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

This paper analyses the self-management of Parkinson’s disease, including its causes, pathophysiology, impact on individuals and family/carers, health promotion strategies, empowerment, and the role of nurses in self-management.

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Name of the Student
Name of University
Author’s note

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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

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in the awareness of the disease condition and its impact on the aged care and the general
community members. The government of Australia is promotes development of person centred
care for people with PD and that too in a cost effective manner (Parkinson’s Australia, 2008).
The second domain of the Ottawa Charter is creating supportive environment. Creating
supportive environment for people with PD mainly focus on the older adults as they are the main
victims of PD. The creation of supportive environment can be done via the making non-skid
floors and minimal use of furniture in interior décor as this will help to minimize accidental fall
due to motor difficulties among individuals with PD. Other approaches include, proper
lightening inside the roo and use of blinds to minimize glares. Wide walking path and easy
access of the movement of wheelchair throughout the room and removal of unwanted electrical
wires and computer cords to preventing tripping (Struckmeyer & Pickens, 2016). Third domain
of Ottawa Charter strengthens the overall community access. According to Lindholm, Hagell,
Hansson and Nilsson (2014), increasing community access can be done via the increase in the
public awareness about the PD. Increase in public awareness will help to create a sustainable
environment for the people with PD where they will face less stigmatization, less fear and social
exclusion. The fourth domain of Ottawa Charter includes development of personal skills.
According to van der Eijk, Nijhuis, Faber and Bloem (2013), development of personal skills help
in the process of self-management of the disease. This development can be done through disease
education about PD. According to Coastes (2017), development of personal skill can be done
via developing coping skills, goal-setting for specific and moderately challenging behaviour
difficulty in walking, eye sight problem and poor hand eye co-ordination. Here coping skills will
mostly employ use of wheel chair or walker in order to facilitate proper movement and thus
enabling the accomplished of DLAs like using bathroom or taking meal at dining table. This

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sense of independence will promote the degree of disease self-management. Other self-
management skills can be promoted via self-monitoring (monitoring of vital signs via the use of
pulse oxymtery), self-reward, arrangement of social support (coming from family members) and
modification of the surrounding environment in order to maximise the self-management success
(Coates, 2017). The fifth domain of Ottawa Charter of WHO includes re-orientation of
healthcare services. This re-orientation of the healthcare service can be done via promotion of
culturally competent care for PD. However, Talbot and Verrinder (2018) highlighted that when
health promotion and health education activities are focused on the individuals and is attempted
to influence their behaviour, might lead to the generation of victim creation especially among the
Aboriginals and the Torres Strait Islanders. They are mainly victims of the healthcare system as
the system holds them responsible for their health-related conditions and thus blaming them for
certain issues which are in most of the cases outside the victim’s control. According to Talbot
and Verrinder (2018), local cultural values and ethnic gender stereotypes prevails on the
healthcare practitioner and this is expressed via their facial expression and thereby generate a
negative feedback among the service users. Talbot and Verrinder (2018) recommended that
victim blaming is a subtle process which is wrapped under kindness and concern and it is the
duty of the healthcare professionals to recognise the health determinants that is responsible for
the that particular health-related behaviours without solely blaming them. Moreover, it also the
duty of the healthcare professionals to re-orient the healthcare service for PD in a culturally
competent way and this can be done via effective communication skills and proper health
literacy about the cultural and spiritual believes of any indigenous people. Effective
communication will help to develop person-centred care plan which is culturally competent and

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withholds the spiritual and ethical values of the indigenous groups with PD or culturally and
linguistically diverse group with PD (van der Marck et al., 2013).
Empowerment
In order to provide empowerment to the individuals with PD, it is the duty of the family
members or the direct care givers to deliver unrelenting support both mentally and physically.
This support will help individuals with PD to refocus and learn the ways of managing new
illness-related, task-directed and affective roles in day-to-day life. This will help to increase the
sense of integrity and self-esteem of the patient with PD and this in turn will help the family’s
overall adjustment to illness. Increase the sense of empowerment will help to promote self-
management of the disease (Chiauzzi et al., 2016). According to Chiauzzi et al. (2016) self-
management is defined as an individual’s ability to manage symptoms and handling the
consequences arising out of change in physical and psychosocial lifestyle. This in turn will help
to promote satisfactory life via promoting necessary cognitive, behavioural and emotional
responses. van Hooft et al. (2015) highlighted in order to promote empowerment and thereby
helping to facilitate self-management of PD, it is the duty of the healthcare professionals to
prefer patients to abide by their choices instead to making choices on their behalf. Suppose if a
patient with PD is comfortable in moving through a wheelchair and not by walker, it is the duty
of the healthcare professionals to first abide by his or her will and then via developing
therapeutic relationship, convince him or her that why use of walker is more beneficial for his
physical health. Via doing this respect to his or her will or autonomy is given while making him
or her realise the importance of walker in therapy plan will increase the sense of empowerment.
According to Birren et al. (2013) development of therapeutic relationship increases the patient
involvement in the care and thereby by helping to provide health literacy. Promotion of health

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literacy increases the problem solving and decision making skills of the patients which in turn
increases the sense of empowerment.
Role of nurses in self-management
World Health Organization (2005) highlighted the nurses also play an important role in
promoting self-management of chronic neurodegenerative disease like Parkinson. The main role
of the nurse in promote of self-management of PD mainly includes devising patient-centred care,
partnering, overall quality improvement of the therapy via proper use of the information and
communication technology (ICT) and taking a public health perspective approach. ICT in PD
sell-management can be done via use of tele-health service and this will reduce the chances of
unwater hospital visit and self-management of PD.
Conclusion
Thus from the above discussion, it can be concluded that progressive neurodegenerative
disease, Parkinson affects the HRQoL of both the individual’s with PD and their family
members. In order improve overall HRQoL, it is the duty of the healthcare professionals to
promote self-management of the disease. The self-management of the disease can be done via
the developing of person coping skills, framing self-management goals, modifications of the
external environment and support from the community and family members. Moreover, the
nursing professionals must also come forward and work on person-centred care plan and thereby
helping in quality improvement leading to cultural competiveness and empowerment of the
service uses.

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