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1773 results in Nursing

Page 61 of 89

  • 2 - Implementing the macro level of the ICCCF

  • from Part 1 - Frameworks for Chronic Care Management
  • Linda Deravin-Malone, Charles Sturt University, Wagga Wagga, New South Wales, Judith Anderson, Charles Sturt University, Bathurst, New South Wales
  • Book:
    Chronic Care Nursing
    Published online:
    21 June 2018
    Print publication:
    01 July 2016, pp 20-32

  • Summary

    LEARNING OBJECTIVES

    After studying this chapter, you should be able to:

  • • explain how the macro level of the Innovative Care for Chronic Conditions Framework addresses care for the person with a chronic condition

  • • understand the importance of national health policy and strategic initiatives to improve primary care services

  • • describe quality and monitoring systems within a chronic care nursing context

  • • understand the importance of education for the nurse and other health professionals in the specialty of chronic care.

    • Introduction

    The macro level of the Innovative Care for Chronic Conditions Framework (ICCCF) reviews policy development and resource allocation. This level also considers the legislative framework and the ability of policymakers to adapt policies to meet changes in health care requirements and create effective intersectoral links. The fragmentation of financial incentives and its impact on health outcomes and services are considered. Maintaining quality health care and monitoring systems are included, together with continuing education for registered nurses.

    A positive policy environment is the macro level that is required to support the micro and meso levels of the ICCCF. It is this level that provides the leadership, regulation and financial support for the health organisation, community and patient interaction (Epping-Jordan, Pruitt, Bengoa & Wagner, 2004).

    Chronic conditions can be viewed as being on a continuum, spanning those with the condition to those without the condition, as these conditions develop over time, beginning with risk, developing into diagnosis and then moving into complications. An awareness of this continuum is required to understand the need to invest at all points in the development of chronic conditions in order to manage them effectively – this is why the ICCCF requires three levels in order to manage chronic conditions (Epping-Jordan et al., 2004).

    Competency

    Table 2.1 identifies the national competency standards for the registered nurse from the Nursing and Midwifery Board of Australia (NMBA) and the Nursing Council of New Zealand (NCNZ) that are addressed in this chapter.

    Describing the macro level

    The macro level of the ICCCF describes the positive policy environment that supports the care provided for people with chronic conditions (see Figure 2.1).

  • 5 - The Australian and New Zealand health care systems

  • from Part 1 - Frameworks for Chronic Care Management
  • Linda Deravin-Malone, Charles Sturt University, Wagga Wagga, New South Wales, Judith Anderson, Charles Sturt University, Bathurst, New South Wales
  • Book:
    Chronic Care Nursing
    Published online:
    21 June 2018
    Print publication:
    01 July 2016, pp 64-76

  • Summary

    LEARNING OBJECTIVES

    After studying this chapter you should be able to:

  • • describe the Australian and New Zealand health care systems

  • • identify and describe the health care challenges faced by rural communities in Australia and New Zealand, including Aboriginal and Torres Strait Islander and Māori rural communities

  • • identify the national health priorities and strategies for achieving improved health outcomes in Australia and New Zealand

  • • critically analyse health differentials and health inequality and their interaction on individuals, groups and communities

  • • discuss the impact that vulnerability has on individuals and populations, and the importance of resilience.

    • Introduction

    This chapter describes the Australian and New Zealand health care systems, which are both predominantly publically funded and aim to provide equity in access to health care for all citizens. In Australia, there is also a private market model that provides a significant amount of funding for health care services. In New Zealand, the Treaty of Waitangi is most important in underpinning all health and social policies, assuring partnership, participation and protection of Māori (NZMOH, 2014b). As in many countries around the world, the Australian and New Zealand governments and health care systems face the significant challenges of an increasing burden of chronic disease among ageing populations. Another challenge in both Australia and New Zealand is that some people live in rural and remote locations where morbidity and mortality are higher than in metropolitan areas. Rurality is classified in Australia according to three systems that determine the level of remoteness and funding available (AIHW, 2004). The impact of rurality is greater in Aboriginal and Torres Strait Islander and Māori peoples and is reflected in their overall poorer health status compared to the non-Indigenous populations (AIHW, 2014; NZMOH, 2014a).

    The Integrated Care for Chronic Conditions Framework (ICCCF) provides a model for change to address these challenges. National health priorities, developed in response to the World Health Organization (WHO) ‘Health for All’ global strategy (WHO, 1981), provide guidance for governments in promoting the health of their citizens and addressing the needs of the most vulnerable groups. Health differentials and inequalities are caused by a range of complex factors including social and economic factors, health behaviours, physical factors, environmental issues, and access to health services and their utilisation.

  • 13 - Arthritis and musculoskeletal conditions

  • from Part 2 - Nursing Care of Clients with Chronic Conditions
  • Linda Deravin-Malone, Charles Sturt University, Wagga Wagga, New South Wales, Judith Anderson, Charles Sturt University, Bathurst, New South Wales
  • Book:
    Chronic Care Nursing
    Published online:
    21 June 2018
    Print publication:
    01 July 2016, pp 194-209

  • Summary

    LEARNING OBJECTIVES

    After studying this chapter, you should be able to:

  • • recognise the biopsychosocial impact arthritis has on the individual as well as the community

  • • understand the underlying pathophysiology and associated modifiable and non-modifiable risk factors relating to osteoarthritis, rheumatoid arthritis and osteoporosis

  • • identify and discuss health prevention and promotion strategies relevant to these conditions

  • • highlight the nurse's role in the collaborative management of these conditions

  • • discuss opportunities for advanced nursing practice in relation to arthritis and osteoporosis.

    • Introduction

    In Australia and New Zealand, arthritis and other musculoskeletal conditions affect a significant proportion of the general population. For example, in Australia it is estimated that approximately 6.1 million people are affected, and in New Zealand arthritis is cited as being the biggest cause of disability with more than half a million people being affected during their lifetime (AIHW, 2014a; Ministry of Health, Manatu Hauora, 2015). People tend to view arthritis as a single disease entity when in fact it may be more accurately described as an umbrella term for more than 100 conditions that affect the musculoskeletal system (Arthritis and Osteoporosis Victoria, 2013). The word ‘arthritis’ originates from the Greek words for joint, ‘arthron’, and inflammation, ‘itis’, with the hallmarks of the condition being pain, swelling and stiffness (AIHW, 2014b). In relation to the impact of this condition, consideration of the biopsychosocial model of care is advantageous in that it delineates a framework that considers the complex interaction of biological, psychological and social factors on individuals as well as the community (Borrell-Carrio, Suchman & Epstein, 2004). To illustrate, arthritis is a significant contributor to disability in that it limits physical activity subsequently affecting the quality of life of those affected.

    The way such conditions affect individuals is highly variable. However, despite their diversity in relation to functional changes, these conditions are linked anatomically in terms of their association with pain and impaired physical functioning (AIHW, 2010). The burden of this group of diseases on the Australian and New Zealand health system is considerable. For example, osteoarthritis (OA), the most common form of arthritis, costs the Australian government $3.75 billion annually (Arthritis and Osteoporosis Victoria, 2013).

  • 3 - Implementing the meso level of the ICCCF

  • from Part 1 - Frameworks for Chronic Care Management
  • Linda Deravin-Malone, Charles Sturt University, Wagga Wagga, New South Wales, Judith Anderson, Charles Sturt University, Bathurst, New South Wales
  • Book:
    Chronic Care Nursing
    Published online:
    21 June 2018
    Print publication:
    01 July 2016, pp 33-48

  • Summary

    LEARNING OBJECTIVES

    After studying this chapter, you should be able to:

  • • explain how the meso level of the Innovative Care for Chronic Conditions Framework addresses care for the person with a chronic condition

  • • understand how to build a supportive environment with the person with a chronic condition and other health partners

  • • explore aspects of health promotion and education within chronic care nursing

  • • consider the available resources within the community that support the care of the person with a chronic condition, and identify methods to develop future resources within health care organisations

  • • describe the impact of stigma in relation to chronic illness.

    • Introduction

    This chapter describes the meso level of the Innovative Care for Chronic Conditions Framework (ICCCF), which focuses on the health care environment and how care is organised. Tools and expertise that are required by nurses to provide evidence-based care within health care organisations, and the need to provide health education and promotion are discussed. This level of the ICCCF, with its focus on the entire organisation, is where other members of the team are valued for their involvement and support of the client. The benefits of information systems and community resources in order to provide comprehensive chronic care are addressed.

    The combining of large health care organisations and community groups to provide health care can lead to very effective interventions, but may require assistance to coordinate and to support clients who may have difficulty understanding the roles of such a variety of groups and people. Nurses are in a unique position to coordinate such care and to advise clients (Anderson & Malone, 2015) about what is available both within their own organisations and in the community, and thereby ensure the best possible outcomes.

    The meso level of the ICCCF is the link between the interaction of the client and the health care team (the micro level) and the overall environment in which care is provided (the macro level). In this way, the meso level supports the interaction with clients by providing the space and services where the interaction takes place, while the macro level provides the regulation and funding to ensure the safety and functioning of the meso-level organisations and community.

  • 15 - Dementia care

  • from Part 2 - Nursing Care of Clients with Chronic Conditions
  • Linda Deravin-Malone, Charles Sturt University, Wagga Wagga, New South Wales, Judith Anderson, Charles Sturt University, Bathurst, New South Wales
  • Book:
    Chronic Care Nursing
    Published online:
    21 June 2018
    Print publication:
    01 July 2016, pp 226-239

  • Summary

    LEARNING OBJECTIVES

    After studying this chapter, you should be able to:

  • • describe the impact of dementia on Australian and New Zealand societies

  • • describe various types of dementia and their associated signs and symptoms

  • • understand the impact of living with dementia on individuals and families

  • • understand the role of the nurse in caring for people with dementia.

    • Introduction

    Australia's and New Zealand's ageing populations represent a significant challenge for both nations’ health care services, aged care and social policy (Ball et al., 2015; Clancy, 2015). The Commonwealth government of Australia and the Ministry of Health in New Zealand have initiated major health reforms by developing action plans for dealing with dementia and increasing dementia services (Clancy, 2015; NZMOH, 2014), consistent with the Innovative Care for Chronic Conditions Framework (ICCCF).

    Australia and New Zealand are ageing societies with high life expectancies (Brodaty & Cumming, 2010; Nay et al., 2015). The management of chronic diseases, including the increasing prevalence of dementia, presents a significant challenge for health services, social policy and aged care (Nay, Garratt & Fetherstonhaugh, 2014; Travers, Lie & Martin-Khan, 2015). The number of people living with dementia in rural and regional parts of Australia and New Zealand is increasing rapidly, resulting in an increase on the demands of available services (Clancy, 2015).

    Dementia has been recognised as a national health priority area and strategies to prevent, delay the onset of and reduce the impact of dementia to contain an ever-increasing disease, health care and costs burden, are crucial (Ball et al., 2015; Travers et al., 2015). The number of people with dementia is predicted to rise by 327 per cent between 2015 and 2050 (Moyle, Kellett, Ballantyne & Gracia, 2011). In 2050, it is expected that there will be 900 000 people with dementia in Australia and New Zealand at an estimated cost of $6 billion in health care and lost productivity (Panegyres & Gray, 2010). As the incidence of dementia in Indigenous individuals in both Australia and New Zealand is significantly higher than non-Indigenous individuals, additional services and resources may be required (Taylor & Guerin, 2014).

    Dementia should not be regarded as a normal part of ageing; it can happen to anybody, but it is more common after the age of 65.

  • 6 - Cancer control

  • from Part 2 - Nursing Care of Clients with Chronic Conditions
  • Linda Deravin-Malone, Charles Sturt University, Wagga Wagga, New South Wales, Judith Anderson, Charles Sturt University, Bathurst, New South Wales
  • Book:
    Chronic Care Nursing
    Published online:
    21 June 2018
    Print publication:
    01 July 2016, pp 79-95

  • Summary

    LEARNING OBJECTIVES

    After studying this chapter, you should be able to:

  • • describe the impact of cancer as a chronic condition

  • • describe the targeted responses required to prevent and mitigate the impact of chronic cancer at a population level

  • • discuss how nurses can promote behaviour change to help meet specific supportive care needs

  • • discuss the potential contribution of all nurses in meeting chronic care needs for the person affected by cancer

  • • describe advanced practice roles in cancer within the chronic conditions framework.

    • Introduction

    Cancer is a disease in which the usual controls of cell division are lost following a series of mutations and uncontrolled cell growth occurs. Cancer can be experienced as an acute illness, but is increasingly viewed from a health system policy perspective as a chronic condition (AGDH, 2015). Cancer is one of the leading causes of morbidity and mortality in Australia (AIHW, 2014a).

    Despite significant improvements in prevention and screening, the overall incidence of cancer is increasing, largely due to the ageing population. Modifiable lifestyle factors are also contributing to cancer incidence. Collectively, overweight and obesity, physical inactivity and unhealthy eating are second only to tobacco as preventable risk factors for cancer (Cancer Council Australia, 2015). In Australia, it is estimated that there will be 169 648 new cases of cancer nationally by 2024, based on an average annual increase of 3.3 per cent per year from 2010 (AIHW, 2014a). Current trends predict that one in two Australians will be diagnosed with cancer by the age of 85. Similarly, in New Zealand cancer is the biggest cause of illness, disability and premature mortality (17.5 per cent) within the context of an ageing population (NZMOH, 2014). With the growing numbers of people being diagnosed with cancer there will be an increased demand on the health system and, importantly, primary health care systems to support the needs of individuals living with cancer or in the shadow of cancer. It is important to understand that many other people are also affected indirectly when a family member or someone else close to them has cancer.

    Survival and prevalence

    While the incidence of cancer is increasing, survival prospects from cancer are also increasing in response to effective population-based screening programs, earlier detection rates, better diagnostic methods, lifestyle modifications and advances in treatments.

  • 9 - Depression, anxiety, and substance misuse and abuse

  • from Part 2 - Nursing Care of Clients with Chronic Conditions
  • Linda Deravin-Malone, Charles Sturt University, Wagga Wagga, New South Wales, Judith Anderson, Charles Sturt University, Bathurst, New South Wales
  • Book:
    Chronic Care Nursing
    Published online:
    21 June 2018
    Print publication:
    01 July 2016, pp 127-142

  • Summary

    LEARNING OBJECTIVES

    After studying this chapter, you should be able to:

  • • understand the prevalence of anxiety, depression, and substance misuse and abuse in Australia and New Zealand

  • • understand the impact of chronic mental illness on individuals, families and communities

  • • discuss the significance of attitudes and beliefs and the impact of stigma on individuals with a mental health illness and their carers

  • • identify the nurse's capacity to engage with individuals, carers and families affected by mental illness to reach optimal health and enable the nurse to realise their potential through reflective practice

  • • describe reflective caring and sensitive practice.

    • Introduction

    Nurses are at the forefront of the health care profession and have a vital role in supporting individuals and their family members in their recovery and restoring mental health to optimal levels. Regardless of their practice, be it in a hospital or community setting, nurses have opportunities every day to promote mental health and provide interventions to assist recovery, improve mental health and wellbeing, and prevent future episodes of illness. This can be achieved through meaningful connection with individuals and families, initiating health promotion and education, and facilitating connections with others.

    Mental health has been identified as one of the major health priorities in Australia and New Zealand (AIHW, 2014; NZMOH, 2014). Mental health has been defined as a state of wellbeing in which an individual can reach their own potential and cope with the normal stressors of life (WHO, 2014). Mental health and wellbeing are influenced by individual characteristics or attributes, socioeconomic circumstances and the broader environment in which people live (WHO, 2012).

    Almost half (45 per cent) of all Australians aged 16–85 will experience mental illness some time in their lives and 1 in 5 will experience mental illness in any given year (AIHW, 2014). The most commonly diagnosed mental illness is anxiety disorders at 14.4 per cent (1 in 7), followed by mood disorders at 6.2 per cent (1 in 16) and substance misuse and abuse disorders at 5.1 per cent (1 in 20) (Slade et al., 2009) (see Figure 9.1). Less prevalent are psychotic disorders (AIHW, 2014) (see Chapter 10).

  • 12 - Chronic respiratory conditions (asthma and COPD)

  • from Part 2 - Nursing Care of Clients with Chronic Conditions
    • By Michelle Baird, Western NSW Local Health District, Dubbo, New South Wales, Elizabeth Forbes, Lung Foundation Australia, Pulmonary Rehabilitation Network, Jody Hook, Canberra Hospital supporting patients in nurse-led clinics and in the community setting, Heather Latham, Charles Sturt University, Bathurst, NSW
  • Linda Deravin-Malone, Charles Sturt University, Wagga Wagga, New South Wales, Judith Anderson, Charles Sturt University, Bathurst, New South Wales
  • Book:
    Chronic Care Nursing
    Published online:
    21 June 2018
    Print publication:
    01 July 2016, pp 175-193

  • Summary

    LEARNING OBJECTIVES

    After studying this chapter you should be able to:

  • • define asthma and chronic obstructive pulmonary disease (COPD), identify the pathophysiological differences, risk factors, and presentations, and explain the principles of nursing care

  • • provide education to clients and their families on health promotion and prevention strategies regarding asthma and COPD

  • • discuss the nurse's role in a variety of health care settings

  • • describe advanced nursing practice in the management of clients and their carers with asthma and COPD.

    • Introduction

    Two chronic conditions affecting the respiratory system discussed in this chapter are asthma and chronic obstructive pulmonary disease (COPD). Both of these conditions are serious chronic health problems in Australia and New Zealand, and while the symptoms experienced by clients can be similar, the aetiology, pathophysiology and treatments vary between the two conditions. The important role that nurses have in the management of these conditions is discussed in this chapter.

    Asthma is Australia's most widespread chronic health problem, affecting one in six children and one in nine adults (Andrews, Jones & Mullan, 2014, p. 34). Asthma has a 9.9 per cent prevalence rate in Australia, which is high by international standards. The rate of asthma among Indigenous Australians is almost twice as high as the rate for non-Indigenous Australians. The difference in prevalence exists across all age groups but is more marked for older Indigenous peoples (ABS, 2013a). People living in inner regional areas experience the highest incidence of asthma – 12.4 per cent compared to 9.7 per cent for those living in major cities and 9.4 per cent for outer regional and remote area residents (ABS, 2012). New Zealand has the second-highest prevalence of asthma in the world, with one in seven children aged 2–14 years (14 per cent) requiring asthma medication and one in nine adults (11 per cent) diagnosed with asthma. Māori and Pacific Island people and people from lower socioeconomic groups are disproportionately affected by asthma (Asthma Foundation, 2012).

    In Australia, COPD is the fifth leading cause of death (AIHW, 2015). COPD is the fourth leading cause of death in New Zealand, ranked second in men and seventh in women for years lost to disability (Lawes et al., 2012).

Page 61 of 89