Partnerships in Chronicity

This article discusses the importance of partnerships in managing chronic conditions, focusing on case studies of patients with type 2 diabetes and multiple sclerosis. The author, a registered nurse, explores the social, cultural, and spiritual aspects of these patients and highlights the need for a patient-nurse collaborative approach in their treatment.

RUNNING HEAD: PARTNERSHIP IN CHRONICITY
PARTNERSHIPS IN CHRONICITY
Name of Student
Name of University
Author note

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Introduction
I am William, a registered nurse, posted at neurology department. I have been
working in this hospital for last 5 years, working in acute and emergency settings initially but
fore last one year – I am caring for the neurological patients.
The two selected case studies are – 1) Mrs Zoya Solarian with a Type 2 diabetes
mellitus. 2) Mrs. Ally Peterson with relapsing – remitting multiple sclerosis (Bomprezzi,
2015)
My contribution was to research the social, cultural and spiritual aspects of these clients.
Case 1
 Mrs Zoya is a 72 year old lady who has recently come under my care.
 She is suffering from type 2 diabetes mellitus since a long time. As because my
patient is suffering with T2DM (type 2 diabetes mellitus) for a very long time, the
metabolic disease can chronically spread to other parts – affecting her eyes, blood
cholesterol and blood pressure (Lin, 2018).
 I came to know that she lives alone in an apartment at 3rd floor and she is a widower.
She has no one to look after. Because she has no children either.
 Talking to her and taking her history, I came to know that she has been raised in a
strict god loving family and how religious discipline is an important part of her life.
 While assessing her cognitive status, I felt that she feel really ‘alone’ but not isolated.
Somewhere deep down, she wanted to live all by herself, peacefully. But given her
chronic condition, inflicted by diabetes type 2 – social isolation is not good for her.
 During my patient centered counselling – when I heard her more at first and tried to
relate how her diabetes mellitus has affected her psychological condition over the
years.

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 I realized more so from her insight that her mental and cognitive condition was more
influenced by a melancholic sadness of not having a children. Her husband has been
her own support system but after he was gone, she was left helpless and desolated.
 According to her, her ‘disease’ never felt so overpowering before her husband was
there.
 As a registered nurse and with my handful of experiences as a mental health nurse, I
felt the need of a patient – nurse collaborative approach imperative in treatment of this
case.
 Her social status has to be reconciled at first and it has to be done pertinently. To me,
as per my nursing diagnosis, I found out that her isolated social situation which more
or less being left blank with the demise of her husband – is the main etiology of her
disturbed cognitive state.
 The anti- hypertensive medicines and food diet control would better her physical
condition and if bettering is a high ask, the medication adherence (Lam & Fresco,
2015)would at least maintain her functional status(Hart, 2017) through to the many
years to come by.
 But improving her mental status is more important because it would eventually
increase her functional independence and better her self-dependence.
 I took her to some diabetes focus groups and she made couple of friends there and it is
perhaps good to see her smiling again with her new found friends.
CASE 2
 Mrs Ally Peterson is a 38 year old woman suffering with remitting relapsing multiple
sclerosis.

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 Ally lives in the ground floor and she lives with her partner whose name is Taylor.
She also has two daughters – one is 9 years old and the other is 12. She has a
complete family and both of her daughters are very jovial and fit as well.
 Even while talking to her husband in the visiting hours, I found that even he is an
optimist and how deeply he has believed and still believes that Ally will get well
soon.
 In spite of this, ally scored really high on depression scale which could have two root
causes – a) her relapsing neurological condition along with neuralgia(Truini, 2016)
and fatigue which in a combination can wash out a positive mindset and set in
obnoxious, inexplicable fears in an individual; b) the second reason was elusive to me
when I first started seeing Ally but it revealed itself dramatically over hospital stay
and during her stay time.
 Due to her dysphonia(Stachler, 2018), the therapeutic communication was getting
difficult for I had to rely too much on her written replies and her husband to come and
visit her – in order to find out about her history.
 I eventually came to know about her past which indeed was remarkable. She was the
second child for her parents and her elder sister was loved more because she was
sturdy and competent as compared to her.
 Ally felt a social anxiety even around her mother but she has loved her father dearly
for he was composed, insightful and placid – something that she could relate too. But
her mother left him when Ally was just 11 and since then, her depression had
embarked.
 With time she felt more fatigued easily, she has double visions and felt a grating pain
at times without any incidents of external injury. She was 24 when she was diagnosed

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with multiple sclerosis and only after two years – after caring for her almost in a
relentless way, her old father expired out of stroke.
 For last twenty seven years, she found no sign of her mother or elder sister who did
almost abandon her but she kept seeking them.
 Inadequate family care and a childhood depression has persisted throughout her
lifetime, aggravated by her devious neurological condition which gets cured and
returns again. The only good side is her present loving family who has been caring
about her and it’s nice to see, she wants to recover faster for them.

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References
Bomprezzi, R. (2015). Dimethyl fumarate in the treatment of relapsing–remitting multiple
sclerosis: an overview. Therapeutic advances in neurological disorders, 8(1), 20-30.
Hart, R. A., Hiratzka, J., Kane, M. S., Lafage, V., Klineberg, E., Ames, C. P., ... & Hamilton,
D. K. (2017). Stiffness after pan-lumbar arthrodesis for adult spinal deformity does
not significantly impact patient functional status or satisfaction irrespective of
proximal endpoint. Spine, 42(15), 1151-1157.
Lam, W. Y., & Fresco, P. (2015). Medication adherence measures: an overview. BioMed
research international, 2015.
Lin, H., Song, Q., Zhang, M., Xiao, W., Zhao, M., & Cui, Y. (2018). Metabolically healthy
obesity increase risk for hypertension, T2DM and the metabolic syndrome: A
community-based cohort study. 广广广广广广广广, (6), 14.
Stachler, R. J., Francis, D. O., Schwartz, S. R., Damask, C. C., Digoy, G. P., Krouse, H. J., ...
& Smith, L. J. (2018). Clinical practice guideline: hoarseness (dysphonia)
(update). Otolaryngology–Head and Neck Surgery, 158(1_suppl), S1-S42.
Truini, A., Prosperini, L., Calistri, V., Fiorelli, M., Pozzilli, C., Millefiorini, E., ... & Cruccu,
G. (2016). A dual concurrent mechanism explains trigeminal neuralgia in patients
with multiple sclerosis. Neurology, 86(22), 2094-2099.

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