Essay for Pay-Nursing People with Chronic Illness

Expectations on references:
• This assignment will use the APA referencing style. You can find information on this from:
• Use at least 15 references from refereed journals published within the last 10 years.
• Citation from credible websites should be kept to a maximum of two (2) for the entire assignment.
• Where possible, use Australian references. Australian literature should be prevalent in your work.
• Please refer to the university website for further information relating to assignment writing, referencing and plagiarism;

• For essay questions (part one and part two), your work needs to have an introduction and a conclusion.
• Headings are allowed in this paper.
• Suggested word counts are provided for each section.
• Please note: the title page and bibliography does not form part of the expected word count.

Ethan is a 52-year-old dairy farmer from regional Victoria. He lives in the house within his farm, 30 kms from the nearest town, with his partner, Alma, and their 25-year-old son, Noel. His son works with him at their farm. Ethan left school at the age of fifteen so that he could work at the farm which was then managed by his parents who have since died. His father died at the age of 57 due to cardiac complications following an abdominal hernia repair surgery. His mother died at the age of 62 from metastatic breast cancer. After his parent’s deaths, Ethan had to take out a substantial mortgage in order to buy out his sister from her share of their parent’s estate.
Alma had been working as a teacher’s aide in the nearest town but was made redundant last year when school enrolments fell. She has been unable to find another job as yet. Alma has been diagnosed with depression by their local GP and is taking medication.
Ethan recently suffered an acute myocardial infarction and has been discharged back home from the large acute hospital in a regional city 70 minutes’ drive from their farm property. He is overweight with a distinctive ‘beer belly,’ smokes 2 packs of cigarettes each day, drinks alcohol (usually between 1 to 2 bottles of beer) daily and only sporadically takes his antihypertensive medication. He occasionally takes mild analgesics to manage an ongoing lower back pain and “dodgy knees”, he states the local GP had said that this is the “wear and tear” of his back and knees related to working in the farm and playing football in his younger years. He has also been referred to the respiratory clinic as it is suspected he has constantly recurring bronchitis and early stages of emphysema.
Ethan reported that the acute myocardial infarction occurred during a heated argument with Alma. He initially blamed her for all of his problems and it has been reported he initially refused to cooperate with hospital staff. However, he found out during the hospitalisation that it was caused by the partial blocking of one of the arteries of his heart with fat deposits. He agrees that he would benefit from a cardiac rehabilitation program but given the distance from the hospital and the demands of the work at the farm, he openly declares that he is likely to be non-compliant to a centre-based program. He says that he really needs to be able to look after the cows himself because he does not think Alma would do it and he feels that it is unfair to impose such a big role on his son.

Part One (500 words):
What are the chronic illnesses that Ethan is likely to have? Explain your answers using the information from the scenario. Describe the potential impact on Ethan and his family if he was to be formally diagnosed with the illnesses you’ve identified. Support your discussion with relevant literature.

Part Two (500 words):
What model of care would suit Ethan’s needs? Explain your answer using information from the scenario. Describe the process that needs to happen to establish this model. Support your discussion with relevant literature. – Research and focus on Chronic Care Model

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Nursing People with Chronic Illness


Today, in both developed and developing countries, chronic illnesses are the leading causes of mortality as well as disability. In fact, chronic diseases tend to elevate with age. Among the most common conditions include heart diseases, obesity, and stroke. In 2012, approximately half of the adult population, 117 million persons suffered from one or more chronic diseases. Studies show these conditions as preventable as these health risk behaviors are changeable. Some of these unhealthy behaviors include excessive alcohol drinking and tobacco use. Statistics show that too much alcohol drinking is accountable for about 88,000 mortality rates every year where half of the number is because of binge drinking ((Centers for Disease Control and Prevention, 2017). This paper entails a discussion of the assignment extract where Ethan is likely to suffer from several chronic illnesses.

Possible Chronic Conditions

Ethan is likely to have at least four chronic diseases which include Hypertension, obesity, osteoarthritis and Chronic Obstructive Pulmonary Disease (COPD). In fact, Ethan appears to suffer from the two types of COPD which entail chronic bronchitis as well as emphysema. In regards to chronic, information obtained from the respiratory clinic that he visits indicate constant re-occurrence of bronchitis. Also, Ethan is likely to have emphysema as the same results indicate early stages of the condition. Besides, Ethan is a chain smoker as he smokes two packets of cigarettes. Hence, this can be attributed to the likelihood of having COPD as cigarette smoking is the primary cause of the condition (Calverley & Pride, 2013). According to the assignment extract, Ethan takes mild analgesics to handle an ongoing pain on the back as well as dodgy knees. Without a doubt, the pain is not temporary as chronic pain hardly disappears without taking any medications.  Analgesic drugs tend to reduce pain and hence Ethan is also likely to be suffering from osteoarthritis. This condition is attributed to deterioration of the joints mostly the knees and the lower back ((Jones & Doherty, 2013).  More so, Osteoarthritis is more bound to affect older adults, and thus Ethan is among the vulnerable group for he is 52 years old. Also, studies show that obesity is one of the primary causes of osteoarthritis (In Merrick, In Aspler, & In Morad, 2014). Additionally, the pain could be related to the enormous workload Ethan encounters while at the farm.  Regarding obesity, Ethan lost his parent at quite a tender age and was forced to drop out of school to manage the farm and thus this would have significantly affected him mentally (Wolin & Petrelli, 2009). Therefore, this can be ascribed to him being overweight with a distinctive ‘beer belly.’ On the other hand, Ethan occasionally takes antihypertensive medication which is attributed to hypertension ((Greydanus, Kamboj, & Merrick, 2017). Evidently, Ethan is ailing from high blood pressure (HBP). One of the principal causes of HBP is stress which is highly stressed in the extract. The acute myocardial infarction occurred while he had a heated argument with his wife. Studies show that HBP results to a heart attack as a consequence of the strain of the coronary arteries which slowly narrow from a fat build-up (Commission on Chronic Illness, 1957). Such accumulation blocks the artery and blood flow is interrupted which in turn damages heart muscles due to nutrient and oxygen deprivation. Hence, this damage that takes places is referred to as myocardial infarction ((Margolis, Klag, & Johns Hopkins Medical Institutions, 1999). Ethan’s lifestyle of smoking and drinking as well as stress can be associated with the condition.

Potential Effects of Illnesses on Patients and Family

When severe diseases strike an individual, it’s not only the patient gets affected but also the entire family. If Ethan gets to be diagnosed with the illnesses, both he and his family get to experience physical effects, social issues, and psychological distress (NCCDP and Health Promotion (U.S.), Centers for Disease Control and Prevention (U.S.), & Prevention Institute, 2013). Besides, ethane will be more dependent on his family than before. Considering psychological distress, his family will struggle with emotional turmoil like stress, frustration as well as worry. Moreover, concerning social problems, a possibility of suffering from all these diseases may subject the family to embarrassment. Hence, the family may shun themselves from the mass. For physical impacts, the family will certainly strain with the expensive medications and the limited financial resources. Chronic diseases are costly to manage as they are sporadically taken to curb further deterioration. Also, this will disrupt the family business as Ethan will have to cut down his daily workload and yet he is not willing to let his son take over.

The Chronic Care Model

There are several models of care for individuals with long-term conditions. Some of which include, the chronic care model (CCM), and the innovative care for chronic diseases model. In this case, the chronic care model best suits Ethan’s needs as he has multiple serious conditions. From the extract, it is quite clear that Ethan is suffering from more than one chronic condition which entails Hypertension, obesity, osteoarthritis, and COPD. Each one of the illnesses demands intensive care by healthcare providers by self. The model provides a profound guideline to every entity that will be involved in managing Ethan’s needs from the individual to clinicians and family (Barnes, Taylor, Hallman, & University of Texas Health Science Center at Houston, 2009). According to Boult (2009), the CCM provides all parties with sufficient knowledge where the medical care providers and Ethan are well aware of the many conditions he is ailing. Hence, this will provide a comprehensive guideline on managing Ethan’s needs as it provides not only a systematic but also a proactive approach.   The CCM is a strategic design to care for persons with chronic illnesses in a primary care setting (Bradford, 2002). It is population-based and generates not only supportive but also possible interactions between informed patients and a prepared healthcare team.  The CCM several aspects which entail, health systems, the community, self-management support, delivery system design, decision support and clinical information systems (Marram, Barrett, & Bevis, 1979). The plan considers health systems crucial as they establish an organization that offers safe and substantial quality care. These systems encourage effective enhancement approaches intended at comprehensive system transformation (Lambert, & Donovan, 1987). They also visibly support improvements at all levels of the set-up as well as present incentives in regards to quality of care. More so, they generate agreements that enable coordination of care within the set-ups.

Concerning the community, the model mobilizes community resources towards meeting the patients’ need. Here, the CCM encourages patients to form partnerships with the society as well as indulge in community programs that are effective. Furthermore, Self-Management Support empowers and prepares patients to be in-charge of their medical care and advocates for policies that enhance patient care. Such emphasizes a patient’s pivotal role in managing one’s health. There’s use of self-management support tools that encompass assessments either by the healthcare providers or self. It also involves organizing of community resources to offer continuing self-management support to persons. On the other hand, clinical information systems assist patient in care planning and tend to provide essential information on individual population and patients. These also document beneficial financial, clinical as well as behavioral impacts to reflect the value of services (Ward, Schiller & Goodman, 2014). Moreover, decision support promotes care consistent with individual preferences backed up by scientific data. Here, physicians have convenient access to current evidence-based principles for care for every chronic illness. On the flip side, the delivery system design assures not only effective but also self-management support as well as efficient care. In this case, the model defines responsibilities and disseminates duties among the team members. Also, it involves exploitation of planned interactions to encourage evidence-based health care (Chang & Johnson, 2014). More so, this ensures regular follow-up by the clinicians.


In conclusion, Ethan is suffering from multiple chronic conditions. The illnesses can mostly be attributed to his lifestyle and partly to his occupation. As a result of drinking and smoking, Ethan ails from COPD and obesity. However, obesity can be ascribed to high levels of stress subjected to Ethan leading him to over eating. On the other hand, his workload at the farm is also partly responsible for Ethan’s deteriorating health. The local GP states that the “wearing and tearing” of Ethan’s joints is due to the enormous work at work. In realization of these diseases, the family is certainly going to encounter a significant amount of impact from financial to emotional turmoil. Hence, the Chronic Care Model will be of great help in this case. The model provides a systematic approach to the proper care of multiple conditions like in Ethan’s case.


Barnes, A. S., Taylor, W. C., Hallman, D. M., & University of Texas Health Science Center at Houston. (2009). Roadmap for implementing the Chronic Care Model for weight management: Healthcare Institution’s Response to Obesity (HIRO). (Masters Abstracts International, 47-5.

Boult, C. (2009). Guided care: A new nurse-physician partnership in chronic care. New York: Springer.

Bradford, R. (2002). Children, families and chronic disease: Psychological models and methods of care. London: Routledge.

Calverley, P. M., & Pride, N. B. (2013). Chronic Obstructive Pulmonary Disease. Boston: Springer US.

Centers for Disease Control and Prevention. (2017). Alcohol and Public Health: Alcohol Related Disease Impact. Retrieved from

Centers for Disease Control and Prevention. (2017). Binge Drinking. Retrieved from

Chang, E., & Johnson, A. (2014). Chronic Illness and Disability: Principles for Nursing Practice.

Commission on Chronic Illness. (1957). Chronic illness in the United States: 1. Cambridge, MA: Harvard Univ. Press.

Greydanus, D. E., Kamboj, M. K., & Merrick, J. (2017). Chronic Disease and Disability. Hauppauge: Nova Science Publishers, Inc.

In Merrick, J., In Aspler, S., & In Morad, M. (2014). Disability and chronic disease.

Jones, A., & Doherty, M. (2013). Osteoarthritis. Oxford: Clinical Pub.

Katz, P. R., Kane, R. L., & Mezey, M. D. (1999). Emerging systems in long-term care. New York, NY: Springer Pub. Co.

Kronenfeld, J. J. (2004). Chronic care, health care systems, and services integration. Amsterdam: Elsevier JAI.

Lambert, C. E., Lambert, V. A., & Donovan, M. (1987). Adaptation to chronic illness. Philadelphia: Saunders.

Margolis, S., Klag, M. J., & Johns Hopkins Medical Institutions. (1999). Hypertension. Baltimore, MD: Johns Hopkins Medical Institutions.

Marram, G. D., Barrett, M. W., & Bevis, E. O. (1979). Primary nursing: A model for individualized care. St. Louis: Mosby.

National Center for Chronic Disease Prevention and Health Promotion (U.S.), Centers for Disease Control and Prevention (U.S.), & Prevention Institute. (2013). A practitioner’s guide for advancing health equity: Community strategies for preventing chronic disease.

Ward, B.W, Schiller, J.S, Goodman, R.A. (2014). Multiple chronic conditions among US adults: a 2012 update. Prev Chronic Dis.

Wolin, K. Y., & Petrelli, J. M. (2009). Obesity. Santa Barbara, CA: Greenwood Press.

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