Editorial: revisioning healthcare of chronic illness

Abstract

Welcome to the first issue of the Journal of Nursing and Healthcare of Chronic Illness. We are delighted to be appointed as editors of the journal. We want to take this opportunity to share with you some of our visions and ideas about the direction of the journal and how it may assist in bridging some of the gaps in our knowledge of chronic illness care. Journal of Nursing and Healthcare of Chronic Illness aims to take a comprehensive, multi-disciplinary approach to chronic illness clinical care and research, addressing a broad spectrum of topics relevant to chronic illness across diagnosis, care environment, gendered roles, cultural frameworks and elements of the experience of living with a chronic illness throughout the lifespan. Journal of Nursing and Healthcare of Chronic Illness meets a unique need by promoting an understanding of the care and experience of chronic illness and by fostering interdisciplinary health research and education within the field of chronic illness care and management. It is our intention to provide clinicians with cutting edge research and with relevant articles that can be used by nurses and the healthcare team to translate research into practice. The past decade has been a time of rapid change in the field of chronic illness nursing and healthcare. The incidence of chronic disease and illness is increasing worldwide. It is estimated that by 2020, chronic illness will account for nearly 80% of worldwide disease (NSW Department of Health 2004). The increasing prevalence of chronic disease and illness has a significant impact on hospital admissions, re-admissions and healthcare organization and delivery in our communities. We face ongoing challenges in the field of chronic illness care and research, particularly the fragmentation of healthcare and the under-funding of research. Tremendous progress has been made in the past decade, and yet, the field has still so much work to do to be able to provide sufficient direction to nurses and to policy and intervention developers about best practices in chronic illness care. We still know far too little about so many aspects of the chronic illness experience and the needs of people with chronic illness. For example, we need to know much more about how best to promote self-care, gender differences in the chronic illness experience and how to promote the uptake of health promotion messages. There is a need for further research about the impact of co-morbidity, including physical and mental health co-morbidities, on disease management, clinical outcomes, quality of life and quality improvements. Addressing the gaps and contradictions in the knowledge about chronic illness should be the aim of all research and health education in the field. This will ultimately result in improved healthcare for people across the lifespan. This first issue presents papers such as that by Lindahl et al. (2007) and Lundman and Jansson (2007) that sensitise us to the meaning of learning to live with illness. Articulating the meaning of the chronic illness experience is an important focus for research because it will enable improved and effective healthcare responses. Papers such as that by Ray and Street (2007) and Ahlstrom (2007) articulate how chronic illness may force many changes in the way life and self is experienced. As people cope with intrusive treatments (Gamble et al. 2007 and Polaschek 2007), changes to bodily sensation and function and shifts in identity, many aspects of their familiar life may present as challenges. The experience of coming to terms with illness consequences, such as inability to work, mobility restrictions, inability to participate socially, loss of a lifestyle etc. can leave people with a profound sense of sorrow and loss (Ahlstrom 2007). Revealed in this issue by Kocaman et al. (2007), are the predictors for psychosocial adjustment. These authors highlight the importance of health care workers determining how the individual perceives the impact of the illness upon their life. The paper by Badger (2007) reveals that for health care to be effective, it is important to work alongside people to explore their perceptions about medication, treatments and recovery experiences. Jakobsson et al. (2007) identify determinants for quality of life for older people who are in pain and suggest healthcare interventions that may make a difference to the lives of older people. Importantly, papers by Token et al. (2007) and Rasmussen et al. (2007) describe processes that can assist in the process of developing self capacity and self care agency which are important to a personós sense of well-being. The Journal of Nursing and Healthcare of Chronic Illness aims to be the vehicle to disseminate innovative research that will foster high-quality chronic illness care. Elements of health care systems that encourage high-quality chronic illness care include population profiling of the community and processes that articulate community needs, self-management support, clinical information systems, and an emphasis on building coordinated multidisciplinary teams. Central to developing and sustaining such a system of health care is understanding and incorporating the experience of living with chronic illness from the perspective of those with a chronic disease. Within this context, evidence-based change concepts will foster productive interactions between informed people in our communities who take an active part in their care and multidisciplinary providers with resources and expertise. Research papers are encouraged that will progress systems to facilitate the integration of preventive, acute, chronic co-morbidity, rehabilitative, and long-term care for the purpose of reducing illness burden and improving health-related quality of life. The complex and challenging nature of chronic illness care and management requires an interdisciplinary focus. Despite this rather obvious assertion, the practicalities of conducting and publishing truly interdisciplinary work are often incompatible with the traditional methods of scientific inquiry and dissemination that are held by research granting agencies, research institutions and scholarly journals (Hall et al. 2006). We are proud that the Journal gives the interdisciplinary work of chronic illness care a literary home. We encourage all disciplines and specialties to submit reports of research, as well as reviews and case reports to this journal. We welcome your research and teachings, value your expertise and commend you for the work you do.