Chronic Illness, Persons and Their Families

CHRONIC ILLNESS, PERSONS AND
THEIR FAMILIES
By Marisol Jane T. Jomaya

MAN - I
ILLNESS
 a state in which a person’s physical, emotional,
intellectual, social, developmental or spiritual
functioning is diminished or impaired compared with
previous experience.
not synonymous to disease
includes the disease process and the effect of
functioning and well being in all dimensions.
i.e. CANCER, LEUKEMIA
Types of Illness:
1. ACUTE ILLNESS – short duration and is severe, symptoms
appear abruptly are intense and often subside after a relatively
short period of time.
2. CHRONIC ILLNESS – persists usually longer than 6 months
and can also affect functioning in any dimension. The client may
fluctuate between maximal functioning and serious health
relapses that may be life threatening.
 “A chronic disabling disease interferes with ongoing life
adaptations by making the performance of routine tasks
more challenging.” (Mechanic 1995)
 *** Chronic illness is the leading health problem
in North America for older adults and children.
Issues surrounding its acceptance and
management are complex and overwhelming.
PREVALENCE AND CAUSES OF CHRONIC ILLNESS/CONDITIONS
Chronic conditions have become the major cause of
health related problems in developed and developing
countries giving these countries the dual burden of
trying to eradicate infectious diseases while learning to
manage chronic conditions.
Longer life spans because of advances in technology
and pharmacology, improved nutrition, safer working
conditions and greater access for some people to
health care.
Improved screening and diagnostic procedures,
enabling early detection and treatment of diseases.
Prompt and aggressive management of acute
conditions, such as myocardial infarction and AIDS
related infections
The tendency to develop single or multiple chronic

illnesses with advancing age.
Modern lifestyle factors such as smoking, chronic
stress and obesity, that increase the risk for chronic
illnesses, such as pulmonary disease, hypertension and
cardiovascular diseases.
ILLNESS BEHAVIOR
it involves how people monitor their bodies, define
and interpret their symptoms, take remedial
actions and use the health care system.
Affected by personal history, social situations, social

norms and the opportunities or constraints of
community institutions.
 Can be used as coping mechanisms – view illness as release

from responsibilities or view illness as added stressors or
burden
VARIABLES INFLUENCING ILLNESS AND ILLNESS
BEHAVIOR
INTERNAL
PERCEPTION OF SYMPTOMS
 If client believes symptoms disrupt their normal routine they
are more likely to seek health care assistance than if they do
not perceive the symptoms to be disruptive
NATURE OF ILLNESS
 Clients with acute illness are more likely to seek health care
assistance and comply readily with therapy. On the other
hand, clients with chronic illness with symptoms which may
not be cured but only partially relieved may not be motivated
to comply
EXTERNAL
VISIBILITY OF SYMPTOMS
SOCIAL GROUP/SOCIAL
SUPPORT
 Client reacts more
positively when there is
social support and at the
same time practicing
positive health behavior.
CULTURAL BACKGROUND
 Culture teaches the person how to be healthy, how to
recognize illness and how to deal with it. Ethnic differences
can influence decisions about health care and the use of
diagnostics as well as health services.
ECONOMIC VARIABLE
Because of financial constraints, client delays
treatment and attempt to carry out daily activities.
ACCESSIBILITY TO HEALTH CARE SYSTEM
Economic variable and seeking health care service
are interrelated factors. For many clients entry into
the system is complex and confusing.
** Illness is never an isolated life event. Client and family
must deal with the changes resulting from the illness
and treatment
CHARACTERISTICS OF CHRONIC ILLNESS
Managing chronic illness involves more than
managing medical problems. Associated psychological
and social problems must also be addressed.
Chronic illnesses usually involve many different phases

over the course of a person’s lifetime. There can be
acute periods, stable and unstable periods, flare ups
and remissions.
Keeping chronic conditions under control requires
persistent adherence to therapeutic regimens.
One chronic disease can lead to development of other
chronic conditions.
Chronic illness affects the whole family. Family life can
be dramatically altered as a result of role reversals,
unfilled roles, loss of income, time spent managing
illness, decreases in family socialization activities and
the costs of treatment.
The major responsibility for the day to day
management of illness falls upon the shoulders of
chronically ill people and their families. The home
rather than the hospital is the center of care.
The management of chronic conditions is a process of

discovery.
Managing chronic conditions is a collaborative process.
The management of chronic illness is expensive.

Chronic conditions raise difficult ethical issues for the
patient, health care professionals and the society.
Living with chronic illness means living with
uncertainty.
PHASES OF CHRONIC ILLNESS
1.PRETRAJECTORY PHASE
-is a stage wherein a person is at risk for developing
chronic conditions because of genetic factors or lifestyle
behaviors which increases susceptibility to chronic
illness.
2. TRAJECTORY PHASE
-is characterized by the onset of symptoms or disability
associated with a chronic condition.
3. STABLE PHASE
-indicates that symptoms and disability are being
managed adequately.
4. UNSTABLE PHASE
-is characterized by an exacerbation of illness symptoms,
development of complications or reactivation of an
illness in remission.
5. ACUTE PHASE
- is characterized by sudden onset of severe or
unrelieved symptoms or complications that require
hospitalizations for their management.
6. CRISIS PHASE
-is characterized by a critical or life threatening situation
that requires emergency treatment or care.
7. COMEBACK PHASE
-is the period in the trajectory marked by recovery after
an acute period.
8. DOWNWARD PHASE
- marks the worsening of the condition. Symptoms and
disability continue to progress despite attempts to gain
some control through the treatment and management
regimen.
9. DYING PHASE
 is characterized y the gradual or rapid decline in the
trajectory despite efforts to halt the disorder or slow
the decline through illness management; it is
characterized by failure of life maintaining body
functions.
IMPACT OF ILLNESS IN CLIENT AND FAMILY
1.BEHAVIORAL AND EMOTIONAL CHANGES
 Short term, non life threatening illness evokes few
behavioral changes in the functioning of the client and
the family.
 Severe illness, particularly one that is life threatening ,

can lead to more extensive emotional and behavioral
changes such as DABDA
 Hopelessness/powerlessness
2. IMPACT ON BODY IMAGE
Body image is the subjective concept of physical
appearance. Some illnesses result in changes in
physical appearance and clients and families react
differently to these changes.
When a change in body image occurs the following

phases is undergone.
SHOCK, WITHDRAWAL, ACKNOWLEDGEMENT,

ACCEPTANCE, REHABILITATION
4. IMPACT ON FAMILY ROLES
When an illness occurs, parents and children try to
adapt to the major changes resulting from a family
members’ illness.
ROLE REVERSAL is very common. It leads to stress,
conflicting responsibilities or direct conflict over
decision making.
3. IMPACT ON SELF CONCEPT
Self –concept is a mental self image of strengths and
weaknesses in all aspect of personality.
It depends in part of body image and roles as well as

other aspects of psychology and spirituality.
Important in family relationships or relationship with

significant others. A client whose self concept changes
because of illness may no longer meet family
expectations, leading to tension or conflict.
5. IMPACT ON FAMILY DYNAMICS
Family dynamics is a process by which the family
functions, makes decisions, give support to individual
members and copes with everyday changes and
challenges.
If a parent in a family becomes ill, family activities and
decision making often come to a halt as the other
family members wait for the illness to pass, or they
delay action because they are reluctant to assume the
ill person’s roles and responsibilities.
INTERVENTIONS
A. EMPOWERMENT
The purpose of the nurse client relationship is to
maintain and restore control to clients.
Empowerment is a social process of identification and

support of an individual’s abilities to attend to one’s
needs to problem solve and to activate necessary
resources to control one’s own life.
HEALTH COACHING
DISCHARGE PLANNING
COLLABORATION
SELF MANAGEMENT
CONTROL
 SELF
DETERMINATION
 ESTABLISHING A
SENSE OF MASTERY
 CLIENT AND FAMILY

EDUCATION
 HEALTH SYSTEM
NAVIGATION
 ADVOCACY
DECISION MAKING
ANTICIPATORY GUIDANCE
CULTURAL COMPETENCE
PROMOTING HOME AND COMMUNITY
BASED CARE
TEACHING PATIENTS SELF CARE
 One of the goal of nursing in the 21st century is to
prevent chronic conditions and care the people
affected by them.
 Promotion of healthy lifestyle, encouraging the use of

safety and disease prevention measures and
prevention should begin early in life and continue
throughout the life span.
 Patient and family teaching is one of the most
significant aspect of nursing care and may make the
difference in the ability of patients and their families
to adapt to chronic health conditions.
CONTINUING CARE
 Chronic Illness management is a collaborative process
between a patient, family, nurse and other health care
professionals. Collaboration is not limited to hospital
settings, rather it is important in all settings and
throughout the illness trajectory.
Management at home
 Nurses should think beyond the individual level to the
community and global levels. In terms of illness
prevention and health promotion, this entails wide
ranging efforts to assess people for risk factors for
chronic illness.
REFERENCES
Fundamentals of Nursing, 7th edition,Potter and
Perry
Fundamentals of Nursing, Kozier
Brunner and Suddarth’s Textbook of Medical

Surgical Nursing, Brunner/Suddarth
Chronic illness impact and intervention,

Larsen/Morof Lubkin
END

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CHRONIC ILLNESS, PERSONS AND

By Marisol Jane T. Jomaya

The tendency to develop single or multiple chronic

Affected by personal history, social situations, social

 Can be used as coping mechanisms – view illness as release

Chronic illnesses usually involve many different phases

The management of chronic conditions is a process of

Managing chronic conditions is a collaborative process.

The management of chronic illness is expensive.

 Severe illness, particularly one that is life threatening ,

When a change in body image occurs the following

SHOCK, WITHDRAWAL, ACKNOWLEDGEMENT,

It depends in part of body image and roles as well as

Important in family relationships or relationship with

Empowerment is a social process of identification and

 CLIENT AND FAMILY

 Promotion of healthy lifestyle, encouraging the use of

Fundamentals of Nursing, Kozier

Brunner and Suddarth’s Textbook of Medical

Chronic illness impact and intervention,

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