Patients with comorbidities perceived that acute care services did not fully acknowledge or accommodate the comprehensive care that they required

摘要

The study by Williams brings to our attention the perspectives and care experiences of 12 people with multiple chronic illnesses who spent time in an acute care hospital. A chronic illness is one that persists over time, without an easily definable beginning, middle, and end. Although the symptoms that accompany chronic illness may be alleviated to some extent, the illness itself is not curable. Increasingly, people are living with multiple and complex chronic illnesses.The findings of Williams suggest that acute healthcare systems are not always designed with clients in mind and often do little to assist clients in self care. Often it is a "do as I say" model of care, and the client's role is often passive. This model may work for acute illness, but it doesn't work well for people learning to live with chronic illness for the rest of their lives. Healthcare professionals are still very much in authority, trying to get clients to do what is needed; and the client's job is to be obedient.This study highlights that most chronic illness care is not provided by nurses, physicians, or other healthcare professionals but by the person who has the illness. On a day to day basis, clients are in charge of their own health, and their daily decisions have an effect on disease outcomes and quality of life. Nurses may know how to manage a wound, or care for diabetes, asthma, or congestive heart failure, but that does not mean they know how clients have learnt to manage illness or symptoms in their everyday lives. Each client is the expert in his or her own life. Nurses, however, can play an important part in a lifelong learning process that can empower clients to be experts in their own self care. Research has shown that effective chronic illness care requires open, equitable communication and a coordinated team approach with the client at the centre.The findings of Williams highlight the complex needs of people with chronic illness. Further research should address the types of approaches nurses can use in the acute care sector when working with people with chronic illness.