Management of a Long Term Condition

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This essay focuses on a patient encountered in clinical practice with the chronic long term condition multiple sclerosis (MS). The National Service Framework for Long Term Conditions (2005) defines a long term condition (LTC) as one which is incurable but manageable with therapeutic interventions. The patient’s name has been changed, and Trust identifiers’ removed to adhere to confidentiality as outlined in the Nursing and Midwifery Council’s Code of Professional Conduct 2008 (NMC 2010).

The second component to be explored will be collaborative working between the members of the healthcare team (Appendix 1). This will be done in conjunction with exploring the management approach

The patient, referred to as Mrs. J, is 57 and was diagnosed with MS in her late twenties. She lives in a bungalow with her husband. Mrs. J worked as a sports teacher up to five years ago. She advised her retirement was not disease related but she would find it difficult to return to teaching due to her MS. At home, Mrs. J requires the assistance of two carers in the morning to assist with getting out of bed and dealing with activities of daily living (ADL). In the evening her husband assists in this capacity.

On a number of occasions prior to the current hospital admission, 3 weeks ago, Mr. J has returned home to discover his wife had fallen. On some of these occasions she has been unable to get up and remained on the floor to await his return home. Mrs. J has also developed a sore in her natal cleft a few days earlier. The additional reasons for her admission to a neurological rehabilitation unit include reduced mobility, inability to intermittently self catheterize (ISC), truncal ataxia, dystonia, passing dark urine and lethargy.

Mrs. J is in the acute phase of her disease trajectory (Corbin & Strauss, 1992). The trajectory model considers the management approach of disease yet maintains focus on the patient’s ability to regain control of their ongoing care. For this to be achievable the period of hospitalization is estimated at six weeks.

Before progressing to consider the management approach it is essential to have an understanding of some of the main government agendas and policies around providing and promoting self care for LTC’s.

National Service Frameworks are commonplace within the NHS. The aim of these strategies is to improve inter profession and inter agency communication thereby leading to improved service provision for patients in hospital and in the community. The outcome is to improve education and support for professionals and patients while promoting and encouraging self management where there is potential for this to occur.

An early initiative was devised in 1999 with the introduction of the Expert Patients Task force group. The idea was to draw together expertise from patients and organizations to develop coping strategies which patients could take ownership of. The results of this was drawn together and published in 2001 by the Department of Health’s (DoH) document: The Expert Patient: A New Approach to Chronic Disease Management for the 21st Century. This highlighted, that by encouraging patients to take responsibility for managing their disease, progression of the disease trajectory could slow or be reversed. Having improved coping mechanisms should enhance patients’ perceptions of well-being, improving their sense of worth and ability to interact in society. Improved support networks could result in a transition back to employment for those of working age. Many Primary Care Trusts have embarked upon this scheme through Stepping Stones to Success published by DoH (2004) which teaches how to set up the Expert Patient Program.

The DoH has published numerous policy documents and drivers in the last 10 years which focus on promoting self management, for example, the Self Care publication in 2005. This builds on earlier documentation and relates to fulfilling patients requests...
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