6b: Coping with illness and disability Flashcards
Transactonal definition of stress
Stress is a condition that results when the person / environment transactions lead the individual to perceive a discrepancy between the demands of the situation and the coping resources available.
Application of stress defiition
I.e. medical proceddures
THREAT: will it be painful/ will I recover
RESOURCES: there’s nothing I can do, I can’t cope with this
Distinguish procedural and sensory information
Procedural information – Information about the procedures to be undertaken
Sensory information – Information about the sensations that may be experienced.
Dual process hypothesis
Procedural and sensory information are both helpful because they work in different ways
Procedural- allows patients to match ongoing events with their expectations in a non-emotional manner
Sensory- allows “mapping” a non-threatening interpretation on to these expectations.
Outline the Auerbach study
Patients undergoing dental surgery were randomly given general or detailed info about tooth extraction.
They, they took a health opinion survey to determine DESIRE FOR INFORMATION AND INVOLVEMENT
Distress during procedure measured (Dental Anxiety Scale)
Of those who said they wanted specific info, they were less distressed if they had the specific info, and more distressed if they had general info
Of those who wanted general info, they were less distressed if they had general info, and more distressed with specific
Outline anger and rodin nursing home study
Floor 1: In a meeting emphasised that residents had choice and responsibility:
- can rearrange furniture in rooms
- decide what they want in free time
- choice of movie
- offered choice of plant and looked after it themselves
Floor 2: meeting—emphasized to residents how staff wanted them to be happy.
- Told that staff will ensure rooms are pleasant.
- Given a timetable of activities.
- Movie night, but no choice.
- Given a plant but nurses watered and cared for it.
What was the finding from langer and rodin
On behavioural measures floor 1 residents (enhanced control group) showed greater engagement in activities.
Self report and nurse’s ratings showed Floor 1 residents had better general well being (psychological & physical measures).
18 Months later – 15% of Floor 1 residents had died compared to 30% of Floor 2 residents.
Effect of perceived control on distress examples
Increasing perceptions of control during treatment can reduce patient distress
e.g.
A device for patient to signal their pain/discomfort during dental treatment can reduce distress.
Self- administration of entonox during labour.
Describe problem focused coping
Seeking relevant information about an illness
Learning specific illness related procedures eg pacing activities
Changing behaviour eg diet
Describe emotion-focused coping
Seeking reassurance and emotional support
Learning relaxation strategies
Meditation
Distraction
Is emotional or problem focussed coping better
Emotion focussed coping strategies are associated with poorer adjustment and greater levels of depression- NOT WANTING TO DISCUSS ILLNESS OR AVOID TREATMENT
But, those who are more distressed may need to engage in more emotion-focussed coping (circular reasoning)
Context important- distraction to reduce anxiety before operation may be helpful
Martelli… emotion vs problem focused coping
It was thought that those with low preference for info would prefer emotional coping
and those with high preference for information would prefer problem based coping
And it was true (as they were less distressed in these respective situations)
What is theory of mind
Ability to attribute mental states to oneself, and to others, and recognise that others may not share this state of mind
Problem with young children’s understanding of illness
are egocentric and lack a ‘theory of mind’ – will not know that others do not share their thoughts/feelings and may not disclose pain/ symptoms
cannot understand abstract or unobservable concepts like infection
How can you help children cope with treatment
COMBINED APPROACH:
1. TELL (simple language, comparisons, avoid -ve words)
- SHOW (on inanimate object)
- DO (only when they understand what will be done)
COPING SKILLS:
Distraction for younger children,
matching coping strategy to child’s preferred coping style for older children
MODELLING INTERVENTIONS
Film ‘Ethan has an operation’ depicting a child in hospital using positive coping strategies reduced anxiety in children undergoing various operations
