Concepts and Models of Chronic Health Care in Your Own Words

1. Complete the following table briefly describing various concepts and models of chronic health care
in your own words.
Various concepts and
models of chronic
health care
Description
a. Chronic disease
continuum (in 50 –
80 words)
It is a concept which involves a systematic approach which aims to
provide guidance and track the compliance of the patient so that
comprehensive care could be provided to the patient. It involves
different array of care process which aims to help the patient to
achieve health and wellbeing (Kennedy et al. 2014).
b. Five (5) key strategic
objectives of the
Chronic Diseases
and Health
Promotion
Department (World
Health Organisation)
 To promote the chronic disease prevention, control
and increase the level of advocacy.
 Prevent premature deaths and disability which
happens due to chronic diseases
 Promotes health among communities who are prone to
chronic diseases
 Prevent deafness and blindness by spreading
awareness about chronic diseases
 Help to slower and reverse the chronic disease trend
c. Innovative Care for
Chronic Conditions
Model
It helps to create a building blocks which helps to create a frame
work so that innovative and affordable care could be provided.
d. Six elements of the
Chronic Care Model
These are: health system, community resources, healthcare
delivery system design, decision support, clinical information
system and providing the patient with self management support
(Männistö et al. 2013).
e. Purpose of the
National Strategic
Framework for
Chronic Conditions
The purpose of this framework is to set direction and evaluate
outcomes so that Australians could be provided with healthy
lifestyle using effective prevention and management of the chronic
health condition.
f. Nine (9) national
health priority areas
agreed by the
Australian Health
Cancer control, dementia, arthritis and musculoskeletal conditions,
mental health, diabetes mellitus, asthma, obesity, injury prevention
and control, cardiovascular health (Oakes et al. 2016).

Various concepts and
models of chronic
health care
Description
Ministers’ Advisory
Council
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2. Provide three (3) examples each for social, emotional, physical, psychological and financial
impacts of chronic disease on a person.
Social impact:
1. It makes the person isolated from the society
2. It makes the person weaker and the person loses his or her ability to communicate within
society
3. It affects the thought process of the person.
Emotional impact:
1. It makes the person emotionally weaker and vulnerable
2. It affects the self esteem and confidence of the patient
3. Increases the stress or depression of the patient
Physical impact
1. It weakens the person by decreasing his muscle strength and core strength
2. It makes his or her immunity weaker and make them prone to infections
3. It affects their ability to move, weakens their posture increases the chances of injury
Psychological impact
1. Affects the mental peace and stability of the patient
2. Disrupts the thinking pattern and fills with negative thinking
3. Makes the patient isolated and aloof from his/her family and friends (Oakes et al. 2016)
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3. List five (5) common sites for cancer development.
Lung, breasts, bladder, prostate, colorectal
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4. Identify five (5) life variables that have an impact on the health and well-being of a person.

Heredity, socio-economic condition, lifestyle of patient, environment or surroundings, employment
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5. Complete the following table briefly describing various strategies to address and manage chronic
diseases.
Description
a. Four (4) strategies to
prevent chronic
diseases
The patient should maintain a healthy weight
Patient should be provided with healthy diet and nutrition
Should maintain physical activity and should limit the sedentary
lifestyle
Should avoid tobacco usage
Should focus on mental health and peace
b. Four (4) treatment
strategies used to
address and manage
chronic diseases
By using patient centered care
Including family centered care
Getting informed care and interventions
Should make the treatment process free from depression and
stress
c. Five (5) principles of
person-focused nursing
practice
Valuing patient
Understanding relationships
Environment
Life experience
And maintaining autonomy
d. Five (5) examples of
recommended
practices for person-
focused nursing
practice
1. By involving family and patient in the care process
2. By making the patient involved in the care process so that
communication could be created
3. Providing the patient the opportunity so that informed care
could be achieved
4. Providing the patient with guiding principles so that care
quality could be maintained
5. Focus the care on personal privacy
e. Four (4) strategies to
assist a person with
chronic disease to
maintain positive life
roles
Suggesting proper diet
Active daily life
Proper sleep
Social life
f. Five (5) strategies to
enable changes in a
person’s behaviour
over time
Asking the person to stick to positive habits
Making the social life more positive so that effective social
connection could be corrected
Asking the person to have complete sleep
Asking the person to have active daily life
The person should be able to receive proper care
g. Five (5) stages of
change to establish
readiness for attitudinal
and behavioural
change
Precontemplation
Contemplation
Preparation
Action
Maintenance
(Männistö et al. 2013)

Description
h. Palliative care and
domains of palliative
care that must be
undertaken as a
strategy to address and
manage chronic
diseases
Structure and process of care
Physical aspect of care
Psychological aspect of care
Social aspect of care
Spiritual aspect of care
And Cultural aspect of care
(Männistö et al. 2013)
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6. Complete the following table briefly describing rehabilitation strategies, techniques and equipment
used for chronic health conditions.
Various rehabilitation
strategies, techniques and
equipment used for
chronic health conditions
Description
a. Five (5) focus areas of
physiotherapy in
managing chronic
conditions
Orthopedic
Geriatric
Neurological
Pediatric and
Cardiopulmonary
b. Aim of occupational
therapy in rehabilitation
The primary aim of occupational therapy is to provide injured
people with ability so that they can perform their activities of daily
life and can improve their disability condition (Miller, Cafazzo and
Seto 2016).
c. Role of hydrotherapy in
rehabilitation
It helps to soothe or relax the inflamed muscles and joints,
decrease body temperature, lowers headache and helps to
rehabilitate injured limbs and eases labor pain.
d. Four (4) advantages of
the use of Pilates in
rehabilitation
It helps to strengthen the muscle function, which weakens after the
muscle injury
It corrects the body structure by providing the body parts with
strength so that pain and discomfort could be treated.
It strengthens the core muscle of the body and strengthens it so
that the posture could be treated.
It helps to improve body balance and helps to improve muscle
coordination (Kennedy et al. 2014).
e. Four (4) advantages of
massage in
rehabilitation
It helps to reduce the stress and decrease the unhealthy level of
cortisol.
It helps to reduce stress and helps to boost energy and helps to
stimulate mental and emotional wellbeing
It helps to promote muscle relaxation and induces flexibility by
reducing soreness.
It helps to improve the body posture which arises due to injuries or
fractures and hence, helps to reduce the pain related to poor
posture (Männistö et al. 2013).
f. Role of art therapy in Art therapy helps to improve self esteem and increases the

Various rehabilitation
strategies, techniques and
equipment used for
chronic health conditions
Description
rehabilitation confidence in people which ultimately is important to handle social
issues and challenges of life. Further, it iis helpful in reducing pain,
stress. Anxiety and depression.
g. Four (4) advantages of
music therapy in
rehabilitation
It helps to reduce stress and depression in people
It helps them to concentrate on a single factor of their life and
overcome the aspect of it is negative for them.
It helps people by increasing their connection with society or
people
Music helps to reduce the level of cortisol which is responsible for
depression hence, it is beneficial.
(Miller, Cafazzo and Seto 2016)
h. Five (5) considerations
when choosing a
wheelchair, scooter or
walking aids for a
person with chronic
disease
So that the person could be protected from falls
Mobilizing with his/her chronic health condition becomes easier
Wheelchair or moving aids could provide the patient with sense of
autonomy so that he or she can move as per his/her wish
Moving them without these aids could increase their chance of
injury.
They could be protected from muscle injury, fracture and many
more aspects (Kennedy et al. 2014)
i. Three (3)
considerations when
choosing a prosthesis
for a person with
chronic disease
Their body structure is balanced while sit, walk or sleep position.
The weight of the body is evenly distributed on both the feet.
It should not increase fatigue or pain in the patient’s body
(Männistö et al. 2013).
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7. List five (5) community based care services that are available in Australia for individuals with a
need for restorative or rehabilitation care.
1. Broadmeadows community care unit
2. Juniper Kununurra community care
3. The rehabilitation, aged and community care
4. On the go rehabilitation services
5. Mind Australia- community services Albert Park

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PART B – CASE STUDY QUESTIONS
Case study scenario 1:
Assume that you are working as an EN in a stroke unit. Sherly, 48 years, is admitted with middle
cerebral artery stroke and is recovering well. She is due to be discharged tomorrow.
Sherly has severe paresis and sensory loss of left extremities, uncoordinated movements and slurred
speech.
Sherly requires restorative care and is anxious about her future life.
She requires a wheel chair to move around.
Sherly is a migrant with permanent residency in Australia. She has limited knowledge and
understanding of resources that she could utilise in managing her condition.
1. Identify and briefly describe any three (3) specific community based care services that are
available for Sherly to ensure a coordinated service approach to provide her with rehabilitation
care.
a. Rehabilitation care should be provided to the patient for her cognitive development
b. Requires mobility care intervention
c. Community care should also be implemented in the care process
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Case study scenario 2:
Mrs Melisa Carfi, a 65-year-old female patient with Type 2 diabetes mellitus, was admitted in your
health care facility with a non-healing foot ulceration. Prior to admission, Melisa’s diabetes was
managed with metformin. Upon admission, subcutaneous insulin with a diabetic diet was initiated
along with oral anti-diabetic agents to achieve optimal blood glucose control.
2. Provide a list of four (4) specific questions you would ask Melisa in order to seek information to
confirm her understanding of the condition and its impact.
1. What diet you should consume in your diabetic condition?
2. Do you think your foot ulcer condition can increase due to your diabetic condition?
3. How you can manage your diabetic condition?
4. How insulin can help you to manage your diabetic condition?
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3. What specific information will you give to Melisa if you are to provide health education on dietary
management and physical activity with the goal of losing weight?
The patient will be asked to maintain diet and nutritional preferences and the patient will be
asked to have food products with less carbohydrate so that her body weight could be
controlled. Further she will be asked to perform light body exercises so that her muscle
strength and mobility could be sustained.
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Case study scenario 3:
Mr David Ventor, 76 years old, has Type 2 Diabetes Mellitus, hypertension and a history of a
Transient Ischemic Attack x 3 months ago. Mr Ventor’s wife passed away a month ago.
A community enrolled nurse visiting Mr Ventor’s home noticed the kitchen in an unhygienic condition
with leftover food including pizza, juice and ice cream cartons.
The enrolled nurse observed that Mr Ventor was upset and teary when talking about his health status
and the demise of his dear wife.
The community RN is due to visit Mr Ventor next week. At the previous visit, there were no unusual
activities to be noted or cause worry in relation to Mr Ventor.
Mr Ventor’s son moved in with him a week ago. His son is unemployed and an alcoholic. He was not
at home during the visit.
The enrolled nurse asked Mr Ventor how supportive his son was in addressing his father’s needs. Mr
Ventor didn’t reply and stared away with teary eyes.
Mr Ventor was unwell with a cough and chronic back pain.
The enrolled nurse convinced Mr Ventor to seek medical support. An ambulance was called and Mr
Ventor was transferred and admitted to a medical ward in the hospital for further evaluation and
management.
4. Identify and discuss the current contribution of community agencies and professionals in
supporting Mr Ventor, referring to the scenario provided (in 40 – 60 words).
The community agencies and professionals help the patient to support the patient with
emotional and mental support so that mental health and stability of the patient could be
achieved. Further, it also helps the patient with counseling so that mental support could
be provided to the patient.
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5. Identify and discuss the level and type of contribution and support made by Mr Ventor’s son in
managing his health condition and current situation (in 60-80 words).
Mr. Ventor’s son did not helped the patient with mental and physical support as he was alcoholic
and this factors affected mental health of the patient.
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6. How effectively did the enrolled nurse respond to variations in Mr Ventor’s needs? (in 40-60
words).
Enrolled nurse helped the patient with mental and emotional support in a time when his
family was unable to give him that support. They convinced patient to seek medical help
and complete his mental and physical health needs. Thereby, maintaining health
improvement,
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7. Mr Ventor’s blood sugar level was observed to be high (14 mmol/dL). Mr Ventor was not
complying with diabetic diet requirements. How should the enrolled nurse respond to these
variations and Mr Ventor’s changing needs? Briefly describe a coordinated service approach
required for Mr Ventor in this situation (in 20 – 40 words).
The patient will be provided with diabetic diet and nutrition so that the blood sugar level
of the patient could be decreased.
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8. Discuss strategies you could implement to actively involve Mr Ventor in the development of
approaches to self-manage his condition (in 90-120 words).
1. The patient will provided with mental and emotional support so that he can seek help
from medical officers so that his health could be improved.
2. The patient will be provided with mental health and diet or nutritional support
3. Patient will be asked to communicate and socialize with people around him so that his
mental health could be sustained ad through that his physical health could be
improved.

References
Kennedy, B.K., Berger, S.L., Brunet, A., Campisi, J., Cuervo, A.M., Epel, E.S., Franceschi, C.,
Lithgow, G.J., Morimoto, R.I., Pessin, J.E. and Rando, T.A., 2014. Geroscience: linking aging to
chronic disease. Cell, 159(4), pp.709-713.
Männistö, T., Mendola, P., Vääräsmäki, M., Järvelin, M.R., Hartikainen, A.L., Pouta, A. and Suvanto,
E., 2013. Elevated Blood Pressure in Pregnancy and Subsequent Chronic Disease RiskClinical
Perspective. Circulation, 127(6), pp.681-690.
Miller, A.S., Cafazzo, J.A. and Seto, E., 2016. A game plan: gamification design principles in mHealth
applications for chronic disease management. Health informatics journal, 22(2), pp.184-193.
Oakes, C.C., Seifert, M., Assenov, Y., Gu, L., Przekopowitz, M., Ruppert, A.S., Wang, Q., Imbusch,
C.D., Serva, A., Koser, S.D. and Brocks, D., 2016. DNA methylation dynamics during B cell
maturation underlie a continuum of disease phenotypes in chronic lymphocytic leukemia. Nature
genetics, 48(3), p.253.