Personal Impact Paper Regardless of which definition of chronic illness you subscribe to, be it Feldman, Cluff, or Curtin & Lublin, they all share common themes. They all describe a condition that is long lasting and persistent, requiring some medical oversight/treatment and personal retraining. Once a diagnosis is applied, specific treatments are started but the training of the individual is just that, individual. Each person has their own unique learning style. The following describes this process experienced by one patient afflicted with Crohn’s disease (CD). CD is an inflammatory bowel disease affecting the gastrointestinal (GI) tract anywhere from the mouth to the anus. Sometimes confused with ulcerative colitis, CD usually confines itself to the distal small bowel (ileum), large intestine (colon), rectum, and anus. Where colitis only affects the lining of the colon and rectum. The exact cause of CD is not known. It is thought to be an autoimmune disease with a genetic component as this condition tends to run in families. The most common symptoms of CD are cramps like abdominal pain, fever, fatigue, poor appetite, painful bowel movements, persistent diarrhea, and unintentional weight loss. More advanced symptoms include: constipation, eye irritation, rectal fistulas, joint pain, mouth ulcers, bloody stool, rectal bleeding, skin lumps/sores, and swollen gums. CD sufferers are also at greater risk of small bowel and colon cancer. The patient The patient is a 37 year old, Caucasian male in otherwise good health. He is married with two tweens. He is a high school graduate with Bachelor Degree College. He is employed as a branch manager in the big security company; a job he describes as “stressful.” He and his family reside in an wealthy neighborhood in a home that they own. His wife is employed in the health care industry as a register nurse, through which both receive their health care. Diagnosis Having experienced diarrhea and abdominal pain for several weeks, the patient resisted seeking medical attention. It was not until the stools became bloody did he seek help. He was 21 years old at the time; never having been sick before in his life. Naturally he was afraid. He endured a number of tests and examinations over the course of several visits, first by his primary care physician, then by a gastroenterologist. When the results were in, he was first diagnosed with ulcerative colitis and later, following several flair-ups and treatment, CD. Personal impact Financially the impact of the diagnosis has not been much of a burden. The patient has always had medical coverage and his co-pays for office visits and medications are easily affordable. His illness has had a far more crippling effect personally and socially. Social situations present some challenges to anyone suffering from CD. According to the patient,

“You can’t go anywhere or do anything without knowing where the nearest bathroom is ... especially during a flair-up.” He expressed anxiety about the likelihood of a bowel accident, embarrassment of the explosiveness of his movements (especially in public places), & the odor associated with them. Long trips also present a challenge for the same reasons. He admits there have been times he refused to go out because of his illness. Personally he wants to be like everyone else. Many a time he consumed things not in his diet, things that he knew to be harmful to him, out of his desire to be normal. Between the ages of 22-30 therapy for his CD’s continued off and on as his condition flared-up and went into remission for short periods. As he points out, “You can see in family pictures if I’m having a flare-up or not.” It is obvious as you look at the pictures he was referring to his appearance. Evident in most of the pictures is the tell tail bloating and “moon face” associated with long term corticosteroid therapy. Educational experience He could not recall how he learned about his new diagnosis, only that he spoke to all types of medical professionals. He said, “(He) took something away from every visit.” He was given all forms of literature to read and sought information on his own. He was also referred to a support group, but he never went to a meeting. He recalls reading about the diet he was supposed to be on and that there was nothing on it that sounded good. As a restaurant manager he was accustomed to eating all types of foods whenever he wanted. Fast food was now discouraged. He also indulged in an occasional beer at home and in social situations. According to the literature, he was no longer able to drink and soda. His experience was a delicate balance of the patient’s desire to be normal and feel healthy. He described his situation to that of a binge drinker, “You may not drink for a long time. Then one night you binge. You regret it the next morning because you feel like (crap). The only difference is it’s easy to get rid of a hangover.” He struggled like this for eight years. When he turned 30, he was tired of the cycle of feeling good and flaring-up. In a effort to feel better more often he became more strict about his diet. He gave up soda and only had a beer every now and again. He enjoyed two and a half years of almost normal living. His run of good fortune was shattered when a routine colonoscopy revealed several large polyps in his colon. A biopsy confirmed his worst fears, colon cancer. The patient has since undergone a total proctocolectomy with temporary ileostomy and the subsequent ileostomy takedown. Education plan The first step in any patient education plan is having an accurate assessment of the patient’s mental state, level of education, and willingness or motivation to learn.
In the case of this patient, his primary motivation is his desire to be “more normal.” This is in direct conflict with his desire to be “healthier.” The most disappointing aspect of this case is that this conflict continued for eight years. The patient made a conscious choice at the age of 30 to commit him to the prescribed regimen and subsequently enjoyed two and a half years of near normal health. His health care providers failed him not having recognized this conflict. Proper assessment and education could have given these patient years of more optimal health. Sufferers of CD require more intensive re-education from their healthcare providers. Through the process of motivational interviewing you can assess the client’s individual learning needs, their willingness to learn and their mental attitude. Through the process of motivational interviewing, according to Redman (2007), “The patient is encouraged to think about his current satisfaction with life and what the future looks like, both if he continues as he is and if he changes his behavior (p. 8).” Through continued conversations you can lead a patient to develop therapeutic lifestyle changes. You may also want to invite other patients with inflammatory bowel diseases to share in a support group. This would allow them to share ideas, learn how others are coping with their illness and provide potential motivation. Redman (2007) also states, “Learning from peers who have successfully completed the transition on which patients are embarking often provides models and an emotional identification that is motivating (p. 29).” The expectancy theory of learning tells us that seeing others living with similar diagnoses may give another patient a perceived chance of success in their own struggle with their disease. The group concept also gives the healthcare provider more opportunity for highlighting and encouraging learned behaviors. The instructor can do this by asking patients to share success stories; then ask them to what factors do they attribute their success. These attributions are heard by the other group members and can be used as educational opportunities. Conclusion There are a staggering number of people suffering from chronic disease. By definition, all or most have a need for education and/or re-education of learned behaviors. Through careful assessment of the patient’s individual situation the health care provider(s) can taylor a learning plan to that persons unique needs. Doing so will provide the optimal conditions for teaching, learning, and hopefully, a healthier patient condition.

References PubMed health. (2011). Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001295/ Redman, B. (2007). The practice of patient education: a case study approaches (10th ed.). Retrieved from University of Phoenix eBook Collection database.