CHRONI C HEALTH CONDI TI ONS I N ADULTS: CONCEPT ANALYSI S
1Mar ia Célia de Fr eit as2 Mar ia Manuela Rino Mendes3
Fr eit as MC, Mendes MMR. Chr onic healt h condit ions in adult s: concept analy sis. Rev Lat ino- am Enfer m agem 2007 j ulho- agost o; 15( 4) : 590- 7.
This st udy aim ed t o define t he concept of chronic healt h condit ion in adult s as present ed in lit erat ure. An evolut ionary perspect ive of concept analysis w as used, as present ed by Rodgers, em phasizing t he essent ial at t ribut es, ant ecedent s, consequences and relat ed concept s. The adult ’s chronic healt h condit ion was present ed by t he char act er ist ics of per m anence, ir r ever sibilit y, r esidual handicap, incur able and degener at ive as essent ial at t r ibut es. The ant ecedent s w er e: genet ic her it age, old age, bir t h condit ion, sm oking and foods w it h sat ur at ed fat ; and, for t he consequences: physical, social and psychological changes, handicaps and inabilit ies, life st yle changes, needs t o adapt and cope. Relat ed concept s w er e: not t r ansm issible diseases, funct ional deficiency , lim it at ions, illness or im pairm ent for m ore t han t hree m ont hs. Chronic healt h condit ion is a com plex const ruct ion of concept s defined as a m odifying for ce of t he life pr ocess over t im e.
DESCRI PTORS: chr onic illness; healt h; adult ; concept for m at ion
CONDI CI ÓN CRÓNI CA DE SALUD DEL ADULTO: ANÁLI SI S DE CONCEPTO
Tu v o com o obj et iv o def in ir el con cept o de con dición cr ón ica de salu d del adu lt o, ex pr esado por la lit er at u r a. Se u t ilizó en est a in v est igación el an álisis de con cept o, en la per spect iv a ev olu t iv a de Rodger s, dest acan do los at r ibu t os esen ciales, ev en t os an t eceden t es, ev en t os con secu en t es y con cept os r elacion ados. La condición cr ónica de salud del adult o es ex pr esada por las car act er íst icas de per m anencia, ir r ev er sibilidad, incapacidad r esidual, incur abilidad, degener ación y lar ga dur ación, configur ando est as los at r ibut os esenciales. Dent ro de los event os ant ecedent es const an: la herancia genét ica, edad avanzada, causas congénit as, t abaquism o y alim ent os con ex ceso de gr asas sat ur adas, de los ev ent os consecuent es las m odificaciones físicas, sociales y p sicológ icas, in cap acid ad es/ in h ab ilid ad es, cam b ios en los est ilos d e v id a, n ecesid ad es d e ad ap t ación y en f r en t am ien t o. Los con cep t os r elacion ad os f u er on : en f er m ed ad es n o- t r an sm isib les, d ef icien cia f u n cion al, lim it acion es, en f er m ed ad o in cap acid ad con d u r ación m ay or d e t r es m eses. Se con clu y e q u e la con d ición cr ónica de salud es una const r ucción com plej a de concept os, definida com o fuer za m odificador a del pr oceso vit al en el t iem po.
DESCRI PTORES: enfer m edad cr ónica; salud; adult o; for m ación de concept o
CONDI ÇÃO CRÔNI CA: ANÁLI SE DO CONCEI TO NO CONTEXTO DA SAÚDE DO ADULTO
Obj et ivo: definir o conceit o de condição crônica no cont ext o da saúde no adult o, expresso pela lit erat ura. Ut ilizou- se a análise de conceit o, na per spect iva evolucionár ia de Rodger s, dest acando os at r ibut os essenciais, ev ent os ant ecedent es, ev ent os conseqüent es e conceit os r elacionados. A condição cr ônica de saúde do adult o é expressa pelas caract eríst icas de perm anência, irreversibilidade, incapacidade residual, incurável, degenerat iva e longa duração, figurando os at ribut os essenciais. Dent re os event os ant ecedent es const am : herança genét ica, id ad e av an çad a, cau sa con g ên it a, t ab ag ism o e alim en t os com ex cesso d e g or d u r a sat u r ad a; os ev en t os conseqüent es r efer em - se às m odificações físicas, sociais e psicológicas, incapacidades/ inabilidades, m udanças n o est ilo de v ida, n ecessidades de adapt ação e en f r en t am en t o. Os con ceit os r elacion ados f or am : doen ças n ão- t r an sm issív eis, d ef iciên cia f u n cion al, lim it ações, d oen ça ou in cap acid ad e com d u r ação m aior q u e t r ês m eses. Concluiu- se que condição cr ônica de saúde é um a const r ução com plex a de conceit os, definida com o for ça m odificador a do pr ocesso v it al no t em po.
DESCRI TORES: doença cr ônica; saúde; adult o; for m ação de conceit o
1
Paper ext ract ed from a Mast er ’s Thesis; 2 RN, Dr. José Frot a I nst it ut e, PhD, Professor at Ceará St at e Universit y, Brazil, e- m ail: m aria.celia30@t erra.com .br;
3
PhD, Professor, Universit y of São Paulo at Ribeirão Pret o College of Nursing, WHO Collaborat ing Cent re for Nursing Research Developm ent , Brazil, m anu@eerp.usp.br
I NTRODUCTI ON
C
u r r e n t s c i e n t i f i c a d v a n c e m e n t s h a v eprovided hum ans wit h t he opport unit y t o considerably ext end t heir life, which direct ly affect s life expect ancy.
Ma n h a s p u r su ed t h i s g o a l si n ce p r i m i t i v e t i m es, seek in g t o u n der st an d essen t ial an d r est less issu es
regarding life and deat h. I n t his view, disease research becom es essent ial for hum an sur v iv al.
Several st udies aim t o underst and t he healt h-d i se a se p r o ce ss, a n h-d so m e f o cu s sp e ci f i ca l l y o n
c h r o n i c h e a l t h s i t u a t i o n s . A t f i r s t , t h e r e w a s a
pr evalence of r esear ch in t he m edical field. How ever, m o r e r e ce n t l y, o t h e r f i e l d s h a v e b e e n i n v o l v e d ,
i n cl u d i n g soci ol og y, p sy ch ol og y, an t h r op ol og y an d n u r sin g.
I n t h is sen se, it is ack n ow led g ed t h at t h e cur r ent epidem iologic pr ofile in Br azil is r epr esent ed
by diseases r elat ed t o under dev elopm ent as w ell as m odern issues. Therefore, t he count ry faces difficult ies
i n d i r ect i n g a ct i o n s t o w a r d h ea l t h p r o m o t i o n a n d prot ect ion, which com prise t he cont rol of t ransm issible
d iseases ( TD) as w ell as ch r on ic n on - t r an sm issib le
diseases ( CNTD)( 1 ).
M o r t a l i t y r a t e s r e g a r d i n g i n f e c t i o u s
-cont agious diseases have been -cont rolled by indicat ing m edicat ions for t heir inhibit ion, cont rol or dissipat ion.
Mo r e o v e r, co n t r o l h a s b e e n p e r f o r m e d b y u si n g t echnology resources t hat allow for early det ect ion of
or g an ic an d p h y sical ch an g es in p op u lat ion s, t h u s im plem ent ing r esour ces in public healt h policies.
Fu r t h e r m o r e , t e ch n o l o g i ca l a n d sci e n t i f i c
dev elopm en t s h av e m ade it possible t o r each ear ly diagnoses and, t hus, ant icipat e appr opr iat e t herapy.
Th i s p r o v i d e s p r o m i s i n g o u t c o m e s f o r d i s e a s e e v o l u t i o n c o n t r o l a n d / o r c u r e , a n d h e l p s t o
char act er ize difficult ies and inefficient m easur es. Scien ce con t r ibu t es n ot on ly by discov er in g
an d u sin g t r eat m en t s w it h m ed icat ion s or n at u r al a ct i v e p r i n ci p l e s, b u t a l so t h r o u g h r e se a r ch t h a t
ex pands t he analy sis of life- lim it ing sit uat ions, such as lim b or body segm ent am put at ion and paraplegias,
cr eat i n g al t er n at i v es an d ad j u st m en t i n st r u m en t s
capable of offer ing bet t er life condit ions.
Along w it h t he effor t t o br oaden discussions
about t he healt h- disease pr ocess, t his st udy aim s t o under st and chr onic healt h condit ion in adult s fr om a
per spect iv e of healt hy liv ing, consider ing t hat people in t his condit ion seek t o prom ot e adj ust m ent s in order
t o balance harm s and lim it at ions posed by t he disease or life sit uat ions w it h healt h pr om ot ion m easur es.
Def in in g n u r sin g con cep t s h as t h e p u r p ose
t o pr ov ide m or e pr ecise t er m inology, w it h a v iew t o f a ci l i t a t i n g a n d e x p a n d i n g co m p r e h e n si o n a m o n g
h ealt h agen t s. Wor d m ean in gs an d t h eir con n ect ion t o t heir hist or y or or igin ar e im por t ant because t hey
r epr esent sy m bols and m eanings est ablished by use, t r adit ions or associat ions( 2).
The obj ect ive of t his research is t o define t he co n ce p t o f ch r o n i c h e a l t h co n d i t i o n i n a d u l t s, a s
ex pr essed in healt h lit er at ur e.
Th is st u d y u ses t h e ev olu t ion ar y m od el of
co n ce p t a n a l y si s( 3 ), w h i ch i d e a l i ze s t h e f o l l o w i n g p h a s e s : t o i d e n t i f y t h e c o n c e p t o f i n t e r e s t a n d associat ed ex p r ession s; t o id en t if y an d select t h e
appr opr iat e field for dat a collect ion; dat a collect ion, r ecognizing at t r ibut es of t he concept and subst it ut e,
associat ed , an t eced en t , an d con seq u en t t er m s; t o analy ze t he dat a and ident ify concept char act er ist ics
and it s ant ecedent , consequent , and subst it ut e t erm s; t o ident ify concept s of int erest ; t o ident ify t he concept ’s
case m odel; t o ident ify hy pot heses and im plicat ions for fur t her st udies.
How ev er, in t his st udy, t he subst it ut e t er m s,
m odel case, hy pot heses and it s im plicat ions ar e not d iscu ssed .
METHOD
Th i s st u d y f o l l o w e d d o cu m e n t a l r e se a r ch p r i n ci p l e s. Th e st u d y co n st r u ct i o n p e r m i t t e d t h e
id en t if icat ion of au t h or s w h o h av e st u d ied ch r on ic
illn esses, t h u s allow in g f or t h e ex p r ession of t h eir v iew s about t he healt h ar ea.
Docu m en t al r esear ch im p lies ch oosin g t h e t y pe of docum ent and t he t hem e t o be inv est igat ed.
I n a d d i t i o n , s i n c e i t i s n o t r a n d o m , i t r e f l e c t s r esea r ch er s’ p u r p o ses, i d ea s a n d p r esu p p o si t i o n s
guiding t he st udy. Aft er select ing a t ype of docum ent , t he next st ep is t o obj ect ively exam ine t he m essages,
which, insert ed in a field of t heoret ical com prehension, w i l l p e r m i t t o cl a ssi f y, co d e a n d ca t e g o r i z e t h e
con cept s( 4 ).
The keyw or ds used t o find publicat ions w er e chr onic disease and chr onic illness in adult s. A gr eat
num ber of st udies focusing on disease w er e locat ed. Th en , it w as est ablish ed t h at t h e st u dy per iod, f or
nat ional and foreign lit erat ure, would be t he five years preceding t he m om ent of st udy, t hat is, 1994 t o 1998.
r a e
Y MEDLINE LILACS CINAHL CEPEn Total
4 9 9
1 08 02 05 02 17
5 9 9
1 09 03 12 03 27
6 9 9
1 11 05 13 02 31
7 9 9
1 06 01 08 02 17
8 9 9
1 10 03 11 03 27
l a t o
T 44 14 49 12 119
e c r u o
S Frequency Total
h s il g n
E Portuguese Spanish
s l a n r u o
J 17 3 2 22
s k o o
B 3 7 - 10
s i s e h
T - 2 - 2
s n o it a t r e s s i
D - 7 - 7
l a t o
T 20 19 2 41
disser t at ion s, t h eses an d book s pu blish ed in Br azil,
i n ad d i t i o n t o t h e b ase o f t h e Cen t er f o r Nu r si n g St u d i e s a n d Re se a r ch ( CEPEn ) , p r o d u ce d b y t h e
Br azilian Nur sing Associat ion ( ABEn) .
To guide t he first select ion, t he aut hors chose
art icles t hat included t he following expressions, in t he t h r ee lan g u ag es: in Por t u g u ese: con d ição cr ôn ica,
doença crônica, doença de longa duração, cronicidade and adult o; in English: chronic illness, chronic disease
and adult m iddle age; and in Spanish, enfer m idades cr ônicas and adult o.
La n g u a g e s w e r e c h o s e n b a s e d o n
r esear ch er s’ lan gu age abilit ies. How ev er, ar t icles in ot h er lan g u ag es w er e f ou n d , in clu d in g Fr en ch an d
Ger m a n .
Af t er an aly zin g t h e abst r act s, ar t icles w er e
ex cluded if t hey m ent ioned childr en or adolescent s, or if t hey focused on infect ious- cont agious processes.
Anot her est ablished cr it er ion w as t hat , in addit ion t o t h e k ey w or d in t h e t it le, au t h or s sh ou ld p r esen t a
definit ion of chr onic disease or chr onic illness in t he m an u scr ip t .
A f t e r t h e s e s t e p s , a n e w r e a d i n g w a s
per for m ed an d docu m en t s t h at m et t h e est ablish ed cr it er ia w er e select ed.
The t im e sam ple used t o analyze t he concept of chr onic healt h condit ion consist ed of 119 ar t icles,
list ed in Table 1 , accor din g t o pu blicat ion y ear an d num ber in t he r espect iv e sour ce.
To p r o v i d e r e l i a b i l i t y t o a d o c u m e n t a l research, t he set of art icles should consist of at least
3 0 % of t he t ot al am ount analy zed accor ding t o t he
est ablish ed cr it er ia.
Table 1 - Num ber of publicat ions and year, according t o t he dat abase. Ribeir ao Pr et o, 1999
Th e t o t a l d i d n o t c o n s i d e r s t u d i e s c i t e d
sim ult aneously in m or e t han one sour ce.
Based on t his set of docum ent s, t he body of
a n a l y si s co u l d b e d et er m i n ed , w h i ch r ep r esen t ed about 30% of t he st udies, t hat is, a t ot al of 41.
The 41 st udies w er e r andom ly select ed fr om t h e or ig in al 1 1 9 n u m b er ed ar t icles, w it h a v iew t o
o b t a i n i n g g r ea t er d i v er si t y o f co n cep t s r eg a r d i n g
chr onic healt h condit ion in adult s. Ar t icles t hat cit ed
t he sam e t heor et ical fr am ew or k w er e ex cluded. Table 2 list s publicat ions, accor ding t o t heir
sour ces and languages, found in lit er at ur e published in Por t uguese, Spanish and English. The list includes
in dex ed j ou r n als, book s an d ch apt er s, disser t at ion s and t heses in nur sing and ot her pr ofessions.
Table 2 - Dist r ibut ion of publicat ions in nur sing and
ot h er p r of ession s, accor d in g t o sou r ce, f r eq u en cy, language, and r esear ch per iod. Ribeir ao Pr et o, 1999
Table 2 shows t he set of docum ent s t hat m et t he research crit eria, which were used t o analyze t he
concept of int erest - chronic healt h condit ion in adult s. Ar t icles w er e obt ained at a public univ er sit y
a n d t h r o u g h a n i n t e r l i b r a r y l o a n n e t w o r k . Ea ch docum ent was subj ect ed t o a brief reading t o analyze
t it le and cont ent , and t o check if t hey m et t he crit eria: ad d r ess t h e t h em e an d p r esen t t h e ch r on ic h ealt h
condit ion concept in adult s.
This reading allowed for a closer look at t hese ar t icles, and t he select ion of ar t icles for t he body of
analysis, in addit ion t o t he refinem ent of t he sensit ivit y in t er m s of r ecognizing t he concept assigned by t he
ar t icles’ aut hor s, ident ify ing phr ases, t hem es, w or ds/ t er m s, ex pr essions, and, w hen possible, par agr aphs.
All ident ified infor m at ion w as r ecor ded on a separ at e piece of paper in order t o bet t er organize t he concept
analysis.
The chr onic illness phenom enon is obser v ed t hrough t he following t erm s: disease/ illness ( incurable,
l o n g t e r m , f o r l i f e ) ; c o n d i t i o n ; p r o b l e m ; ch a r a ct e r i st i cs; sy m p t o m s; se v e r e a n d a d v a n ce d
st at us; gr oup of diseases t hat oft en appear w it h age and unhealt hy life st y les.
Th er ef or e, ch r on ic illn ess is u n d er st ood as t he m edical condit ion or healt h problem wit h sym pt om s
or lim it at ions t hat r equir e long t er m m anagem ent( 5). These sam ples w er e analy zed, sear ching for descr ipt ions r egar ding t he concept s of chr onic illness
and chr onic illness in adult s. Aft er t he r eadings, t he d a t a w e r e r e v i e w e d a n d o r g a n i z e d t o a s s u r e a
s e t u b i r t t a l a i t n e s s
E Numberofauthors
r e t c a r a h c t n e n a m r e
P 17
y t i c a p a c n i l a u d i s e
R 17
m r e t g n o
L 15
e l b a r u c n
I 12
e v i t a r e n e g e
D 07
e l b i s r e v e r r
I 07
e c n e d n e p e d n o i t a c i d e m s u o u n i t n o
C 07
r e t c a r a h c g n i r r u c e
R 05
condit ion and chr onic illness pr ev ailed as t hose used t o refer t o t he concept .
Anot her st r at egy used t o st at e and br oaden concept s w as t o pair t he ident ified sam ples. Hence,
af t er t ak in g n ot e of w or ds an d/ or ex pr ession s t h at m ost closely expressed t he ideas, essent ial at t ribut es t h a t p e r m i t t e d t o u n d e r st a n d t h e co n ce p t w e r e highlight ed, in addit ion t o ant ecedent and consequent
ev en t s.
H o w e v e r, t h i s i n v e s t i g a t i o n r e v e a l s a s u r p r i s i n g a n d o r d e r e d u s e o f i n t e r p r e t a t i o n s , ex p r essed as ch r on ic illn ess, w h er eas f ew st u d ies
addr ess t he issue as chr onic healt h condit ion, in t he per spect iv e of being healt hy.
Th e ch r o n i c h ea l t h co n d i t i o n co n cep t h a s a t t r a c t e d m u c h i n t e r e s t b e c a u s e i t e m p h a s i z e s
p r e v e n t i o n o v e r cu r e , d e l a y o v e r p a l l i a t i o n a n d aut onom y ov er pat er nalist ic healt h car e( 3).
Th is id ea r eaf f ir m s t h e n eed t o d ef in e t h e com pr ehension of chr onic healt h condit ion w it hin t he
h e a l t h co n t e x t , a sso ci a t e d w i t h t h e r e l a t i o n sh i p bet w een people and env ir onm ent , det er m ining t heir needs, view of t he world and orient at ion in life.
CO N CEP T AN ALY SI S ACCO RD I N G T O
RODGERS
At t r ibut es of t he st udy concept
At t em p t s w er e m a d e t o o b ser v e h o w t h e c o n c e p t i s d e f i n e d , a s w e l l a s t h e a t t r i b u t e d ch ar act er ist ics, an d t h e id eas t h at d iscu ss ch r on ic healt h condit ions in adult s, since t he essent ial at t ribut es
ex pr ess t he concept ’s nat ur e.
The following guiding quest ions were used t o ident ify t he concept : How does t he aut hor define t he co n cep t ? Wh at ch ar act er i st i cs/ at t r i b u t es d o es t h e au t h or st at e? Wh at id eas d oes t h e au t h or d iscu ss r egar ding t he concept of chr onic healt h condit ions in adu lt s?
Sev en at t r ibut es w er e alw ay s pr esent in t he ch r on ic h ealt h con dit ion an d per m it t ed t o r ecogn ize t he effect s on t he person, fam ily and com m unit y: long t erm healt h condit ion; causes residual incapacit y and
in abilit y ; r equ ir es m or e palliat iv e ef f or t ; f av or s t h e o n se t o f m u l t i p l e i l l n e sse s; r e q u i r e s co n t i n u o u s m onit oring; requires a broad support service net work; and is cost ly.
The concept assem bles at t ribut es t hat perm it t o d i f f er en t i at e t h em f r o m ex p r essi o n s w i t h f al se
concept s, which are evidenced by t heir use. At t ribut es
are words and/ or expressions t hat are frequent ly used
a n d p r e s e n t e d a s s t a t e m e n t s o f t h e e l a b o r a t e d
con cept s, w h ich ar e con sider ed essen t ial( 3 ). Am on g t h e at t r i b u t es i d en t i f i ed i n t h e an al y si s o f t h e 4 1
docum ent s, som e were st at ed m ore oft en t han ot hers,
as shown in Table 3.
Table 3 - The m ost oft en st at ed essent ial at t r ibut es
abou t ch r on ic disease an d ch r on ic h ealt h con dit ion ,
accor ding t o t he num ber of aut hor s. Ribeir ao Pr et o,
1 9 9 9
Chronic healt h condit ion can be considered a
l i f e e x p e r i e n ce t h a t i n v o l v e s p e r m a n e n ce a n d a
dev iat ion fr om nor m alit y, caused by pat hologies t hat
im ply loss and dysfunct ion, in addit ion t o t he perm anent
change in everyday life. Furt herm ore, it expresses t hat
t his perm anence causes st ress due t o t he changes t o
b od y im ag e, t h e n eed f or social an d p sy ch olog ical
adj ust m ent and t he change in life expect ancy( 6). Th e f o l l o w i n g at t r i b u t es r ef er t o co n cep t s
st at ed by t he afor em ent ioned aut hor s.
Chronic healt h condit ion im plies a com plex, cont inuous,
perm anent sit uat ion, and requires specific st rat egies t o change
one’s lifest yle; Chronic healt h condit ion is charact erized by it s
long t erm and requires m ent al preparat ion t o adj ust and adopt
precaut ions in life, which involves st rat egies t o deal wit h t he
sy m pt om s and face t he changes in lifest y le, and fam ily and
social relat ionships; Chronic illness is an incapacit at ing condit ion
t hat r equir es long t er m car e, in addit ion t o cont inuous and
sim ult aneous pr im ar y and secondar y pr ev ent ion, as w ell as
rehabilit at ion services. The cure process is very slow or inexist ent
wit h age, which generat es residual incapacit y and som et im es
frequent illness recurrences ( A1, A2, and A3) .
Ot h e r a t t r i b u t e s a r e s t a t e d , i n c l u d i n g :
adv anced age, lim it at ions, inabilit ies, dev iat ion fr om
norm alit y, disease or incapacit y for over t hree m ont hs,
a sl o w an d p r o g r essi v e i l l n ess, o n e t h at ch an g es
r elat ion sh ip s, an d cau ses d ef or m at ion s an d sev er e
fu n ct ion al im pair m en t .
Th e d i s t i n c t i o n b e t w e e n s e c o n d a r y a n d
essen t ial at t r ibu t es. Secon dar y at t r ibu t es r epr esen t
s t n e d e c e t n
A Numberof
s r o h t u a ) … s d o o f y t t a f , m s il o h o c l a , g n i k o m s ( e l y t s e f il y h tl a e h n
U 29
e c n a t i r e h n i c it e n e
G 19
t n e m t a e r t h t i w e c n a il p m o c n o
N 17
s r o t c a f c i m o n o c e d n a l a i c o s o h c s y p ,l a t n e m n o r i v n
E 16
s l e v e l s s e r t s h g i
H 13
s e s u a c l a t i n e g n o
C 11
e g a d e c n a v d
A 09
s t n e d i c c
A 06
t n e m e c n a v d a l a c i g o l o n h c e
T 06
w h e r e a s e s s e n t i a l a t t r i b u t e s a l l o w f o r b r o a d com p r eh en sion( 7 ).
Som e au t h or s r ef er t o ad v an ced ag e as a secon dar y at t r ibu t e of ch r on ic h ealt h con dit ion s, as
show n in t he follow ing ar t icle ex cer pt s.
Chr onic healt h condit ion is ent ir ely associat ed w it h
elder ly adult s but , in som e sit uat ions, it does not lim it t he
per f or m an ce of h ealt h pr om ot ion act iv it ies. Ch r on ic h ealt h
condit ion is t he age label and appears as people get older. I t
m eans life span has increased; som et im es it is self- generat ed,
inherent t o t he lifest yle and environm ent al risks ( A4 and A5) .
Alt hough t hese aut hors referred t o advanced
ag e as an at t r ib u t e of ch r on ic h ealt h con d it ion s in adult s, it is acknowledged t hat t his concept is not well d e f i n e d , s i n c e i t w o u l d b e m o r e a p p r o p r i a t e t o ch ar act er ize an t eceden t ev en t s.
The purpose of analyzing t he concept chronic healt h condit ion in adult s is t o pr ov ide a num ber of n e w p a t h w a y s a n d i n f o r m a t i o n r e g a r d i n g t h e con st r u ct ion of t h e ex pr ession . Th is w ou ld m ak e it
less disperse and am biguous. I t is im port ant t o ident ify t he at t r ibut es of t he ex pr ession in or der t o obt ain a br oader com pr ehension of t his concept .
CONCEPT ANTECEDENTS
An t eced en t s ar e r ef er r ed t o as sit u at ion s,
e v e n t s o r p h e n o m e n a t h a t p r e ce d e a co n ce p t o f int er est . They help t o under st and t he social cont ex t in which t he concept is generally used, and t hey favor r efining t hat concept .
I n t his invest igat ion, ant ecedent event s were ident ified t hr ough answ er s t o t he follow ing quest ion: What event s cont ribut e t o t he em inence of t he chronic healt h condit ion concept ?
Som e of t h e an aly zed d ocu m en t s r ev ealed a n t e ce d e n t s t h a t e m e r g e d m o r e f r e q u e n t l y t h a n ot hers, as shown in Table 4:
Table 4 - Most fr equent ant ecedent s for t he chr onic healt h condit ion concept , according t o t he num ber of
aut hor s. Ribeir ao Pr et o, 1999
A m o n g t h e i d e n t i f i e d a n t e c e d e n t s , i t i s
observed t hat genet ic inherit ance is appoint ed as t he m ain gener at or of healt h pr oblem s, including chr onic
illn ess.
St u d ies h av e sou g h t t o id en t if y, in g en et ic
st ruct ure, t he m ain generat or of any healt h problem . Du e t o it s ch ar act er ist ics, st r en gt h en in g t h at f act or
w o u l d r e p r e s e n t t h e s u p r e m e e x p r e s s i o n o f biologizat ion in illness causes and indiv idualizat ion in
healt h car e pr act ice( 1).
Th e f o l l o w i n g s t a t e m e n t s r e p o r t t h e s e
an t eced en t s.
Diabet es has a heredit ary com ponent , but also obliges
t o fact ors associat ed wit h lifest yle; cont inuous genet ic following
could lead t o early t reat m ent and allow for reducing com plicat ions.
However, it is essent ial t o m anage not only t he illness but also
t h e associat ed r isk f act or s; Hab it s of m od er n societ y also
cont ribut e t o increasing t he incidence of chronic illness. Diet s
r ich in sat u r at ed f at an d ch olest er ol, sed en t ar y lif est y les,
subst ance abuse, sm oking, and high st ress levels are all relat ed
t o t he developm ent of chronic healt h condit ions in genet ically
suscept ible individuals ( A1 and A8) .
Moreover, ot her ant ecedent event s have also
b een st at ed as b ein g r esp on sib le f or t h e g r ou p of det er m in an t s t h at cau se ch r on ic h ealt h con dit ion in
adult s, t hat is, life/ lifest yle condit ions ( sedent ariness, obesit y, alcohol m isuse, hy per cholest er olem ia) , high
st ress levels, environm ent al fact ors ( workers exposed t o elect r om agn et ic w av es in elect r icit y com pan ies) ,
b e s i d e s c o n d i t i o n s r e s u l t i n g f r o m t e c h n o l o g i c a l adv ancem ent s and accident s, w hich ar e found in t he
follow in g segm en t s:
Ex o g e n o u s f a c t o r s , p a r t i c u l a r l y t h e incorporat ion of new t echnologies, have a predom inant
r ole in set t in g n ew m or bid st an dar ds, r egar dless of
t he social and econom ic dev elopm ent char act er ist ics, t he form s of social organizat ion, and t he const ruct ion
o f so ci a l p o l i ci e s, w h i ch co n si st o f p a r t i cu l a r i t i e s
int r insic t o each societ y( 1).
Chronic healt h condit ion is usually linked t o t he st ress
affect in g all life com pon en t s, r epr esen t ed t h r ou gh per son al
int ernal and ext ernal fact ors; A cont inuous disease t hat m akes
people dependent on specialist care and t herapies, which dem and
people t o quit sm oking, change t heir lifest yle, and m anage st ress
( A9 e A10) .
I n t h i s sen se, i t i s b el i ev ed t h a t , f o r t h e t w en t iet h cen t u r y, ch r on ic h ealt h con dit ion s w ill be
r esponsible for m aj or healt h pr oblem s in t he w or ld,
co m p r o m i si n g e sp e ci a l l y t h e e l d e r l y. Hi g h l i g h t e d cau ses ar e: lif est y le, en v ir on m en t al f act or s, st r ess,
CONCEPT CONSEQUENCES
Co n s e q u e n t e v e n t s r e f e r t o e v e n t s o r
sit uat ions r esult ing fr om chr onic healt h condit ions in
adult s, which are evident in t he effect ive concept use.
They were ident ified based on t he following quest ion:
What consequences w er e ev ident aft er adult chr onic
illness set t led in?
Consequent ev ent s ar e useful because t hey
p r o v i d e n ew r esea r ch i d ea s, si n ce t h ey a l l o w f o r
broader research regarding all aspect s of t he concept
and st udy( 7).
The exam ined docum ent s, rich in inform at ion
r e g a r d i n g t h e c o n c e p t o f i n t e r e s t , c o n t a i n e d
consequent ev ent s, w hich ar e discussed in biological
as w ell as social and cult ur al quest ions.
Table 5 - Event s consequent t o chronic healt h condit ion
in adult s and chronic disease, according t o t he num ber
of aut hor s analy zed
t n e v e t n e q e s n o
C Nauumtbhoerrsof
s e g n a h c l a c i g o l o h c y s p d n a ,l a i c o s ,l a c i s y h
P 21
e l y t s e f il n i s e g n a h
C 25
y t il i b a n i/ y t i c a p a c n
I 11
s n o it a u t i s h t i w e p o c d n a o t t p a d a o t d e e
N 17
a m g it
S 06
t n e m t a e r t s u o u n it n o c a h t i w y l p m o c o t d e e
N 05
n o i s s e r p e
D 05
s r e d r o s i d e v it s e g i d d n a y r o t a r i p s e r , y r o t a l u c r i c ,l a t e l e k s o l u c s u
M 05
e c n e d n e p e
D 05
Ch r o n i ci t y ca n a l so b e i m p l i e d i n t o p i cs
inv olv in g var iou s con sequ en t ev en t s, list ed in Table 5, point ing t o ot her indicat ors, for inst ance: cont rolling
m ult iple nat ure problem s, changes and ident ificat ions
of ev ent s in sev er al disease cour se ar r angem ent s( 5). Chronic illness generat es ot her chronic healt h
con d it ion s, af f ect in g f am ilies t h at t ak e u p g r eat er
r espon sibilit ies in con t r ollin g t h ese ev en t s, t h r ou gh daily discoveries, which dem and special m edical, social
and em ot ional abilit ies inherent t o t he condit ion. This
m akes fam ilies live w it h uncert aint y and face et hical, i n d i v i d u a l , so ci a l a n d p r o f e ssi o n a l d i l e m m a s, i n
ad d it ion t o t h e ob lig at ion of b ein g r esp on sib le f or
oner ous and cont inuous ex penses w it h t r eat m ent . Con seq u en t ev en t s ar e con sid er ed as su ch
because people dem and fam ily int er v ent ion, changes
in lifest yle, reduct ion in pain, social isolat ion and early r et ir em en t . Th ese f am ily r esp on sib ilit ies ad d u p t o
depr ession an d ev iden ce t h e in cr ease in cost s as a
result of chronic healt h condit ion in adult s( 9).
Th e an aly sis of con seq u en t ev en t s can , in
som e cases, evidence ot her concept s of int erest , which
ar e associat ed w it h chr onic healt h condit ion.
Th er ef or e, i t i s ack n o w l ed g ed t h at ev en t s
consequent t o chronic healt h condit ions include: social
st igm a, problem s relat ed t o sex life, reduct ion in
self-est eem , n eed f or d aily h ealt h m on it or in g , n eed t o
a d a p t t o t h e co n t i n u o u s u se o f m e d i ca t i o n , a n d
pr ofessional and social changes( 10).
These sit uat ions cause changes in ev er y day
lif e, in v olv in g t h e u n d er st an d in g of p r ob lem s t h at
dem and t he im plem ent at ion of st r at egies t o r educe,
av oid an d / or solv e r isk s an d com p licat ion s d u e t o
chr onic healt h condit ions. These effor t s can pr om ot e
an ex t ended healt hy life t im e.
Ot her aut hor s hav e pr esent ed t he follow ing
st at em en t s r eg ar d in g con seq u en t ev en t s, list ed in
Table 5.
Ch r on ic illn ess ap p ear s as an ev en t t h at cau ses
significant changes in fam ily life, which are oft en perm anent .
There are social, econom ic and personal losses, changing norm ality
in fam ily life, br eak in g social r elat ion sh ips, an d som et im es
causing depression; The need t o change one’s lifest yle, cult ural
fact ors, and daily act ivit ies due t o life habit s considered healt hy,
causes conflict s t o som e people, even when it is clear t hat t he
reason for t hose changes is t o prevent recurrences and chronic
illness com plicat ions ( A13 and A11) .
Th e so ci a l st i g m a sh o w n b y p e o p l e w i t h
chronic healt h condit ions is caused by t he changes in
m obilit y, body im age, and sexualit y. The psychosocial
i m p a ct i n cl u d e s l o ss o f se l f - e st e e m , a n x i e t y a n d
isolat ion( 10).
Hence, it is observed t hat people wit h chronic
healt h condit ions go t hrough dist inct phases t hat lead
t o periods of st abilit y and inst abilit y, which exacerbat e
r em ission . Each ph ase h as it s ow n set of ph y sical,
p sy ch o l o g i ca l a n d so ci a l p r o b l em s, w h i ch r eq u i r e
differ ent for m s and t y pes of m anagem ent( 8).
The com plexit y and ext ension of t he problem s
inher ent t o hav ing a chr onic illness has encour aged
m any aut hor s t o dev elop st udies aim ed at analy zing
t he im pact and consequences of t his condit ion. I n t his
case, it is observed t hat all help act ions t oward people
w it h ch r on ic h ealt h con d it ion s in v olv e in d iv id u ally
f a c i n g t h e p r o b l e m , w i t h e f f e c t i v e p s y c h o s o c i a l
a d j u s t m e n t , b u i l d i n g s u p p o r t t o f i n d f a v o r a b l e
pat hways and t o deal wit h t hese life experiences in a
h ealt hy w ay.
Mo r e o v e r, c o n s e q u e n t p s y c h o l o g i c a l a n d
ev olu t ion of lif e qu alit y, ch r on ic illn ess cou r se, an d
su bsequ en t ch r on icit y con dit ion , m an ifest at ion s an d com p licat ion s.
RELATED CONCEPTS
The report ed concept s gat her som e secondary at t r ib u t es t h at d o n ot ag r ee w it h t h ose con sid er ed
essent ial t o t he inv est igat ed concept . Many of t hese concept s are close t o t he phenom ena t hey represent ,
or ar e connect ed w it h t he specific fact s or ev ent s t o
be in v est igat ed.
Th e l i t e r a t u r e r e v i e w i n d i ca t e d co n ce p t s
associat ed w it h ch r on ic h ealt h con dit ion , in clu din g: l i m i t a t i o n s, n o n - t r a n sm i ssi b l e d i sea ses, i l l n ess o r
incapacit y for ov er t hr ee m ont hs, im per fect ions, and inabilit y and funct ional im pair m ent .
Chr onic illness is per ceived as som et hing bad, t hat
causes changes and life t roubles like lim it at ions, inabilit ies, and
or ganic and body dy sfunct ions; This illness r esult s fr om t he
social way of organizing life, t ransit ory im perfect ions or not , due
t o societ y’s delay in advancing, present ing m any defect s, besides
t he hypert rophy of healt h services t hat t reat t hose im perfect ions;
Non - in f ect iou s, n on - t r an sm issib le or ch r on ic- d eg en er at iv e
d i seases ar e t er m s u sed t o d ef i n e g r ou p s of p at h ol og i es
ch ar act er i zed b y t h e ab sen ce o f a m i cr o o r g an i sm i n t h e
epidem iological m ode, by non- t ransm issibilit y, by long clinical
course and irreversibilit y ( A14, A15 and A16) .
The ident ificat ion of t he associat ed concept s allow s r esear ch er s t o r en ov at e t h e m ean in g of t h e
con cept of in t er est becau se, t h u s, t h e ph ilosoph ical
beliefs t hat gr ound t he concept s ar e r ecognized and st r en g t h en ed .
I n t h i s s e n s e , i t i s o b s e r v e d t h a t t h e k n o w l e d g e c o n s t r u c t i o n p r o c e s s a n d i t s r e c e n t
t ech n ological an d scien t ific adv an cem en t s r egar din g t his kind of phenom ena has increased, influencing t he
p er sp ect iv e of h ealt h car e p r of ession als, in clu d in g nur ses, about t he condit ion in w hich m any diseases
ar e pr esen t ed in an ir r ev er sible st at e; t h u s, h ealt h ca r e co n d u ct s sh o u l d b e r ev i ew ed , a d o p t i n g n ew
t ech n olog ical in n ov at ion s in ad d it ion t o h u m an ist ic
st r at egies in a balanced w ay( 11).
Nu r ses, w h en t ak in g r espon sibilit y f or car e
d e l i v e r y t o p e o p l e w i t h c h r o n i c i l l n e s s , s h o u l d differ ent iat e per sonal obj ect iv es fr om r eal sit uat ions,
in which t hese people and t heir fam ilies live. Moreover, t h e y s h o u l d t a k e c u l t u r a l , r e l i g i o u s , s o c i a l a n d
p s y c h o l o g i c a l f a c t o r s i n t o c o n s i d e r a t i o n i n t h e expressed conduct s, which dem and professional care.
FI NAL CONSI DERATI ONS
Concept analysis, guided by t he evolut ionary
p e r sp e ct i v e , g o e s t h r o u g h st a g e s t o i d e n t i f y t h e essent ial at t ribut es t hat charact erize t hat concept ; t o
r ecognize pr eceding and follow ing ev ent s as w ell as t he associat ed concept s, sit uat ed in t he cont ex t s in
w hich aut hor s dev elop r esear ch.
Th e con cep t of ch r on ic h ealt h con d it ion in
ad u lt s sh ow ed an associat ion w it h ch r on ic illn ess, sp e ci f i ca l l y w h e n f o cu si n g o n t h e a t t r i b u t e s t h a t
ch ar act er ize t h e r h y t h m an d d ir ect ion of t h e liv in g pr ocess ov er t im e.
Th i s c o m p l e x d y n a m i c s r e g a r d i n g t h e
ch an g es t h at occu r is in d isp en sab le t o h ealt h car e p r of ession al k n ow led g e, sin ce it of f er s t h e su p p or t
needed t o provide pat ient care t hat values knowledge ex ch a n g e i n d i f f er en t su b j ect f i el d s. Th ese f i el d s
include nur sing, w hich has at t em pt ed t o dev elop it s own body of knowledge, for which t hese concept s are
essen t ial.
Analy sis r esult s show t her e ar e im plicat ions
f o r n u r s i n g d e v e l o p m e n t , b e c a u s e k n o w l e d g e
or gan izat ion r egar din g t h e ch r on ic h ealt h con dit ion c o n c e p t f a v o r s t h e u n d e r s t a n d i n g o f s i t u a t i o n s
associat ed w it h t h eir p r act ice, t h u s av oid in g f alse con cep t s.
Th e i n v e s t i g a t i o n a l s o a l l o w e d f o r t h e r ecognit ion of differ ent at t r ibut es, ev ent s t hat cause
t hem , as well as out com es of chronic healt h condit ions in adult s, w hich ar e r elevant t o guide healt h car e. I t
also allowed for observing t hat chronic healt h condit ion involves t he healt h concept in a dynam ic relat ion wit h
t he disease, in w hich perm anent irreversible changes
occur t o people’s liv es, com pat ible w it h chr onicit y.
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