Running head: NURSING INTERVENTIONS FOR CHRONIC ILLNESSES 1

Nursing Interventions for Chronic Illnesses

[Author Name(s), First M. Last, Omit Titles and Degrees]

[Institutional Affiliation(s)]
NURSING INTERVENTIONS FOR CHRONIC ILLNESSES 2

Nursing Interventions for Chronic Illnesses

Mr. Bale is an 85-year-old immigrant from Mexico into the US. His primary

communication language is Spanish, although he understands limited English; hence his family

translates communication for him. He and his wife live with his eldest son, daughter in law and

two grandchildren. His two other children also live nearby. Mr. Bale has been diagnosed with

Chronic Obstructive Pulmonary Disorder (COPD) and has Congestive Heart Failure (CHF) and

hearing loss. He is a heavy smoker with a history of smoking two packs every day for 50 years.

Mr. Bale is currently a smoker despite his condition and treatment. As part of his treatment, he

uses both western and cultural medicines.

The patient has some health risk factors associated with his lifestyle and living

conditions. Being diagnosed with Chronic Obstructive Pulmonary Disorder, the patient is

supposed to stop smoking. His continued risk of smoking is likely to worsen his condition and

render oxygen therapy ineffective (Laborín, 2009). Secondly, his use of cultural remedies poses a

threat to his health and life. In as much as cultural remedies have been credited for assisting with

various illnesses, they are also attributed to adverse side effects and reactions when consumed

without careful evaluation and analysis (Peter, 2004). Living independently with his wife in his

son`s house is also a health and safety problem. Owing to the patient`s chronic conditions and

age, he is supposed to have constant care in emergencies.

The Chronic Care Model (CCM) is set up to help health practices improve patients`

health outcomes by changing the design to help practices improve patient health outcomes by

changing the routine delivery of outpatient care through the use of interrelated system changes.

These changes ensure care is patient-centered and evidence-based (Coleman, Austin, & et al.,
NURSING INTERVENTIONS FOR CHRONIC ILLNESSES 3

2009). These system changes are the community, clinical information systems, the health system,

delivery systems, self-management support, and decision support.

The community can be used through the mobilization of community resources to meet

the needs of the patient. This includes the provision of care personnel to assist the patient with

his day to day activities (Coleman, Austin, & et al., 2009). Owing to the patient`s COPD, he is

not supposed to exert themselves. The use of community members in assisting the patient would

be helpful. This can be through offering individuals who can help in translation or individuals

willing to help with the patient`s exerting daily tasks.

Self-management support can be used to support Mr. Bale`s care through educating him

regarding the importance of him being responsible for his health. Through patient education

regarding how to care for himself through avoidance of smoking, self-assessment, goal-setting,

action planning, problem-solving and follow-up (Coleman, Austin, & et al., 2009).

Through the delivery system, the patient`s healthcare provider can ensure that the patient

receives quality, efficient care as well as support for self-management. Regular visits by health

workers ensure that the patient`s goals are incorporated into the care plan. It ensures that the

patient can understand the care he is receiving (Nimra, Hewson, & Randhawa, 2020). Decision

support will ensure the patient receives evidence-based care, backed by scientific data and meets

the patient`s preferences. The patient will benefit as evidence-based guidelines will be shared

and encourage patient participation in their care (Nimra, Hewson, & Randhawa, 2020).

Clinical information systems will ensure that data is organized in a way that enables

effective and efficient care of the patient. It provides nurses with a registry of patients with

chronic conditions (Coleman, Austin, & et al., 2009). Through this registry, the patient`s health

status can be monitored to prevent complications arising from the chronic conditions he has. The
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health system is beneficial to the patient as it enables the creation of an organization that will

ensure proper high-quality care is available for the patient. The health system encourages errors

and quality problems to be handled openly, thus providing improved care (Nimra, Hewson, &

Randhawa, 2020).

As a home healthcare nurse, Mr. Bale`s health is of the highest priority. Based on the risk

factors faced due to his lifestyle and living conditions, changes need to be made. The risk factor

of worsening his Chronic Obstructive Pulmonary Disorder through smoking needs to be

addressed. Patient and family education on care is vital. Education will involve the clearance of

the airways, management of daily exercises accordingly, improving activity intolerance and

improving breathing patterns (Belleza, 2019). These are all vital in ensuring that the health of the

patient is managed.

Nursing intervention for Congestive Heart Failure will include diet modification for the

patient, such as reduction of fatty and oily foods as well as low intake of salt (Stellenberg &

Bruce, 2007). The intervention will also involve lifestyle modification such as limiting the

workload to avoid overexertion of the heart and cessation of tobacco consumption (Kumar,

Ababas, & et al., 2007). Additionally, administration of medication and oxygen therapy will be

essential in helping the patient manage his condition.

Nursing intervention for hearing loss will involve the use of hearing aids, assistive

listening, and alerting devices. Environment modifications are also necessary to ensure effective

communication (Larsby, 2005).

The ethical issue is in relation to patient autonomy. Mr. Bale has to make decisions

regarding his medical care plan, although he receives translated information. Since the patient

needs translation into Spanish of communication between care pre provider and himself, there is
NURSING INTERVENTIONS FOR CHRONIC ILLNESSES 5

an ethical issue about the loss of meaning or urgency of situations. This causes a moral problem

as the patient may make decisions based on misinformation.

The ethical principle being impacted is the patient`s right to autonomy and decision

making. This can be solved by either ensuring that a competent medical interpreter is available

during the treatment of the patient or a different nurse who is fluent in Spanish be assigned to the

patient (Allison, 2008). The most effective is the assigning of a nurse fluent in Spanish. This is

better since the nurse will be aware of the patient`s language limitations. As a result, the nurse

will be able to address the patient directly in a language that he understands. Additionally, this

will be cheaper and faster as compared to using an interpreter.

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References

Allison, S. (2008). Strategies for overcoming language barriers in healthcare. Nursing

Management, 20-27.

Belleza, M. R. (2019). Chronic Obstructive Pulmonary Disease (COPD). Nurselabs.

Coleman, K. m., Austin, B. T., & et al. (2009). Evidence On The Chronic Care Model In The

New Millennium. HHS Author Manuscripts.

Kumar, V. m., Ababas, A. K., & et al. (2007). Robbins Basic Pathology. Saunders: Elsevier.

Laborín, R. L. (2009). Smoking and Chronic Obstructive Pulmonary Disease (COPD). Parallel

Epidemics of the 21st Century. Int J Environ Res Public Health, 209-224.

Larsby, B. e. (2005). Cognitive performance and perceived effort in speech processing tasks:

effects of different noise backgrounds in normal-hearing and hearing-impaired subjects.

Int J Audiol, 131-143.

Nimra, K. m., Hewson, D. m., & Randhawa, G. (2020). Effectiveness of integrated chronic care

interventions for older people with different frailty levels: a systematic review protocol.

BMJ.

Peter, A. G. (2004). Health risks of herbal remedies: An update. Clinical Pharmacology and

Therapeutics.

Stellenberg, E. L., & Bruce, J. C. (2007). Medical-Surgical Nursing for Hospital and

Community. Churchill Livingstone: Elsevier.