published_or_final_version / Public Health / Master / Master of Public Health

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M.A. / When a person is diagnosed with a chronic illness, the family as a whole is affected. The family members as caregivers to the patient become the clients. During the course of their care-giving, family members encounter various situations that require them to give ethical and value-ridden decisions that are related to the care and wellbeing of their patients. Many of the issues and dilemmas facing family members as caregivers place them in a double-bind situation. The decision to act or not to act is emotionally painful and guilt-provoking. These impacts on the family members warrant that they be assisted by a social worker, to adjust to a new situation as caregivers and also to preserve the normal family functioning system. The goal of this study is to investigate the emotional and social impact chronic illness has on the patient's family, with the purpose of formulating recommendations for the improvement of current family interventions as part of chronically ill patients rehabilitation programme. The study was conducted at Emseni Chronic Care center, which is a hospital for the chronically ill patients in Hillbrow. There are about 240 patients of which more than 60% are dislocated from their families. Purposive sampling was used in this study and 26 patient's families were interviewed. The qualitative approach is adopted in this study. The qualitative approach has advantages that it is a highly effective means of obtaining the information required for further understanding and exploration of a topic, Cresswell (1994). A qualitative interview was used with one main question, to gather data for the study. The data was also analyzed qualitatively and conclusions are drawn from the results. The study presents the guidelines as recommendations to be considered when working with families of chronically ill patients. The researcher is of the opinion that if practiced properly, the guidelines can be a valuable asset as a tool for social workers working with the family members as part of rehabilitation programme for the chronically ill patients. / Dr. W. Roestenburg

Almost everyone experiences an incident, illness, or concern that requires clinical advice or assistance. Most persons obtain the desired care and renew their daily activities. Some people, however, appear to be (medical) problem-prone, wellness-resistant or reinforced by illness sequelae. Individuals who maintained illness behaviors are often called, for example, chronic pain, asthma, or psychiatric patients by caregivers who focus on diagnoses. Some patients may be viewed as primarily chronic, with specific diagnoses considered secondary. Chronicity is here defined as a measure of individual, situation, exposure, and provider interaction outcomes. Independent of disease processes, chronicity-producing interactions often predict inappropriate and atypical medical utilization patterns. The assessment of chronicity, its precursors, and dynamics may identity high risk person, situation, provider, and environment combinations and permit more effective and relevant prevention and treatment strategies. The study patient chronicity, the Pre-Assistance Questionnaire (PAQ) was developed with 320 items on medical, personal, and situational topics. PAQ responses from 60 medical and 40 psychiatric VA outpatients were correlated with three estimators of patient chronicity: PAQ totals (from an empirically-derived key), clinicians' subjective ratings of patients' chronicity, and indices of subjects' 2 year use of VA medical center resources. PAQ totals correlated significantly with 240 items, medical usage with 119, and clinicians' ratings with 100. For replication, a 40 item short form was given to 120 medical and 80 psychiatric outpatients. Thirty-four items correlated significantly with two of the three measures, 26 with all three. The short form demonstrated high reliability (alpha = .91; test-retest reliability = .90; split-half reliability = .89). PAQ totals, chronicity ratings, and use indices showed no significant differences across from administrations although the psychiatric patients scored significantly higher (more chronic) on all measures. The findings support a general chronicity construct and suggest many applications from the screening of potential employees to the development of specific treatment plans matched to particular PAQ patterns. The major message, however, is that public health, medical, psychological, and sociological constructs may be integrated into a comprehensive model of medical utilization patterns that provides views of illness, wellness, and health care delivery and assessment.

Inadequate, expensive health care services for the chronically ill, confront the lay person as one of the major forces in the social movement toward self-care. The purpose of this predictive correlational study was to investigate within a theoretical framework derived from Orem's conceptual model of nursing relationships among family as a social support system, exercise of self-care agency, and health status for the person with a chronic illness. The sample group was 51 chronically ill adults diagnosed with diabetes mellitus who attended diabetic instructions from one of the Central Indiana Hospitals. Findings indicated a weak positive correlation between self-care and cohesion and weak negative correlation between health status and cohesion. Findings also revealed significant differences between male and female for the variables self-care and conflict.Conclusions were that this study supported certain relationships proposed by Orem's conceptual model in nursing. Results can guide diabetics in providing optimal daily self-care. Professionals in the health care arena can utilize the results for educational development and encouragement of self-care agency in the adult diabetic. The family members can also clarify roles in supporting the diabetic adult. / School of Nursing

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