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

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

2
COMMUNITY NURSING
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

3
COMMUNITY NURSING
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

4
COMMUNITY NURSING
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