Behavioral Changes

7/28/2019 Behavioral Changes

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Chronic illness presents immense challenges to a persons sense of self-image and

self-worth. The physical symptoms, reduced abilities, financial woes and relationshipchallenges of chronic illness can breed strong feelings of self-doubt and worthlessness. Theresulting decreased self-esteem leads to feelings of guilt and a tendency toward socialisolation. Isolation and guilt, however, further damage a persons self-image, creating avicious cycle of negativity that can be difficult to break.

Negative emotions and feelings are very common in chronic illness. In fact, studies have

identified ten basic emotions experienced frequently by patients with chronic illness:

Helplessness Helplessness is often the result of necessary reliance on others and a loss

of independence due to reduced abilities.

Frustration Reduced abilities, persistent physical or mental symptoms and a generalloss of control over life can all lead to extreme frustration.

Hopelessness Chronic illness breeds hopelessness for the present due to symptoms

and lost abilities, and hopelessness for the future due to uncertainty.

Sadness People with chronic illness often experience both a sadness for what they arefacing and a sadness for what they have lost.

Resentment Resentment in chronic illness can be aimed at oneself due to inabilities, at

others due to abundance of abilities, or both simultaneously.

Anxiety A sense of fear and anxiety are common in chronic illness, both in terms of thepresent and in terms of the future.

Irritability The frustration, resentment, anxiety and hopelessness of chronic illness can

cause a person to be irritable with him or herself and with others.

Tension Physical, financial, relationship and other challenges can cause physical andemotional tension that often further aggravates chronic illness.

Stress External factors (physical symptoms, financial troubles, etc.) combine with

internal factors (relationship and self-image challenges, etc.) to cause stress.

Anger Those with chronic illness may feel angry at themselves for being ill, at others fornot fixing things, or at a higher power for punishing them.

These negative feelings and emotions are all a natural part of the grieving processexperienced by many if not all individuals diagnosed with chronic illness. A diagnosis ofchronic illness usually means a loss of some type for both the individual and his or herfamily. The normal human response to loss is to follow a grieving process that ends in anacceptance of the diagnosis and a willingness to make the most of life in spite of the illnessor condition.

Most peoples grief follows a progression that can be outlined in five basic steps:

Step 1:At this stage, a person is unwilling to accept the diagnosis. He or she will often deny that thediagnosis is correct and may discount symptoms and even medical tests. He or she may

refuse medication or treatment and try to maintain a previous standard of life or activity.

Step 2:At this stage, a person has accepted the diagnosis as real and experiences a strong sense ofthe unfairness of the situation. He or she may be angry, irritable, frustrated or bittern and

may display some degree of hostility, especially toward medical personnel and caregivers.


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Step 3:

At this stage, a person has moved past his or her sense of unfairness or injustice and has atemporarily renewed sense of hope. He or she may try to reason with doctors and othermedical professionals about a cure, may throw him or herself into research of the illness orcondition, or may try to make deals with God or another higher power.

Step 4:

At this stage, a persons bargaining, reasoning and dealing have all come to a screeching

halt and the revived hope is completely deflated. He or she enters a period of extremesadness and depression, often exhibiting hopelessness and a desire for isolation. Suicidalthoughts may also become evident at this stage.

Stage 5:At this stage, a person finally comes to a sense of true acceptance of his or her diagnosis.He or she develops coping strategies and learns to live with and adapt to the specifics of hisor her illness or condition. He or she may also be willing to offer support and encouragementto others at this stage.

Powerlessness:

Perception that ones action will not significantly affect an outcome; a perceived lack ofcontrol over a current situation or immediate happening.

Defining Characteristics

Severe

Verbal expression of having no control of influence over the situation or outcome of

self-care.

Depression over physical deterioration that occurs despite patient compliance withregimen

Apathy

Moderate Nonparticipation in care or decision making when opportunities are provided

Expression of dissatisfaction and frustration over inability to perform previous task

and/or activities Does not monitor progress

Expression of doubt regarding role performance

Reluctance to express true feelings, fearing alienation from caregivers Inability to seek information regarding care

Dependence on others that may result in irritability, resentment, anger and guilt.

Does not defend self-care practices when challenged.

Low Passivity

Expressions of uncertainty about fluctuating energy levels.

INTERVENTIONS

Patients need to recognize that they are not helpless and that they can influence thedirection of their lives and the outcomes of treatment.

The nurse assess for factors contributing to a sense of powerlessness and intervenes

accordingly: lack of knowledge and lack of opportunities to make decisions Taking time to listen actively to patient often encourages them to express their

concerns and ask questions. Provide the patient with decision-making opportunities such as when activities are to

occur or where objects are to be placed and increasing the frequency and significanceof those opportunities over time.


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Assist the patient to differentiate between factors that can be controlled and those

that cannot.Hopelessness

The subjective state in which an individual sees limited or no alternatives or personal

choices available and cannot mobilize energy on own behalf.

Defining Characteristics

Major Passivity, decreased verbalization

Decreased affect

Verbal cues indicating despondency (I cant, sighing)

Minor Lack of initiative

Decreased response to stimuli

Turning away from speaker

Closing eyes Shrugging in response to speaker

Decreased appetite

Altered sleep pattern

Lack of involvement in or passively allowing care

Nursing Interventions for enabling and supporting hope include:

Listening attentively

Encouraging sharing of feelings

Providing accurate information (realistic hope that is specific to the patients andfamilys needs for information)

Encouraging and supporting patient control over his or her circumstances, choices and

environment whenever possible Assisting the patient to explore ways for finding meaning in his or her life

Encouraging realistic goal

Facilitating effective communication within the family

Making referrals for psychosocial and spiritual counseling

Assisting with the development of supports in the home or community when none

exist

Sensory Deprivation

Sensory deprivation is a state of reduced sensory input from the internal or external

environment, manifested by alterations in sensory perception.

Sensory deprivation generally means a lessening or lack of meaningful sensory

stimuli, monotonous sensory input, or an interference the processing of

information(Rodemich,1997)

Sensory deprivation is the deliberate reduction or removal of stimuli from one or moreof the senses (Wikipedia dictionary)

FACTORS CONTRIBUTING TO SENSORY DEPRIVATION

Visual or auditory impairments that limit or prohibit perception of stimuli

Drugs that produce sedative effect on the CNS and interfere with the interpretation of

stimuli

Trauma that result in the brain damage and decreased cognitive function


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Isolation(either physical or social)that results in the creation of a non stimulating

environment

TYPES OF SENSORY DEPRIVATION

Reduced sensory input(e.g. visual or hearing loss)

Elimination of order or meaning from input(e.g. exposure to strange environment)

produces monotony and boredom

CLINICAL SIGNS OF SENSORY DEPRIVATION

-Excessive yawning, drowsiness, sleeping

-Decreased attention span, difficulty in concentrating, decreased problem solving

-impaired memory

-periodic disorientation, confusion, irritability

-pre occupation with somatic complaints

-hallucinations-visual, auditory, tactile, olfactory, gustatory

-crying, annoyance over small matters

-Boredom and apathy, emotional lability

Nursing Interventions for Clients with Sensory Deprivation

Encourage the client to use aids such as eyeglasses and hearing aids

Address the client by name and touch the client while speaking if this is not culturallyoffensive

Communicate frequently with the client and maintain meaningful interactions (e.g.

discuss current events) Provide a radio and/or TV clock and calendar

Adjust the environment to provide meaningful stimulation (e.g. enable the client to

look through a window) Encourage social interaction

Interventions for the understimulated client should address the etiology of the deprivation

such as inadequate stimuli, inability to receive stimuli, or inability to process stimuli.

Inadequate stimuli

Providing the client with a variety of stimuli appropriate for the person is important

(ex. newspapers, books, and TV can stimulate the visual and auditory senses. Providing objects that are pleasant to touch such as pet to stroke can provide tactile

and interactive stimulation. Clocks that differentiate night from day by color can help orient a client to time.

For the client who is inadequately stimulated, the nurse can arrange for people to visit

and talk with the clients regularly.

Inability to Receive Stimuli

The nurse should make extra effort to provide stimuli for the other senses.

Inability to Process Stimuli

The nurse can provide suitable explanation and perhaps written notes to help them

know what to expect.


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For ex. The man who cannot remember to take his pills may be able to take them at

the right time from a pill compartment is labeled with the date and time.

Sleeplessness

A prolonged disturbance results in decrease in amount, quality and consistency of sleep. Itproduces a variety of physiologic and behavioral symptoms, the degree of which depends on

the degree of deprivation.

Clinical Signs

Behavior Changes: increasing irritability, restlessness, listlessness, lethargy,

decreased attention span, frequent daytime napping, disorientation. Physical Signs: dark circles under eyes, frequent yawning, postural changes, slight

hand tremor, mild nystagmus and expressionless face.

Difficulty performing ADLs

Nursing Interventions

Assess the clients daytime and nighttime sleeping patterns

Discuss possible causes that contribute to sleeplessness

Explore sleep-promoting techniques.

Provide clients desired comfort measures.

Provide a quiet, peaceful environment during sleep periods.

Inform the client of necessary care interruptions ahead of time.

Implement measures as indicated to prevent frequent voiding at night such asdecreasing fluid intake before the bedtime.

Encourage the client o express concerns when unable to sleep.

Health Education

Teaching Patients Self-care

Patient and family teaching is one of the most significant aspects of nursing care and may

make the difference in the ability of patients and their families to adapt to chronic healthconditions.

Well-informed, educated patients are more likely than uniformed px to be concerned abouttheir health and do what is necessary to maintain it. Knowledge is the key to making

informed choices and decisions during all phases of the chronic illness trajectory.

Despite the importance of teaching the px and the family, the nurse must recognize thatpatients recently diagnosed with serious chronic conditions and their families need time tograsp the significance of their condition and its effect on their life.

Teaching should be planned carefully so that it provides information that is important to thepatients well-being at the time without being overwhelming.

The nurse should assess each pxs knowledge about the illness and its management. Thenurse cannot assume that a patient with a long-standing chronic condition has theknowledge necessary to manage the condition.

A pxs learning needs change as the trajectory phase and his or her personal situationchanges.


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The nurse must also recognize that patients may know how their body responds under

certain conditions and how best to manage their symptoms.

Role of Family

As you treat your chronically ill patients, it is important to remember that their families arealso dramatically impacted by diagnosis of and living with chronic illness. Illness can createa dependence on others that may not be welcomed by the patient or by his or her familymembers. It can also breed a negative attitude or sense of self-deprecation that can be

discouraging to family members who are trying to be helpful and understanding.

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Behavioral Changes