Chronicity Flashcards
Define chronicity.
It is an ongoing health condition that at the time of diagnosis, or during the expected trajectory of the condition, will produce one or more of the following current or long term sequelae:
- limitation of functions appropriate for age and development
- dependency on meds, technology, diet
- disfigurement
What are the six characteristics of chronic illness.
1) person experiences impaired functioning in more than one dimension
2) dependency on meds and technology
3) unpredictability and uncertainty
4) ongoing diseases symptoms and treatment can interfere with norm activities
5) individuals experience multiple losses
6) unpredictability and uncertainty
Describe the things that are associated with the diagnosis of a chronic illness.
Emotional experience
- may involve relief that symptoms are legitimized
HC professionals may be unaware of the impact of the illness
Can signal a scientific dead end
What is the emotional response to chronic illness?
FEAR
GRIEF
ANXIETY
GUILT
How might an individual feel prior to being diagnosed with a chronic condition?
Uncertain b/c they have no cause
What might happen to symptoms when someone has an undiagnosed chronic illness?
symptoms may be minimized or misdiagnosed by health care professionals
How do individuals typically respond emotionally to a diagnosis of chronic illness?
Often feel relief that symptoms are legitimized
Highly varied response: depends on the impact of the illness
What are the two ways that fear can be a response to chronic illness?
ADAPTIVE: drives you to act, learn, and adapt
MALADAPTIVE: paralyze you, create anger, withdrawal, and strain on relationships
Why might individuals experience grief in response to a chronic illness?
Loss of….
- activities
- function
- independence
- career
- relationships
- dreams
- income
Why might individuals anxiety in response to chronic illness?
over uncertainty and treatment
Why might individuals experience guilt in response to chronic illness?
Feel like it is there fault
Self blame
Not catching it earlier
Not complying earlier (ex exercise and diet)
What is the most common manifestation of chronic illness?
Fatigue
What is the non-pharmacological therapy for fatigue?
Exercise, at a level that is manageable
What is one of the things that can disrupt or interfere with social relationships?
the stigma associated with the illness
ex: diabetics don’t eat properly, blaming the patient, etc
What could the visibility of the disease cause?
Diminished social credibility (seen as invalid)
Stereotyping.
results from altered appearance, restricted mobility, unusual behaviours
What are the 4 things that make up the invisible side of the disease?
Fatigue
Pain (b/c HCP often rely on visual confirmation of pain b4 meds)
Limited sympathy and empathy for chronic pain
Emotional turmoil
What did Thorne define as the goals/tasks of individuals regarding chronic illness
1) prevent acute episodes
2) manage treatment regimes, meds, and procedures
3) to access HCP
4) to pace and plan activities to reduce fatigue
5) to protect self from anxiety and depression
What are three concepts regarding living with chronicity?
POWERLESSNESS: (use power resources) uncertainty
ADAPTATION:
- normalization
- shifting perspectives
COPING STRATEGIES:
- approach
- avoidance
Who developed the concept of power resources? What are they?
Miller
strengths that individuals possess to manage living with a chronic disease
List the 7 power resources
1) Knowledge of disease
2) Motivation
3) Positive self concept
4) Physical str and energy
5) Spirituality
6) Psychological stamina and social support
7) Energy
At what points does uncertainty occur in chronic disease?
at all points: leading up to diagnosis, treatment, and prognosis
What are some factors that influence uncertainty. (MISHEL)
Severity of illness
Diagnosis and lack of information
Personality factors
Social support
HCP
Demographic variables
how does uncertainty vary in chronic vs acute illness?
ACUTE: self limiting
CHRONIC: constant.
may dissolve with adaptation
What are the 6 attributes of situations leading to uncertainty (McCormick)
1) Ambiguity: more than one interpretation
2) Inconsistency
3) Vagueness
4) Unpredictability
5) Lack of information
6) Unfamiliarity
List and explain three sources of uncertainty in parents with sick children.
DIAGNOSIS:
lack of knowledge, impact on future, etc
SYMPTOMS:
management, interpretation, prioritization
HCP:
lack of confidence in them, too much jargon, no validation
List three ways to resolve uncertainty.
Acknowledge the circumstances
Seek information
Engage in the transition
List three ineffective ways of dealing with uncertainty
EMOTIONAL FOCUSED COPING:
anxiousness, angry, instant gratification
AVOIDANCE
DENIAL
What can a nurse do for a patient experiencing uncertainty?
Assist pt to interpret illness events
Provide psychosocial support
Provide information including alternatives
Advocate for pt
Foster hope (success stories, encouragement, recognize strengths)
Enhance spiritual well being
What is normalization?
altering one’s sense of normal by constructing a new sense of normal.
find ways to live as normal as possible to minimize social effects
What is one of the negative things that normalization can cause?
denial or delayed request for assistance.
may cause individual not to follow treatment
Describe the shifting perspectives theory by Patterson
It explains that wellness and illness shift from foreground to background constantly, especially in chronic illness
Wellness in the foreground: don’t see self as sick
Illness in the foreground: focused on symptoms and management until new norm is achieved
List the adaptive tasks for parents who have children with chronic illnesses
Accept the child’s condition
Manage the illness on a day to day basis
Meet normal developmental needs
Meet developmental needs of other family members
Cope with ongoing stress and periodic crises
Educate others about the illness
Establish a support system
Describe approach coping strategies
Behaviours that indicate a willingness to confront the realities of the illness, awareness of personal reactions, and an attempt to deal with them
Give some examples of approach coping strategies
seeking information enhancing spiritual life self distraction expressing feelings seeking social support
Describe what avoidance coping strategies are.
Behaviours that protect the individual from conscious confrontation with the threat
Give some examples of avoidance coping strategies
denial, suppression, minimizing symptoms, withdrawal, talking about self, passive acceptance
What are some things that help with acceptance of the chronic illness
recognition of the illness by HCP
faith in higher power
put illness in context of other losses
find some good in an otherwise neg experience
Can mechanical items like a w/c, crutches, or walker be a part of body image?
yes
What are the 4 phases of readjustment to body image disturbances?
1) psychological shock
2) withdrawal
3) acknowledgement
4) integration
Explain how chronic illness effects sexuality.
fatigue, pain, disability, meds, altered body image, dec self esteem all impact
fearful of intimate relationships
need time to grieve the losses and gradually adjust
List the three phases of the relationship development between families living with chronic illness and the HCP
1) Naïve trust
2) Disenchantment
3) Guarded alliance
