Chronic And Acute Illness Lecture

Social & Behavioral Aspects of Illness: Acute and Chronic Illness C. Denise Clemmons, MS Guest Lecturer

Lecture Objectives
Identify the differences between illness and disease;
Define acute and chronic illness;
Compare and contrast chronic and acute illness;
Explain Parson’s sick role model;
Apply Parson’s sick role model to chronic and acute illnesses;
Define biography;
Define and describe illness trajectories;
Define and describe time phases of illness; and
Identify opportunities for pharmacist in caring for patients with acute and chronic illnesses and disabilities.

Video Time: Pharmacists

Introduction
Pharmacist are the most accessible health professionals in America.
SK&A Information, 2007
Pharmacist are highly regarded and trust by consumers.
Gallup Organization, 2005
Pharmacists encounter many patients with many illnesses.

Introduction, cont’d
Chronic illnesses (CI) are the leading causes of death and disability in the US.
CI account for 7 of every 10 deaths and affect the quality of life of 90 million Americans.
Many CI are preventable.
Many CI come in multiples.
http://www.health.state.ny.us/diseases/chronic/

Illness Vs. Disease

Illness vs. Disease
Disease
A pathological process
Involves some abnormality
Cellular or subcellular level
Illness
Social and psychological phenomena
Directly influences by disease
Involves perception, behavior and experience
Source: Helman (1981). Disease versus illness in general practice

Biomedical Model of Health and Illness
Health is equated with the absence of disease.
Assumes that every disease process can be explained in terms of an underlying deviation.
The focus is on physical causes of disease.
It does not take into account the role of social factors or individual subjectivity.
Very limiting
Source: Annandale (1998). The Sociology of Health and Medicine: A Critical Introduction.
Source: Engel (1977). "The need for a new medical model"

Biopsyhosocial (BPS) Model of Health and Illness
BPS factors play a role in context of health and illness and should all be treated.
The workings of the body can affect the mind, and the workings of the mind can affect the body.
Integration of professional services to better address all aspects (i.e., Veteran’s Administration)

Biopsychosocial Model of Health and Illness Source: http://cnx.org/content/m13589/latest/

What are Acute and Chronic Illness?

Acute Illness Defined
“ disease with an abrupt onset and usually a short course”
“ illness of short duration, rapidly progressive, and in need of urgent care”
Source: Webster's New World Medical Dictionary

Acute Illness
Defining characteristics
Starts suddenly and are short lived
“ Runs its course” regardless of drug intervention

Examples of Acute Illnesses
Coughs
Colds
Sleeplessness
Flu

Chronic Illness Defined
“ illnesses that are prolonged, do not resolve spontaneously, and are rarely cured completely”
Source: National Center for Chronic Disease Prevention and Health Promotion
“ a disease or disorder developing slowly and persisting for a long period of time, often for the remainder of the lifetime of the individual
Source: Mosby’s Medical and Nursing Dictionary

Chronic Illness
Defining characteristics
Develop slowly and are long term
Multiple chronic illness
Uncertainty
Intrusiveness
Cost
Need for wide array of services
Requires medical supervision
Medicine is usually regulated as Prescription Only
VERY different from acute illness

Examples of Chronic Diseases
Cancer
AIDS
Kidney Disease
Diabetes
Tuberculosis
Alzheimer’s
Parkinson’s
Sarcadosis

Differences and Similarities: Acute and Chronic Illness Similar “coping” style Requires less care and resources because it is temporary Requires more care and resources to normalize lifestyle Responds to treatment Uncertain future Usually isolated to one bodily area Frequently involve multiple systems Acute Illness Chronic Illness

The Illness Experience

The Sick Role
Coined by Talcott Parsons in 1951
Widely used in medical sociology
“ Being sick” is a social role.
Outlined two rights and two obligations

The Sick Role: Rights & Obligations
Rights
The sick person is exempt from normal social roles.
The sick person is not responsible for their condition.
Obligations
The sick person should try to get well.
The sick person should seek technically competent help and cooperate with the medical professional.

What do you think about the Sick Role?
What criticisms of Parsons’ model might you make?
Can you see any strengths in the idea of the sick role?

The Sick Role: Flaws & Criticisms
“ Ability to get well” violation
Ignores those who are poor or lack other resources
Doctors are not always sole authority
Doctor-patient conflict of interest

Who Does Illness Affect?
The ill person
Family members
Health professionals
Coworkers
Employer
Community
Others

Video Time

Questions To Think About
Who did Chris’ illness affect?
What words did Chris use to describe his illness?
What does Chris do to gain normalcy?

The Illness Trajectory and Work

Illness Trajectory
Properties of an illness trajectory
Duration of disease (phases)
Work

Phases of Chronic Illness
Illness onset
Stability
Instability
Acute
Crisis
Comeback
Deterioration
Dying

http://www.unc.edu/courses/2008spring/nurs/595/960/chronic_illness/ci_segment2.html Sample Trajectory

Themes of Trajectory Model
Chronic Illness
Long-term
Uncertain
Requires work

Illness Work
Comfort work
Usual life work
Clinical safety work
Work on trajectory scheme
Work on biography

Comfort Work
Work to be pain-free and comfortable
May include specific exercises or behaviors

Usual Life Work
Work to maintain your normal life and relationships:
Family life
Work life
Student life
Relationships

Clinical Safety Work
Work to keep illness under control and avoid crises
May involve taking medication, doctor visits, blood pressure checks, etc.

Trajectory Work
Thinking about the future of your illness and planning accordingly

Biographical Work
Adjusting who you are now in light of your illness

Biography & Biographical Work

Somethings to Ponder
“ Who are you?”
“ What is your biography”

Biography
“ Who am I now?”
Re-shaping and re-molding of your self-concept and identity.
In light of illness how life changes
New life story

Video Time

While Watching the Video:
Think about how biography changes in light of chronic illness.
Think about how perception of time changes.

Facets of Biography
Biographical time
Body
Conceptions of self
Components make up the BBC
Slide adapted from Lambert, BL (2008) Social and Behavioral Aspects of Pharmacy Course, University of Illinois-Chicago, College of Pharmacy

Biographical Time
Past, present, future
Personal assessment
Misrepresentation

Conceptions of Self
Private self
Branded activities
Assimilation

Body
Vehicle used to make identity
Socialization (stigma)
Needed for identity-relevant performances

Performance
Must be a mind body connection (harmony)
Ability to act and perform

Impact of BBC Chain
Depends on
Trajectory phase
Sub phase
Severity of illness
Degree of control over symptoms
Slide taken from Lambert, BL (2008) Social and Behavioral Aspects of Pharmacy Course, University of Illinois-Chicago, College of Pharmacy

Impact of BBC Chain
Biographical conditions
Life stage
Salient aspect of self lost
Ability to learn new ways of adapting
Ability to come to term with losses
Slide taken from Lambert, BL (2008) Social and Behavioral Aspects of Pharmacy Course, University of Illinois-Chicago, College of Pharmacy

Biographical Time
Life has changed
Life is seen in aspect of time

The Patient’s Response to Illness

Patient Response to Illness
Denial or disbelief
Acceptance
Recovery, rehabilitation, or convalescence
Over dependency
Feelings of helplessness
Fear
Anxiety
Stress

Opportunities for Pharmacists

Communicate
Communication is key
Communication affects every aspect of healthcare
Focus communication with patient to discover meaning
Communication with other health professionals
Ask questions
Listening skills
Empathize

Evaluate
Avoiding stereotyping
Individualize treatment of patients
Listen to what the patient is saying
Everything isn’t common knowledge

Educate
Life-long learning
Inform the patient about disease
Ask questions

Summary
Recognize that illnesses are different
The chronically ill need more care
The actual illness goes beyond the medication
Pharmacists are the Drug Experts

QUESTIONS?

On a piece of paper, tell me:
What was one thing you learned today?
What was something you did not understand?

Contact Information
Carla Clemmons, MS
[email_address]
312-498-6821

Chronic And Acute Illness Lecture

by cclemm1 on Nov 26, 2008

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Chronic And Acute Illness Lecture — Presentation Transcript