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Chronic Illness Framework

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05.10.2020
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The onset of chronic illness has significant implications for the family. Chronic health events induce a stress response, which poses the need for the family to adapt to the needs of the sick person. In the literature, numerous studies have been conducted to explore the impacts of chronic illnesses on the family. This literature review focuses on the research studies that have been carried out to explore the effects of chronic illnesses on the patients’ families.

Nelson, Cox, Hope, and Carson (2010) performed a systematic review that sought to outline the burden of a chronic illness diagnosis on the family. Their findings indicate that a chronic illness imposes an onerous burden on the patient’s family in the form of financial hardships and depression. Their evidence demonstrates that family caregivers show severe depressive symptoms, especially people taking care of patients having spinal cord injury and Alzheimer’s disease. Their findings also suggest that chronic illnesses increase caregivers’ workload. Other impacts of chronic illnesses on the family reported by Nelson et al. (2010) include either resigning from a job or changing work hours in order to accommodate the needs of the patient and significant losses in terms of savings and income.

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Another study on the impact of chronic illnesses on the family was conducted by Long and Marsland (2011), who performed a systematic review to determine the family changes following the diagnosis of a chronic illness, particularly childhood cancer. The methodology adopted by the researchers involved a systematic review of 28 qualitative and 42 quantitative studies. The concepts explored in the research included family functioning, parenting, and marital quality. The findings of the study indicate that the diagnosis of childhood cancer in the family leads to alteration of family responsibilities, roles, and daily functioning in order to cater to the needs of the patient. The results also show that different families follow different improvement trajectories in terms of marital quality and closeness in the family.

From the review of the two sources, it is evident that chronic illnesses have a considerable impact on the family. A key issue of concern is how nurses can assist families in relieving the burden posed by the diagnosis. In this respect, further research is needed to examine the effectiveness of family nursing theoretical models in supporting families having a chronically ill patient.

Evaluation of the Theory

Introduction and Overview of the Theory

Models and theories prepare nurses to exercise critical and creative thinking regarding the health events that have an impact on a patient. They also enable nurses to understand the circumstances and problems that affect families; thus, they offer more options for developing interventions that best fit the needs of the family. Numerous theories have been developed to help nurses to understand the family. One of important theories in family nursing is the Chronic Illness Framework, which was created by Rolland (1987, 1984, cited in Kaakinen, Padgett, Steele, Tabacco, & Harmon, 2014) in order facilitate understanding of the impact of a chronic illness on the family as well as the individual. This paper describes and evaluates the Chronic Illness Framework and discusses its strengths and weaknesses, including its application and relevance to family nursing.

Individual or Group the Theory Best Supports

This theory best supports individuals having chronic health problems and their families. This can be deduced from the emphasis of this conceptual framework on understanding the vast implications that chronic illnesses have on the family (Kaakinen et al., 2014). Since its inception, the Chronic Illness Framework has progressed to help nurses understand various factors associated with chronic illnesses and their impacts on family functioning. As a whole, patients might experience chronic health events, which might compel the family to adapt to the needs of the sick individual; thus, this framework guides nurses on how they can cater for the needs of family members and the individual with a chronic illness.

The Primary Focus of the Theory and its Key Concepts

The main focus of this framework is on enhancing understanding of various factors associated with chronic illnesses and implications of these factors on the functioning of the family (Cole & Reiss, 2013). The three main concepts in the framework are types, illness phases, and the functioning of the family. Illness types comprise a number of aspects, such as the inception of an illness, its course and outcomes, and the level to which the illness incapacitates the member of the family (Kaakinen et al., 2014). Illness inception can be gradual or acute. Additionally, illness types can also be classified into progressive, constant, and episodic. Another important consideration for the illness type is its trajectory, which affects the functioning of the family. In this respect, chronic illnesses can be incapacitating or capacitating (Goldberg & Rickler, 2011). The trajectory can also be described as non-fatal, unpredictable, or fatal.

The time aspect is related to how problems that affect individuals and families vary with respect to the timing in the course of a chronic condition (Kaakinen et al., 2014). The time phases outlined in the framework include the crisis/initial time phase, mid-time phase, and the terminal time phase. The time aspect and illness types affect the functioning of the family, which is the third key concept of the framework. The functioning of the family relates to demands associated with managing a chronic illness, including vulnerabilities and strengths of the family (Kaakinen et al., 2014). These demands stem from the need for the family to adapt to the needs of the sick individual.

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Description and Analysis of the Theory

Main Problem the Theory Attempts to Explain

The main theory addressed by the Chronic Illness Framework is the effects of chronic illnesses on the functioning of the family (Walsh, 2012). This framework stipulates that the demands on the family associated with chronic illnesses take diverse forms and depend on the type of the illnesses as well as its phase. With the acute condition developing into a chronic illness (gradual onset), the family adapts in the long-term. Families should gradually change their roles with progression of the severity of the illness. Perpetual symptoms pose the need for the family to continually adapt, resulting in exhaustion stemming from the demands associated with the illness. Further progression of the disease might lead to the development of new family roles along with the evolution of the tasks of the family caregiver and an increase in uncertainty and unpredictability (Kaakinen et al., 2014). Fatal outcomes of chronic illnesses also result in family stress because of the need for adjustment to new reality.

Explanation Offered by the Theory

The Chronic Illness Framework postulates that the effects of chronic illnesses on the functioning of the family emanate from the need for the family to adapt to the needs of the individual (Cole & Reiss, 2013). Also, the demands of illness lead to exhaustion and stress among family members due to the development of novel family roles and caregiving tasks. Chronic illnesses also compel families to adjust to the social stigma related to the chronic health events (Kaakinen et al., 2014). The uncertainty and unpredictability associated with chronic illnesses also increase the stress level for the family. In essence, the diagnosis of a chronic illness throws the family into the crisis mode. It is also necessary to note that families are unique in terms of their vulnerabilities and strengths; thus, the manner in which families respond to the challenges posed by chronic conditions are numerous (Kaakinen et al., 2014).

Solution Suggested by the Theory

The solution recommended by the theory is to help families having a chronically ill member to contextualize and normalize his/her experience, which needs the family to be informed about the illness and the time-phases of its progression (Blais, 2015). This will help the family to effectively adapt to the challenges posed by the chronic disease. Effectively adapting to the illnesses requires families to develop positive working relationships with care providers, gather relevant information concerning the diagnosis, and accept the diagnosis (Cole & Reiss, 2013). Therefore, nurses perform a key role in providing families with information regarding the diagnosis and assisting them in navigating the healthcare system. However, this framework underscores the importance of family education and integration of medical treatment plans into the family roles and life.

Strengths and Weaknesses of the Theory

Strengths

The key strength of the Chronic Illness Framework is that it describes how various factors associated with chronic illnesses can be categorized depending on their impact on family functioning (Kaakinen et al., 2014). Moreover, this framework illustrates the complexity of chronic illnesses as well as diverse ways in which families can respond to them. Ostensibly, families with the same chronic illness have similar circumstances; however, a closer look reveals that the experiences of a family regarding the different components outlined in the Chronic Illness Framework depend on dissimilar family strengths and stressors. Furthermore, this framework is it illustrates the manner in which a family can advance through various phases of a chronic illness (Cole & Reiss, 2013). In addition, the Chronic Illness Framework describes particular coping tasks that result in stress for families in the course of various illness phases. Consequently, nurses who do not have a vast knowledge of these stressors can rely on the framework when providing family care.

Weaknesses

The weakness of this model stems from its strength. Thus, the complexity depicted in this framework is not predictive but descriptive. Since this framework describes the manner in which chronic illnesses progress in an individual only from a medical perspective, nurses can easily focus on that component of the framework and disregard the central aspect of viewing the family as a whole (Kaakinen et al., 2014). Thus, this model places more emphasis on the medical aspect of care, showing scant regard for other aspects influencing family care. Another weakness of this framework is that it requires nurses to have an in-depth understanding of the existing family literature during each stage of the illness (Cole & Reiss, 2013).

Application and Relevance to Family Nursing

Application and a Case

The Chronic Illness Framework can help nurses to better understand the implications of chronic illnesses on the functioning of the family. The key concepts of the framework, illness type and time phase of the illness, can be applied by nurses to understand how the chronic illness is affecting the family. A potential case where this framework can be applied is described in Kouzoupis, Paparrigopoulos, Soldatos, and Papadimitriou (2010). It is a hypothetical case study involving a family with an individual who has been diagnosed with multiple sclerosis (MS).

Addressing the Problem in the Case Using the Theory

The Chronic Illness Framework offers guidelines that can be used to address the problem in the case. By recognizing the time phase and type of the illness, a family nurse can make appropriate interventions to assist the family in managing stress and facilitating changes in family roles. In this respect, the family should develop its relationship with caregivers and be actively involved in the treatment plan. The nurse can also help with family functioning through exploring options and the likely future challenges that the family might face with the progression of MS towards a terminal phase (Kaakinen et al., 2014).

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Explaining the Problem in the Case Using the Theory

The Chronic Illness Framework can be employed to discuss the interaction between the family and the illness, in particular the influence of the MS on the family from the onset and throughout the course of the illness. MS is characterized by symptoms that develop gradually. In the analyzed case, the individual has been having MS for the past 5 years, including periods of remission and exacerbation, which makes the disease episodic. Therefore, it can be inferred that the case family is in the mid-time phase with respect to the trajectory of the disease. The illness also has high levels of incapacitation and unpredictability with regard to outcomes (Kouzoupis et al., 2010). It has affected the ability of the family member to work. It is also very costly with respect to intangible costs in the form of lower quality of life as a result of functional impairment.

Conclusion

The Chronic Illness Framework helps nurses to understand various factors associated with chronic illnesses and their impacts on family functioning. The main concepts in the framework are illness types, illness phases, and family functioning. The type and time phases of the illness affect the functioning of the family. The diagnosis of chronic illness increases the demands of family members and stress as a result of the development of new family roles and caregiving tasks. The recommended solution based on this framework is to assist families in contextualizing and normalizing their experience; thus, family education is an important aspect outlined in the framework. A key strength of this theory is that it categorizes various factors associated with chronic illnesses that affect family functioning. However, the framework is merely descriptive rather than prescriptive, and it places a lot of emphasis on the medical perspective.

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