The lesion is about people living with long-term condition (LTC). The definition of LTC according to (NICE:2019). It a condition that generally lasts a year or longer and impacts on a person’s life.

It applies to conditions that cannot currently be cured but can be controlled with the use of medication and /or other therapies.

It may be referred to as a chronic condition, but this is a somewhat date term.

LTC can be of physical, neurological, or mental health origin.

 

I learnt that this can be manifested at any point across the lifespan:

• From birth or childhood – including hereditary and congenital conditions.
• In childhood, adolescence, and adulthood as symptoms present.

The following are some of the Long-Term Conditions:

• Arthritis (Osteo and rheumatoid)
• Anxiety.
• Cancer
• Chronic Obstructive Pulmonary Disease (COPD)
• Crohn’s disease
• Dementia
• depression
• Diabetes
• Epilepsy
• Heart disease
• Hypertension
• Irritable bowel syndrome (IBS)
• Motor Neurone disease (MND)
• Multiple sclerosis
• Parkinson’s disease
• pain
• Renal disease
• stroke
• Schizophrenia to name but a few.

Caring and supporting people with LTC, holistic care plan should be in place.

Example: physical health (group 1), mental health (group 2) neurological (group 3)

For Physical health: arthritis, pain (chronic), stroke, heart disease, hypertension to name but a few.

For mental health: schizophrenia, dementia, depression to name but a few.

And for neurological: motor neurone disease, Parkinson’s disease, to name but a few. Looking at the impact of having a LTC, having a LTC (or more than one) can have a significant impact on any or all aspect of a person’s life. Physically, emotionally, psychologically, and socially. Its affects people2y differently.  Multi-morbidity / co-morbidity refers to the presence of two or more LTC which can include: the physical and the mental health conditions such as diabetes and schizophrenia. Ongoing conditions such as learning disabilities.

Diagnosis of LTC may challenge individuals’ self-identity and self-esteem. The impact of LTC can result in a sense of changed self. For some living with a LTC will lead to it becoming part of their identity. Some individuals find the LTC restricts their activities and adversely affects their sense of identity. It may change the role that they play in society or their social circle.

Reconciling having an LTC- being able to accept and take ownership of a LTC is recognized to be a contributory factor in patient’s feelings of well-being. Perceptions vary between something that can be assimilated into life by those affected or seen as something to be contended with.  Can provide a new perspective on well-being that inspires the individual to find possibility within illness.

Conversely, for other people, a LTC may be viewed as a burden. They are unlikely to feel knowledge and may not accept all aspect of the condition.

LTC can impact on an individual’s independence. Individual may require assistance with some or all their activities of daily living.  He may be advised to learn to do things differently to maintain a level of independence where possible. He may be completely unable to carry out their everyday activities or feel obligated to change aspects of their lifestyle due to an LTC.

Their partners, family, friends, carers, and peers can play a significant role in supporting individuals many aspects of managing LTCs including supporting emotionally and encouraging lifestyle and adaptations.

Personal relationships may feel changed, particularly if those individuals take on caring responsibilities (change nature of the relationship) or they feel unsupported or trapped. They may experiences feeling of isolation as well as their loved ones.

Working with LTC is the ability to work and progress professionally may be affected by long periods of absence or disability because of the LTC. They may no longer be able to work or may require changes to be made at work. These changes may include:

• Alterations to their workplace
• Working different hours
• Working in a way that makes allowances for their condition (having more breaks)
• Provision of materials that may help.
• Changing job role.

The link between LTCs and social inequalities. When compared to those in the highest social class, those in the lowest social class have 60% higher prevalence of LTCs and 30% higher severity of conditions. (BMA:2016)

Life expectancy continues to improve for the most affluent 10% and multimorbidity is most common in areas of deprivation.

In planning care, the following are things to remember:

• People will have different experiences of how their condition affects them and this will influence what they see as their needs and priorities.
• Patient with multi-morbidities have a high treatment burden in terms of understanding and self-managing their conditions, attending multiple outpatient appointments and managing complex drug regimes.
• People with LTCs, and their carers must be at the heart of how we plan, design and deliver treatment and care (person-centred care).

 

 

KSB ADDRESSED.

 

KNOWLEDGE:

K1: Understand the code: Professional standards of practice and behaviour for nurses, midwives, and nursing associates (NMC 2018), and how to fulfil all registration requirements.

K4: Understand the principles of research and how research findings are used to inform evidence-based practice.

 

K5: Understand the meaning of resilience and emotional intelligence, and their influence on an individual’s ability to provide care.

 

K6: Understand and apply relevant legal, regulatory and governance requirements, policies, and ethical frameworks, including any mandatory reporting duties, to all areas of practice.

K7: Understand the importance of courage and transparency and apply the Duty of Candour.

K8: Understand how discriminatory behaviour is exhibited.

K9: Understand the aims and principles of health promotion, protection and improvement and the prevention of ill health when engaging with people.

K10: Understand the principles of epidemiology, demography, and genomics and how these may influence health and well-being outcomes.

K11: Understand the principles of epidemiology, demography, and genomics and how these may influence health and well-being outcomes.

K12: Understand the importance of early years and childhood experiences and the possible impact on life choices, mental, physical, and behavioural health, and well-being.

K13: Understand the contribution of social influences, health literacy, individual circumstances, behaviours, and lifestyle choices to mental, physical, and behavioural health outcomes.

K15: Understand human development from conception to death, to enable delivery of person-centred safe and effective care.

K16: Understand body systems and homeostasis, human anatomy and physiology, biology, genomics, pharmacology, social and behavioural sciences as applied to delivery of care.

K17: Understand commonly encountered mental, physical, behavioural, and cognitive health conditions as applied to delivery of care.

K18:  Understand and apply the principles and processes for making reasonable adjustments.

K19: Know how and when to escalate to the appropriate professional for expert help and advice.

K20: Know how people’s needs for safety, dignity, privacy, comfort, and sleep can be met.

K21: Understand co-morbidities and the demands of meeting people’s holistic needs when prioritising care.

K22: Know how to meet people’s needs related to nutrition, hydration and bladder and bowel health.

K23: Know how to meet people’s needs related to mobility, hygiene, oral care, wound care, and skin integrity.

K24:  Know how to support people with commonly encountered symptoms including anxiety, confusion, discomfort, and pain.

K25: Know how to deliver sensitive and compassionate end of life care to support people to plan for their end of life.

K26: Understand where and how to seek guidance and support from others to ensure that the best interests of those receiving care are upheld.

K27: Understand the principles of safe and effective administration and optimisation of medicines in accordance with local and national policies.

K28: Understand the effects of medicines, allergies, drug sensitivity, side effects, contraindications, and adverse reactions.

K29: Understand the different ways by which medicines can be prescribed.

K30: Understand the principles of health and safety legislation and regulations and maintain safe work and care environments.

K33: Understand when to seek appropriate advice to manage a risk and avoid compromising quality of care and health outcomes.

K36: Understand the roles of the different providers of health and care.

K39: Understand the principles and processes involved in supporting people and families with a range of care needs to maintain optimal independence and avoid unnecessary interventions and disruptions to their lives.

K40: Understand own role and contribution when involved in the care of a person who is undergoing discharge or a transition of care between professionals, settings, or services.

K41: Know the roles, responsibilities, and scope of practice of different members of the nursing and interdisciplinary team, and own role within it.

 

SKILLS:

S1: Act in accordance with the Code: Professional standards of practice and behaviour for nurses, midwives, and nursing associates (NMC, 2018), and fulfil all registration requirements.

S2: Keep complete, clear, accurate and timely records.

S5: Safely demonstrate evidence-based practice in all skills and procedures required for entry to the register: Standards of proficiency for nursing associates Annex A & B (NMC 2018).

S17: Safely demonstrate evidence-based practice in all skills and procedures required for entry to the register: Standards of proficiency for nursing associates Annex A & B (NMC 2018).

S18: Recognise when capacity has changed recognise and how a person’s capacity affects their ability to make decisions about their own care and to give or withhold consent.

S21: Monitor the effectiveness of care in partnership with people, families and carers, documenting progress, and reporting outcomes.

S23: Work in partnership with people, to encourage shared decision making, to support individuals, their families, and carers to manage their own care when appropriate.

S25: Meet people’s needs for safety, dignity, privacy, comfort, and sleep.

S26: Meet people’s needs related to nutrition, hydration and bladder and bowel health.

S27: Meet people’s needs related to mobility, hygiene, oral care, wound care, and skin integrity.

S28: Support people with commonly encountered symptoms including anxiety, confusion, discomfort, and pain.

S30:  when a person’s condition has improved or deteriorated by undertaking health monitoring, interpreting, promptly responding, sharing findings, and escalating as needed.

S32: Work collaboratively and in partnership with professionals from different agencies in interdisciplinary teams.

S35: Accurately undertake risk assessments, using contemporary assessment tools.

 

BEHAVIOUR:

B1: Treat people with dignity, respecting individual’s diversity, beliefs, culture, needs, values, privacy, and preferences.

B2: Show respect and empathy for those you work with, have the courage to challenge areas of concern and work to evidence based best practice.

B3: Be adaptable, reliable, and consistent, show discretion, resilience, and self-awareness.