Essay About Care Of Persons And Chronic Illness Presents Challenges

Nursing
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Maxine Adegbola, RNy MSN
Abstract: Chronic illness presents challenges and opportunities to the person affected. Persons with
chronic illness have identified spirituality as a resource that promotes quality of life. Few authors and
researchers have considered spirituality as a factor in quality of life. This paper presents theoretical and
research tools to support the inclusion of spirituality and quality of life assessments as inseparable,
essential elements in the care of persons with chronic illness. The philosophical underpinnings of nursing
are caring and holism. Because of these underpinnings, nursing is well positioned to implement spiritual
interventions in practice, propel the development of theory, and build a body of evidence to promote
quality of life for persons with chronic illnesses.
Key words: spirituality, quality of life, FACT-Sp, FACT-G, chronic, holistic health
Spirituality and Quality of Life in Chronic Illness
The focus of healthcare has shifted from acute, infectious
diseases to chronic states (Lorig & Holman, 2003; Lorig,
1993; Schlenk et al., 1998). Chronicity is an irreversible
state of disease for which there is no cure (Connelly, 1987). The
prudent individual with chronic disease must employ strategies to
reduce the impact of the illness. By reducing the impact of the
illness and enhancing health, the individual strives for balanced
bio-psycho-social-spiritual health and well-being.
The individuals subjective psychological outlook in the
presence or absence of physiological and functional burden
determines the individuals perceived quality of life (Burckhart &
Anderson, 2003; Murdaugh, 1997). Quality of life (QOL) then
in the context of chronicity is a multidimensional, multifaceted,
dynamic, subjective view of varying degrees of health-related
satisfaction. This health-related satisfaction is connected to
spiritual well being. Spirituality is an important part of weilness
and indispensable in holistic, multidisciplinary care (Young &
Koopsen, 2005; Hill & Pargament, 2003; OConnell &
Skevington, 2005).
Some have confusingly represented spirituality as religiosity,
but the two, although contiguous, are not synonymous. Spirituality
is a broader, overarching domain that may include religiosity,
but religiosity is not a necessary element of spirituality (Cooper-
Effa, Blount, Kaslow, Rothenberg, & Eckman, 2001; Estanek,
2006). Spirituality is best described by the apt quote that is
attributed to Pierre Teilhard de Chardin,
“We are not human beings having a spiritual
journey, but spiritual beings having a human
experience” -(Teilhardde Chardin, n.d.).
In recent years, numerous documents and research articles
have been published on religiosity and health, but few have
focused on spirituality and health (Peterman, Fitchett, Brady,
Hernandez, & Cella, 2002). Even fewer have considered spirituality
as a factor in maintaining quality of life. The purpose of this
paper is to provide theoretical and research tools to support the
inclusion of spirituality and quality of life assessments as inseparable,
essential elements in the care of persons with chronic
illness. Care that prevents the broken spirit and enhances spiritual
balance has the potential for improving QOL. The implications
of the constructs for practice, theory development, and research
will be described.
Quality of Life
With todays healthcare delivery system and impact of
managed care, it becomes imperative to justify interventions that
promote quality of life , show cost effectiveness of treatment
options (Thomas, 2000), and can holistically include spiritual
needs (Krupski, 2006). The subjectivity and multidimensionality
of individuals spiritual needs result in a phenomenon that is not
clearly understood by others, as the individual adapts to disease
and illness burden. The adaptation of the individual to a gap
existing between expected and actual functional states may have
health policy implications. Individuals with chronic illness, who
unexpectedly tolerate more aggressive therapy, and demonstrate
resilience, perplex healthcare providers, stakeholders, and expert
planners (Bonomi, 1996; Cella et al., 1992). In chronic and
palliative care QOL reports serve as a predictor providing
prognostic input regarding survival and well-being (Dharma-
Warden, Au, Hanson, Dupere, Hewitt, Feeny, 2004).
Definition