Chapter 10- Illness, Culture and Caring: Impact on Pts., Families and Nurses

What are acute vs. chronic illness? Name some acute illnesses and some chronic illness? - Illness affects not just the sick person, but the people providing care - the spouse, the

partner, their children. Illness changes lives. - A unique characteristic of nursing is the emphasis on viewing patient holistically.

Nurses recognize that human beings are complex beings with physical, mental, emotional, spiritual, social and cultural dimensions.

SUMMARY:

Acute Illness Chronic Illness

- characterized by severe symptoms that are short-lived - usu. develops gradually (pervasive and life altering) - requires ongoing medical attention (financial hardship) - may continue for the duration of the individual’s life - pervasive and life altering for family and individual

- symptoms tend to appear suddenly, progress steadily, and subside quickly

- have a significant social and economic impact, being one of the fastest-growing health problems in the US

Ex: COMMON COLD Factors such as sedentary lifestyle, obesity, and the aging of the population are expected to contribute to a continued increase in the number of chronically ill Americans for the foreseeable future

- usually return to their previous level of wellness c/b PERMANENT changes that leave RESIDUAL DISABILITY

- some acute illness may lead to chronic conditions Ex: acute MI --> congestive HF

- some chronic illness are progressively debilitating and result in premature death Ex: TB & autoimmune diseases, OBESITY

- Individuals with sudden, catastrophic injuries (such as spinal cord injury or major stroke) experience dramatic and extensive change in an instant

- face daily challenges that may seem unbearable - use a variety of coping mechanisms, strategies that differ

from person to person

Some chronic illnesses go through periods of REMISSION (when symptoms subside) and EXACERBATION (when symptoms reappear or worsen) - may undergo cycles of depression- pts. become experts in their own care and management of their

conditions

Acute Chronic

- Sudden onset of symptoms - Gradual onset of symptoms

- Symptoms progress quickly from mild to severe - Symtoms may be mild or vague; once illness is resolved may have remissions and exacerbations

- Patient usually returns to former level of functioning - Illness continues through the life span

- Changes often not permanent by may progress to chronic illness - Changes are permanent and progressive

- Does not usually require long-term behavioral change/treatment - Requires long-term behavioral change/tx

- May represent a life crisis - Often represent a life crisis

Topics - Test 3 SG

How do the different types of illness affect family? - Change in one family member changes the functioning of the total family - Illness drastically increases the stress in a family and disrupts usual family function - Sick family member has to give up responsibility to other family members - Family members who are able to shift and assume different roles, who can share their feelings, and who seek assistance can be expected to to adjust better to changes than those who are inflexible. Chronic illness = usually stressful because it us never completely cured - families experience emotional highs and lows as the pt. has remissions and exacerbations. - may experience resentment and other negative feelings - family members who must take over the sick person’s responsibilities may be angry and then feel guilty about their anger - family members may withdraw from each other because they fear that their negative feelings may not be understood and accepted = leads to feelings of isolation for both patients and family members - families are often confused or uncertain about how to treat the sick member - families may find it difficult to shift responsibilities back to the formerly ill member as he or she become able to resume role functions, thereby prolonging dependence; due to pt. self-care deficit

What are the stages of adjustment to illness? Give some examples? Stages = descriptive; patients do not move through these states in a LINEAR way

1) Disbelief and Denial = defense mechanism used to avoid anxiety and fear - fear of illness often leads to the mistaken belief that they s/s will subside without treatment and can delay seeking a diagnosis Ex: breast cancer pt. feels a lump on her breast and denies the fact to check it out; leading the cancer to metastize to the spine 2) Irritablilty and Anger = emotions related to alterations of functioning caused by illness = Pt. get irritable as their ability to function declines (prolonged = depression) = Anger may: be directed toward the body because it is not performing as it did - GUILT feelings may occur for failing to prevent the illness - directed toward others - family, friends, co-workers, HCPs 3) Attempting to Gain Control = pts. are knowledge-seeking to understand the options of treatments to gain control over the illness Ex: Pts. may consult HCPs or use over-the-counter medications, folk practices, or home remedies = FEARS: stimulate treatment-seeking behavior & can lead to further denial and avoidance

4) Depression and Despair - Common mood resulting from: ability to work is altered - modification of daily activities - diminished sense of well-being & freedom - pain Ex: Pt. will not eat, get out of bed, or perform to ADLs = s/s of depression 5) Acceptance and Participation - Patient has acknowledged the reality of the illness and is ready to participate in decisions about treatment * pts. work WITH the doctor (active involvement)

** Nurses should NOT use these stages to characterize a particular pt’s response **

How do we view illness today? How does it differ from the past? Sick role = behavior that is dependent, passive, and submissive 1) Is exempt from social responsibilities 2) Cannot be expected to care from himself or herself 3) Should want to get well 4) Should seek medical advice 5) Should cooperate with the medical experts

** This view is NO LONGER ADEQUATE, because different cultures have differing

sick role expectations **

What are illness behaviors? Give an example.** Although every culture has expectations about how people sick people should behave; previous experience and personality characteristics also affect individuals’ response to illness **

Dependence/Independence - pts. vary along a continuum in their response to illness - adapt a passive attitude and overly rely on others to care for them (dep) - others continue denial and try to live as independently as before illness (indep)

Internal Influences External Influences

- Dependence/Independence needs

- Coping abilities - Hardiness- Learned resourcefulness - Resilience - Spirituality- Resourcefulness

- Past experiences - Culture *** - Communication patterns- Personal space norms - Role expectations - Values - Reaction to prescribed medications- Ethnocentrism

Resourcefulness - the use of cognitive skills that minimize the negative effects of thoughts and feelings on one’s daily life and the way one adjusts to adversity Ex: - STRESS INOCULATION = substitute anxiety with (+) thoughts - problem solving - conflict resolution - emotion management - skill in self regulationResilience - a successful adaptation despite challenging or threatening circumstances Result of 3 factors: 1) Disposition - temperament, personality 2) Family factors - warmth, support, organization 3) Outside support factors - supportive network, success in school or work Ex: Cancer patient who is positive, despite all the illness Spirituality - a belief in a higher power, interconnectedness among living beings, and an awareness of life’s purpose and meaning - spiritual beliefs may have psychological, medical, and financial benefits Culture - pattern of learned behavior and values that are reinforced through social interactions - shared by members of a particular group and transmitted from one generation to another - can exert considerable influence over meanings attached to health and illness

What is coping? What are the types of coping? Coping - the strategies a person uses to assess and manage demands of care Acute illness - short term and lead to pre-illness state coping behaviors Chronic illness - continuous coping behaviors Types: Pet therapy Exercise Seeing a therapist Spiritual rituals -----> Look at family dynamics Define culturally competent nursing? Give examples of culturally competent nursing. Cultural competence - a nurse’s knowledge about cultural influences that can be used to plan appropriate approaches to a patient’s needs Problems of cultural competence: - Stereotyping - Communication difficulties - Misperceptions about personal space - Differing values and role expectations - Ethnopharmacologic considerations - Ethnocentrism

** Ethonopharmacology - research on how people of different ethnic groups respond to medications Ethnocentrism - the inclination to view one’s own cultural group as the standard by which to judge the value of other cultural groups. **

What are the levels of anxiety? Give examples. Anxiety - an ill-defined, diffuse feeling of apprehension and uncertainty

What is stress? How does one cope with stress? Stress = an interaction between the individual and environment = all the responses the body makes while striving to maintain equilibrium and deal with demands Direct coping = help pts. to identify stressful situations that can be changed and to take responsibility for changing them ** use problem-solving skills and planning to eliminate or avoid as many stressors as possible ** Indirect coping = nurses’ actions are aimed at reducing the affective (feelings) and physiological (body) disturbances resulting from stress Ex: deep breathing techniques muscle relaxation relaxing imagery Educational coping = when pts. are competent in the knowledge and skill they need to manage their illnesses they tend to feel more masterful and less stressed

Mild Anxiety

Moderate Anxiety

Severe Anxiety

PANIC!!

- increased alertness - increased ability to focus - improved concentration - expanded capacity for learning

- concentration limited to one thing - increased body movement - rapid speech - subjective awareness of discomfort

- scattered thoughts- difficulty with verbal communication - considerable discomfort - purposeless movements

- complete disorganization - difficulty differentiating reality from unreality - constant random movements- unable to function without assistance

Chapter 11- The Science of Nursing and Evidence-Based Practice

What is evidence-based nursing? How do nurses use it? Evidence-based nursing = an approach to the delivery of health care that “integrates the best evidence from (research) studies and patient care data with clinician expertise and patient preferences and values”. - taking data and information and applying to practice of nursing - - In nursing, EBP requires research that supports the specific interventions

What is nursing research? Nursing research = systemic investigation of PHENOMENA related to improving pt. care ** Goal: improving patient care through EBP **

How is nursing research amenable to a nursing problem?

Why should nurses be involved with research? - IMPROVE THEIR INDIVIDUALIZED CARE ** NEED to keep informed of CURRENT EBP research literature **

What are the types of nursing research? Quantitative Research = involves standardized experimental designs driven by: 1) hypotheses, 2) measurable variables and outcomes, and 3) statistical analyses - EXPERIMENTAL Design - MANIPULATES variables and statistical analysis Qualitative Research = involves exploration of HUMAN EXPERIENCE, described and interpreted by the researcher - NON-experimental Design

Focusing on evidence of effective interventions prevents practice from deteriorating into routine or traditional care based

on “what has always been done” without concern for advances in care.

A problem may be AMENDABLE to being

addressed by research if these criteria are met:

1) A conceptual framework exists or can be constructed to logically be fit with previous knowledge

A problem may be AMENDABLE to being

addressed by research if these criteria are met:

2) The proposed research project is based on related research findings published in professional peer-reviewed journals

A problem may be AMENDABLE to being

addressed by research if these criteria are met:

3) Research is carefully designed so results will be applicable in similar situations or generate hypotheses

Chapter 12 - Conceptual and Philosophical Bases of Nursing

What are systems? What are the different types and how do they relate to the environment? Systems = is a set of interrelated parts that come together to form a whole that performs a function Open system = promotes the exchange of matter, energy and information with other system and the environment (Person) Closed system = does NOT interact with other systems or with the surrounding environment - Matter, energy, and info do NOT flow into or out of a closed sys. Suprasystem = larger system outside of the hospital How does environment affect patient healing? Environment = includes all circumstances, influences and conditions that surround and affect individuals, families and groups ** can promote or interfere with homeostasis and well-being

What is Maslow’s hierarchy of needs? Maslow’s hierarchy rests on several basic assumptions about human needs: - Basic needs must be at least partially satisfied before higher-order needs become relevant - Individuals meet their needs in different ways - A nurse must determine a person’s perceptions of his/her needs to provide individual care (Adaptation) - When a person’s needs are not met, homeostasis is altered

Key Concepts about Systems

- a system is a set of interrelated parts

- parts form a meaningful whole - the whole is different from and

greater than the sum of its parts - systems may be open or closed - all living systems are opens

systems - systems strive for homeostasis

(internal stability) - systems are part of suprasystems - systems have subsystems - A change in one part of a system creates change in other pars

WHEN ENVIRONMENTAL FACTORS AFFECT HOMEOSTASIS OF A PERSON, THE PERSON ATTEMPTS TO ADAPT TO THE CHANGE - If ADAPTATION is unsuccessful, disequilibrium may occur, setting

the stage for the development of illness or disease - Pts. respond to stress = major factor in the development of disease

How does family influence health? Healing? Extended families = children are nurtured by a variety of relatives Nuclear families = children are nurtured by mother & father ** Single-parent families = must earn a living and fulfill nurturing roles in the family = a demanding system

How does culture influence healing? Cultural systems = consists of attitudes, beliefs, and behaviors, of social and ethnic groups that are perpetuated through generations - basic beliefs abut health and illness vary widely form culture to culture, nurse needs to develop cultural competence to meet the needs of culturally diverse patients

What is the definition of health? Health = is dynamic & viewed as a continuum - varies day by day - “that state of optimum capacity of an individual for the effective performance of roles and tasks” - Parsons - “state of complete physical, mental, and social well-being and no merely the absence of disease or infirmity” - World Health Organization - continuum with high-level wellness at one end and death at the other

** Integrating of a patient’s cultural health beliefs into the individualized care plan can make a strong impact on the patients desire and ability to improve health**

** The quality and amount of parenting provided to infants and growing children constitute a major determinant of health **

** Nurses view health HOLISTICALLY, including its affect on an individual’s physical, emotional, social, and spiritual functioning, as well as its effect on the

family **