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ItemContinuity of care and general wellbeing of patients with comorbidities requiring joint replacementWILLIAMS, ALLISON ; Dunning, Trisha ; MANIAS, ELIZABETH (Blackwell, 2007-01)Aim: This paper reports a study investigating the continuity of care and general wellbeing of patients with comorbidities who required an elective total hip or knee joint replacement. Background: Advances in medical science and improved lifestyles have reduced mortality rates in most western countries. As a result, there is an ageing population with a concomitant growth in the number of people who are living with chronic illnesses. Indeed a significant number of people will experience multiple chronic illnesses (comorbidities). Osteoarthritis is a common comorbidity and joint replacement surgery is frequently performed in people who have comorbidities that may require joint replacement surgery to relieve symptoms, creating a blend of acute and chronic needs. Method: A purposive sample of twenty participants with multiple comorbidities who required joint replacement surgery were recruited to obtain survey, interview and medical record audit data. Data was analysed for descriptive statistics and Ritchie and Spencer’s a theoretical method of qualitative analysis (Ritchie & Spencer, 1994). Findings: The findings demonstrate that the participants did not receive co-ordinated, continuity of care of their comorbidities prior to having surgery, during the acute care stay and following surgery. The acute care setting was primarily concerned with patient throughput following joint replacement surgery according to a prescribed clinical pathway. Pain, fatigue, insomnia and alterations in urinary elimination were chief sources of discomfort from preadmission to eight weeks postdischarge. Conclusion: These findings have implications for a comprehensive and coordinated approach to patients with comorbidities in need of acute care, in particular, joint replacement. Acute care, clinical pathways, and the specialisation of medicine and nursing, subordinated the general problem of patients with comorbidities. Models of chronic illness management and systems designed to integrate and co-ordinate chronic illness care had limited application in the acute care setting. A multidisciplinary, holistic approach is required. Recommendations for further research conclude this paper.
ItemPatient with comorbidities: perceptions of care during an acute illnessWILLIAMS, ALLISON (Blackwell, 2004)Background. Advances in medical science and improved lifestyles have reduced mortality rates in Australia and most Western countries. As a result, there is an ageing population with a concomitant growth in the number of people living with chronic illnesses. Indeed, a significant number of people will experience multiple chronic illnesses (comorbidities) and may require admission to hospital for acute care that is superimposed on their chronic illnesses. Aim. The aim of this study was to investigate perceptions of quality of care by patients experiencing comorbidities who required an acute hospital stay. Method. A qualitative descriptive design was adopted, informed by Colaizzi’ sphenomenological method. Single semi-structured interviews were conducted with12 patients within 14 days of being discharged home after an acute illness episode. Findings. Data analysis revealed three themes: poor continuity of care for comorbidities, the inevitability of something going wrong during acute care and chronic conditions persisting after discharge. Combinations of chronic illnesses and treatments affected these patients’ experiences of acute care and recovery postdischarge. Medicalized conceptualizations of comorbidity failed to capture the underlying health care needs of these patients. Limitations. No generalizations can be drawn because the findings and conclusions were derived from a purposive sample of patients who agreed to participate. Conclusion. These findings have implications for a comprehensive and co-ordinated approach to this group of patients, and inform the body of nursing knowledge about how patients with comorbidities experience nursing care.