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1773 results in Nursing

Page 62 of 89

  • 19 - Parkinson's disease and multiple sclerosis

  • 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 289-302

  • Summary

    LEARNING OBJECTIVES

    After studying this chapter, you should be able to:

  • • understand the impact of Parkinson's disease and multiple sclerosis on people living with these chronic conditions

  • • describe the signs, symptoms and pathophysiology of Parkinson's disease and multiple sclerosis

  • • describe health promotion and prevention strategies which are appropriate for people living with Parkinson's disease or multiple sclerosis

  • • describe nursing assessment and management strategies of the person living with Parkinson's disease or multiple sclerosis

  • • understand advanced nursing practice in relation to Parkinson's disease and multiple sclerosis.

    • Introduction

    Multiple sclerosis (MS) and Parkinson's disease are complex disorders. Both of these groups of patients require the strong links and communication between community organisations, such as patient organisations, and acute health care systems. There is a need for collaborative care, and it is a large part of the nursing role that nurses act as advocates and educators for patients and their carers (Chaplin, Hazan & Wilson, 2012). This collaborative link allows patients to be informed and motivated to self-manage their conditions, seeking support appropriately from the health care team and community partners. The incidence of these disorders is provided in Table 19.1.

    Competency

    Table 19.2 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.

    Parkinson's disease – risk factors, pathophysiology and diagnosis

    Parkinson's disease is an incurable, neurodegenerative disease, in which the progressive loss of dopamine neurons causes the disease's classic motor symptoms, alongside a background of cognitive, mood, autonomic and sensory symptoms. It is the most common neurodegenerative disease after Alzheimer's disease. In Australia, it is reported that more than 80 000 people live with Parkinson's disease (Parkinson's Australia, 2015). The burden of Parkinson's disease in Australia is estimated at $775.4 million per year (Deloitte Access Economics, 2011), a figure that includes health system costs at $478.5 million, loss of productivity at $107.3 million and informal care at $11.2 million. Over the course of the disease (most commonly 12 years in length) the average cost, therefore, would be $144 000 per person living with Parkinson's disease.

  • 11 - Diabetes mellitus

  • 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 159-174

  • Summary

    LEARNING OBJECTIVES

    After studying this chapter, you should be able to:

  • • gain an understanding of the global prevalence, risk factors and burden (complications and socioeconomic costs) that diabetes mellitus places on both individuals and the community

  • • understand the pathophysiology, assessment and risk factors of diabetes mellitus

  • • plan individualised care for people with diabetes mellitus including health prevention and promotion

  • • understand the nurse's role in supporting education and self care management strategies.

    • Introduction

    Diabetes mellitus is a serious chronic illness that alters the body's ability to metabolise carbohydrate, fat and protein, and is characterised by fasting plasma glucose levels above 7 mmol/L. The most common forms of diabetes mellitus, type 1 and type 2, are differentiated by unique pathophysiology, clinical presentation concerns, preventative efforts and treatments. Type 1 diabetes accounts for 5–10 per cent of diabetes mellitus cases and is an autoimmune disorder with complete (or near complete) pancreatic cell dysfunction in producing insulin. Type 2 diabetes accounts for 90–95 per cent of diabetes mellitus cases and is associated with insulin resistance and some degree of insulin deficiency.

    Prevalence of diabetes mellitus

    Today, 9 per cent of the global adult population live with diabetes mellitus, with this figure projected to increase to approximately 366 to 439 million in 2030 (Shaw, Sicree & Zimmet, 2010; WHO, 2015). Currently in Australia, over 787 500 people live with type 2 diabetes and over 122 300 people live with type 1 diabetes. However, the condition does not affect everyone equally, with 7 per 100 000 Aboriginal and Torres Strait Islander people being affected by diabetes and 10 per 100 000 non-Indigenous people being affected (AIHW, 2013). Type 1 diabetes is considered to be the most common chronic disease among children under the age of 14, affecting one in every 720 children (AIHW, 2015; JDRF, Australia, 2015). In New Zealand, 257 000 people live with diabetes mellitus, with 40 new cases diagnosed per day (Ministry of Health – Manatu Hauora, 2015). Currently, diabetes mellitus is the eighth leading cause of death globally and is expected to increase to the seventh leading cause of death by the year 2030 (WHO, 2015).

    Diabetes mellitus is associated with microvascular and macrovascular damage because of prolonged hyperglycaemic exposure within the body. Retinopathy, nephropathy and neuropathy are potential microvascular complications (Moore, 2013).

  • 16 - Chronic kidney disease (CKD)

  • 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 240-257

  • Summary

    LEARNING OBJECTIVES

    After studying this chapter, you should be able to:

  • • describe the underlying pathophysiology and risk factors of chronic kidney disease (CKD)

  • • describe the different treatment options for people with CKD

  • • understand the health prevention and health promotion requirements for people with CKD

  • • identify issues affecting quality of life related to treatment of CKD

  • • understand the nurse's role in working with patients with CKD.

    • Introduction

    Chronic kidney disease (CKD) continues to be an under-recognised condition globally and occurs in both adults and children. Kidney Health Australia (2015b) suggests that around 1.7 million Australians over the age of 18 have clinical evidence of CKD, and less than 10 per cent of people with the condition are aware that they have it, as CKD typically has no symptoms. Unfortunately, up to 90 per cent of kidney function can be lost before symptoms become evident. These results are similar in New Zealand with an estimated 7–10 per cent (approximately 210 000 people in 2015) of the total population living with some degree of CKD. The New Zealand Ministry of Health (NZMOH, 2015) states that there was an increase of 84 per cent in 12 years of reported cases of end stage CKD within the New Zealand population.

    CKD is diagnosed when a person has evidence of kidney damage and/or a reduced kidney function which lasts longer than three months (Sandilands, Dhaun, Dear & Webb, 2013). CKD can be categorised into five stages (1–5), in accordance with the glomerular filtration rate (GFR) and the presence of albuminuria. End stage kidney disease (ESKD) is the most severe form of CKD, with those affected often requiring kidney replacement therapy, either in the form of dialysis or kidney transplantation, without which they would not survive (Hite & DeBellis, 2009).

    The health care and economic burden of CKD on individuals, communities and globally is high, and is predicted to further increase as the population ages and the prevalence of diabetes increases. The cost of CKD to the Australian and New Zealand health care budgets accounted for around 1.7 per cent of total expenditure in 2004–05 ($898.7 million), with the cost of treatment for a patient with ESKD on kidney replacement therapy (KRT) such as haemodialysis ranging from $101 189 per person per year in a hospital to $54 017 per person per year in the community/home self-care (AIHW, 2014; NZMOH, 2015).

  • 1 - Frameworks for chronic care management

  • 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 3-19

  • Summary

    LEARNING OBJECTIVES

    After studying this chapter, you should be able to:

  • • understand the impact of chronic disease burden on communities both in Australia and New Zealand

  • • describe what a model of care is and how this applies to chronic care management

  • • outline the Chronic Care Model developed by Wagner et al.

  • • describe the Innovative Care for Chronic Conditions Framework

  • • explain the value of evidence-based practice to patient outcomes and the nursing profession in relation to chronic conditions.

    • Introduction

    Chronic conditions are prolonged and unable to be cured. They frequently have multiple causes, take a long time to develop and can lead to complications (AIHW, 2012). In 2012, chronic conditions accounted for 68 per cent of death in the world (WHO, 2014a). The burden of chronic conditions is estimated to account for approximately 80 per cent of disability adjusted life years (DALYs) and continues to increase, according to the Australian National Chronic Disease Strategy (National Health Priority Action Council, 2006). In Australia and New Zealand in 2014, chronic conditions accounted for 91 per cent and 89 per cent of deaths respectively (WHO, 2014b).

    These figures indicate the substantial impact that chronic conditions have on life worldwide, and this will also impact on health systems (Nuño, Coleman, Bengoa & Sauto, 2012). Nurses, who are the majority of workers within those systems, are able to have a significant impact on dealing with the issues that are arising from the increase in chronic conditions. Health systems will need to reorganise from a focus on acute health care to a focus on addressing and preventing chronic conditions. A focus on prevention, self-management, organisational change and political change is required to create better client outcomes, and this will require specialised skills from nurses if they are to be an effective part of the workforce to make these changes (Nuño et al., 2012). As indicated by the International Council of Nurses (2010), there is a growing global need for nurses to engage with communities and other sectors to intervene at the earliest stages to prevent chronic conditions.

  • 4 - Implementing the micro 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 49-63

  • Summary

    LEARNING OBJECTIVES

    After studying this chapter, you should be able to:

  • • explain how the micro level of the Innovative Care for Chronic Conditions Framework (ICCCF) interacts with other levels in order to provide care for the person with a chronic condition

  • • describe how collaborative client interaction can be fostered between the nurse and the person with a chronic condition

  • • understand important aspects of holistic nursing care, including psychosocial aspects, for the person with a chronic condition

  • • describe the importance of the nursing role at the micro level of the ICCCF.

    • Introduction

    This chapter introduces the micro level of the Innovative Care for Chronic Conditions Framework (ICCCF). This level of the ICCCF focuses on patient interaction and the need to empower patients/clients. The imperative of valuing patient interactions and the role of the nurse in supporting them in self-care strategies is explored. Empowerment as the basis of self-care is described and psychosocial aspects of care are reviewed. Patients/clients and family members are viewed holistically and their contextual backgrounds (for example, cultural and lifestyle factors) are included in the framework (Epping-Jordan, Pruitt, Bengoa, & Wagner, 2004; WHO, 2002).

    Prevention of chronic conditions, early detection, effective management and prevention of complications are all aims of the ICCCF. The micro level focuses on interacting with individuals to meet these aims.

    The micro level is at the centre of the ICCCF, with direct contact and interaction between the patient/client, health care team and the community. This level of the ICCCF is also directly supported by the meso level, which includes the wider community and health care services where this interaction takes place (Epping-Jordan et al., 2004).

    Competency

    Table 4.1 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 micro level

    The micro level of the ICCCF attempts to encapsulate the importance of patient behaviours and the value of good-quality interactions with health care workers (see Figure 4.1). The majority of research that has been undertaken in relation to the care of people with chronic conditions has targeted this level and needs to be well incorporated into current practice (WHO, 2002).

  • 8 - Injury prevention

  • 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 113-126

  • Summary

    LEARNING OBJECTIVES

    After studying this chapter, you should be able to:

  • • understand the impact of injuries on the health and wellbeing of communities

  • • identify potential risk factors for falls

  • • describe the main causes of transportation injuries

  • • describe the signs, pathophysiology and long-term effects of an acquired brain injury

  • • outline the effects of interpersonal violence, including self-harm and assault

  • • consider the impact of chronic pain on an individual that occurs as a result of injury

  • • understand the role of the nurse in injury prevention.

    • Introduction

    Injury prevention has been identified as one of Australia's targeted national health priorities (AIHW, 2015a). In New Zealand, injuries are the fifth most important cause of health loss (NZMOH and Accident Compensation Corporation, 2013). There is a significantly increasing trend in chronic illness and disability as a consequence of falls, transportation injuries, sporting and workplace accidents, and interpersonal violence. Many of these injuries result in hospitalisation. After receiving immediate treatment and stabilisation in the acute care setting, a person may require long-term physical rehabilitation or ongoing psychological support and counselling resulting from the injury sustained.

    Health promotion and prevention programs are critical to raising awareness and reducing the incidence of injuries that occur. Falls account for 39.4 per cent of injuries, transportation 12 per cent, interpersonal violence, including self-harm, 5.9 per cent, assault 5.2 per cent, and other unintentional injuries 32.1 per cent. These alarming statistics have a significant impact on the cost to both people and health systems (AIHW, 2015b). A multi-layered approach is required to reduce the incidence of injuries. This includes government-led awareness programs such as driver safety campaigns (Proffitt & Beacham, 2012; Transport for NSW, 2015), domestic violence awareness (Parliament of Australia, 2011; Proffitt & Beacham, 2012), workplaces improving safety systems, and individuals taking responsibility for their own safety as well. Falls, transportation injuries, acquired brain injuries, interpersonal violence as a result of self-harm or assault, and the chronic pain that often results from injury will be the focus of this chapter.

    Competency

    Table 8.1 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.

  • 18 - End of life 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 273-288

  • Summary

    LEARNING OBJECTIVES

    After studying this chapter, you should be able to:

  • • understand the relationship between chronic conditions and fatal burden in both Australia and New Zealand

  • • identify pain management and symptom control techniques for the person at end of life

  • • consider the issues in providing emergency care for the palliative patient

  • • describe the importance of psychosocial aspects of end of life care

  • • outline the importance of advanced care planning

  • • understand the nurse's role in end of life care.

    • Introduction

    End of life care or palliative care is defined by Palliative Care Australia (2005) as ‘ the care provided for people of all ages who have a life limiting illness, with little or no prospect of cure, and for whom the primary treatment goal is quality of life’. On a global scale, chronic conditions including non-communicable diseases and communicable diseases accounted for 68 per cent and 23 per cent, respectively, of all deaths in 2012 (WHO, 2015).

    Chronic conditions are attributed to be the cause of early death, significantly contributing to fatal burden worldwide. In Australia, chronic conditions accounted for the following mortality rates: cancer (35 per cent), cardiovascular disease (23 per cent), injuries (13 per cent), neurological conditions (6 per cent) and respiratory diseases (5 per cent) of the total burden. These five chronic condition groups were estimated to account for 82 per cent of all years of life lost (YLL) in 2010 (AIHW, 2015). Similarly in New Zealand, chronic conditions accounted for 63 per cent of fatal burden comprising of: cancers (17.5 per cent), vascular and blood disorders (17.5 per cent) followed by mental health disorders (11 per cent), musculoskeletal disorders (9 per cent) and injury (8 per cent) in 2006 (NZMOH, 2014).

    Several national bodies exist which provide guidance and support to nurses working in the area of palliative care. In Australia, Palliative Care Australia (2015b) provides a range of resources, as does Hospice New Zealand (2015) in New Zealand. These bodies provide useful guidelines for best practice that are current and contextualised to country of origin, which can be especially useful for legal issues. The exact model of palliative care used differs due to services and resources available, local legislation, demographics and demand for services (AIHW, 2014).

  • Preface

  • 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 xv-xvi

  • Summary

    Impact of chronic conditions in Australia and New Zealand, and worldwide

    This is the first edition of Chronic Care Nursing: A framework for practice, which we believe will be a useful resource for this area of clinical nursing practice. This book has been developed for undergraduate nurses and registered nurses who wish to develop their knowledge about the care of people living with chronic conditions in our communities.

    The structure of the book is based on the Innovative Care for Chronic Conditions Framework (ICCCF), which is an internationally recognised framework for the delivery of chronic care. The ICCCF extends the Chronic Care Model (CCM) that was developed by Wagner (Wagner, Davis, Schaefer, Von Korff & Austin, 1999). The CCM is well recognised as providing a systematic approach to chronic care management. It incorporates six components: health system (organisation of health care); self-management support; decision support; delivery system design; clinical information systems; and community resources and policies (Stellefson, Dipnarine & Stopka, 2013). The model provides a multidimensional solution to the complex problem of the provision of chronic care (Bodenheimer, Wagner & Grumbach, 2002).

    The Chronic Care Model has been expanded and internationalised by the World Health Organization (WHO) to be developed into the ICCCF. Nurses need to lead the redesign of the health care system in order to improve health outcomes through the implementation of the CCM. The ICCCF extends this model by adding micro, meso and macro levels to it, and incorporates six guiding principles: evidence-based decision making; population focus; prevention focus; quality focus; integration; and flexibility and adaptability (WHO, 2002). These levels extend the involvement of community, and describe policies and financing as the drivers at the macro level (Bengoa, Epping-Jordan, Pruitt & Wagner, 2004). An important aspect of the implementation of this model and framework is how well it is integrated into undergraduate nursing education so that an informed and well-prepared nursing workforce is established in Australia and New Zealand.

    The first section of this textbook focuses on the ICCCF to support the learning of undergraduate student nurses about the complexity of chronic conditions and how the framework is best implemented in order to improve patient outcomes at both a national and international level.

  • 14 - Chronic obesity

  • 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 210-225

  • Summary

    LEARNING OBJECTIVES

    After studying this chapter, you should be able to:

  • • understand the underlying pathophysiology of chronic obesity and the associated risk factors

  • • describe health promotion and prevention strategies appropriate for individuals who are overweight and obese

  • • understand the nurse's role in the management of the chronically obese individual

  • • appreciate the impact chronic obesity has on the future of health care

  • • recognise the importance of advanced nursing practice in the management of obesity.

    • Introduction

    The worldwide prevalence of chronic obesity is rising and Australia is no exception with approximately 60 per cent of adults and 25 per cent of children classified as either overweight or obese (Grima & Dixon, 2013). The public health burden of obesity is significant as it is closely associated with other chronic conditions including cardiovascular disease and diabetes mellitus (Schuklenk & Zhang, 2014). Chronic obesity has not only physical implications for the individual – excess weight is closely associated with a reduced quality of life and an increased risk of morbidity and mortality (Grima & Dixon, 2013).

    Obesity is defined as an excessive accumulation of adipose tissue with potentially negative health consequences (Townsend & Scriven, 2014). There are a number of methods that can be used to measure obesity. The more commonly used methods include the body mass index (BMI), a weight-for-height calculation which determines weight status (Townsend & Scriven, 2014), and abdominal circumference measurements, both of which are simple and cost-effective assessment tools (Schuklenk & Zhang, 2014). However, the limitation of BMI measurement is that it fails to consider additional factors that can influence weight, including gender, age, bone structure, fat distribution and muscle mass (Schuklenk & Zhang, 2014), and is therefore an inaccurate reflection of adiposity (Townsend & Scriven, 2014). Abdominal circumference measurements, which indicate central obesity, are considered to more accurately reflect total body fat (Townsend & Scriven, 2014). This specific type of obesity measurement takes into consideration not only the degree of adipose tissue which is present but also where the fat is distributed, and suggests that greater levels of adipose tissue around the midsection are linked to poorer health outcomes (Rossen & Rossen, 2012).

    The nursing workforce spans an assortment of clinical settings, therefore placing nurses at the forefront of health promotion and obesity prevention.

  • 7 - Chronic cardiovascular 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 96-112

  • Summary

    LEARNING OBJECTIVES

    After studying this chapter, you should be able to:

  • • demonstrate knowledge of the underlying pathogenesis of cardiovascular conditions and their associated risk factors

  • • recognise the importance of health promotion and prevention in the management of chronic cardiovascular conditions

  • • understand the concepts of patient-centred care and care coordination in relation to chronic cardiovascular conditions

  • • identify the nurse's role in the care of chronic cardiovascular conditions

  • • identify the characteristics of the role of a nurse who practises at an advanced level in cardiovascular health.

    • Introduction

    Cardiovascular disease (CVD) is considered the main contributor of death and disease burden in Australia and New Zealand. In 2012, CVD accounted for approximately 30 per cent of all deaths recorded within both nations (Department of Health, 2015; National Heart Foundation of New Zealand, 2015). This is the result of increased longevity and advances in CVD treatments (Department of Health, 2015). The successful management of CVD requires a number of key strategies, including continuous monitoring, prevention, risk factor reduction and advanced clinical management (Mendis, Puska & Norrving, 2011). Patients suffering from CVD are found across a variety of care environments. The nurses who provide care to these individuals are required to possess skills and knowledge that will enable optimal patient outcomes.

    The term ‘cardiovascular disease’ is used in reference to health conditions that affect the heart and blood vessels. This includes coronary heart disease (also known as ischaemic heart disease), acute myocardial infarction, heart failure and cardiomyopathy, hypertension, peripheral vascular disease and stroke (Department of Health, 2015). It is important to realise that CVDs are largely preventable. Increasing and improving health care access, in conjunction with early identification and reduction of CVD risk factors, may lead to a decrease in the health burden to which this collection of chronic conditions contributes (Mendis et al., 2011).

    This chapter focuses on several key issues relating to chronic CVD. The pathophysiology of the differing disease processes associated with CVD will be outlined. The importance of health prevention and promotion in CVD will be discussed, highlighting primary and secondary prevention.

  • 10 - Mental health issues of a psychotic nature

  • 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 143-158

  • Summary

    LEARNING OBJECTIVES

    After studying this chapter, you should be able to:

  • • describe the challenges that face people experiencing mental health issues of a psychotic nature

  • • discuss the factors that increase the risk of experiencing mental health issues of a psychotic nature – pathophysiology and social determinants

  • • outline the principles underlying trauma-informed care

  • • discuss the significant features of recovery principles

  • • identify actions to support health promotion in relationship to mental health issues

  • • describe the various nursing roles and settings when working with people experiencing mental health issues of a psychotic nature.

    • Introduction

    This chapter focuses on the complex nature of psychotic illnesses and describes the care approach known as trauma informed strength based holistic care. Psychotic illness has been defined as a ‘low prevalence’ condition, but it is often more severe and enduring than this would suggest, and can require complex care (Morgan et al., 2014; Sara, Burgess, Malhi, Whiteford & Hall, 2014).

    Psychotic illnesses are conditions with varying symptoms. Each is an individual clinical presentation making diagnosis and treatment difficult. The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-V) (American Psychiatric Association, 2013, p. 87) defines psychotic illnesses by abnormalities in one or more of the five areas of hallucination, delusions, disorganised thinking (speech), grossly disorganised or abnormal motor behaviour and negative symptoms. People experiencing psychotic illnesses may exhibit disturbances in thinking, perception, emotional responses and behaviour (Morgan et al., 2011).

    The DSM-V (American Psychiatric Association, 2013) categorises a broad spectrum of psychotic illnesses with the most common being schizophrenia, bipolar disorder, schizoaffective disorder, schizotypal (personality) disorder, brief psychotic disorder and schizophreniform disorder. Age of onset is in the late teens to early adulthood, with males (3.7 cases per 1000) experiencing earlier episodes and more frequent episodes than females (2.4 cases per 1000). Early onset disrupts a person's development of critical life skills, education, employment and relationships (Morgan et al., 2011). Table 10.1 lists the features of different psychotic disorders.

    In 2010, 4.5 people per 1000 in the Australian population, aged 18 to 64 years, were living with a psychotic illness and in contact with the public health system (Morgan et al., 2011). This accounts for a third of individuals living with a severe mental illness (Department of Health, 2013).

Page 62 of 89