Self-Management of Parkinson's Disease: Causes, Pathophysiology, Impact, Health Promotion, Empowerment, and Nursing Role

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Introduction
“Chronic Health Conditions” is a term that includes disability and diseased conditions
that people may “live with” for an extended period of time (more than 6 months). Chronic health
conditions can begin gradually and are mainly progressive which require long-term care and
timely monitoring by the healthcare professionals (Coulter et al., 2015). The following paper
aims to analyse one such chronic health condition, Parkinson’s disease, a neurodegerative dis-
order with progressive impairment in the cognitive and motor functioning. Parkinson’s disease
(PD) hampers the health-related quality of life (HRQoL) of both the diseased individual and their
family of carers (Nandipati & Litvan, 2016). The paper mainly attempts to explain the self-
management of PD. In explaining this, the paper will throw brief light on the causes of the
disease development, pathophysiology of the disease and impact of the disease on the disease on
the HRQoL of the individuals and the family of carers. The paper will also analyse the health
promotion strategies towards the self-management of Parkinson’s and importance of culturally
safe care towards the promotion of the disease empowerment.
Cause of disease development
PD is a condition under which some parts of the brain become progressively damaged
during the course of time. Damage of the brain is mainly attributed to the damage of the nerves
leading to the development of neurogenerative disease, Parkinson’s. The neuro-degeneration is
associated with involuntary sharing of different parts of the body like neck, hands and feet
leading to the development of tremor, slow movement of the body muscles or muscle stiffness
(Bonifati, 2014). The damage of the nerves cells is mainly facilitated by the loss of function of
the nerve cells in the substantia nigra of the brain. This loss of nerve cells is a slow process and

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thus the symptoms of Parkinson’s disease only start to develop when 80% of the nerve cells in
the substantia nigra region of the brain have been lost. It is still not known why the loss of nerve
cells is associated with the development of PD. At present research highlights the combination of
both genetic and environmental factors are responsible for the diseased conditions. The main
gene associated with the disease development is the loss of function of the Parkin gene. This is
due to this genetic linkage of the Parkinson’s disease makes in inherited and might run in
families (Bonifati, 2014). The main environmental factors leading to the development of the
disease include exposure from pesticides, herbicides, industrial pollution. However, the evidence
associated with the environmental factors underlying PD is inconclusive (Nandipati & Litvan,
2016). Other causes include prevalence of progressive brain conditions, drug-induced
Parkinsonism and cerebrovascular disease (Bonifati, 2014).
Pathophysiology of the disease
The main pathophysiology of the PD is guided by the damage in the nerve cells of the
brain. Loss of function of the nerve cells in the brain or damage of the nerve cells causes
reduction in the secretion of dopamine mainly in the basal ganglia. This lack of secretion of
dopamine which acts as a neuro-transmitter leads to altered discharge rates, increase in the rate
of incidence of burst firing, altered sensorimotor processing and disruption in the equilibrium of
the oscillatory activity and interneuronal synchrony. These malfunctions lead to disruption in the
synchronization between different parts of the brain like ganglia, thalamus and cortex leading
defects in neuro-transmission and ultimately development of Parkinsonism (Bastide et al., 2015).

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Impact of the disease on individuals and family/carers
According to Parkinson’s Australia (2018) people living with PD require re-adjustment
as the progress of disease is slow. Depending of the degree or neuronal impairment, the daily
living activities (DLAs) like driving, bathing, having food, getting dressed and walking become
more challenging over-time. In relation to this, Narme et al. (2013) stated that individual’s
experience with PD is not only limited too physical discomfort brought during the course of
disease development but also cause significant psychological distress. Narme et al. (2013) further
highlighted that increased dependency on a care in order to accomplish DLAs, generates a sense
of depression and low-self-esteem. An individual start feeling that he or she might be the burden
to others and a strain in relationship. In order to cope up with this the roles with the family and
the community or team-mates at work is required to be re-defined. Providing care to the
individual with PD generates huge mental and physical exhaustion to the group of direct carers
which increases health burden and disruption in the HRQoL of the family members (Carod-
Artal, Mesquita, Ziomkowski & Martinez-Martin, 2013). Carod-Artal, Mesquita, Ziomkowski
and Martinez-Martin, (2013) highlighted that patient’s psychiatric and sleep disorders and the
mood of the carer is significantly affected decreasing HRQoL.
Health promotion
The overall concept of health-promotion must be facilitated under the framework of the
Ottawa Charter for Health Promotion of WHO. This framework of health promotion has 5
different parameters. First parameter includes building public health policy (PHP). According to
WHO (1986) PHP requires identification of obstacles and subsequent adoption of the health
promotion policies in order to overcome those obstacles. The PHP for Parkinson’s disease in
Australia is mostly aimed towards identification of the disease specific age groups and increase