Coping with Multiple Chronic Conditions in the Family Context: A Meta-Synthesis

Chronic Conditions ◽

Qualitative Assessment ◽

Family Interactions ◽

Family Coping ◽

Coping Process ◽

The Family ◽

Family Based ◽

Synthesis Approach

This study was to collect, synthesize, and interpret the current qualitative evidence from studies that investigated family coping among people with multiple chronic conditions (MCCs). A meta-synthesis approach was used to report this study. A systematic search was performed in five electronic databases, including CINAHL, EMBASE, PsycINFO, Web of Science, and PubMed from January 2000 to December 2020. The PRISMA flow chart and Joanna Briggs Institute Qualitative Assessment and Review Instrument checklist are integrated into the meta-synthesis. A total of ten eligible studies including data from 381 participants were identified. Three meta-themes were identified in the synthesis: (1) family role maintenance in MCCs management, (2) coping as a family, and (3) be frustrated with family interactions. This meta-synthesis indicated the importance of maintaining social roles and family support within family interactions for coping with MCCs. It also demonstrated the frustrations in the family coping process experienced by people with MCCs. Health care professionals should understand the interactions between people with MCCs and their family members that may impact people’s coping. Such an understanding may contribute to the development of supportive programs such as family-based interventions for people with MCCs.

eHealth Technologies, Multimorbidity, and the Office Visit: Qualitative Interview Study on the Perspectives of Physicians and Nurses (Preprint)

10.2196/preprints.8983 ◽

2017 ◽

Author(s):

Graham G Macdonald ◽

Anne F Townsend ◽

Paul Adam ◽

Linda C Li ◽

Sheila Kerr ◽

...

Keyword(s):

Information And Communication Technologies ◽

Chronic Conditions ◽

Health Sector ◽

Office Visit ◽

Best Interests ◽

Management Support ◽

Web Based ◽

Qualitative Interview Study

BACKGROUND eHealth is a broad term referring to the application of information and communication technologies in the health sector, ranging from health records to telemedicine and multiple forms of health education and digital tools. By providing increased and anytime access to information, opportunities to exchange experiences with others, and self-management support, eHealth has been heralded as transformational. It has created a group of informed, engaged, and empowered patients as partners, equipped to take part in shared decision making and effectively self-manage chronic illness. Less attention has been given to health care professionals’ (HCPs) experiences of the role of eHealth in patient encounters. OBJECTIVE The objective of this study was to examine HCPs’ perspectives on how eHealth affects their relationships with patients living with multiple chronic conditions, as well as its ethical and practical ramifications. METHODS We interviewed HCPs about their experiences with eHealth and its impact on the office visit. Eligible participants needed to report a caseload of ≥25% of patients with multimorbidity to address issues of managing complex chronic conditions and coordination of care. We used a semistructured discussion guide for in-depth interviews, and follow-up interviews served to clarify and expand upon initial discussions. Constant comparisons and a narrative approach guided the analyses, and a relational ethics conceptual lens was applied to the data to identify emergent themes. RESULTS A total of 12 physicians and nurses (6 male, 6 female; median years of practice=13) participated. eHealth tools most frequently described were Web-based educational resources for patients and Web-based resources for HCPs such as curated scientific summaries on diagnostic criteria, clinical therapies, and dosage calculators. Analysis centered on a grand theme of the two-way conversation between HCPs and patients, which addresses a general recentering of the ethical relationship between HCPs and patients around engagement. Subthemes explain the evolution of the two-way conversation, and having, using, and supporting the two-way conversation with patients, primarily as this relates to achieving adherence and health outcomes. CONCLUSIONS Emerging ethical concerns were related to the ambiguity of the ideal of empowered patients and the ways in which health professionals described enacting those ideals in practice, showing how the cultural shift toward truly mutually respectful and collaborative practice is in transition. HCPs aim to act in the best interests of their patients; the challenge is to benefit from emergent technologies that may enhance patient-HCP interactions and effective care, while abiding by regulations, dealing with the strictures of the technology itself, and managing changing demands on their time.

INTERPROFESSIONAL SKILLS AND CULTURAL AWARENESS OF STUDENTS CARING FOR OLDER ADULTS WITH MULTIPLE CHRONIC CONDITIONS

Innovation in Aging ◽

10.1093/geroni/igz038.2799 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S761-S762

Author(s):

Kathryn M Daniel ◽

Mary Lou Bond

Keyword(s):

Older Adults ◽

Cultural Differences ◽

Interprofessional Education ◽

Chronic Conditions ◽

Cultural Awareness ◽

Social Work Students ◽

Delivery Of Care ◽

Cultural Programming

Abstract Based on rapidly increasing numbers of older adults and growing populations of culturally diverse citizens, we developed and provided an interprofessional education program for graduate nursing and social work students that focused on the delivery of care to older adults and veterans with multiple chronic conditions. The students participated in multiple activities together over a year long period. Activities included an introductory IPE day with all students together and simulated patient cases that had required roles for the students’ specialties. Knowledge and skills of interprofessional collaborative practice were measured with the Interprofessional Self Assessment Competencies (IPEC) and Assessment of Interprofessional Team Collaboration Scale (AITCS). We also measured attitudes toward cultural differences using the Cultural Awareness Scale (CAS). The entire project was repeated a second year with a second cohort of students. Overall, our students were better able to understand and work collaboratively with other health care professionals after participating in this program. Regarding cultural awareness, both NP and SW students were more aware of and comfortable with cultural differences after participating in the program. After one year of experience, we wanted to know more about our students’ skills and attitudes. Focus groups were added to the design to dive deeper into the students’ perceptions about which activities were most impactful and recommendations for future IPE activities. This paper will describe these data and implications for future planning of more effective interprofessional and cultural programming for students caring for older adults and veterans.

Primary care for diabetes mellitus patients from the perspective of the care model for chronic conditions

Revista Latino-Americana de Enfermagem ◽

10.1590/1518-8345.1474.2882 ◽

2017 ◽

Vol 25 (0) ◽

Cited By ~ 6

Author(s):

Maria Aparecida Salci ◽

Betina Hörner Schlindwein Meirelles ◽

Denise Maria Guerreiro Vieira da Silva

Keyword(s):

Diabetes Mellitus ◽

Health Care ◽

Chronic Conditions ◽

Family Health ◽

Care Practice ◽

Analysis Technique ◽

Health Strategy ◽

The Family ◽

Family Health Strategy

ABSTRACT Objective: to assess the health care Primary Health Care professionals provide to diabetes mellitus patients from the perspective of the Modelo de Atenção às Condições Crônicas. Method: qualitative study, using the theoretical framework of Complex Thinking and the Modelo de Atenção às Condições Crônicas and the methodological framework of assessment research. To collect the data, 38 interviews were held with health professionals and managers; observation of the activities by the health teams; and analysis of 25 files of people who received this care. The data analysis was supported by the software ATLAS.ti, using the directed content analysis technique. Results: at the micro level, care was distant from the integrality of the actions needed to assist people with chronic conditions and was centered on the biomedical model. At the meso level, there was disarticulation among the professionals of the Family Health Strategy, between them and the users, family and community. At the macro level, there was a lack of guiding strategies to implement public policies for diabetes in care practice. Conclusion: the implementation of the Modelo de Atenção às Condições Crônicas represents a great challenge, mainly needing professionals and managers who are prepared to work with chronic conditions are who are open to break with the traditional model.

Factors affecting medication adherence among patients with rheumatic disorders

Journal of Nursing Education and Practice ◽

10.5430/jnep.v7n8p7 ◽

2017 ◽

Vol 7 (8) ◽

pp. 7 ◽

Cited By ~ 3

Author(s):

Lamia Mohamed Nabil Ismail ◽

Mohga Abed-AlAziz Selim ◽

Sahar Omar Yehia Elkhashab

Keyword(s):

Health Care ◽

Medication Adherence ◽

Chronic Conditions ◽

Medication Cost ◽

Central Component ◽

Missed Appointments ◽

Factors Affecting ◽

Adherence To Medication

Background and objective: Patient's adherence is an important factor affecting the successful maintenance of treatment, slow progression of the disease; reduce costs of health care especially in the presence of multiple chronic conditions as rheumatic disorders. While, medication non-adherence is a significant problem leads to increased mortality and morbidity. So, identification of the factors affecting non-adherence to medication regimens is beneficial for healthcare providers to improve patient’s health condition. The aim of the study was to determine factors affecting medication adherence among sample of Egyptian patients with rheumatic disorders.Methods: Design: An exploratory descriptive research design. Subjects: Purposive sampling of patients with history of rheumatic disorders. Setting: The study was carried out in rheumatology department and medical wards at Al-Kaser Al-Aini hospital. Tool: Patient Preliminary Informational Variables, Morisky Medication Adherence Scale 8-Items and Factors affecting drug adherence checklist were used to collect pertinent data.Results: The study showed 59.2% of study group had low adherence, followed by medium adherence and high adherence (28%, 12.7%) to prescribed medications respectively. Findings also; revealed that the highest percent of these factors that may combine to render patients to be less able to adhere to prescribed medication ranked as complexity of medication regimen; chronic conditions, restricted formularies, changing medications covered on formularies; fear of possible adverse effects, fear of dependence; lack of continuity of care, treatment interferes with lifestyle or requires significant behavioral changes; patient information materials written at too high literacy level; severity of symptoms; lack of knowledge on adherence and the effective interventions for improving it; as well the medication cost; long wait times; burdensome schedule; poor access or missed appointments; actual or perceived unpleasant side effects; duration of therapy; medication negative effect on liver and kidney; in addition, psychosocial stress, anxiety and anger.Conclusions: Due to the diversity of causes of non-adherence, the health care professionals must understand factors affecting medication adherence when dealing with problems of medication adherence especially with chronic conditions as rheumatic disorders. Recommendation: Interventions for overcoming factors affecting adherence must become a central component of efforts to improve patients’ health worldwide. This could be done by proper determination for factors affecting medication adherence, also to consider patient condition individually and modify the treatment approach accordingly.

DO MULTIPLE CHRONIC CONDITIONS INFLUENCE PERSONAL VIEWS ON THE AGEING PROCESS? A QUALITATIVE ANALYSIS

Journal of Aging Research and Lifestyle ◽

10.14283/jarcp.2018.5 ◽

2018 ◽

pp. 1-7

Author(s):

R.E. Pel-Littel ◽

M. van Rijn ◽

P.W. Vermunt ◽

J.C.M. van Weert ◽

M.M. Minkman ◽

...

Keyword(s):

Qualitative Analysis ◽

Chronic Conditions ◽

Older Persons ◽

Positive Attitude ◽

Community Dwelling ◽

Healthy Ageing ◽

Ageing Process ◽

Structured Interviews

Objectives: For older persons with two or more chronic diseases (multiple chronic conditions) insight into what they perceive as important in their lives is essential when discussing preferences in the shared decision making process. The aims of this study were to 1) investigate the personal views on the ageing process communicated by older persons and 2) compare the personal views of older persons with and without multiple chronic conditions. Design: Using structured interviews participants were asked five questions about what they perceived as important in terms of ageing, worries, their future, healthy ageing and quality of life. Two independent researchers coded the data and performed content analyses. A stratified content analysis was performed to explore whether persons with and without multiple chronic conditions expressed different personal views with regard to the ageing process. Participants & setting: 547 community dwelling older persons aged 70 years and above. Results: The mean (SD) age was 78.9 (5.9) years, and 60.3% were female. Multiple chronic conditions were present in 72% of the study sample. There were no significant differences in demographic characteristics between persons with and without multiple chronic conditions . However persons with multiple chronic conditions more often had polypharmacy (43% vs 24%; p<0.001), more difficulties with (instrumental) activities of daily living (mean number of impairments 2.4 vs 0.8; p< 0.001) and reported more falls (35% vs 23% p = 0.01) than those without multiple chronic conditions. The qualitative analysis identified the following main themes: ageing was associated with acceptance of ageing, (further) deterioration and worries about limitations and family. A healthy lifestyle, keeping busy, maintaining social contacts and a positive attitude were considered prerequisites to healthy ageing. In 24 out of 28 sub-themes no significant differences were found between participants with and without multiple chronic conditions (MCC). Persons with multiple chronic conditions more often expressed that ageing for them meant having to cope with deterioration and limitations, they had more worries and feared more deteriorations compared to those without multiple chronic conditions. Also persons with multiple chronic conditions less often considered a positive attitude to life a prerequisite to healthy ageing. Conclusions: Acceptance of ageing, (further) deterioration and worries about limitations and family were important themes on the ageing process communicated by older persons. Overall, we found no major differences between persons with and without multiple chronic conditions. The results of this study may help raising awareness amongst health care professionals that eliciting and understanding an older persons’ views on the ageing process is an important first step in making health decisions that support older persons’ personal goals and expectations.

Crianças com autismo, família e espiritualidade

REFLEXUS - Revista Semestral de Teologia e Ciências das Religiões ◽

10.20890/reflexus.v10i15.349 ◽

2016 ◽

Vol 10 (15) ◽

pp. 127

Author(s):

Nilton Eliseu Herbes Liane Rossales Dalprá

Keyword(s):

Autism Spectrum ◽

Repetitive Behaviors ◽

Spectrum Disorder ◽

Family Coping ◽

Communicative Skills ◽

The Family ◽

De Se ◽

Family Based ◽

The Individual ◽

The Impact

O Transtorno do Espectro do Autismo (TEA) é uma condição neurodesenvolvimental caracterizada pelo comprometimento de duas áreas do desenvolvimento: habilidades sociocomunicativos e comportamentos restritos e repetitivos, os quais têm influência nas relações e nas trocas estabelecidas com o meio. A família é o grupo social primário, constituindo um suporte de extrema importância para que o indivíduo se desenvolva, se forme e aprenda a viver em sociedade. Quando nasce um filho com autismo, o impacto do diagnóstico nos pais faz com que o ciclo de vida familiar se altere, acarretando um esforço adicional para os pais, pois têm de se reorganizar para se adaptarem à família com uma realidade nova. Esta pesquisa teve como objetivo, investigar quais as implicações que o diagnóstico de transtorno do espectro autista (TEA) traz à família. Trata-se de um estudo de descritivo, bibliográfico, documental, realizado através de uma revisão da literatura. Para a revisão foram selecionados os estudos que respondessem à questão norteadora: Quais as implicações que o diagnóstico de TEA traz à família? Baseado na pesquisa, conclui-se que quando nasce um filho com autismo, o impacto do diagnóstico na família faz com que o ciclo de vida familiar se altere, acarretando um esforço conjunto para se reorganizar e se adaptar a uma realidade nova. As adaptações e mudanças efetuadas ao nível familiar e social são significativas. As redes de apoio e as estratégias de coping familiar facilitam o ajustamento e diminuem a angústia e a ansiedade da família que convive com um membro autista.Autism Spectrum Disorder (TEA) is a neurodevelopmental condition characterized by impairment of two areas of development: socio-communicative skills and restricted and repetitive behaviors which influence the relations and the exchanges established with the surroundings. The family is the primary social group, constituting an extremely important support system for the individual to develop, to be formed and to learn to live in society. When a child is born with autism the impact of the diagnostic on the parents causes a change in the cycle of the family life, demanding additional effort for the parents since they have to reorganize in order to adapt to the family with a new reality. The goal of this research is to investigate what implications the diagnostics of autism spectrum disorder have on the family. It is a descriptive, bibliographic, documental study carried out through a review of literature. For this review studies that answered the following guiding question were selected: What are the implications of a diagnostic of TEA on the family? Based on the research the conclusion is that when a child is born with autism, the impact of the diagnostic on the family causes alterations in the family cycle, demanding joint effort to reorganize and to adapt to a new reality. The adaptations and changes that take place at the family and social level are significant. The support networks and the strategies of family coping facilitate adjustment and diminish the anguish and anxiety of the family living with an autistic member.