Faculty of Nursing - Padjadjaran University: Kusman Ibrahim, PH.D

Kusman Ibrahim, Ph.D.
Faculty of Nursing - Padjadjaran University

Phenomena of chronicity
 Chronic diseases are diseases of long
duration and generally slow
progression.
 Chronic diseases, such as heart
disease, stroke, cancer, chronic
respiratory diseases and diabetes, are
the leading cause of mortality in the
world, representing 63% of all deaths.
 Out of the 36 million people who died
from chronic disease in 2008, 9
million were under 60 and 90% of
these premature deaths occurred in
low- and middle-income countries.
 Chronic condition has its own
specific physiologic characteristics,
and share common qualities.
 Many chronic conditions have pain,
fatigue, disability, limiting the
patient’s participation in activities
(Collins, 1997).
 Require long therapeutic regimens
to keep them under control 
adherence
 Chronic describes a long disease
course and conditions that may be
incurable. It is difficult for those who
must live with them.
 Reaction: shock, disbelief, depression, anger, resentment,
or a number of other emotions.
 People react and cope with chronic conditions is usually
similar to they react to other events in their lives.
 Psychological, emotional, and cognitive reactions to chronic
conditions are likely to occur at the initial onset, but they
may also recur if symptoms worsen or recur after a period
of remission.
 Symptoms associated with chronic illnesses are often
unpredictable, and some are perceived as crisis events by
patients and their families, who must contend with both the
uncertainty of chronic illness and the changes it brings to
their lives.
Factors affect adjustment to chronic illness:
- Personality before the illness
- Unresolved anger or grief from the past
- Suddenness, extent, and duration of
lifestyle changes necessitated by the
illness
- Family and individual resources for dealing
with stress
- Stages of individual/family life cycle
- Previous experience with illness and
crises
- Codependency in family systems (Lewis,
1998)
Definition of chronic conditions
 As medical conditions or health
problems with associated symptoms or
disabilities that require long-term (3
months or longer) management
(Robert Wood Johnson Foundation,
1996).
 Management; learning to live with
symptoms and/or disabilities and
carrying out the lifestyle changes and
regimens that are designed to keep
symptoms under control and to prevent
complications.
The reasons that so many people are afflicted
with chronic conditions :
 Decrease in mortality from infectious diseases
 Longer life spans because of advances in technology and
pharmacology, improved nutrition, safer working
conditions, and greater access to health care
 Improved screening and diagnostic procedures, enabling
early detection and treatment of diseases
 Prompt and aggressive management of acute conditions
 Modern lifestyle factors, such as smoking, chronic stress,
and obesity, that increase the risk for chronic illnesses,
such as pulmonary disease, hypertension, and
cardiovascular disease
The Characteristics of Chronic Conditions
 Managing chronic illness involves more than
managing medical problems
 Chronic conditions usually involve many different
phases over the course of a person’s lifetime. There
can be acute periods, stable and unstable periods,
flare-ups, and remissions.Each phase brings its own
set of physical, psychological, and social problems,
and each requires different regimens and types of
management (Corbin & Strauss, 1991).
 Keeping chronic conditions under control requires
persistent adherence to therapeutic regimens
 One chronic disease can lead to the development of
other chronic conditions
 Chronic illness affects the whole family
 The major responsibility for the day-to-day
management of illness falls upon the shoulders of
chronically ill people and their families
 The management of chronic conditions is a process
of discovery
 Managing chronic conditions is a collaborative
process
 The management of chronic

conditions is expensive.
 Chronic conditions raise
difficult ethical issues for the
patient, health care
professionals, and society.
 Living with chronic illness
means living with uncertainty
(Mishel, 1999; Price, 1996
PHASES OF CHRONIC ILLNESS
 Pretrajectory phase
 Trajectory
 Stable
 Unstable
 Acute
 Crisis
 Comeback
 Downward
 Dying
The challenges of living with chronic conditions
 Alleviating and managing symptoms
 Psychologically adjusting to and
physically accommodating
disabilities
 Preventing and managing crises and
complications
 Carrying out regimens as prescribed
 Validating individual self-worth and
family functioning
The challenges of living with chronic conditions
 Managing threats to identity
 Normalizing individual and family life as
much as possible
 Living with altered time, social isolation,
and loneliness
 Establishing the networks of support
and resources that can enhance quality
of life
 Returning to a satisfactory way of life
after an acute debilitating episode
(another myocardial infarction or stroke)
or reactivation of a chronic condition
 Dying with dignity and comfort

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What are some characteristics of chronic conditions?

How do people typically react to being diagnosed with a chronic condition?

Kusman Ibrahim, Ph.D.

Faculty of Nursing - Padjadjaran University

 The management of chronic

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