MANAGING CHRONIC ILLNESS

Sharon A. Denham, PhD, RN, CNE

Professor Emeritus, Ohio University School of Nursing
Professor, Texas Woman’s University< College of Nursing
Houston J. & Florence A. Doswell Endowed Chair in Nursing for Teaching Excellence
 OBJECTIVES
Differentiate among things that influence management of
chronic illness in rural areas.

Identify ways coordinated care is needed to address

prevention, wellness, and management of chronic disease self-
management.

Consider chronic conditions in a specific population.

 LEVEL OF RURALITY
51.4% Bullock County, GA is Rural
2011-2015 (2010 Census)
9.0% live completely rural counties
41.0% live in mostly rural counties 2013 Rural - Urban Continuum Codes
50.0% live in mostly urban counties Bullock County - #4 RUCC -70,217 population
Nonmetro-Urban -20,000 or more adjacent to metro area

In contrast to colloquial use, there is no

consensus among researchers about how to
define or measure the concept of rurality.
Many existing measures are ill suited, if not
flawed—including the commonly used
metropolitan/nonmetropolitan definitions
from the federal Office of Management and
Budget (OMB).
 RURAL VS URBAN LIVING
RURAL PEOPLE
97% of nation’s land, but 19.3% of the
population
Likely to own home free & clear (44.0%
compared to 32.3% urban)
Live in their state of birth
Have served in the military (10.4%
compared to 7.8% in urban areas)
Have transportation needs
76.3% of children live in married couple
families (67.4% urban)
URBAN PEOPLE
Numbers are increasing worldwide
Size of an urban community is larger than
rural community
Greater attention placed on individual than
family
Greater preponderance of love marriages
& freedom in life partners
Major occupations are industrial,
administrative & professional in nature
Class extremes characterize locations
Greater variety in food habits, dress
habits, living conditions, religious beliefs,
cultural outlook, & traditions
 RURAL VS URBAN HEALTH

Physician access - 39.8 (rural) compared to

53.3 physicians (urban) per 100,000
30 generalist dentists (urban) vs. 22 per
100,000 (rural)
Rural per capita income is $9,242 lower than
average U.S. More frequent occurrences of diabetes
Rural people use more Supplemental & coronary heart disease
Nutrition Assistance Program (SNAP) benefits Less access to mental health services
(Bailey, 2014) Rural youth are more than twice
Rural residents have greater transportation as likely to commit suicide
Rural residents live longer than
difficulties
urban residents
Tobacco use is significant among youth Rural couples (30%) less likely to have
Rural Americans lack access to high speed dual-eligible Medicare beneficiaries (70%)
internet Percent covered by Medicaid -
Rural communities have more uninsured Rural (16%) vs. Urban (13%)
residents
More than 50% of vehicle crashes in rural
areas
22% higher risk of injury related deaths occur
(rural)
 CHRONIC ILLNESS

• Symptoms fluctuate over time

• As symptoms change, challenges & needs change
• Individual & family face adaptive changes over time
• Care is co-produced within the family household
• Family collaborative work
 CHRONIC ILLNESS

• Who are the true care managers?

• Nurses can be effective guides, coaches, & help

individuals & families promote independence

• Communities need to support those managing chronic

illness

• Solutions that are “high touch” and “high tech”

 WHO - BETTER HEALTH FOR ALL

1. Reduce exclusion and social disparities in health;

2. Organize health services around people's needs and expectations;

3. Integrate health into all sectors (public policy reforms);

4. Pursue collaborative models of policy dialogue (leadership reforms);

5. Increase stakeholder participation.

 After Hurricane Mitch, Honduras (1998)

The roads on either end of the bridge completely vanished, leaving no visible trace of their
prior existence. The Choluteca River (which is several hundred feet wide) carved a new
channel and no longer flowed beneath the bridge at all, the bridge now spans dry ground.
This impressive structure quickly became known as “The Bridge to Nowhere.”
CHRONIC DISEASE SELF-MANAGEMENT

Social determinants of health

Excellent communication skills - Hear patient stories
Interdisciplinary collaboration
Care coordination
Involve family and friends
Rethink educational needs
Create meaningful measurable action plans
Identify needed resources
Families
 Complexity of
Chronic Disease Management

Household Niche
$$$
Motivation
Resources
Routines

Interactions

Personal Traits
Community
Societal Circumstances

Values
Social Networks
Individual’s Disease - Family
Choices
Family Context
Family Function
Family Health Routines
(Structure)
Living with Chronic Illness
 QUESTIONS TO ASK

Are you a Veteran?

Are you part of a military family?

VETERANS & VETERAN FAMILIES

Georgia Department of Veteran Services - https://veterans.georgia.gov

Charlie Norwood VA Medical Center (Augusta, GA)

Statesboro Clinic - 3-A West Altman Street, Statesboro, GA 30458

 NURSING ROLES
Communication skills (build respectful relationships)
Family -focused care: context, function, routines)
Address potential complications (de-prescribing)
Educate about risks & prevention
Involve others and identify needed supports
Provide clear instructions & explain care rationale
Assist in goal setting - Identify small steps to be taken
Give positive feedback & ongoing ENCOURAGEMENT