Nursing II Dr' Kathleen C' Ashton

1
Nursing IIDr. Kathleen C. Ashton

• Adaptive and Maladaptive Responses to Illness

2
Theories of Illness Causation

• Biomedical/scientific view
• germ theory
• cause and effect
• mechanistic model associated with industrial
  revolution
• statistics
• Holistic view
• balance of nature, natural forces
• yin/yang, hot/cold
• alternative and complementary practices

3

• Nursing View

• - Nursing espouses bio-psycho-social-environmen
  tal- spiritual view.
• Religious view
• oldest notion may include demonic possession
• can be deleterious or empowering

4
Health and illness behavior

• The real issue for nursing
• Illness behavior -
• the ways individuals monitor their bodies, define
  and interpret their symptoms, and seek care
• Many variations among people
• individual differences
• outside influences

5

• Population demographics (Pop. 300 million)
• 51 female
• More elderly
• Minorities becoming the majority
• Advances in technology
• Communication systems
• Medical and surgical techniques
• Healthcare delivery systems

6

• Culture - good assessment needed
• accepted among group or family of origin
• ex Migraine headaches France liver problems,
  England gi problems, US vascular problems
• Political system
• bipartisan politics
• political correctness

7

• Economic influences at all levels
• lower levels - issues of access
• upper levels - dangers of rich foods, limitless
  choices, value of health care
• managed care
• Support systems
• affect longevity, immune functioning, recovery
• men live longer when married, stressful marriages
  associated with heart disease in women

8
Personal beliefs - The Health Belief Model

• Developed in the late 40s in response to the
  under-utilization of services in USPHS
• Attitudes and beliefs play an important role in
  health behaviors
• Behaviors based on 3 factors
• Susceptibility/seriousness - perceived threat
• Benefits - is the recommended behavior of any
  value
• Barriers - costs or things which prevent care
  seeking
• Cues also are important - prompt behavior or
  change in behavior
• TV ad
• Postcard from dentist

9
Values, Beliefs, Knowledge, Behaviors

• Personal beliefs come to us by early childhood
  experiences, family relationships, and values we
  hold dear
• Value system is difficult to change can change
  beliefs based on our values
• In giving facts and information, we can change
  what we believe to be true, thus change our
  behavior
• Knowledge Behavior
• Beliefs/Values
• Teach and understand values to change behavior

10
Biological Factors

• Heredity and environment both play a role in
  health
• Complex relationship
• Things which seem to be environment, eg, diet,
  may be heredity eg, a gene for taste
• Similar cultures imply similar hygienic practices
• Things such as heredity were thought not to be
  under our control - now changing re gene mapping

11
Gender Differences

• Men use healthcare services less but more acutely
  than women, yet women have a longer life
  expectancy
• Men more likely to get a diagnostic workup, women
  more likely to get pills
• Research frequently done on men and extrapolated
  to women
• The medical norm is the 70 kg male - women are
  measured against this standard
• Stereotypes - Men are babies when sick, Women
  must be tougher to endure birth

12
Psychological factors

• Psychological state influences susceptibility and
  response to health and illness
• Much of what happens to our body depends on
  whats going on in our mind
• Holmes and Rahe scale
• Humor and laughter - the best medicine
• In 1979, N. Cousins wrote Anatomy of an Illness.
  Claims to have been cured of fatal illness. Ten
  minutes of belly laughs gave him hours of
  pain-free sleep. Humor carts in hospitals
• Endorphins and natural immunity

13
Other psychological factors

• The search for meaning in an illness - a means of
  coping for some, others just want a way out
• The Sick Role (Talcott Parsons) - how one is
  expected to behave - expectations
• Locus of control - internal vs. external -
  passive recipient vs. active participant
  (Walstons)
• Feelings of aloneness or uniqueness may be
  overwhelming - a support group may help. Support
  systems play a major role in recovery.
• Personality styles affect adaptation - emotional,
  fearful, dependent, hostile, avoiding,
  intellectual

14
Spiritual beliefs

• Three types
• Inspiring - growth-producing, provide peace
• Ineffectual - neutral, provide neither support or
  harm. Religion is a label, a ritual
• Deleterious - can provoke feelings of distress,
  eg, guilt, anger, anxiety or shame
• Must understand role of beliefs in clients life,
  provide support or referral
• Research is documenting power of prayer, role of
  attendance at religious services
• Imposing own beliefs is never appropriate,
  supporting and offering hope is role of nurse

15
Hospitalization

• Body image - begins in childhood during Eriksons
  stage II (autonomy vs. shame and doubt). Can be
  threatened in hospital due to nature of illness
  or surgery.
• Hospital culture - restrictions (space, movement,
  personal functions), jargon, routines. Dignity
  gowns. Addressing clients.
• Typical reactions anxiety, anger, hostility (may
  be directed at nurse), complaints
• Respect and professionalism are vital in every
  interaction with another individual

16
Death and Dying

• Grief occurs with any loss - manifested overtly
  or covertly
• Role of nurse frequently is to give realistic
  hope. May be last one to do this.
• Nursing goal death with dignity. Comfort care
• We can learn from our clients and share that with
  other clients.
• We react to illness and death based on our own
  experiences. Must be aware of our own feelings,
  or they will come through and take us by surprise