On reading the study conducted by Navarta-Sanchez et al. (2017) two issues warrant mention. First, the methodology used for proposed intervention was based on the Chronic Care Model (Coleman et al., 2009), which is a framework for improving chronic illness care at both the individual and population level. However, in this study, the researchers focused on the idea that nurses should take charge of redirecting the coping process related to Parkinson’s Disease when it is inadequate. Furthermore, they stress the importance of reinforcing the “acceptance” of this disease in both the patients and their family carers (Navarta-Sanchez, 2017). This approach appears to focus on a medical view of the patients and their families. Considering using the Resilience Theory (Zauszniewski, Bekhet & Suresky, 2009) as a guiding framework would have been more appropriate in addressing the idea of “acceptance of disease as one of the most important steps” (Navarro-Sanchez, 2017). Creating opportunities to change perspectives, creating positive, constructive strategies and strengthening family bonds can be accomplished through fostering resilience (Zauszniewski, Bekhet & Suresky, 2009). Considering this approach in their study would have reinforced the individual and family strengths as opposed to focusing on a healthcare providers’ perception of what is deficient and what needs “acceptance” (Gottlieb, 2014).
Second, the intervention suggested in this study was a combination of ten topics where “all components interact and are necessary and relevant to improve coping with Parkinson’s Disease” (Navarro-Sanchez, 2017). Even though the intervention addresses the process of coping with Parkinson’s Disease, it’s generalization to both the patient and the caregivers is questionable. From the “relatives focus group”, Peter (one of the carers in the study) expresses the desperate need for caregiver support. However, in the discussion section, the researchers refer to redirecting coping skills for improving patient and carers’ well-being and quality of life. Little attention is given to caregivers' own health and handling of the chronic illness. Previous research has demonstrated that caregivers’ decrease in well-being and perceived burden is directly related to patients’ functional status, thus strategies should be aimed at reducing psychological burden associated with caregiving and not just at “redirecting” the process of coping (Grunfeld et al, 2004).
Overall this study has expressed the importance of the meaning of coping with Parkinson’s Disease and its relevance for clinical nursing practice, related both to patients and their caregivers. While it acknowledges the need for resources in helping nurses integrate the intervention proposed, its feasibility and relevance to nursing practice could be challenged.
McGill University, Ingram School of Nursing
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Zauszniewski, J., Bekhet, A., & Suresky, M. (2009). Effects on resilience of women family caregivers of adults withserious mental illness: the role of positive cognitions. Archives of Psychiatric Nursing, 23, 412-422.