people is essential. This book focuses on the relevant essential knowledge and skills, including the impact of long term conditions across the lifespan, the therapeutic relationship, health promotion and empowerment, self-management, symptom management, case management and advance care planning.

Chapter 1 Long term conditions across the lifespan

NMC Future nurse: Standards of proficiency for registered nurses

This chapter will address the following proficiencies:

Platform 1: Being an accountable professional

At the point of registration, the registered nurse will be able to:

• 1.6 understand the professional responsibility to adopt a healthy lifestyle to maintain the level of personal fitness and wellbeing required to meet people’s needs for mental and physical care
• 1.12 demonstrate the skills and abilities required to support people at all stages of life who are emotionally or physically vulnerable

Platform 2: Promoting health and preventing ill health

At the point of registration, the registered nurse will be able to:

• 2.2 demonstrate knowledge of epidemiology, demography, genomics and the wider determinants of health, illness and wellbeing and apply this to an understanding of global patterns of health and wellbeing outcomes
• 2.3 understand the factors that may lead to inequalities in health outcomes

This chapter will address the following interventions:

NMC Annexe A:

2 Evidence based, best practice approaches to communication for supporting people of all ages, their families and carers, in preventing ill health and managing their care

• 2.8 provide information and explanation to people, families and carers and respond to questions about their treatment and care and possible ways of preventing ill health to enhance understanding

Annexe B:

Part 1: Procedures for assessing people’s needs for person-centred care

• 1 Use evidence based, best practice approaches to take a history, observe, recognise and accurately assess people of all ages:
  • 1.1 mental health and wellbeing status
  • 1.2 physical health and wellbeing

Chapter aims

After reading this chapter, you will be able to:

• describe the difference between an LTC and an acute condition;
• discuss the incidence of LTCs and their impact on healthcare provision;
• understand how the care and management of people living with a long term condition are organised;
• reflect on the physical and psychological impacts of living with LTCs;
• recognise the importance of appropriate care during the transition from child to adult services.

Introduction

When I was looking after it I could cope better, I checked her blood levels, made sure her insulin was given properly, but now I’m supposed to let go, trust her to manage and it’s terrifying.

(Mother of a 15-year-old girl living with type 1 diabetes)

The amount of times I was going to give up (smoking), after every big birthday, and now the doctor says this is it, it’ll only get worse, I can’t run around with the grandkids without getting out of breath, I feel old before I’m ready … I know I’ve got to stop but I don’t know how.

(54-year-old male diagnosed with COPD)

There’s a sense of hopelessness as everyday things I took for granted become more difficult. You have to adjust your goal posts. I focus on tomorrow now, not so much about what I won’t be able to control in the future.

(62-year-old female diagnosed with motor neurone disease six months ago)

Diagnosis of a long term condition (LTC) can occur at all stages across the lifespan, resulting in different implications for the person, their future and for those caring for them. For a child and their family, a diagnosis of asthma will mean a lifetime of adjustment and self-management of their condition. For a person diagnosed with type 1 diabetes, it may mean making lifestyle choices that they do not want to make, or living with the consequences. For a person learning to live with the long term complications of a condition, this could mean a long process of readjustment and finding new ways of doing things. Not only will their immediate concerns be different, the impact that their condition has on their day-to-day life will vary across the person’s life. This will result in a range of needs having to be met, with the impact being felt physically, emotionally, socially and psychologically. In order for you to effectively support people living with LTCs, their family and carers, it is important to have an understanding of what LTCs are, their incidence across the lifespan and the frameworks used to guide their care and management. In order to do this, this chapter will develop your knowledge and understanding about LTCs, including transition of care from child to adult services and the importance of recognising the physical and psychological impact of living with LTCs.

Activity 1.1 Critical thinking

The Department of Health (DH) defines an LTC as: a condition that cannot, at present, be cured but is controlled by medication and/or other treatment/therapies (DH, 2012).

Using the above quote as a starting point, take some time to answer these questions.

• How many LTCs can you list?
• What is the difference between an acute condition and an LTC? Can you answer in terms of onset, duration, treatment and outcome?

A brief outline answer is given at the end of the chapter.

Activity 1.1 has drawn your attention to the complex nature of LTCs, their care, management and prognosis. Over time, it is likely that the symptoms of the condition become worse and there is a gradual, or sometimes sudden, deterioration in the health and well-being of the person living with the condition.

The incidence and impact of LTCs globally and in the UK

Globally, 70 per cent of deaths are attributable to LTCs, totalling over 40 million deaths a year. Cardiovascular disease, cancers, respiratory diseases and diabetes account for 80 per cent of all of these deaths and between them they share the following risk factors: tobacco use, physical inactivity, harmful alcohol use and unhealthy diets (WHO, 2017). This highlights and emphasises the fact that the majority of LTCs are exacerbated by lifestyle choices.

Living with an LTC can have a profound effect on a person’s quality of life. Over 40 percent of people living with one LTC and over 80 per cent of people living with three or more report chronic pain (DH, 2012). However, the impact of LTCs can be felt beyond the person and their family. Globally, the rise in LTCs and the associated health costs in low-income countries can reduce household incomes; this in turn forces people into poverty and prevents economic development (WHO, 2013).

Since the National Health Service was founded in 1948, both life expectancy and the incidence of LTCs have increased. The Office for National Statistics (ONS) states that today, the life expectancy for men in the UK is 79.2 years and for women 82.9 years (ONS, 2017a). In addition, figures identify that the population of the UK is getting older, with the number of people over the age of 85 doubling in 25 years, equating to 5 per cent of the population (ONS, 2017b). These developments have led to an increase in the incidence and prevalence of LTCs, especially some cancers – e.g., prostate, chronic kidney disease and diabetes (DH, 2012).

The Department for Health (DH) estimates that the number of people living with LTCs will remain relatively stable over the next ten years, but that the number of people living with multiple LTCs will rise from 1.9 million (in 2008) to 2.9 million in 2018 (DH, 2012). Figures from the DH (2012) estimate that approximately 10 per cent of children under the age of 10 are living with one or more LTC, and of these, 2 per cent are living with a mental health LTC and 4 per cent are living with asthma. By the age of 60, 40 per cent of people have one or more LTCs, rising to 70 per cent in the over 80s (DH, 2012).

The most common LTCs are diabetes, mental health problems, hypertension, asthma, musculoskeletal problems and heart disease (DH, 2012). In the UK, people living with LTCs are the most intensive users of health and social care services; currently, 70 per cent of the health budget is spent on the 30 per cent of the population living with LTCs (George and Martin, 2016). Therefore, to promote well-being and to reduce pressures on health and social care services, the care and management for people with LTCs should focus on delaying the progression of LTCs through effective self-management. Combating LTCs, both in the UK and globally, requires change on many levels, from supporting a person to make a change in their lifestyle to promoting public health policies that promote the prevention of LTCs.

Case study: Frazer

Frazer was diagnosed with type 1 diabetes when he was 8 years old. As a child, Frazer was supported in managing his condition by his parents. However, as he grew up and became a young person, he did not manage his diabetes well. He started to smoke and drink heavily; this made it harder for him to maintain his blood glucose levels below 7.8mmol/l and throughout his early adulthood his blood glucose levels were consistently raised.

Frazer lives with his partner Claire and their 11-year-old daughter Fiona. Claire works full time for a local whisky distillery. Frazer works part time as an office administrator and takes care of his daughter after school. Frazer stopped smoking five years ago; however, he continues to drink alcohol on a daily basis, despite being asked to stop by family and healthcare professionals.

Frazer is now 47 years old and was diagnosed with diabetic polyneuropathy in his late 30s; this means that he has reduced nerve sensation in his feet. He has had both great toes amputated as a result of this; in addition, he has had longstanding problems with foot ulcers and recurrent infections. Most recently, Frazer has received negative pressure wound therapy as an inpatient to try to prevent amputation of his lower leg.

Activity 1.2 Critical thinking

Read the case study above about Frazer and then answer the following questions.

• Over the course of his disease progression, what health and social care services would Frazer and his family access? Can you identify these services within the clinical area that you work in and do you know how to refer to them?
• What impact will Frazer’s LTC have on his family?

A brief outline answer is given at the end of the chapter.

Activity 1.2 emphasises the impact that caring and managing LTCs has not only for health and social care services, but for the family of the person living with the condition. Over the course of their life, people living with LTCs will have contact with many health and social care professionals. Their care may be delivered in a primary, secondary or tertiary care setting. However, public policy (NHS, Scotland, 2010; Department of Health, Social Services and Public Safety (DHSSPS), 2012; NHS England, 2017; Wales Audit Office, 2014) emphasises the importance of health promotion and self-management in LTCs with out-of-hospital care playing a larger part in overall NHS services. This is reflected in Activity 1.2 where it can be seen that the majority of Frazer’s care and management is provided in primary care. In all of these documents there is a clear emphasis on the importance of working with the person to provide patient-centred care and promote empowerment, self-care and management. As an LTC progresses, professionals are expected to deliver effective care and case management, and prepare for palliative care requirements.

Quality Outcomes Framework

The Quality Outcomes Framework (QOF) is a voluntary, annual incentive programme that pays GP surgeries for achievement in three doma...

Table of contents

• Cover
• Half Title
• Publisher Note
• Title Page
• Copyright Page
• Contents
• Publisher Note
• Publisher Note
• Acknowledgements
• About the authors
• Acknowledgements
• Introduction
• Chapter 1 Long term conditions across the lifespan
• Chapter 2 The nurse–patient relationship in long term conditions
• Chapter 3 Health promotion in long term conditions
• Chapter 4 Self-management in long term conditions
• Chapter 5 Quality of life and symptom management in long term conditions
• Chapter 6 Managing complex care in long term conditions
• Chapter 7 Palliative care in long term conditions
• Glossary
• References
• Index