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Questions: 1.How is chronicity defined? Why is an illness rather than a disease approach to chronic and complex illness important from a Nursing perspective? Discuss regarding depression as a co-morbidity. 2.Is Self-Management beneficial to positive health outcomes in chronic illness? Critically discuss in relation to outcome research and the Chronic Care Model. Answers: 1.Chronicity According to Larsen (2006), health care systems were not designed for the maintenance and prevention of chronic conditions but rater identifying, treating, and at times producing cure for symptoms. Most health care providers deal with chronic disorders as if they are episodic and acute, the consequence is a mismatch between the costly demands of health care and the health needs of the patients. Most of the common diseases that cause this mismatch include obstructive pulmonary, diabetes, asthma; arthritis, cancer, HIV/Aids and hepatitis C (Scher, Buse, Adams and Lipton 2017). When one is suffering from a chronic condition one can suffer from a number of different illness, have diminished mental or physical capacity, or even disability. Illness approach rather than disease approach Disease refers to the issue that the health care provider views from a biomedical replica, which is an alteration in function or structure. On the other hand, illness refers to the experience of suffering and symptoms and points to how the disease is alleged, lived with, and reacted to by the patient and their families. In most cases, a chronic illness like obstructive pulmonary is addressed as an acute illness rather than a disease. Due to this the medical practices are usually organized to respond to patients illnesses which are tended to be urgent , sort and are easily treated and diagnosed. This approach leads to poor health care services as the medical staff requires that the patients should be the one contacting them. At the time of administering the treatment, most of the patients are usually passive. The visits to the doctors are usually more focused on symptoms rather than patient centered. Chronic conditions should be treated as chronic disease, this enable the medical prac titioners to have a planned and integrated care within the system that most clients can easily relate to. The patients are also expected to be partners in ways which the clients can manage their diseases (Larsen, 2006). Depression as co-morbidity Depression commonly occur to patients suffering from chronic illness. In other cases depression is usually as a result of chronic illnesses. Patients who suffer from chronic disease have an overall burden to their illnesses leading to depression. Depression causes a faster progression of chronic diseases such as heart diseases. People who suffer from chronic diseases may be forced to use alcohol and tobacco which is a lot more harmful to their health. Most physicians hardly recognize that a patient is suffering from a chronic disease. The physicians may not even look beyond the chronic illnesses and fail to explain symptoms such as poor concentration or fatigue. However, depression can be treated through first identifying whether medications or the medical problems are causing depression. Treating the disease or changing the medication can treat depression (Green et al. 2013). 2.Self-management One of the most chronic and burdensome condition is chronic obstructive pulmonary disease (Warwick, Gallagher, Chenoweth Parbury 2010). This condition requires self- management to prevent it from becoming severe. Self-management is a daily process where persons aims to manage their illness. It is also the ability of people who have chronic diseases to work together with the community, family and healthcare professionals to treat diseases, manage symptoms and have lifestyle changes. People living with chronic diseases can reduce the progression of the disease through self-management. The individual should first understand the illness he or she is suffering from, this will allow them get involved in its management (Chang and Johnson 2014). According to Schulman-Green et al. 2013, self-management means the ability to manage the lifestyle changes, treatment ,symptoms psychological and physical change that are brought about by a chronic disease. It is also the ability of an individual to monitor his or her condition to adjust to the emotional, behavioral and cognitive responses that are required for one to live a quality life. Self-management skills that should be acquired in order to manage their chronic diseases include adjusting of ones lifestyle, managing medication, gathering information, managing symptoms and communicating effectively. Self-management goes hand in hand with modern opinions on how humans behave and how the quality of life can be improved through health care. This is mostly with patients suffering from chronic illnesses. How patients live with a chronic condition is not fully dependent on the nature of the illness they are suffering from. Lubkin and Larsen (2006) have shown that these patients live with fear, adjusted life, and hope and they are always looking for solutions. Their perspective which includes beliefs, attitude and values determine how they respond to treatment of the chronic disease. How a person understood his or her chronic disease determined the life they will live. Studies have also shown that peoples perspective on their illnesses do determine how they respond to triggers and symptoms and the methods that they use in incorporating their disease in their day to day lives. For examples people who suffer from diabetes believe that they should exercise a lot and at healthy, while thos e that are suffering from arthritis should know how to manage pain. Outcome research Outcome research is one of the branches of public health that studies the results of a healthcare system and also how the patient care coping with the disease. Outcome research tends to show the safety, effectiveness, equity, efficiency, timeliness, system responsiveness and patient-centeredness of the self-management design of coping with chronic diseases (Ski, Page, Thompson, Cummins, Salzberg, and Carter, 2012). Chronic care model Chronic care model is important as it offers the patient with self- management skills of chronic diseases (Hickman, Rolley Davidson, 2010). Chronic care model has six components which are self-management support, health system, community polices and responses, clinical information systems, decision support and the design of delivering. Chronic care model offers the patients with self-management skills that offer them with ways of managing their diseases (Thirsk and Clark, 2014). Reference List Chang, E. and Johnson, A. eds., 2014.Chronic illness and disability: Principles for nursing practice. Elsevier Health Sciences. 12(2), 56-72 Hickman, L. D., Rolley, J. X., Davidson, P. M. (2010). Can principles of the Chronic Care Model be used to improve care of the older person in the acute care sector?.Collegian,17(2), 63-69. Larsen, P.D., 2006. Chronicity.Chronic illness. Impact and interventions,6, pp.3-22. Lubkin, I.M. and Larsen, P.D., 2006.Chronic illness: Impact and interventions. Jones Bartlett Learning. Ski, C.F., Page, K., Thompson, D.R., Cummins, R.A., Salzberg, M. and Worrall?Carter, L., 2012. Clinical outcomes associated with screening and referral for depression in an acute cardiac ward.Journal of clinical nursing,21(15?16), pp.2228-2234. Schulman-Green. D. et al. 2013 Process of self- management in chronic illness. Journal of Nursing Scholarship 34(8), pp. 89- 110 Scher, A.I., Buse, Adams, A.M. and Lipton, R.B., 2017.Comorbid pain and migraine chronicity The Chronic Migraine Epidemiology and Outcomes Study.Neurology, 89(5), pp.461-468. Sanders, J.B., Bremmer, M.A., Comijs, H.C., Deeg, D.J. and Beekman, A.T., 2016. Gait speed and the natural course of depressive symptoms in late life; an independent association with chronicity?.Journal of the American Medical Directors Association, 17(4), pp.331-335. Thirsk, L.M. and Clark, A.M., 2014. What is the selfin chronic disease self-management?.International Journal of Nursing Studies,51(5), pp.691-693. Warwick, M., Gallagher, R., Chenoweth, L. and Stein?Parbury, J., 2010. Self?management and symptom monitoring among older adults with chronic obstructive pulmonary disease.Journal of Advanced Nursing,66(4), pp.784-793