title: Cardiovascular disease and prediabetes as complex illness: People's perspectives.
abstract: Cardiovascular disease (CVD) and sustained high blood glucose as prediabetes are an established comorbidity. People's experience in reconciling these long-term conditions requires deeper appreciation if nurses are to more effectively support person-centred care for people who have them. Our analysis explores the initial experience of people admitted to hospital with CVD who then find they also have sustained high blood glucose. Our methodology is informed by the philosophy of Gadamer and applies interpretive description to develop an interpretation of participant experiences. The major theme emerging from participant interviews was the 'invisible disequilibrium' characterised by three subthemes: 'losing equilibrium', 'becoming embattled' and 'evolving illness'. This study examines CVD and prediabetes in conjunction with the Gadamerian notion of the 'whole', as being in a social and emotional world in which illness is also a component part. We explore how participants lived within an 'invisible disequilibrium', with prediabetes frequently remaining unnoticed, while CVD was manifest. To identify multiple conditions and support effective intervention to manage them as part of person-centric care, nursing practice should explore the 'whole' of the person's experience, value people's knowledge as potential indicators of complex illness, thereby reducing the risk of accelerating complex illness.
authors.affiliation: School of Nursing, Massey University, Wellington, New Zealand.
authors.forename: Kim
authors.initials: K
authors.lastname: van Wissen
authors.affiliation: School of Food and Nutrition, Massey University, Wellington, New Zealand.
authors.forename: Michelle
authors.initials: M
authors.lastname: Thunders
authors.affiliation: Postgraduate School of Nursing Midwifery and Health, Victoria University of Wellington, Wellington, New Zealand.
authors.forename: Karen
authors.initials: K
authors.lastname: Mcbride-Henry
authors.affiliation: Endocrine, Diabetes and Research Centre, Capital and Coast District Health Board, Wellington, New Zealand.
authors.forename: Margaret
authors.initials: M
authors.lastname: Ward
authors.affiliation: Endocrine, Diabetes and Research Centre, Capital and Coast District Health Board, Wellington, New Zealand.|Otago University, Dunedin, New Zealand.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Krebs
authors.affiliation: School of Food and Nutrition, Massey University, Wellington, New Zealand.
authors.forename: Rachel
authors.initials: R
authors.lastname: Page
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000628:therapy; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015404:Nursing Methodology Research; D011236:Prediabetic State / Q000175:diagnosis*; D012307:Risk Factors
chemical_list: D001786:Blood Glucose
keywords: cardiovascular disease; complex illness; interpretive description; multimorbidity; prediabetes