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TPN in the Home Setting

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Continued advancements in technology and medicine now make it possible for patients with severe life-threatening nutritional disorders to thrive--without the need for inpatient hospitalization. The social and psychological implications for the patient and family necessitate major permanent adaptations in behavior and lifestyle.

A multidisciplinary team that acknowledges and develops a care plan for both the individual and family as a social system is able to optimally treat patients on home TPN. The issues faced by these families include:

Ø      Adherence to prescribed regimens to avoid crises and to control symptoms

Ø      Alteration in self perception

Ø      Modification of their accustomed roles to reorder priorities and re-think values

Ø      Accommodating coping mechanisms related to a focused dependency on mechanized treatment approach

Ø      Evaluating monetary value and significance to their lives

Adaptation not only by the patient, but the family as well, to treatment regimens will need supportive counseling and encouragement by the entire team. The social worker may have to assist with suggested behavioral changes to assist in this adaptation.

Self-image issues may create interpersonal problems such as depression, anger, anxiety, self-esteem, and specific body image concerns. Supportive counseling to acknowledge, express, and assist in coping with each of these as they arise, will give the patient the ability to make the social and psychological adjustments needed to be successful in role changes. As part of this process, new insights into values and priorities may shift as the patient’s functioning improves and they realign their interactions within the social system.

Central to the coping of the new lifestyle for the patient and family is the treatment-centered dependency that must be acknowledged.  The initial focus of the patient may be exhibited as either depression or anger toward the dependency that will require supportive counseling. This will lead to acceptance and positive adaptation.

Financial aspects of treatment and assigning monetary value to their lives are a natural part of the adjustment of the patient and family to the realities of the treatment issue at hand. In summary, supportive counseling, assessment of resources and reimbursement issues will become a significant part of the social worker’s role. Reaching a stable financial equilibrium will be a key factor in the success of the patient's achievement of a quality lifestyle.

References:
Robinovitch AE. Home total parenteral nutrition: A psycho-social viewpoint. JPEN J Parenter Enter Nutr. 1981 Nov-Dec; 5(6):522-5