Interventions aimed at solving non-adherence of a patient with chronic illness
A chronic illness is a disease, which is described by recurrence and as one that requires lasting treatment. As a persisting disease; chronic illness is regarded as long term as opposed to acute illness which is a disease characterized by having a quick onset, a short course, or both. Chronic diseases can affect several body functions at the same time (Rand, 2005, p. 97-101).
The symptoms and effects of a chronic disease are dependent on the type of illness and its severity. It can make a person disabled if it, as a disease, can considerably inhibit the person from doing a key action or activity necessary in his or her daily life. Examples of chronic illnesses are cancer, diabetes, epilepsy, chronic fatigue syndrome, chronic obstructive pulmonary disease, and more. The physician or the professional giving a patient with chronic illness medical attention should be skilled and eligible to do the job as should also be considered in the diagnosis of other illnesses (Haynes, 1979).
Medications are rendered to sick individuals and the patients are known either to comply or not with the treatment procedures and instructions by the physicians. Adherence refers to the willingness of a patient to follow the medications and routines or procedures prescribed by the attending medical doctor with regards to the disease. Even if the treatment is effective, the patient’s health will not be restored if he or she would not commit into following the clinical instructions faithfully. Non-adherence of patients has been observed in both children and adult population. This may be caused to several reasons such as the cost of medications (Haynes, 1971, p. 49-62), effect of the scheduled regimen to an established daily routine (Ryan and Wagner, 2003, p. 795-806), and severity of the disease (Pepin et al, 1996, p. 1144-1150).
Adherence is also defined as the degree into which the behavior of a person agrees with medical advice. Non-adherence of patients can be due to different determining factors; and can be outlined based on psychological, social, and medical features of established investigating and diagnostic systems in different hospitals and medical clinics (Fielding and Duff, 1990, p. 196-200 and George et al, 2006).
The patient’s name is Michael Burrows. He is 52 years old and has chronic obstructive pulmonary disease or COPD. The patient had been previously examined and recorded to have experienced shortness of breath, chest pains, difficulty in breathing, swollen ankles, and severe cough. The said signs were observed gradually and were all symtoms of COPD. Mr. Burrows had long been exposed to cigarette smoke and is a smoker himself. He works in the packaging department of a manufacturing company. He was exposed to dust, chemical fumes, and other lung irritants for the past 25 years. The patient is American, resides in Chicago with his wife. He has two children who are both working in Illinois. Mr. Burrows is Roman Catholic.
The patient’s illness, chronic obstructive pulmonary disease or COPD, is a chronic disease characterized by severe cough usually accompanied by sputum with or without blood, wheezing, and dyspnea. The chronic illness has several causes. The top major cause is tobacco smoking, which induces a 25 percent risk to the smoker (James et al, 1985, p. 7-10).
Another symptom is sleep apnea, which is commonly diagnosed in individuals with heart failure and lung sickness. It is also common in obese people, stroke victims, and in individuals with central nervous system and neuromuscular illness. COPD is likewise associated with other diseases such as pulmonary hypertension and sarcoidosis (Rand, 2005, p. 97-101).
A person also has a greater risk of acquiring COPD when he is exposed to materials such as coal and asbestos. Coal causes pneumonoconiosis, which is also known as black lung disease. Asbestos, on the other hand, has carcinogenic properties meaning exposure to the material can cause cancer. Its existence in the air and water makes it difficult to control inhalation of its fibers. These fibers can attach to lung tissues. Exposure of the patient, Mr. Burrows, to asbestos increased his chances of getting sick of COPD (James et al, 1985, p. 7-10).
The patient also might have acquired the chronic disease through frequent inhalation of chemical solvents in the manufacturing company where he works. These solvents are known to be mutagenic, and are one of the causes of COPD. The patient was likewise exposed to iron, arsenic, cadmium, and zinc. These heavy metals pose risks of lung damage and COPD (Rand, 2005, p. 97-101).
Since Mr. Burrows is also exposed to silica and radon in the manufacturing company, he did not avoid COPD which is also hastened by his habitual chain smoking. Radon gas is the second major cause of lung cancer, next to cigarette smoking (James et al, 1985, p. 7-10).
The patient’s disease requires several tests in its diagnosis. Results of X-ray tests are shown to be helpful, particularly in the case of Mr. Burrows who is a smoker and who is exposed in coal and asbestos. The accumulation of these materials is clearly seen in his X-ray results (Wagner, 1997, p. 702-714).
Chronic obstructive pulmonary disease can not be cured but several ways can be employed to control the disease. The most important thing that can be done to slow down the disease progression is for the patient to quit smoking (James et al, 1985, p. 7-10).
The patient was suggested to gradually lessen his tobacco smoking until he could completely eliminate the habit. This advice is extremely helpful and was shown in previous studies to lessen the severity of the disease even in its later stages (Hoth, 2007, p. 69-76). The patient complied to this but only for a short duration of time. He complained of palpitations whenever he counteracts his urge to smoke.
The palpitation and excessive sweating observed by the patient was normal since he was on the stage of adaptation which occurs as his body adjusts to the sudden shift of being a chain smoker to a non-smoker. His smoking was suggested to be lessened gradually so his body would not experience shock, and will have time to regulate its processes in order to adapt to the changes (Wagner, 1997, p. 702-714).
The patient was also advised to change his line of work so as to avoid any more exposure to hazardous chemical fumes, fibers, metals, and other lung irritating materials. This would help in preventing further progression of the disease. This will also give the patient a chance to improve his conditions and delay the onset of more symptoms or illnesses associated with COPD (Rand, 2005, p. 97-101).
In response to the advice of change in the patient’s line of work, Mr. Burrows did not completely follow the complete shift to another occupation. The patient had his valid reasons, one of which is that in his age and medical condition; it would be difficult for him to find another job. Another is that he had been engaged in his current work for already a long period of time; he was used to it, and it was his specialization. Though Mr. Burrows did not completely adhere with the medical advice; he requested his immediate supervisor to transfer him to another department of his company. The patient showed his medical certificate and since he was an asset employee of the company; the request was granted. Mr. Burrows was transferred to a considerably less contaminated working area. This move would help the patient avoid exposure to materials that may worsen his current condition. This move, though non-completely adherent to the exact prescription, was significant to the patient’s health maintenance. The patient’s decision also means that he is concerned with his recovery (Wiebe and Christensen, 1996).
Mr. Burrows was prescribed medicines that will help him experience quick relief in breathing; as well as bronchodilators to relax his airway smooth muscles. The patient was also prescribed to be vaccinated against diseases like influenza. This is needed to prevent opportunistic illnesses and death (Haynes, 1979).
The patient was non-adherent to these medical recommendations despite the comfort that they offer to the patient. The patient complained of the costs of medicines and vaccines. He also did not cooperate in meeting routine check-ups and appointments with the physician. He reasoned his need to be at work, stating that he could not file a leave or an absence because he needed to finish his job assignments. The schedules of medical visits were not followed and his health condition was not properly monitored for certain times. This is critical since the doctor would not be able to diagnose the progress of the disease, and eventually would not be able of giving other needed prescriptions. Non-adherence could result in the hastening of disease progression and eventually death if the patient becomes completely non-compliant (Ban, 2003, p. 74-76).
Another medical advice given to Mr. Burrows was pulmonary rehabilitation. It was a type of program which focuses on the management of pulmonary diseases. It employs counseling and lectures for the benefit of patients. Pulmonary rehabilitation was also shown to give an individual with COPD the relief of having lessened shortness of breath. The program also minimizes the stress and fatigue brought about by the chronic disease through exercise and other therapeutic strategies. The program likewise helps the patient to acquire control of their emotions, which can improve their outlook and well-being despite their health conditions (Hoth, 2007, p. 69-76).
Though the patient did not regularly participate in the pulmonary rehabilitation program, his counted attendances had shown to be helpful in his emotional control over his chronic illness. He stated that he felt a lot hopeful after the program and that his thinking was influenced to dwell on the possibility of minimizing the adverse effects of COPD. However, the following non-attendance caused him to be non-mindful of his condition and just accept his situation despite the possibility of the disease being less progressive through treatments. His cause for non-attendance was his usual non-adherence reason, which is his need to be at work. Mr. Burrows could not attend even the programs scheduled on weekends because according to him, weekends are his time to rest from the 5-day work in the manufacturing company. This factor of non-adherence is common not only to patients with the same condition as his, but also to other patients with simpler diseases. This same reason was often raised by children who do not adhere to their doctor’s recommended schedule of check-ups because they did not want to be absent in school (Ryan and Wagner, 2003, p. 795-806).
Adherence of patients with chronic obstructive pulmonary disease is critical since the said chronic illness can be prevented from elevating levels of progression if it is diagnosed early. Treatment would also be given promptly for the patients to experience improvement of lung conditions. However, since the disease is chronic; the clinical symptoms and other accompanying signs of the disease would eventually be observed as the illness progresses. The chance of survival is approximately 10 years if at the first diagnosis the lung functions was already two-thirds deteriorated (Haynes, 1979).
The non-adherence of the patient is understandable since COPD management is indeed multifarious and difficult. Dealing with the disease requires the patient to follow changes in lifestyle accompanied by optimal compliance to therapy curricula. This might have induced Mr. Burrows’ non-adherence to certain medical advice. He usually encounter depression, which is a common risk factor associated with non-adherence of COPD patients (George et al, 2006).
Especially for older patients like Mr. Burrows; adherence to medical advice is more likely if the treatments coincide with the patient’s beliefs, or basically if the prescribed treatment has sense based on the patient’s experiences. Mr. Burrow relates his experiences in the past when it comes to health issues to the given advice of the attending physician. This therefore proves that an individual’s beliefs on health matters greatly influence his or her adherence (George et al, 2006 and Haynes, 1979).
The patient’s non-adherence might also be due to his limited knowledge of his chronic illness. His limited understanding of the disease and the medical treatments prescribed induced him to be non-adherent to the medications. The complex routines for his therapy also made him less interested in cooperating with doctors and nurses. Mr. Burrows’ negative outlook after he consistently became absent in the pulmonary therapy programs made him less motivated and less expectant of being cured.
Attending physicians, nurses, and other healthcare professionals must emphasize the importance of patient adherence to sick individuals during medical visits and follow-up check ups. Educating the patient will also help improve the patient’s adherence behavior (Rand, 2005, p. 97-101).
As the attending nurse to Mr. Burrows, I employed several intervention techniques which are potentially helpful in improving the patient’s adherence to medications and recommended treatments. I think patient education is of utmost importance in making him gain control over his health conditions. I explained to Mr. Burrows the nature of his chronic illness to provide educational support aimed to increase his willingness to adhere with medical instructions. The intervention can be considered successful because the patient is now open in asking questions about how his disease affects his body; as well as the appropriate medications that can counteract the adverse effects of his chronic illness in his everyday life. This is a good sign that can further lead to an increase in adherence by the patient. This is in accordance with literature stating that adherence of patients can be improved when healthcare professionals have the initiative to educate their patients regarding their disease. This can also increase the interest of patients to cooperate in their treatment regimen (Nagy and Wolfe, 1984, p. 912-921).
As a nurse, I maintained effective medical attendant-patient relationship with Mr. Burrows. This was done as a form of moral and emotional support to the patient. This was important since the words of encouragement and hope were already proven to elevate the patient’s mood in dealing with his illness. Aside from this reason, it is an alternative therapy for Mr. Burrows since he could not faithfully attend the pulmonary therapy programs offered. Finding options on how to intervene with the patient’s non-adherent attitude was shown to be effective based on the case of Mr. Burrows. The social support gained from the programs could also be given by his immediate health attendants. This more personalized dealing can make the patient feel important and more cared for. As part of monitoring the patient’s adherence; phone calls were also made to check his condition at home. This monitoring strategy helped the patient to report about his health conditions in different points in time. I relayed the information to his physician who, in turn studied the feedbacks to arrive into more applicable form of treatment and medications. Monitoring, according to researches on patient adherence, can induce the patient to be more responsible in his own care. The monitoring strategies can further be accompanied by referrals to pulmonary specialists to help the patient cope up with the disease even more (Katon, 2000, p. 709-711 and George et al, 2006).
Empathy and understanding are considered to be among the major factors which lead a patient to adhere, resulting to his or her benefit in terms of health improvement (Ciechanowski, 2001, p. 29; Nagy and Wolfe, 1984, p. 912-921; Squier, 1990, p. 330; and Turner et al, 1995). These types of emotional support were also effective with Mr. Burrows as he seemed to be more adherent in times when he was satisfied and convinced that he was well guided by his health attendants.
By understanding the inherent attitude of Mr. Burrows, I was also able to help him adhere with his treatment regimen. This was with accordance with studies which state (Earnest, 2002, p. 749-755 and Dompeling et al, 1992, p. 161-166).
Mr. Burrows was also often stressed at work, and this affects his cognitive faculty, leading to confusion, tension, anxiety, and fatigue. To provide assistance during these inevitable times; I recommended the patient to come up with a list of medications he was into, and with compartmentalized boxes for his medicines. The compartments have labels for easier access to his medicines especially when the regimen appears to be really complex. This increased the adherence of Mr. Burrows in following his treatment regimen. These aids for adherence have also been proven by studies to help patients gain faith in the medications recommended by health professionals. Mr. Burrows also has fully accepted his illness, which helped him to have control over his disease with the help of therapies. As stated in literature; adherence of a patient to prescribed medicines requires that the patient accepts his condition. This will also give him or her confidence in his medicines (Incalzi et al, 2001).
Based on the observations, it can be concluded that the nursing interventions taken were, in general, effective in helping Mr. Burrows to adhere with his medications. The interventions were therefore beneficial to the health of the patient with chronic illness COPD.
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