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Chronic Illness Research:

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... related to chronic physical illness evaluated by Thorne and Paterson (1998) ... Mary Ellen Michelle Heisler, University of Michigan ... – PowerPoint PPT presentation

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Title: Chronic Illness Research:


1
  • Chronic Illness Research
  • Creating an Evidence Base for Practice
  • Pamala D. Larsen, PhD., CRRN, FNGNA
  • University of Wyoming

2
Commission on Chronic Illness (1957)
  • All impairments or deviations from normal which
    have one or more of the following
    characteristics
  • Permanent
  • Leave residual disability
  • Caused by non-reversible pathology
  • Rehabilitation
  • Require a long period of care

3
  • The Illness Experience
  • vs
  • The Disease

4
Evidence-Based Practice
  • Archie Cochranes call for systematic review of
    the literature
  • Birth of the Cochrane Library Database in 1992

5
Cochrane Database
  • Prevention and Treatment of Urinary Incontinence
    after Stroke in Adults
  • Specialist continence nursing
  • Structured assessment management of care

6
Cochrane Database
  • Specialist Home-Based Nursing Services for
    Children with Acute and Chronic Illnesses
  • No adverse impact on physical health outcomes
  • Improved satisfaction with home based care

7
Evidence Based Practice
  • Best possible research
  • Clinical expertise
  • Patient needs
  • Porter-OGrady (2006, p. 1)

8
http//www.acestar.uthscsa.edu/Resources_www.htm
9
EBP
  • Agency for Healthcare Research Quality (AHRQ)
  • Cochrane Library Database
  • Task Force on Community Preventive Services
  • US Preventive Services Task Force
  • Veterans Evidence-Based Research Dissemination
    Implementation Center (VERDICT)

10
National Guideline Clearinghouse
  • www.guideline.gov

11
  • www.clinicalevidence.com
  • British Medical Journal
  • United Health Foundation

12
Nursing Interventions Classification (NIC)
  • Standardized language
  • 514 interventions (2004 edition) for RNs,
    RNs-post basic and nursing assistants

13
  • Illness is the night-side of life, a more onerous
    citizenship. Everyone who is born holds dual
    citizenship, in the kingdom of the well and in
    the kingdom of the sick. Although we all prefer
    to use only the good passport, sooner or later
    each of us is obligated, at least for a spell, to
    identify ourselves as citizens of that other
    place
  • Sontag (1988, p. 3)

14
Shifting Perspectives of Chronic Illness
  • Based on 158 qualitative studies related to
    chronic physical illness evaluated by Thorne and
    Paterson (1998)
  • Paterson (2001)

15
Self-Management Programs
  • Self-management or disease management programs
  • Kate Lorig
  • Stanford Patient Education Research Center
  • Arthritis

16
Reviews of Self-Management Programs
  • Archives of Internal Medicine (2004)
  • 71 studies on arthritis, diabetes, asthma,
    hypertension miscellaneous
  • Small/moderate benefit on HgbA1c systolic BP
  • Minimal effect asthma
  • No effect - arthritis

17
Reviews (cont)
  • Annals of Internal Medicine (2005)
  • Diabetes (26) Osteoarthritis (14)
    Hypertension (13)
  • HgbA1c decreased by .81
  • Systolic reading decreased 5 mm.
  • Diastolic reading decreased 4.3 mm.
  • Arthritis studies without clinical effects

18
Reviews (cont)
  • Patient Education and Counseling (2002)
  • Positive results in arthritis self-management
    programs
  • Increased knowledge compliance in asthma
  • Increased use of self-management behaviors in
    diabetes

19
Chronic Care Model
  • Crafted by Edward Wagner colleagues at the
    Group Health Cooperative of Puget Sound in
    Seattle
  • Now the primary product of Improving Chronic
    Illness Care, RWJ Foundation

20
Chronic Care Model
  • Internal Components
  • Self-management support
  • Decision support
  • Delivery system redesign
  • Clinical information systems
  • External Components
  • Community resources
  • Health care organization

21
Utilizing the CCM in Practice
  • Two state-level diabetes collaboratives in
    Washington
  • North Carolina Diabetes and Control Branch with
    12 community health clinics

22
Heart Failure
  • McCauley, Bixby Naylor (2006)
  • APN interventions being effective
  • Sisk et al. (2006)
  • Less hospitalizations greater self-functioning
    (per self-report)

23
State of the Science Review of Nursing
Interventions with HF Patients
  • Home based studies
  • Multidisciplinary intervention studies
  • Extended roles of nurses in HF clinics
  • Technology/telephone home interventions

24
Cancer
  • Sherwood et al. (2005)
  • RCT and cognitive behavioral interventions for
    symptom management
  • Doorenbos et al. (2004).
  • RCT and cognitive behavioral interventions for
    symptom management

25
Cancer-Related Fatigue
  • Stricker, Drake, Hoyer Mock (2004)
  • Analysis of 20 experimental studies
  • Exercise is the most effective nonpharmacologic
    intervention

26
Technology/Telephone Interventions
  • Badger et al. (2005)
  • Intervention group experienced decreases in
    depression, fatigue stress
  • Coleman et al. (2005)
  • Mailed resource kit, alone, appeared to be as
    effective as the telephone social support

27
Wellness Interventions
  • Stuifbergen et al. (2003)
  • RCT of 113 women with MS
  • Two phases of the intervention
  • Educational skill-building lifestyle
  • Supportive telephone follow-up
  • Experimental group improved their self-efficacy,
    increased their health beahviors improved
    aspects of QOL

28
Heart Failure
  • Kutzleb Reiner (2006)
  • Clark et al. (2006)

29
Chronic Illness Technology
  • Women to Women technology based intervention
    via computer to provide support to isolated,
    chronically ill rural women
  • Increased QOL

30
Other
  • vanServellen, Fongwa DErrico (2006)
  • Does continuity of patient care improve quality
    of care?

31
  • THE FUTURE

32
  • Computer Retrieval of Information
  • On
  • Scientific Projects
  • http//crisp.cit.nih.gov/

33
NIH funded - Pediatric
  • Margaret Grey, Yale University
  • Assessing Family Management of Childhood Illness
  • Family Management Style Survey (FMSS)
  • NINR
  • 5R01NR008048-03

34
NIH Funded - Pediatric
  • Gail Kieckhefer, University of Washington
  • Childhood Chronic Illness Enhancing Family
    Capabilities
  • Agency for Healthcare Research and Quality
  • 5R01HS013384-04

35
NIH Funded - Pediatric
  • Suzanne Johnson, Florida State University
  • Clinic-based Adherence Intervention for Diabetes
    and Cystic Fibrosis
  • National Heart, Lung Blood Institute
  • 5R01HL069736-04

36
NIH Funded - Adult
  • Alexa Stuifbergen, University of Texas at Austin
  • Health Promotion and Quality of Life in Chronic
    Illness
  • NINR
  • 5R01NR003195-12

37
NIH Funded - Adult
  • Karen Schwarz, University of Akron
  • Effects of Telemonitoring of Heart Failure
    Patients and Caregivers
  • NINR
  • 1R15NR008698-01

38
NIH Funded - Adult
  • Mary Ellen Michelle Heisler, University of
    Michigan
  • Peer Support Congestive Heart Failure
    Self-Management
  • National Heart, Lung Blood Institute
  • 1R01HL085420-01

39
COPD
  • Lynn Reinke, University of Washington
  • End-of-Life Caring Needs for Patients with COPD
  • NINR
  • 1F31NR010055-01

40
Systemic Lupus Erythematosus
  • Megan Lewis, Research Triangle Institute
  • Tailored Messaging for Couple Chronic Illness
    Management
  • National Institute of Arthritis and
    Musculoskeletal and Skin Diseases
  • 7R03AR054067-02

41
Chronic Illness
  • Clarann Weinert, Montana State University
  • Rural Chronically Ill Women Online Support Group
  • NINR
  • 2R01NR007908-04A1

42
Improving Chronic Illness Care
  • A national program of the Robert Wood Johnson
    Foundation since 1998
  • Chronic Care Model (CCM) is its core
  • Purpose is to better the health of chronically
    ill patients by helping health systems,
    especially those that serve low-income
    populations, improve their care
  • http//www.improvingchroniccare.org

43
T32 Training Grants
  • Merle Mishel
  • Interventions for Preventing and Managing Chronic
    Illness - 2T32NR007091-11
  • University of North Carolina at Chapel Hill
  • Judith Erlen
  • Technology Research in Chronic Critical
    Illness 5T32NR008857-02
  • University of Pittsburgh

44
Research Center for Symptom Management UCSF
School of Nursing
45
Oncology Nursing Society
  • Smoking Cessation for Women Evidence of the
    Effectiveness of Nursing Interventions
  • Evidence-based Interventions for Sleep-Wake
    Disturbances
  • Evidence-based Interventions for Prevention of
    Infection

46
  • How do we add to the evidence?
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