Health&Illness

sharpfartsAI and Robotics

Nov 8, 2013 (3 years and 8 months ago)

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1

Health, Illness,

&

Nursing

2

Health


What does health mean to be healthy?


Has your perception of the meaning of health
changed since you began nursing?


Can health and illness co
-
exist?




3

Health Model


Clinical Model:


Health = absence of S/S of disease/disability


Medically orientated



Role Performance Model:


Health viewed in terms of performance of social roles


Health = effective performance of roles



Adaptive Model:


Health = maintaining flexible adaptation to environment and
interacting with it to maximum advantage



Eudaimonistic model:


Health seen as exuberant well
-
being


Healthy person is self
-
actualized and fulfilled.

4

Health defined


WHO


Complete physical, mental, social well
-
being; not merely
absence of disease/infirmity



Pender


The actualization of inherent and acquired human potential
through goal
-
directed behavior, competent self
-
care, and
satisfying relationships with others, while adjustments are
made as needed to maintain structural integrity and
harmony with relevant environments



Bevis


The ability to set goals and to mobilize the energy and
resources needed to meet these goals while feeling good
and caring about self and others and helping others feel
good about themselves

5

Health defined


U of W


A dynamic process whereby client is able to realize
aspirations, satisfy needs, and change/cope with
environment



A resource for everyday life



A positive concept emphasizing social and personal
resources as well as physical capacity



The goal of all nursing behaviors

6

Alterations in Health


Acute/Episodic Illness


Rapid onset, short duration


Self
-
limiting or responds to Rx



Long term/Chronic Illness


Permanent


Irreversible pathologic conditions


Residual disability

7

Disease versus Illness



Disease:


Objective state of ill health manifested by
pathology detectable by medicine



Illness:


subjective experience of loss of health

8

Impact of Long Term Illness


Physiologic/Somatic



Psychologic



Sexual



Social



Occupational



Financial

9

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




10

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


11

Family Caregivers


Family Caregivers


21% of caregivers are
>

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)

12

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.


13

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



14

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


15

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 (e;g. roles traditionally
fulfilled by spouse)


Role Reversal


Children caring for parents


16

Nursing Interventions for Family
Caregivers


Encourage verbalization and acceptance of
negative emotions


Facilitate Realistic expectations re


client’s illness and expected course


Own limitations


Common feelings


Encourage to accept assistance from others


Info about resources (support groups, respite
services)


17

Lazarus’ Theory of Stress and
Coping

Pschological

Stress


Cognitive

Appraisal


Coping

Health

Outcome


18

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


19

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




20

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

21

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

22

Lazarus’ Theory of Stress and
Coping


Coping


Person’s constantly changing cognitive and
behavioral efforts to manage specific external
and/or internal demand that are appraised as
taxing or exceeding the person’s resources


i.e., efforts to master the demands

23

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


24

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
)

25

Nursing System (Bevis)




Input


Needs, goals problems & desires of clients


Includes assessment data






26

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)

27

Nursing System (Bevis)


Output


Behaviors, services, roles, functions of nurses

28

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


29

Review of Nursing Process


Assessment


Data collection


Sources


Client


Family/significant others


Records


Collaboration (other health professionals)



Formulate nursing judgements



Data clustering: organize into meaningful clusters



(e.g., physiological systems, Gordon’s functional health

patterns)










30

Review of Nursing Process


Analysis


Analyze and interpret data: draw conclusions
re health risks/problems


Nursing Diagnosis


A clinical judgement about a response to actual
potential health problems/life processes


Nurse is accountable/responsible for developing
and treating


Collaborative Problem


potential problem for
which nurse monitors; requires collaboration with
MDs




31

Review of Nursing Process


Planning


Sets priorities


Establishes outcomes/goals (collaborate with client)


client
-
centered


Realistic


specific and measurable


Select nursing interventions
-

individualized for the client



Implementation


Carry out the plan of care



Evaluation



Determine the degree to which expected outcomes were met


Essentially a re
-
assessment of the client in relation to the goals