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Page 1 of 2

Chronic Care Nursing
  • A Framework for Practice
  • Linda Deravin-Malone, Judith Anderson
  • Published online:
    21 June 2018
    Print publication:
    01 July 2016
  • Chronic Care Nursing: A Framework for Practice provides a comprehensive and accessible overview of the role of the nurse in dealing with chronic conditions across a variety of healthcare settings in Australia and New Zealand. The first part of the book provides a road map for the implementation of chronic care, by outlining how two essential approaches to chronic care management - the Chronic Care Model and the World Health Organization's Innovative Care for Chronic Conditions Framework - can help to improve patient outcomes at both national and international levels. The second part devotes separate chapters to key conditions - including dementia, disability, palliative care and mental health - and highlights the pressing contemporary considerations of each condition. Written by an expert author team of clinicians and academics, this book is full of helpful educational tools such as national competencies, case studies and reflective questions, and is an indispensable resource for students and registered nurses.

  • 2 - Implementing the macro level of the ICCCF

  • from Part 1 - Frameworks for Chronic Care Management
  • Linda Deravin-Malone, Charles Sturt University, Wagga Wagga, New South Wales, Judith Anderson, Charles Sturt University, Bathurst, New South Wales
  • Book:
    Chronic Care Nursing
    Published online:
    21 June 2018
    Print publication:
    01 July 2016, pp 20-32

  • Summary

    LEARNING OBJECTIVES

    After studying this chapter, you should be able to:

  • • explain how the macro level of the Innovative Care for Chronic Conditions Framework addresses care for the person with a chronic condition

  • • understand the importance of national health policy and strategic initiatives to improve primary care services

  • • describe quality and monitoring systems within a chronic care nursing context

  • • understand the importance of education for the nurse and other health professionals in the specialty of chronic care.

    • Introduction

    The macro level of the Innovative Care for Chronic Conditions Framework (ICCCF) reviews policy development and resource allocation. This level also considers the legislative framework and the ability of policymakers to adapt policies to meet changes in health care requirements and create effective intersectoral links. The fragmentation of financial incentives and its impact on health outcomes and services are considered. Maintaining quality health care and monitoring systems are included, together with continuing education for registered nurses.

    A positive policy environment is the macro level that is required to support the micro and meso levels of the ICCCF. It is this level that provides the leadership, regulation and financial support for the health organisation, community and patient interaction (Epping-Jordan, Pruitt, Bengoa & Wagner, 2004).

    Chronic conditions can be viewed as being on a continuum, spanning those with the condition to those without the condition, as these conditions develop over time, beginning with risk, developing into diagnosis and then moving into complications. An awareness of this continuum is required to understand the need to invest at all points in the development of chronic conditions in order to manage them effectively – this is why the ICCCF requires three levels in order to manage chronic conditions (Epping-Jordan et al., 2004).

    Competency

    Table 2.1 identifies the national competency standards for the registered nurse from the Nursing and Midwifery Board of Australia (NMBA) and the Nursing Council of New Zealand (NCNZ) that are addressed in this chapter.

    Describing the macro level

    The macro level of the ICCCF describes the positive policy environment that supports the care provided for people with chronic conditions (see Figure 2.1).

  • 3 - Implementing the meso level of the ICCCF

  • from Part 1 - Frameworks for Chronic Care Management
  • Linda Deravin-Malone, Charles Sturt University, Wagga Wagga, New South Wales, Judith Anderson, Charles Sturt University, Bathurst, New South Wales
  • Book:
    Chronic Care Nursing
    Published online:
    21 June 2018
    Print publication:
    01 July 2016, pp 33-48

  • Summary

    LEARNING OBJECTIVES

    After studying this chapter, you should be able to:

  • • explain how the meso level of the Innovative Care for Chronic Conditions Framework addresses care for the person with a chronic condition

  • • understand how to build a supportive environment with the person with a chronic condition and other health partners

  • • explore aspects of health promotion and education within chronic care nursing

  • • consider the available resources within the community that support the care of the person with a chronic condition, and identify methods to develop future resources within health care organisations

  • • describe the impact of stigma in relation to chronic illness.

    • Introduction

    This chapter describes the meso level of the Innovative Care for Chronic Conditions Framework (ICCCF), which focuses on the health care environment and how care is organised. Tools and expertise that are required by nurses to provide evidence-based care within health care organisations, and the need to provide health education and promotion are discussed. This level of the ICCCF, with its focus on the entire organisation, is where other members of the team are valued for their involvement and support of the client. The benefits of information systems and community resources in order to provide comprehensive chronic care are addressed.

    The combining of large health care organisations and community groups to provide health care can lead to very effective interventions, but may require assistance to coordinate and to support clients who may have difficulty understanding the roles of such a variety of groups and people. Nurses are in a unique position to coordinate such care and to advise clients (Anderson & Malone, 2015) about what is available both within their own organisations and in the community, and thereby ensure the best possible outcomes.

    The meso level of the ICCCF is the link between the interaction of the client and the health care team (the micro level) and the overall environment in which care is provided (the macro level). In this way, the meso level supports the interaction with clients by providing the space and services where the interaction takes place, while the macro level provides the regulation and funding to ensure the safety and functioning of the meso-level organisations and community.

  • 1 - Frameworks for chronic care management

  • from Part 1 - Frameworks for Chronic Care Management
  • Linda Deravin-Malone, Charles Sturt University, Wagga Wagga, New South Wales, Judith Anderson, Charles Sturt University, Bathurst, New South Wales
  • Book:
    Chronic Care Nursing
    Published online:
    21 June 2018
    Print publication:
    01 July 2016, pp 3-19

  • Summary

    LEARNING OBJECTIVES

    After studying this chapter, you should be able to:

  • • understand the impact of chronic disease burden on communities both in Australia and New Zealand

  • • describe what a model of care is and how this applies to chronic care management

  • • outline the Chronic Care Model developed by Wagner et al.

  • • describe the Innovative Care for Chronic Conditions Framework

  • • explain the value of evidence-based practice to patient outcomes and the nursing profession in relation to chronic conditions.

    • Introduction

    Chronic conditions are prolonged and unable to be cured. They frequently have multiple causes, take a long time to develop and can lead to complications (AIHW, 2012). In 2012, chronic conditions accounted for 68 per cent of death in the world (WHO, 2014a). The burden of chronic conditions is estimated to account for approximately 80 per cent of disability adjusted life years (DALYs) and continues to increase, according to the Australian National Chronic Disease Strategy (National Health Priority Action Council, 2006). In Australia and New Zealand in 2014, chronic conditions accounted for 91 per cent and 89 per cent of deaths respectively (WHO, 2014b).

    These figures indicate the substantial impact that chronic conditions have on life worldwide, and this will also impact on health systems (Nuño, Coleman, Bengoa & Sauto, 2012). Nurses, who are the majority of workers within those systems, are able to have a significant impact on dealing with the issues that are arising from the increase in chronic conditions. Health systems will need to reorganise from a focus on acute health care to a focus on addressing and preventing chronic conditions. A focus on prevention, self-management, organisational change and political change is required to create better client outcomes, and this will require specialised skills from nurses if they are to be an effective part of the workforce to make these changes (Nuño et al., 2012). As indicated by the International Council of Nurses (2010), there is a growing global need for nurses to engage with communities and other sectors to intervene at the earliest stages to prevent chronic conditions.

  • 4 - Implementing the micro level of the ICCCF

  • from Part 1 - Frameworks for Chronic Care Management
  • Linda Deravin-Malone, Charles Sturt University, Wagga Wagga, New South Wales, Judith Anderson, Charles Sturt University, Bathurst, New South Wales
  • Book:
    Chronic Care Nursing
    Published online:
    21 June 2018
    Print publication:
    01 July 2016, pp 49-63

  • Summary

    LEARNING OBJECTIVES

    After studying this chapter, you should be able to:

  • • explain how the micro level of the Innovative Care for Chronic Conditions Framework (ICCCF) interacts with other levels in order to provide care for the person with a chronic condition

  • • describe how collaborative client interaction can be fostered between the nurse and the person with a chronic condition

  • • understand important aspects of holistic nursing care, including psychosocial aspects, for the person with a chronic condition

  • • describe the importance of the nursing role at the micro level of the ICCCF.

    • Introduction

    This chapter introduces the micro level of the Innovative Care for Chronic Conditions Framework (ICCCF). This level of the ICCCF focuses on patient interaction and the need to empower patients/clients. The imperative of valuing patient interactions and the role of the nurse in supporting them in self-care strategies is explored. Empowerment as the basis of self-care is described and psychosocial aspects of care are reviewed. Patients/clients and family members are viewed holistically and their contextual backgrounds (for example, cultural and lifestyle factors) are included in the framework (Epping-Jordan, Pruitt, Bengoa, & Wagner, 2004; WHO, 2002).

    Prevention of chronic conditions, early detection, effective management and prevention of complications are all aims of the ICCCF. The micro level focuses on interacting with individuals to meet these aims.

    The micro level is at the centre of the ICCCF, with direct contact and interaction between the patient/client, health care team and the community. This level of the ICCCF is also directly supported by the meso level, which includes the wider community and health care services where this interaction takes place (Epping-Jordan et al., 2004).

    Competency

    Table 4.1 identifies the national competency standards for the registered nurse from the Nursing and Midwifery Board of Australia (NMBA) and the Nursing Council of New Zealand (NCNZ) that are addressed in this chapter.

    Describing the micro level

    The micro level of the ICCCF attempts to encapsulate the importance of patient behaviours and the value of good-quality interactions with health care workers (see Figure 4.1). The majority of research that has been undertaken in relation to the care of people with chronic conditions has targeted this level and needs to be well incorporated into current practice (WHO, 2002).

  • 8 - Injury prevention

  • from Part 2 - Nursing Care of Clients with Chronic Conditions
  • Linda Deravin-Malone, Charles Sturt University, Wagga Wagga, New South Wales, Judith Anderson, Charles Sturt University, Bathurst, New South Wales
  • Book:
    Chronic Care Nursing
    Published online:
    21 June 2018
    Print publication:
    01 July 2016, pp 113-126

  • Summary

    LEARNING OBJECTIVES

    After studying this chapter, you should be able to:

  • • understand the impact of injuries on the health and wellbeing of communities

  • • identify potential risk factors for falls

  • • describe the main causes of transportation injuries

  • • describe the signs, pathophysiology and long-term effects of an acquired brain injury

  • • outline the effects of interpersonal violence, including self-harm and assault

  • • consider the impact of chronic pain on an individual that occurs as a result of injury

  • • understand the role of the nurse in injury prevention.

    • Introduction

    Injury prevention has been identified as one of Australia's targeted national health priorities (AIHW, 2015a). In New Zealand, injuries are the fifth most important cause of health loss (NZMOH and Accident Compensation Corporation, 2013). There is a significantly increasing trend in chronic illness and disability as a consequence of falls, transportation injuries, sporting and workplace accidents, and interpersonal violence. Many of these injuries result in hospitalisation. After receiving immediate treatment and stabilisation in the acute care setting, a person may require long-term physical rehabilitation or ongoing psychological support and counselling resulting from the injury sustained.

    Health promotion and prevention programs are critical to raising awareness and reducing the incidence of injuries that occur. Falls account for 39.4 per cent of injuries, transportation 12 per cent, interpersonal violence, including self-harm, 5.9 per cent, assault 5.2 per cent, and other unintentional injuries 32.1 per cent. These alarming statistics have a significant impact on the cost to both people and health systems (AIHW, 2015b). A multi-layered approach is required to reduce the incidence of injuries. This includes government-led awareness programs such as driver safety campaigns (Proffitt & Beacham, 2012; Transport for NSW, 2015), domestic violence awareness (Parliament of Australia, 2011; Proffitt & Beacham, 2012), workplaces improving safety systems, and individuals taking responsibility for their own safety as well. Falls, transportation injuries, acquired brain injuries, interpersonal violence as a result of self-harm or assault, and the chronic pain that often results from injury will be the focus of this chapter.

    Competency

    Table 8.1 identifies the national competency standards for the registered nurse from the Nursing and Midwifery Board of Australia (NMBA) and the Nursing Council of New Zealand (NCNZ) that are addressed in this chapter.

  • 18 - End of life care

  • from Part 2 - Nursing Care of Clients with Chronic Conditions
  • Linda Deravin-Malone, Charles Sturt University, Wagga Wagga, New South Wales, Judith Anderson, Charles Sturt University, Bathurst, New South Wales
  • Book:
    Chronic Care Nursing
    Published online:
    21 June 2018
    Print publication:
    01 July 2016, pp 273-288

  • Summary

    LEARNING OBJECTIVES

    After studying this chapter, you should be able to:

  • • understand the relationship between chronic conditions and fatal burden in both Australia and New Zealand

  • • identify pain management and symptom control techniques for the person at end of life

  • • consider the issues in providing emergency care for the palliative patient

  • • describe the importance of psychosocial aspects of end of life care

  • • outline the importance of advanced care planning

  • • understand the nurse's role in end of life care.

    • Introduction

    End of life care or palliative care is defined by Palliative Care Australia (2005) as ‘ the care provided for people of all ages who have a life limiting illness, with little or no prospect of cure, and for whom the primary treatment goal is quality of life’. On a global scale, chronic conditions including non-communicable diseases and communicable diseases accounted for 68 per cent and 23 per cent, respectively, of all deaths in 2012 (WHO, 2015).

    Chronic conditions are attributed to be the cause of early death, significantly contributing to fatal burden worldwide. In Australia, chronic conditions accounted for the following mortality rates: cancer (35 per cent), cardiovascular disease (23 per cent), injuries (13 per cent), neurological conditions (6 per cent) and respiratory diseases (5 per cent) of the total burden. These five chronic condition groups were estimated to account for 82 per cent of all years of life lost (YLL) in 2010 (AIHW, 2015). Similarly in New Zealand, chronic conditions accounted for 63 per cent of fatal burden comprising of: cancers (17.5 per cent), vascular and blood disorders (17.5 per cent) followed by mental health disorders (11 per cent), musculoskeletal disorders (9 per cent) and injury (8 per cent) in 2006 (NZMOH, 2014).

    Several national bodies exist which provide guidance and support to nurses working in the area of palliative care. In Australia, Palliative Care Australia (2015b) provides a range of resources, as does Hospice New Zealand (2015) in New Zealand. These bodies provide useful guidelines for best practice that are current and contextualised to country of origin, which can be especially useful for legal issues. The exact model of palliative care used differs due to services and resources available, local legislation, demographics and demand for services (AIHW, 2014).

  • Preface

  • Linda Deravin-Malone, Charles Sturt University, Wagga Wagga, New South Wales, Judith Anderson, Charles Sturt University, Bathurst, New South Wales
  • Book:
    Chronic Care Nursing
    Published online:
    21 June 2018
    Print publication:
    01 July 2016, pp xv-xvi

  • Summary

    Impact of chronic conditions in Australia and New Zealand, and worldwide

    This is the first edition of Chronic Care Nursing: A framework for practice, which we believe will be a useful resource for this area of clinical nursing practice. This book has been developed for undergraduate nurses and registered nurses who wish to develop their knowledge about the care of people living with chronic conditions in our communities.

    The structure of the book is based on the Innovative Care for Chronic Conditions Framework (ICCCF), which is an internationally recognised framework for the delivery of chronic care. The ICCCF extends the Chronic Care Model (CCM) that was developed by Wagner (Wagner, Davis, Schaefer, Von Korff & Austin, 1999). The CCM is well recognised as providing a systematic approach to chronic care management. It incorporates six components: health system (organisation of health care); self-management support; decision support; delivery system design; clinical information systems; and community resources and policies (Stellefson, Dipnarine & Stopka, 2013). The model provides a multidimensional solution to the complex problem of the provision of chronic care (Bodenheimer, Wagner & Grumbach, 2002).

    The Chronic Care Model has been expanded and internationalised by the World Health Organization (WHO) to be developed into the ICCCF. Nurses need to lead the redesign of the health care system in order to improve health outcomes through the implementation of the CCM. The ICCCF extends this model by adding micro, meso and macro levels to it, and incorporates six guiding principles: evidence-based decision making; population focus; prevention focus; quality focus; integration; and flexibility and adaptability (WHO, 2002). These levels extend the involvement of community, and describe policies and financing as the drivers at the macro level (Bengoa, Epping-Jordan, Pruitt & Wagner, 2004). An important aspect of the implementation of this model and framework is how well it is integrated into undergraduate nursing education so that an informed and well-prepared nursing workforce is established in Australia and New Zealand.

    The first section of this textbook focuses on the ICCCF to support the learning of undergraduate student nurses about the complexity of chronic conditions and how the framework is best implemented in order to improve patient outcomes at both a national and international level.

  • 30 - The 2004 U.S. Ocean Report and Its Implications for Land Use Reform to Improve Ocean Water Quality

    • By Linda A. Malone, Marshall-Wythe Foundation Professor of Law William and Mary Law School, Williamsburg, Virginia, USA
  • Edited by Nathalie J. Chalifour, University of Ottawa, Patricia Kameri-Mbote, University of Nairobi, Lin Heng Lye, National University of Singapore, John R. Nolon, Pace University, New York
  • Book:
    Land Use Law for Sustainable Development
    Published online:
    17 August 2009
    Print publication:
    20 November 2006, pp 555-580

  • Summary

    INTRODUCTION

    Background

    In response to the increasing degradation of water quality in the nation's waterways and oceans, the United States Congress in 2000 mandated the first comprehensive review of ocean policy in over 30 years. That review resulted in the 1969 Stratton Commission report and led to the establishment of a legal and regulatory framework for ocean policy. Since then, the growing coastal population and ad hoc governmental approach to environmental problems compelled Congress to create the United States Commission on Ocean Policy (Commission) to make recommendations for a coordinated and comprehensive national ocean policy. Although the final report was delayed, it was released in September 2004. The report is a result of multiple regional public meetings held by the Commission with input from various federal and state governments, industry, interest groups, the academic community, the international community, and interested citizens. Notably in November 2001, just as the Commission was beginning its public meetings, it unanimously passed a one-sentence resolution urging the United States to accede immediately to the United Nations Convention on the Law of the Sea.

    As discussed in this chapter, the Commission's overall recommendation was to move quickly toward an ecosystem-based management approach to water quality. Achievement of this goal requires the creation of a National Ocean Council (NOC), composed of all cabinet secretaries and directors of federal agencies with ocean and coastal responsibilities, to advise the President regarding the national coordination of ocean policies.

  • Intrathecal polymer-based interleukin-10* gene delivery for neuropathic pain

  • Erin D. Milligan, Ryan G. Soderquist, Stephanie M. Malone, John H. Mahoney, Travis S. Hughes, Stephen J. Langer, Evan M. Sloane, Steven F. Maier, Leslie A. Leinwand, Linda R. Watkins, Melissa J. Mahoney
  • Journal:
    Neuron Glia Biology / Volume 2 / Issue 4 / November 2006
    Published online by Cambridge University Press:
    13 July 2007, pp. 293-308
    Print publication:
    November 2006

  • Research on communication between glia and neurons has increased in the past decade. The onset of neuropathic pain, a major clinical problem that is not resolved by available therapeutics, involves activation of spinal cord glia through the release of proinflammatory cytokines in acute animal models of neuropathic pain. Here, we demonstrate for the first time that the spinal action of the proinflammatory cytokine, interleukin 1 (IL-1) is involved in maintaining persistent (2 months) allodynia induced by chronic-constriction injury (CCI). The anti-inflammatory cytokine IL-10 can suppress proinflammatory cytokines and spinal cord glial amplification of pain. Given that IL-1 is a key mediator of neuropathic pain, developing a clinically viable means of long-term delivery of IL-10 to the spinal cord is desirable. High doses of intrathecal IL-10-gene therapy using naked plasmid DNA (free pDNA-IL-10) is effective, but the dose required limits its potential clinical utility. Here we show that intrathecal gene therapy for neuropathic pain is improved sufficiently using two, distinct synthetic polymers, poly(lactic-co-glycolic) and polyethylenimine, that substantially lower doses of pDNA-IL-10 are effective. In conclusion, synthetic polymers used as i.t. gene-delivery systems are well-tolerated and improve the long-duration efficacy of pDNA-IL-10 gene therapy.

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