Coping with Chronic Illness

1
Coping with Chronic Illness

• Lazarus Theory of Stress and Coping

2
Coping with Chronic Illness

• Nursing role Facilitate achievement of coping
  tasks
• Coping Tasks
• Maintaining sense of normalcy
• Modifying daily routine, adjusting lifestyle
• Obtaining knowledge and skill for self care
• Maintaining positive self-concept
• Adjusting to altered social relationships

3
Coping with Chronic Illness

• Coping Tasks (cont)
• Grieving over losses associated with chronic
  illness
• Dealing with role change
• Handling physical discomfort
• Confronting inevitability of death (make most of
  life)
• Dealing with social stigma of illness/disability
• Maintaining sense of being in control
• Maintaining hope despite uncertain or downward
  course of health

4
Family Caregivers

• Family Caregivers
• 21 of caregivers are gt 75 yrs
• Caregivers of elderly with long-term illness
  usually
• Spouses
• Children (usually daughters, daughters-in-law)
• Other family members
• Outside sources (when needs exceed family
  resources)

5
Types of Caregivers

• Care Providers
• perform direct care
• Care Managers
• manage/arrange services to provided by others
• Often have own careers
• Often provide psychosocial support,
  transportation, visiting, etc.

6
Impact of Long Term Illness

• Physiologic/Somatic
• Psychologic
• Sexual
• Social
• Occupational
• Financial

7
Impact of Long Term Illness on Families

• Burden
• Decreased social, recreational involvement,
  financial difficulties, depression, declining
  personal health
• May lead to nursing home placement
• Problems related to home care
• Financial
• Competing demands

8
Impact of Long Term Illness on Families

• Physical Strain
• Lifting, 24/7 physical care, sleep deprivation,
  chronic fatigue
• Emotional Strain
• High incidence of stress-related disorders (HTN,
  heart disease)
• Manifested as anxiety, anger, guilt, loss of self
• Could lead to elder abuse

9
Impact of Long Term Illness on Families

• Role Changes Associated with Caregiving
• Pre-existing relationships change
• Take on new duties
• Role Ambiguity
• Taking on of new roles (eg. roles traditionally
  fulfilled by spouse)
• Role Reversal
• Children caring for parents

10
Nursing Interventions for Family Caregivers

• Encourage verbalization and acceptance of
  negative emotions
• Facilitate Realistic expectations re
• clients illness and expected course
• Own limitations
• Common feelings
• Encourage to accept assistance from others
• Info about resources (support groups, respite
  services)

11
Lazarus Theory of Stress and Coping
Pschological Stress
Cognitive Appraisal
Health Outcome

• Coping

12
Lazarus Theory of Stress and Coping

• Stress
• Relationship b/w person and environment that is
  appraised by the person as
• Taxing or exceeding his/her resources
• Endangering his/her well-being

13
Lazarus Theory of Stress and Coping

• Cognitive Appraisal
• Process through which person evaluates whether a
  particular encounter with the environment is
  relevant to his/her well-being and if so, in what
  way(s)
• i.e., evaluation of the significance or meaning
  of an event to the individual

14
Lazarus Theory of Stress and Coping

• Two Types of Cognitive Appraisal
• Primary Appraisal
• Person evaluates whether he/she has anything at
  stake (i.e., is there potential harm or
  benefit?).
• Evaluates significance of the event with
  respect to well-being
• Types of appraisal
• Stressful harm, loss, threat
• Challenge opportunity for growth, gain or
  mastery

15
Lazarus Theory of Stress and Coping

• Secondary Appraisal
• Evaluates what if anything can be done to
  overcome or prevent harm or to improve the
  prospects of benefit (ie., evaluates coping
  resources and options)
• Various coping options (e.g., altering the
  situation, accepting it, seeking information) are
  evaluated

16
Lazarus Theory of Stress and Coping

• Coping
• Persons constantly changing cognitive and
  behavioral efforts to manage specific external
  and/or internal demand that are appraised as
  taxing or exceeding the persons resources
• i.e., efforts to master the demands

17
Lazarus Theory of Stress and Coping

• Two major types of coping strategies
• Emotion-focused coping
• Used to control distressing emotions, sometimes
  by altering the meaning of an outcome
• Likely to be used in situations that are
  perceived not be not amenable to change
• Problem-focused coping
• Used to control the troubles person-environment
  relationship through problem-solving,
  decision-making and/or direct action
• More likely to be used in situations perceived as
  changeable

18
Alterations in Health Role of the Nurse(Bevis)

• Nursing
• A process
• Purpose - promote optimal health facilitate
  maturation and adaptation in clients (individuals
  intrapersonal, groups interpersonal
  community)

19
Nursing System (Bevis)

• Input
• Needs, goals problems desires of clients
• Includes assessment data

20
Nursing System (Bevis)

• Throughput
• Theories, concepts, processes used
• Tools used
• Problems-solving/decision-making (critical
  thinking)
• Caring
• Teaching/Learning (Educator)
• Communication
• Management/change (change agent)

21
Nursing System (Bevis)

• Output
• Behaviors, services, roles, functions of nurses

22
Life Tasks (Bevis)

• Stress
• Forces that press in upon or noxiously stimulate
  the individual. e.g. health problems, medical
  diagnoses, social problems
• Strain
• Expresses itself in symptoms, signs or behaviors
  that signal response to stress. E.g., S/S of an
  illness physical assessment findings, behaviors
  (crying)
• Maturation
• Process of human development
• Adaptation/Maladaptation
• Coping patterns or ways of behaving that can
  head to an interruption or maintenance of health