Most participants identified with a medical model of self-
management. The epitome of management of asthma for
older people appeared to be taking prescribed medications.
Closely tied to this was following orders from the doctor.
Mostly, people took responsibility for management of their
medications. In addition to taking medications, prevention of
asthma attacks was linked to identification and avoidance of
Issues and innovations in nursing practice Chronic illness self-management
triggers. When people were first diagnosed with asthma, they
often found themselves in the medical management model.
Jane commented:
I feel I’ve only had it a short while but I have the right doctor and
follow through with my medication. I’ve learnt a lot. We really must
do what the doctors and specialists tell [us].
Jane followed the doctor’s orders and respected that doctors
held authority about her condition. Isabel reported that her
‘doctor did all the managing…I have to check my lung
capacity. He monitored it very closely…I had to trust him’.
In this model, the doctor rather than the patient managed
the disease process; instead the patient learnt to trust medical
knowledge and management. Learning to trust was part of
slotting into a medical management programme, precisely
because the patient was not invited to take part in asthma
management. Medical management was something done to
patients and people were expected to comply with medical
orders. However, older people might have expectations that
doctors would tell them what they should do. Even so, they
expected that the doctor’s authority and trust should be
earned through having specific disease knowledge, Linda
expected her GP to provide this knowledge:
I had a heavy cold and she [my doctor] asked if I had asthma – I was
thinking, ‘You should be telling me!’ I went onto the preventer and
the reliever – it was good since, except when hot and dry or very cold.
I consider (myself) lucky to have developed it later.
Julie added, ‘Doctors play a more significant role – I think
sometimes the doctor doesn’t know what he is talking about’.
Jim raised another aspect of medical management:
Some doctors do become complacent with you if you see them for too
long. If I have arthritis on my record – it doesn’t matter what problem
I have, it’s to do with the arthritis. I couldn’t move my foot off the
floor and I went to the doctor and he looked at the card and said, ‘It’s
to do with the arthritis’.
Medical expertise was questioned by Jim, and having another
chronic illness label meant that asthma did not receive
equivalent medical attention.
Medical management sometimes led to a narrow focus,
whereas effective management of asthma demanded that the
person’s life be viewed in context, and not only as a disease-
specific response. Frasier made a claim for holistic manage-
ment of his asthma:
Well, this rather interests me because I have been asthmatic for years.
I have a good background of science. I think we need the set up of
special clinics that can give a holistic view of people and their
medications, dietary habits, dangers of things like preservatives…It
Most participants identified with a medical model of self-management. The epitome of management of asthma forolder people appeared to be taking prescribed medications.Closely tied to this was following orders from the doctor.Mostly, people took responsibility for management of theirmedications. In addition to taking medications, prevention ofasthma attacks was linked to identification and avoidance ofIssues and innovations in nursing practice Chronic illness self-management triggers. When people were first diagnosed with asthma, theyoften found themselves in the medical management model.Jane commented:I feel I’ve only had it a short while but I have the right doctor andfollow through with my medication. I’ve learnt a lot. We really mustdo what the doctors and specialists tell [us].Jane followed the doctor’s orders and respected that doctorsheld authority about her condition. Isabel reported that her‘doctor did all the managing…I have to check my lungcapacity. He monitored it very closely…I had to trust him’.In this model, the doctor rather than the patient managedthe disease process; instead the patient learnt to trust medicalknowledge and management. Learning to trust was part ofslotting into a medical management programme, preciselybecause the patient was not invited to take part in asthmamanagement. Medical management was something done topatients and people were expected to comply with medicalใบสั่ง อย่างไรก็ตาม คนสูงอายุอาจมีความคาดหวังที่แพทย์จะบอกพวกเขาสิ่งที่พวกเขาควรทำ มาก พวกเขาคาดว่า หน่วยงานและความน่าเชื่อถือของแพทย์ควรได้ผ่านการมีความรู้เฉพาะโรค ลินดาคาดว่า GP ของเธอเพื่อให้ความรู้นี้:ผมเย็นหนัก และเธอ [แพทย์ของฉัน] ขอมีโรคหอบหืดผมคิด 'คุณควรจะบอกฉัน' ยิ้มไป preventer ที่ และยาระงับ – ดีตั้งแต่ ยกเว้นเมื่อร้อน และแห้ง หรือเย็นมากพิจารณา (ตัวเอง) โชคดีได้พัฒนาในภายหลังจูลี่เพิ่ม, ' แพทย์มีบทบาทสำคัญมากขึ้น – คิดบางครั้งแพทย์ไม่รู้ว่าเขากำลังพูดเกี่ยวกับ 'จิมยกของการจัดการทางการแพทย์:แพทย์บางคนกลายเป็นนอนกับคุณถ้าคุณเห็นการเกินไปยาว ได้โรคไขข้ออักเสบกับเรกคอร์ดของฉัน – มันไม่สำคัญว่าปัญหาอะไรมี จะ มีการอักเสบ ฉันไม่สามารถย้ายเท้าของฉันออกจากชั้นและไปปรึกษากับคุณหมอ และเขามองดูที่บัตร และกล่าว ว่า, ' มีไม่ มีการอักเสบความเชี่ยวชาญทางการแพทย์ถูกไต่สวน โดยจิม และมีอีกป้ายโรคหมายความ ว่า โรคหอบหืดไม่ได้รับเทียบเท่าพยาบาลบางครั้งนำไปสู่ความแคบ การจัดการทางการแพทย์ในขณะที่การจัดการที่มีประสิทธิภาพของโรคหอบหืดต้องที่นี้ดูชีวิตของคน ในบริบท และไม่เพียงแต่ เป็นโรค-การตอบสนองเฉพาะการ Frasier ทำคำร้องในแบบองค์รวมจัดการ-ment of his asthma:Well, this rather interests me because I have been asthmatic for years.I have a good background of science. I think we need the set up ofspecial clinics that can give a holistic view of people and theirmedications, dietary habits, dangers of things like preservatives…It
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