Personal Impact Paper: Lyme Disease
Eric Bickhart
University of Phoenix student
NUR/427
August 4, 2014
Amy Highland

Personal Impact Paper: Lyme Disease

“Since its identification nearly 30 years ago, Lyme disease has continued to spread, and there have been increasing numbers of cases in the northeastern and north central US. The Lyme disease agent, Borrelia burgdorferi, causes infection by migration through tissues, adhesion to host cells and evasion of immune clearance” (Steere, 2004). This disease is transmitted to humans from the bite of the Blacklegged (deer) tick. It usually produces a bulls-eye rash, but not in all cases. According to National Library of Medicine (2013), "Stage 3 or late disseminated Lyme disease can cause long-term joint inflammation (Lyme arthritis and heart problems. Brain and nervous system problems are also possible" (Outlook (Prognosis)). Lyme disease has afflicted a high school basketball coach and gym teacher of a small school in Liberty, Pa at age 36. He is the father of two children and a member of a local sportsman's club. He has been dealing with the ongoing symptoms related to chronic Lyme disease for about seven years. It has been a life altering disease for a previously active young man. He reports symptoms as severe pain and swelling in all of his joints that inhibit full rotation similar to rheumatoid arthritis. Also, he has persistent severe back pain which keeps him on the sidelines during most of his career and personal activities. He no longer hunts with his friends or plays ball with his children. These had always been previously paramount in his life. Some days he is unable to work due to the pain flare ups and ultimately affecting his career. The school superintendent has told him that he would be replaced if he couldn't show up to work more consistently. Poor health has unbalanced his sense of self-worth. On his elderly father’s family farm, he is limited in the amount of help he can provide physically or financially. In addition, to his physical pain he suffers from bouts of severe depression. Stress about his professional, personal and financial losses are driving him further into depression. Currently, he does not participate in outpatient counseling for his depression and refuses to admit it would help. He feels there is no hope and reports he does not believe there will be any real relief on the horizon for his pain. Coach was diagnosed in 2007 by his primary care physician with chronic Lyme disease (disseminated Lyme disease- stage 3), and he was the one that gave him the initial education on the disease and treatment process. He was prescribed pain medications with steroids after his treatment of antibiotics. Then when the medications were not working, he and his wife researched the internet for additional information on medical and holistic treatments currently available. After they had felt they researched enough about the cures or treatment, they contacted a friend in the medical profession for any possible latest cures. He has tried the copper bands, electric shock to his back, bee stings to his joints, herbs and anything recommended. Now, he has completely shut down on the subject and remains in a complete depression. He will not entertain another treatment without evidence of a cure related to it. However, the chance of a cure is not known yet, and the narcotics and medications only mask the symptoms. He has gained almost 150 lbs since diagnosis and suffered a mild heart attack six months ago, and it is believed to be related to the Lyme disease. He eats when depressed and cannot exercise or work as much due to the disease symptoms. The cardiologist recommended a structured rehabilitation program, which includes dieting, but he is completely shut down to even trying. He exhibits a common barrier to successful self-management of his chronic condition and co-morbidity. He is an intelligent person and has a basic understanding of the disease and treatment process. People with chronic diseases identify barriers to self-management often report aggravation of one condition by the symptoms or treatment of another, and problems created by multiple medications. Nurses can help patients set goals that will affect real-life challenges, rather than disease-oriented goals. He can benefit from an educational plan designed to help him deal with the symptoms of depression and Lyme disease. According to Bodenheimer, MacGregor, and Sharifim (2006), all patients with chronic conditions self-manage every day. They decide what to eat, whether to exercise, if and when they will take medications. The important question is whether they will make changes that improve their health-related behaviors and clinical outcomes. The coach is not participating in self-management possibly related to his depression. He was presented the education of his disease in the traditional method. He needed an interaction that was more collaborative. "This method provides information and skills taught based on the patient's agenda. There is a belief that one's confidence in the ability to change (called "self-efficacy" by behavior researchers), together with knowledge, creates behavior change. The goal is increased confidence in the ability to change, rather than a compliance with a caregiver's advice, and decisions are made as a patient-caregiver partnership. Under the collaborative model, an agenda for the visit is negotiated between the patient and caregiver, but the patient has the last word. In the coach's situation, he needs to see the value in a treatment process. However, his depression could be blocking him from being ready to make a change. The collaborative approach addresses this readiness by two models. One, the transtheroretical model (TTM), is based on the stages of change: pre-contemplation (not intending to make a behavior change during the following six months), contemplation (thinking about change), preparation (intending to take action within a month), and maintenance (prevention of relapse, with change persisting from six months to five years). These models were initially formulated for problems of addiction but were increasingly being applied to chronic disease-related lifestyles (diet, exercise, taking medications). The second model offers motivational interviewing (MI) readiness equals importance multiplies confidence (R=IxC). This is more a fit for patients with multiple health issues to identify barriers to learning. It guides clinicians in interviewing techniques to develop a non-judgmental, non-authoritarian relationship that more closely resembles a partnership than a traditional clinician-patient interaction. In a true collaboration, the clinician refrains from giving advice and instead evokes the experiences, beliefs, and ideas that motivate the patient. Ideally, it is the patient, not a clinician, who presents the argument for change. Goal setting in self-management support is the result of the interaction with the patient agreeing to a concrete, usually short-term, goal. It is formalized by a simple action plan and detailed. It is important that the patient is successful in the goal that will increase self-efficacy.” With the seriousness of the coach’s myocardial infarction, he needs to focus and celebrate on setting goals. “Statements of goals and objectives are intended learning outcomes. They provide direction for choosing instructional activities that will yield those outcomes. Educational objectives are based on an assessment of a patient’s readiness and need to learn; they are the framework for the instructional plan. Instructional forms. Educational objectives, instruction and teaching materials are identified or constructed to provide the learning conditions necessary for meeting the objectives (Redman, 2007, pp. 92-93). Teaching plans with these elements put together and guide the implementation process. Coach would benefit from a collaborative teaching plan and motivational interviewing process. He needs to be ready to receive the information and realize the value in it. If he could realize the short term goals, he might be open to lifestyle changes and improve his overall health. “Maslow described the individual as an integrated and organic whole motivated by needs that are hierarchical – unfulfilled lower needs dominate thinking and behavior until they are satisfied. Once satisfied, the next level dominates or is expressed in everyday life. Only when the deficiency needs are satisfied, are individuals free to pursue the higher needs (Gorman, 2010, para.). In summary, the coach needs help with a well-designed plan focused to inspire him to want to become successful in improving his cardiac, physical and mental health. Hopefully, the outlined elements or tools mentioned above can help design a lifestyle changing plan. Without his active participation and valuing the information, he will continue to be depressed and increase the number of co-morbities in his life or possibly a premature terminal illness.

References
Steere, A. C., Coburn, J., & Glickstein, L. (2004). The Emergence of Lyme Disease. Journal of Clinical Investigation, 113(8), 1093-101. Retrieved from http://search.proquest.com/docview/200540330?accountid=458
Bodenheimer, T., MacGregor, K., & Sharifi, C. (2006). Helping Patients Manage Their Chronic Conditions. Oakland, Ca: California HealthCare Foundation.
Redman, B. K. (2007). The Practice of Patient Education: A Case Study Approach. Retrieved from The University of Phoenix eBook Collection database.
National Library of Medicine. (2013). Lyme Disease. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002296/
Gorman, D. (2010, January/February). Maslow's Hierarchy and Social and Emotional Wellbeing. Aboriginal & Islander Health Worker Journal, 34(1), 27-29.