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Medical Social Work in Chronic Illness Care and Management

Advances in medical technology have altered the trajectory of illness in our society. Many illnesses that were once considered acute or terminal are now considered chronic. The trajectory of advanced chronic illness, thus, has shifted from a brief period of time to longer periods with impaired quality of life. Patients and/or families living with chronic illnesses are often forced to adjust their aspirations and lifestyle. They also are vulnerable to protracted distress and developing psychiatric illness.

Optimal care and management of chronic illness is significant because it is likely to minimize distress, prevent psychiatric illness, and improve health outcomes and quality of life (Wagner, 2000). A professional team including a medical social worker can deliver optimal care for chronic illness (Wagner, 2013).

To prepare for this Discussion:

Review this week’s resources. Consider a chronic illness that is of interest to you. Think about how the following medical social work practice skills might apply to the illness you chose:

• Assessment
• Crisis intervention
• Case management
• Education and counseling
• Advocacy
• Team collaboration
• Community-level intervention

By Day 3

Post a brief description of the illness you selected and the psychosocial effects of the illness on patients and families. Analyze the issues and concerns surrounding the care and management of the illness. Choose three medical social work practice skills, and explain how a medical social worker might implement them to improve the care and management of the illness. Explain challenges that might arise for families or caregivers caring for a patient with your chosen illness. Explain how you as a medical social worker might address the struggles or challenges experienced by families or caregivers.

Be sure to support your postings and responses with specific references to the resources and the current literature using appropriate APA format and style.

Read a selection of your colleagues’ postings.

By Day 5

Respond to at least two of your colleagues’ postings in one or more of the following ways:

• Suggest an additional insight about psychosocial aspects of illness and management that your colleague did not explain.
• Analyze your colleague’s post. Expand on the post by providing a different perspective on social work practice skills.
• Share an additional insight you gained from reading a colleague’s post about caregiver burden for his or her selected illness.

References:

Centers for Disease Control. (2010a). Chronic disease and health promotion. Retrieved from
http://www.cdc.gov/chronicdisease/overview/index.htm

Gehlert, S., & Browne, T. A. (2006). Handbook of health social work. New York, NY: John
Wiley & Sons.

Vélez‐Vélez, E., & Bosch, R. J. (2016). Illness perception, coping and adherence to treatment among patients with chronic kidney disease. Journal of advanced nursing, 72(4), 849-863.

According to The Center for Disease Control (2010), approximately 133 million Americans, or at least 1 out of every two adults, had at least one chronic illness; and by 2020, this number is expected to increase to 157 million (Centers for Disease Control, 2010). The care of an individual with a chronic illness can be challenging on both a personal/patient as well as a health care system perspective (Gehlert& Browne, 2006). Caring for an individual with a chronic illness is different from an acute injury or condition, as the care is ongoing and requires a variety of health care providers and other resources (Findley, 2013). Social workers play a crucial role in managing chronic illnesses for patients as they help mediate between systems when diversity issues become a barrier in receiving proper access to care. Thus, their broad perspective on the range of physical, emotional, and environmental factors affect the well-being of individuals and communities alike (NASW, 2005).

One chronic illness that impacts patients and families is the illness of diabetes. According to Penckofer, Ferrans, Velsor-Friedrich, & Savoy (2007), diabetes is the leading cause of morbidity in the United States. From a psychosocial perspective, traditional management of diabetes targets diet, medication, and exercise, yet the psychosomatic aspects of this disease are overwhelming because of the life-long maintenance it requires to manage the illness (Penckofer et al., 2007). Feelings of stress, worry, depression, and anxiety in persons with diabetes are common, and the challenges encountered in managing the disease, affect both patients and their caregivers alike (Penckofer et al., 2007). Issues and concerns surrounding diabetes include the somatic fears of losing limbs such as feet and the potential increase for heart attacks and strokes, as well as identifying drug and disease management to cope with the demands of a complex chronic disease effectively. Because patients and families handle the vast majority of day-to-day care in diabetes, there is an essential need for reliable and valid measures for self-management of diabetes (Grant, Devita, Singer, Meigs, 2003). Additional issues and concerns are that genetics play a crucial role in the development of diabetes, and overall treatment adherence to the illness. Other barriers include socio-demographic and cultural barriers such as poor access to drugs, high cost, patient satisfaction with their medical care, patient-provider relationship, and the degree of symptoms per individual (Grant, Devita, Singer, Meigs, 2003).

One medical social work practice skill includes implementing communication within chronic care programs to teach self-management skills that help to manage symptoms of a variety of prolonged diseases such as arthritis, diabetes, lung and heart disease (Centers for Disease Control, 2010a). Medical social workers might use communication as a teaching tool focused on medication use, exercise, nutrition, and treatment evaluation to enhance the patient’s ability to care for him/ herself and to make health behavior changes (Von Korff et al., 1997). Another practice skill includes developing psychosocial strategies for diabetes care such as empowerment, faith-based, cultural competence and community-based approaches. Medical social workers may use the empowerment approach to assist persons with diabetes in engaging in diabetes self-management (Two Feathers et al., 2007).  Anderson & Funnel (2002) state that the empowerment approach involves three principals that integrate “the psychology of behavior change” to promote successful diabetes management. The principles include an acknowledgment that a majority of diabetes care relies on action by the patient, and lastly requiring health care professionals to keep in mind that behavior change is more likely to occur when clients engage in change behavior that is salient on a personal level (Anderson & Funnel, 2002). Additionally, Miley and DuBois (2007) encourage social workers to conceptualize empowerment practice as a “social justice contract” between the clinician and society at large; ensuring that social workers practice in a way that ensures “the social participation of individuals and their capacity to contribute to the resource pool of society” (pg. 31). When applied to clinical interventions in diabetes prevention or management, social workers offer a unique care perspective, which seeks to partner with the client, value their expertise, highlight the resources and skill set clients can utilize to solve the presenting problem, and build upon past successes to encourage future growth (Wallerstein, 2002). Lastly, faith-based diabetes interventions can help diabetic patients view and value spirituality and religious institutions as significant sources of psychological and social support. From a social work perspective, integration of spiritual practices can increase personal understanding of diabetes-related education and improved specific diabetes self-management behaviors among participants (Mitchell and Hawkins, 2014). It is crucial for social workers to emphasize the integration of faith-based strategies for specific populations to ensure successful diabetes prevention and management.

Challenges that family members and caregivers may experience when assisting a loved one with diabetes includes concerns for the family well-being, responsible management of the disease, and cultural interests on diabetic health disparities. Increased irritability as a symptom of diabetes can present as a challenge to family harmony. According to Orvik, Ribu, & Johansen, (2010), patients can “get angry easily” and “easily throw a temper tantrum” when their blood glucose is high, thus interpreting family harmony, particularly for more private family systems such as Asian cultures. From another cultural perspective, observing a bio-medically prescribed diabetes regimen requires patients to distance themselves from familiar and shared cultural food habits and practices within the family and community. Thus, impacting how individuals find familiarity and comfort with family members. Strict diets require patients to find a balance within food variation, and this can affect how family food practices are played out. According to Orvik, Ribu, & Johansen, (2010), disease-related food restrictions neglect cultural concerns for balancing foods with specific medicinal properties. Diabetic diets also complicate shared social experiences of outings, meals, and celebrations with family and friends. Difficulties in managing the social elements of meals can be severe during celebrations of birthdays, and weddings, banquets, with the temptation of multiple courses and desserts.

Living with diabetes also challenges family roles in accommodating the disease. For example, differing beliefs about who in the family should be responsible for managing the disease creates conflicts in negotiating differing role expectations. The challenges arise when family role conflicts are centered on who should create, observe, and enforce food restrictions. Differences in opinion, the role of the spouse, caregiver, and patient are additionally challenged when everyone’s expectations on managing the disease and symptoms are diverse. Nevertheless, dietary restrictions on carbohydrates can be particularly challenging to a population that has historical, symbolic, and ritualized inclusion of rice and bread in their daily diets.

Families with diabetic loved ones also suffer from a wide range of concerns, including the constant existence of a needle in their everyday life, persistence fear of hypoglycemia, fear of complications, as well as the panic of diabetes development in other family members. Given the chronic nature of diabetes, the family is pierced down to a context of continuous care. Another source of tension within the families is the high-cost therapy of disease. Furthermore, in the process of managing an individual with diabetes, the family tries to form a new concept of life which is living with diabetes for the remainder of one’s life. How the family is structured and its belief and problem-solving skills or lack thereof, can exacerbate the stresses associated with disease management (Fisher, Chelsa, &Bartz, 1998). Through their communications and attitudes, family members often have a significant impact on a patient’s psychological well-being, decision to follow recommendations for medical treatment, and ability to initiate and maintain changes in diet and exercise (Fisher et al., 1998). Knowledge about the disease, strategies to alter family routines, and optimal ways to cope with the emotional aspects of the disease are some of the aspects of diabetes self-management that family members need (Orvik, Ribu, & Johansen, 2010).

Considering that adults with diabetes depend on the support of family for assistance in managing their diabetes, examining family-based interventions for adults with diabetes is vital in understanding how to strengthen current diabetes self-care programs. Social workers must involve diabetes self-management interventions with family members and place greater emphasis on targeting communication skills and teaching families positive ways to influence patient health behaviors (Martire, Schulz, Helgeson, Small, Saghafi, 2010). This is because family members can feel distressed by their loved one’s diabetes, due to limited knowledge about diabetes or not knowing how to support their loved one (Martire, Schulz, Helgeson, Small, Saghafi, 2010). Social workers must also engage families about the disease, and find diverse strategies to alter family routines and optimal ways to cope with the emotional aspects of the disease (Martire, Schulz, Helgeson, Small, Saghafi, 2010). Educating family members about diabetes-care can help ease this strain by explaining why these changes are necessary, how these changes can best be implemented, and where to find additional information, such as healthy recipes or exercise routines (Trief, Morin, Izquierdo, 2006). It is important to provide family members with information about the illness and possible treatment options, by validating their experiences and help teach various stress management skills, to help both families and patients plan for the future (Martire, Schulz, Helgeson, Small, Saghafi, 2010).

References

Centers for Disease Control. (2010a). Chronic disease and health promotion. Retrieved from
http://www.cdc.gov/chronicdisease/overview/index.htm

Gehlert, S., & Browne, T. A. (2006). Handbook of health social work. New York, NY: John
Wiley & Sons.

Grant R.W., Devita N.G., Singer D.E., Meigs J.B. (2003). Poly-pharmacy and medication
adherence in patients with type 2 diabetes. Diabetes Care. 26 (5):1408–1412. doi:
10.2337/diacare.26.5.1408.

Findley, P. A. (2013, February 28). Social work practice in the chronic care model: Chronic
illness and disability care. Journal of Social Work[Published online ahead of print].

Fisher L, Chesla C.A., Bartz R.J. (1998). The family and type 2 diabetes: a framework for
intervention.Diabetes Education. 24:599–607.

Martire L.M., Schulz R., Helgeson V.S., Small B.J., Saghafi E.M. (2010). Review and Meta-a
analysis of Couple-Oriented Interventions for Chronic Illness. Annals of behavioral medicine a
publication of the Society of Behavioral Medicine. 40: 325–42.

Miley K, DuBois B. Ethical Preferences for the Clinical Practice of Empowerment Social
Work. Social Work in Health Care. 2007;44(1/2):29–44.

Mitchell, J.A. and Hawkins, J. (2014). Current Approaches to Support the Psychosocial Care of
African American Adults with Diabetes: A Brief Review. Social Work Public Health; 19;
29(6): 518–527.

National Association of Social Workers (NASW). (2005). NASW standard for social work in
health care practice. Washington, DC: Author.

Orvik E, Ribu L, Johansen O.E. (2010). Spouses’ educational needs and perceptions of health in
partners with type 2 diabetes. European Diabetes Nursing. 7:63–9.

Trief P.M, Morin P.C., Izquierdo R. (2006). Marital quality and diabetes outcomes: The IDEA
Tel Project. Families, Systems, & Health. 24: 318.

Two Feather J, Kieffer E, Palmisano G, Anderson M, Sinco B, Janz M, Heisler M, et al. Racial
and ethnic approaches to community health (REACH) Detroit partnership: Improving diabetes-related
outcomes among African American and Latino adults. American Journal of
Public Health. 2005;95(9):1552–1560.

Von Korff, M., Gruman, J., Schaefer, J., Curry, S. J., & Wagner, E. H. (1997). Collaborative
management of chronic illness. Annals of Internal Medicine, 127(12), 1097–1102.

Wallerstein N. Empowerment to Reduce Health Disparities. Scandinavian Journal of Public

Health. 2002;30(59):72–77.

The chronic illness that I selected to focus on is Bio Polar disorder. This disorder can affect a person in every aspect of their life and if it is not managed then they can be a real danger to themselves.  When this disorder is undiagnosed the manic episodes can be extremely difficult to handle for both the person and the family (Bennett, Coleman, Parry, Bodenheimer, & Chen, 2010). They can do very extremely things such as experiment with drugs, be promiscuous, and have random moments of trying to do things that are not in their normal character. This can be especially hard on the family members because they do not know what their loved one will do or how they will react to things now since they seem to be unpredictable (Bennett, Coleman, Parry, Bodenheimer, & Chen, 2010). On the opposite end of this disorder the extreme lows a person can have are severe depression where they do not get out of beds for days and have suicidal ideations.

With this disorder a lot of care and status checks need to be performed in order to see if the patient is following their treatment plan and more importantly if they are on medications they will need to comply with them (Bennett, Coleman, Parry, Bodenheimer, & Chen, 2010). Without the assistance of some medications the patient can be constantly go through episodes of mania and depression (Lee, Piette, Heisler, Janevic, Langa, & Rosland, 2017). This can lead to frustration on families’ part because there is a level of uncertainty about what will happen to their loved one (Bennett, Coleman, Parry, Bodenheimer, & Chen, 2010). So providing intensive case management and psychotherapy will be needed to help this person through the process of coping and managing their disorder (Bennett, Coleman, Parry, Bodenheimer, & Chen, 2010).

Three social worker practice skills that would be helpful with a patient like this would be case management, crisis intervention, and education (Bennett, Coleman, Parry, Bodenheimer, & Chen, 2010). With these three specific practice skills we can assist the patient with any crisis that they may be going through and help them work their problem out in a health manner instead of using a negative solution such as substances or other risky behaviors (Lee, Piette, Heisler, Janevic, Langa, & Rosland, 2017). Case management allows us to have a working relationship with the patient and help them focus on specific tasks that they need to accomplish in order to have some form of stability in their life (Bennett, Coleman, Parry, Bodenheimer, & Chen, 2010). Since patients with Bi polar disorder can be disorganized and all over the places we can provide them with task that they are capable of doing and within their ability to complete. This will allow them to feel confident about themselves and know that there is someone to speak with when they need help (Lee, Piette, Heisler, Janevic, Langa, & Rosland, 2017). Education is an important part for both the patient and the family because we can explain how this disorder affects both of them and what they can expect when an episode occurs and how they should approach one another (Bennett, Coleman, Parry, Bodenheimer, & Chen, 2010). The idea of understanding someone’s disorder is always going to be better than ignoring it or pretending it does not exist as some people elect to do (Bennett, Coleman, Parry, Bodenheimer, & Chen, 2010).

Some challenges that a family can expect to go through is their family member not willing to go through treatment or resisting the medications that they are on. A common occurrence is that a person does not like how they feel on their medications (Lee, Piette, Heisler, Janevic, Langa, & Rosland, 2017). It is going to be important to have a good relationship with the prescribing physician so that there can be an open line of communication if and when this problem happens. They can adjust their medications or change them depending on what they feel the patient needs (Lee, Piette, Heisler, Janevic, Langa, & Rosland, 2017). While medications are only a part of the conversation undergoing some form of therapy maybe need so that the patient has a place to talk about their disorder. Some patients do not want to go to treatment because they feel that they are not crazy and do not need to see a therapist. However, the social worker and the family needs to let this person know that no one thinks that they are crazy and that therapy is a safe place for them to discuss their disorder and their problems in an open and safe environment (Lee, Piette, Heisler, Janevic, Langa, & Rosland, 2017).

References

Bennett, H. D., Coleman, E. A., Parry, C., Bodenheimer, T., & Chen, E. H. (2010). Health

coaching for patients with chronic illness. Family Practice Management, 17(5), 24–29.

Lee, A.A., Piette, J.D., Heisler, M., Janevic, M.R. Langa, K.M. & Rosland, A-M. (2017). Family

members’ experiences supporting adults with chronic illness: A national survey. Families, Systems, & Health, 35(4), 463-473.