Home total parenteral nutrition: a psycho-social viewpoint.

Home total parenteral nutrition (TPN) usually necessitates major and probably permanent changes in the patient's major and probably changes in the patient's lifestyle. Among the nonmedical, nontechnological issues these patients face are the need to: (1) adhere to prescribed regimens to avoid crises and to control symptoms; (2) alter their self-perceptions; (3) modify their accustomed roles; (4) reorder their priorities and re-think their values; (5) deal with machine and medical center dependency; (6) assign a monetary value to their lives. The emotional and environmental pressures that are the chief issues for these patients include financial, employment, psychological, and interpersonal problems such as depression, anger, anxiety, relief, body image, and self-esteem. Patients on hom TPN are best treated with a clinical team that serves both the patient and family as individuals and as a social system. Services offered include: (1) medical diagnosis, treatment, and rehabilitation; (2) professional and technical support services including pharmacy, dietary, and nursing to teach, demonstrated and monitor self-care, nutrition, and use of the home TPN system; and (3) professional social work services to assist patients and families to deal with the feelings, relationships, environmental pressures, and advocacy needs associated with home TPN.