Chronic Disease Self-Management Model - Nursing Assignment Help

Assignment Task:

CASE STUDY:  FIBROMYALGIA

You are the PTA/OTA for the Joint Wellness Program, an interdisciplinary therapy and education program that assesses, treats and educates clients with a variety of arthritic conditions including inflammatory arthritis, osteoporosis, osteoarthritis and fibromyalgia.   The program is affiliated with the community’s regional hospital but is physically located in a commercial mall with a variety of businesses, offices, retail stores and recreation facilities, including a YMCA and a movie theatre.  Team members include two rheumatologists, a pharmacist, a dietician, a social worker, an occupational therapist, a physiotherapist, clerical staff and several volunteers. Most of the volunteers are graduates of the Joint Wellness Program. 

The Joint Wellness Program is based on a chronic disease self-management model, a community-based approach that has been gaining in popularity worldwide.  This approach emphasizes the client’s role in managing chronic illness.  The self-management model is designed to provide clients with the knowledge, skills and confidence they needs to actively deal with their own illness-related problems and avoid dependence on healthcare professionals (Brady et al., 2013; Lorig et al., 2001).    

Although each client is assessed individually, and some individual counselling and treatments are offered, many of the interventions in the Joint Wellness Program are provided in a group format.  For example, the social worker and volunteers lead support groups.  As the PTA/OTA on the team, you lead exercise classes with groups of six to eight clients.  In addition, the team delivers regular 30 minute group education session on topic such as:

• The pathophysiology of specific conditions such as fibromyalgia

• Nutrition for general health

• Medications for pain management and other symptoms

• Non-pharmacological pain management (modalities such as heat, cold and electrical stimulation)

• Energy conservation techniques

• Sleep hygiene

• Joint protection techniques and assistive devices

• Exercise

• Stress management

You are working with a new client, Anita Hope, a 43 year-old woman with fibromyalgia.  Anita spent more than ten years visiting doctor after doctor, desperately seeking a diagnosis for her chronic fatigue, generalized pain, and sleep disturbances.  She also has irritable bowel syndrome, but did not realize this could be related to her other symptoms until she was finally diagnosed with fibromyalgia.  

Her symptoms increased after the birth of her second daughter eight years ago, so her family doctor initially diagnosed her with post-partum depression and prescribed anti-depressants.  The medication helped slightly, but failed to address most of her symptoms.  Finally, she was referred to a rheumatologist in the Joint Wellness program, who diagnosed her with fibromyalgia. Although Anita is relieved to finally have a diagnosis that 

makes sense to her, she has spent so many years being disappointed by her health care providers that she is skeptical about the fibromyalgia therapy and education program.  

She is currently taking amitriptyline, an antidepressant, and pregablin a medication used to treat fibromyalgia pain.  Anita also takes over-the counter pain killers and anti-inflammatories.  The pharmacist has concerns about the amount of over-the-counter medications Anita is taking and their possible interactions with her prescribed medications.

She will be attending two 90 minute group sessions for clients with fibromyalgia per week for the next six weeks.  This will include 60 minutes of education and 30 minutes of exercise.  Additional individual sessions with appropriate team members will be scheduled as needed.  

Anita lives with her husband and two daughters in a small townhouse.  Anita’s husband works as a financial advisor, and Anita works part-time as a translator, a job that allows her to work from home.  Together they make a reasonable income, but since Anita started working part-time eight years ago, they do not have a lot of money for extras, such as vacations abroad or music lessons for the kids.  

Over the years, Anita’s level of activity has progressively decreased.  She rarely leaves the house and spends up to six hours a day resting.  She is afraid of doing anything that may provoke pain, so she avoids physical activity and retreats from other daily tasks.  For example, most of the housekeeping activities have been taken over by her husband and her eldest daughter.  Lately, her relationship with Theresa, her sixteen-year-old daughter, has been strained.  Theresa resents doing so many household chores and accuses her mom of being lazy.  In contrast, her husband reinforces Anita’s pain-avoidance behavior by bringing Anita pain medication and telling her to rest, even if Anita has not expressed a need to do so.  

In keeping with an interdisciplinary approach, the OT and the PT assess all clients together (Jessup, 2007).  As the PTA/OTA you also attend the assessment when it fits into your schedule.  Depending on the client’s goals and primary treatment interventions, often either the PT or the OT takes the lead as rehab therapist with a specific client.  The OT and PT are cross-trained so they can provide treatments that may traditionally fall under another discipline.  For example, as many of Anita’s goals and interests are related to exercise, the PT will be taking the lead in her rehabilitation, including education in areas such as energy conservation.   The OT will work with Anita on increasing her involvement in household chores.

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