Caring for Patients with Chronic Illness: Community vs. Institutional Care

This article discusses the differences between community and institutional care for patients with chronic illness. It explores the advantages and disadvantages of each approach and highlights the importance of data sharing and regular team meetings in providing quality care. The article also identifies barriers and facilitators in caring for patients with chronic illness and emphasizes the need for a patient-centered approach.

Running head: COMMUNITY NURSING
Name of the student;
Name of the university:
Author note:

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Introduction:
Chronic diseases are a growing health care problem which worsen the quality of life of
the population as they ages and increases the health care expenditure exponentially (Hicks et al.,
2018). According to the 2014-15 National Health Survey, one in two Australians have at least
one prominent chronic disease and more than one disease is associated with a high mortality rate
(Trogdon et al, 2015) . Due to the level of chronicity, a considerate number of people tend to
seek long term care. When I was appointed as a community nurse in the community care, I have
encountered a considerate number of individuals with severe chronic disease. I have observed
that because of chronic diseases not only the patients but family members are also experiencing
high psychological distress. The challenges that I have identified and recognized for the patient
with the chronic illness, I understood that these challenges are extremely difficult to cope with
without proper and professional assistance. To explore the current statistics, I have conducted a
literature search using a database such as CINAHL, Medline, Pubmed with the key terms such
as “family pressures of caring for a chronically ill patient at home” and with the inclusion criteria
of peer review, written in English and within 10 years was
Part 1: compare and contrast community and institutional carw
To treat the patient with chronic illness, the caring patient in the community and
institution differs in terms of the patient’s need and experiences. Considering the community
care centers, Levine et al. (2010), highlighted that one of the main advantages of the community
care is that caregivers involve family members of the patient and engage patients in the care
process, successfully prioritizing not only the physical need of the patient but also emotional

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need of the patient. Therefore, the patient with chronic disease feels secure and comfortable in
the presence of the family members which act as a facilitator in this case. Considering the social
context, Levine et al. (2010), highlighted that family members are bedrock of the long term
care and in community care center the interactions with other people is better compared to the
care provided in the institutions which further reduce the helplessness of a person and social
isolation and improve patient’s experience which is special need of patient . This interactions
further have an impact on the psychosocial health of the patient and improve the physical
wellbeing of the patient. Hickman and Douglas (2010), suggested that the biggest advantage in
the treatment of a patient in the community care is family members are usually involved in the
decision making of the patient. Therefore, because of the higher exposure to psychological
distress such as high anxiety, and post-traumatic stress disorder can cause family members to
take irrational decisions for the patient. Therefore for a family under pressure, the following are
especially important: information sharing that can lead to relevant, timely, high-quality referrals
and regular team meetings. These will now be discussed in greater detail.
On the other hand, in the institution, the environment is more clinical and sterile to
provide care to the patient. Therefore, in terms of care provision, the facilities in the institutes are
quite advance which facilitate the error-free monitoring and diagnosis of chronic diseases (Hicks
et al., 2018). In this case, the advantage over community care setting is that family members
feel more secure and confident because of professional handling. However, the financial cost is
higher in this case. Moreover, in the institutional setting, the involvement of the multidisciplinary
team and regular team meeting alters the experience of the patient. In the social context, Sav et
al. (2015), the interactions with the surrounding people and family members are restricted in the

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institutional setting which further highlighted as one of the disadvantages of the institutional care
where patient feel more helpless.
Part 2- data sharing and referral
Communication, especially in the community setting gained greater importance because
the communication between health professionals and family members enhances the treatment
procedure of the patient with chronic disease. In the current context, this team consists of health
care professionals and family careers. The importance of data sharing is that data sharing enables
the team to prioritize grievances of a patient, change in physical and mental health, diagnoses
and treatment requirement. A chronically ill patient living at home generally requires a caring
involving family members and health professionals (Bhawra et al., 2016). Therefore, data
sharing has become one of the crucial factors of caring for the patient with chronic disease and
support the wellbeing of the patient. For example, if a family caregiver at home notices that the
patient is losing weight. This information needs to be shared amongst the teams. Wiley et al.
(2015), reported that the data sharing has given special importance for the chronically ill patient
since the patient is living at home not under the constant monitoring assessment of staffs in the
hospital. Brown, (2018), highlighted that if data sharing is not properly happening then lack or
error in data sharing may give rise to the gap in the treatment procedure and between the team
members regarding the progress of the patient. Consequently, the error in data sharing also
affects the family members of the patient. Since the chronically ill patient lives at home, the
family members are exposed at high psychological stress and accurate data sharing able to
reduce the anxiety of the family members. After data sharing, if any changes observed which
require special clinical attention then a referral needs to be made to the right health professional
(Lim et al., 2016). The team members in this case request for a referral of GP or coordinator

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health professionals to improve the wellbeing of the patient. Hargraves et al. (2016) discussed
that referral is a powerful tool since it improves the quality of the care and communication
between the primary care physicians, specialist and any other health care providers such as
family members in a patient’s care.
Part 3- regular team meeting:
The new model of care calls for a new approach for the primary care delivery which
focuses on the patient centeredness, quality, and safety of the patient as well as interdisciplinary
teamwork. Regular team meeting plays a crucial role in offering the patient centeredness, quality,
and safety of the patient. As discussed in part 3, a chronically ill patient lives at home and being
cared for by their family not by hospital staffs where patient is under constant monitoring and
observation. Therefore, Mitchell and Golden ( 2012), highlighted that it is important to conduct
regular team meeting for patient care at home. The authors suggested that one of the purposes of
team meetings is to review the patient’s overall care plan and its goals. The goal of the team
meeting in this case also involves providing time, space, and support for exchanging information
regarding the status and health progress of patient (Davy et al., 2015). As discussed by Kadu and
Stolee (2015), The regular team meeting is important for the chronically ill patient living at home
since it helps to facilitate the maintenance and establishment plan and assists in monitoring
progress towards of goal. For example, if family members of the patient are away from for time
being and failed to monitor the health status of the patient then regular team meeting is useful to
address the change. Regular teams meetings help adjust care plans to changing circumstances so
that goals remain relevant and feasible. West and Lyubovnikova (2013), highlighted that if
regular team meeting is not taking place then there would be a communication gap regarding
the progress of the patient, the gap of the identification of the additional need of the patient

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would be observed and care plan cannot be amended which is crucial for achieving the desired
outcome for patient. However, conducting team meeting is not only criteria of achieving
desired outcome for the patient rather conducting regular team meeting with the higher quality is
required to achieve the desired outcome for the patient. In the current context, the poor quality of
the team meeting would lead to miscommunication and poor interpretation of the health progress
of the patient. As discussed by Anderson et al. (2015) miscommunication and poor interpretation
of the health progress may lead to the erroneous management of the chronic illness, monitoring
of the patient. The erroneous management can further question the patient safety and breaching
of the code of ethics in the clinical practice. Therefore, to achieve the desired outcome for caring
for the patient with chronic disease at home regular team meeting involving the family members
and family members and sharing the crucial information is required.
Part 4- barriers and facilitators:
Chronic illnesses such as cardiac disease, cancer, COPD, diabetes have become major
public health issues because of rapid increase in prevalence and increased morbidity rate
associated with the chronic disease. In the current context, as discussed in the part one there
were differences observed in the community setting and institutional setting. In the community
setting, as discussed by Ranchordás (2015), to provide safe and responsive care to the patient,
one of the prominent barriers is the lack of advanced equipment’s to manage the chronic illness.
The reason behind it is that the location of the patient can be outskirt where they failed to seek
clinical assistance. Another barrier of caring for the chronically ill patient at the home is that
family is not competent enough to provide the care to the patient and therefore the sudden fall
injury can happen to monitor the patient. Laplante et al. (2018) One of the biggest facilitator, in
this case, is the care to the facilities of long term care which is appropriate in the community care

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and other facilitators are family relationship of the patient, safety, security, comfort, warmth
financial strain. On the other hand, one of the barriers of the caring patient with chronic illness in
the institute is that it is not designed for the long term care process. Moreover, another barrier is
limited time of health professionals, language barriers of the incompetence to provide long term
care to the patient. In the current context, the facilitators are improved quality, hygiene,
advanced equipment’s and comprehensive monitoring,
As discussed in part two about the data sharing and referral in caring for the patient with
chronic illness at home. Bee et al. (2015), One of the biggest barriers of the data sharing and
referral is lack of technological literacy and incompetency of the health family members to
interpret data. The facilitators, in this case, are the reduction of stressor of the family members,
comprehensive monitoring of patient and achievement of the desired outcome.
As discussed in part three about the regular team meeting, one of the barriers
identified by Eden et al. (2016) , is that time constraint of the team members. The language
barriers, limited resources, incompetency to understand the condition of the patient is also
identified as barriers. The facilitator, in this case, is the identification of the additional need of
the patient, exchange of data regarding any changes observed by any of the team members and
improving skills to better management of the patient.
Conclusion:
Thus it can be concluded that with the increase of the global burden of disease, chronic illness
has contributed maximum in the mortality and morbidity rate. To treat the patient with Chronic
illness, the caring for the community and institution differs in terms of the patient’s need and
experiences. In community care center, patients with chronic illness receive long term care in

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the presence of family members where they feel secure, comfortable and empowered. However,
in the community care the stress level of family members are extremely high and they tend to
feel anxious, depressed. In the institution, patients receive excellent monitoring and assessment
for the patient. To provide safe and responsive care the data sharing and a regular team meeting
is required to identify the needs of the patient and progress of the patient to achieve the desired
outcome.

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