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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 sociaisolation. 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 eperienced fre!uently by patients with chronic illness"

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

of independence due to reduced abilities.

# Frustration %educed abilities, persistent physical or mental symptoms and a generalloss of control over life can all lead to etreme frustration.

# Hopelessness Chronic illness breeds hopelessness for the present due to symptoms

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

# Sadness &eople with chronic illness often eperience both a sadness for what they arefacing and a sadness for what they have lost.

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

others due to abundance of abilities, or both simultaneously.

# Anxiety ' sense of fear and aniety are common in chronic illness, both in terms of thepresent and in terms of the future.

# Irritability The frustration, resentment, aniety and hopelessness of chronic illness can

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

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

# Stress (ternal 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 +fiing things, or at a +higher power for punishing them.

These negative feelings and emotions are all a natural part of the grieving processeperienced by many if not all individuals diagnosed with chronic illness. ' 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.

ost peoples grief follows a progression that can be outlined in five basic steps"


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't this stage, a person is unwilling to accept the diagnosis. $e or she will often deny that thediagnosis is correct and may discount symptoms and even medical tests. $e or she mayrefuse medication or treatment and try to maintain a previous standard of life or activity.

/tep 1"'t this stage, a person has accepted the diagnosis as real and eperiences a strong sense o

the unfairness of the situation. $e or she may be angry, irritable, frustrated or bittern and

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

/tep 2"'t this stage, a person has moved past his or her sense of unfairness or in3ustice and has a

temporarily renewed sense of hope. $e or she may try to reason with doctors and othemedical professionals about a cure, may throw him or herself into research of the illness ocondition, or may try to make deals with 4od or another +higher power.

/tep 5"'t this stage, a persons bargaining, reasoning and dealing have all come to a screeching

halt and the revived hope is completely deflated. $e or she enters a period of etreme

sadness and depression, often ehibiting hopelessness and a desire for isolation. /uicidathoughts may also become evident at this stage.

/tage 6"'t this stage, a person finally comes to a sense of true acceptance of his or her diagnosis

$e or she develops coping strategies and learns to live with and adapt to the specifics of hisor her illness or condition. $e or she may also be willing to offer support and encouragementto others at this stage.

Powerlessness:

&erception that ones action will not significantly affect an outcome7 a perceived lack ofcontrol over a current situation or immediate happening.

Defining !ara"teristi"s

/evere

8erbal epression of having no control of influence over the situation or outcome of

self-care.

9epression over physical deterioration that occurs despite patient compliance with

regimen 'pathy

oderate Nonparticipation in care or decision making when opportunities are provided

(pression of dissatisfaction and frustration over inability to perform previous task

and:or activities 9oes not monitor progress

(pression of doubt regarding role performance


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%eluctance to epress true feelings, fearing alienation from caregivers

Inability to seek information regarding care

9ependence on others that may result in irritability, resentment, anger and guilt.

9oes not defend self-care practices when challenged.

;ow &assivity

(pressions of uncertainty about fluctuating energy levels.

INT(%8(NTI


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&roviding accurate information )realistic hope that is specific to the patients and

familys needs for information* (ncouraging and supporting patient control over his or her circumstances, choices and

environment whenever possible 'ssisting the patient to eplore ways for finding meaning in his or her life

(ncouraging realistic goal

>acilitating effective communication within the family

aking referrals for psychosocial and spiritual counseling 'ssisting with the development of supports in the home or community when none

eist

Sensory Depri$ation

/ensory deprivation is a state of reduced sensory input from the internal or eterna

environment, manifested by alterations in sensory perception.

/ensory deprivation generally means a lessening or lack of meaningful sensory

stimuli, monotonous sensory input, or an interference the processing oinformation)%odemich,0??@*

/ensory deprivation is the deliberate reduction or removal of stimuli from one or more

of the senses )Aikipedia dictionary*

FAT%RS %#TRI&'TI#( T% S)#S%R* D)PRI+ATI%#

8isual or auditory impairments that limit or prohibit perception of stimuli

9rugs that produce sedative effect on the CN/ and interfere with the interpretation of

stimuli Trauma that result in the brain damage and decreased cognitive function

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

environment

T*P)S %F S)#S%R* D)PRI+ATI%#

%educed sensory input)e.g. visual or hearing loss*

(limination of order or meaning from input)e.g. eposure to strange environment*

produces monotony and boredom

,I#IA, SI(#S %F S)#S%R* D)PRI+ATI%#

-(cessive yawning, drowsiness, sleeping

-9ecreased attention span, difficulty in concentrating, decreased problem solving

-impaired memory

-periodic disorientation, confusion, irritability


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-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 /ensory 9eprivation

(ncourage the client to use aids such as eyeglasses and hearing aids

'ddress the client by name and touch the client while speaking if this is not culturally

offensive Communicate fre!uently with the client and maintain meaningful interactions )e.g.

discuss current events* &rovide a radio and:or T8 clock and calendar

'd3ust the environment to provide meaningful stimulation )e.g. enable the client to

look through a window* (ncourage social interaction

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

such as inade!uate stimuli, inability to receive stimuli, or inability to process stimuli.

Inade-uate stimuli

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

)e. newspapers, books, and T8 can stimulate the visual and auditory senses. &roviding ob3ects 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.

>or the client who is inade!uately stimulated, the nurse can arrange for people to visit

and talk with the clients regularly.

Inability to Re"ei$e Stimuli

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

Inability to Pro"ess Stimuli

The nurse can provide suitable eplanation and perhaps written notes to help themknow what to epect.

>or e. 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


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' prolonged disturbance results in decrease in amount, !uality and consistency of sleep. It

produces a variety of physiologic and behavioral symptoms, the degree of which depends onthe degree of deprivation.

Clinical /igns

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

decreased attention span, fre!uent daytime napping, disorientation. &hysical /igns" dark circles under eyes, fre!uent yawning, postural changes, slight

hand tremor, mild nystagmus and epressionless face. 9ifficulty performing '9;s

Nursing Interventions

'ssess the clients daytime and nighttime sleeping patterns

9iscuss possible causes that contribute to sleeplessness

(plore sleep-promoting techni!ues.

&rovide clients desired comfort measures. &rovide a !uiet, peaceful environment during sleep periods.

Inform the client of necessary care interruptions ahead of time.

Implement measures as indicated to prevent fre!uent voiding at night such as

decreasing fluid intake before the bedtime. (ncourage the client o epress concerns when unable to sleep.

Healt! )du"ation

Teaching &atients /elf-care

&atient and family teaching is one of the most significant aspects of nursing care and maymake the difference in the ability of patients and their families to adapt to chronic healthconditions.

Aell-informed, educated patients are more likely than uniformed p to be concerned about

their health and do what is necessary to maintain it. nowledge is the key to makinginformed choices and decisions during all phases of the chronic illness tra3ectory.

9espite the importance of teaching the p and the family, the nurse must recogni=e that

patients 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 ps knowledge about the illness and its management. The

nurse cannot assume that a patient with a long-standing chronic condition has theknowledge necessary to manage the condition.


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' ps learning needs change as the tra3ectory phase and his or her personal situation

changes.

The nurse must also recogni=e that patients may know how their body responds undercertain conditions and how best to manage their symptoms.

Role of Family

's you treat your chronically ill patients, it is important to remember that their families are

also 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 bediscouraging to family members who are trying to be helpful and understanding.

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