HLCD Week 10--> Chronic Illness

Question 1

Types of Adjustment Problems in Chronic Illness

Answer 1

• Physical- Being unable to cope with disability or pain
• Vocational- Having difficulty revising educational and career plans or finding a new job
• Self concept- Being unable to accept ones changed body image, self esteem and level of achievement or competence
• Social- Having difficulty with losing enjoyable activities or finding new ones and coping with changed relationships with family, friends and sexual partners
• Emotional- Experiencing high levels of denial, anxiety or depression
• Compliance- Failing to adhere to the rehabilitation regimen

Question 2

Effective systems of social support for chronic illness

Answer 2

Effective systems of social support are also important for patients and their families adaptation to chronic health problems. People with chronic medical conditions usually receive this support from family or friends but it can also come from support groups that offer patients and family info and opportunities to meet with people who are in the same situation

Question 3

Self management programs for chronic illness

Answer 3

Self management programs provide info and train patients in behavioural and cognitive skills to enhance their ability to carry out their regimens and adapt to the new behaviours or life roles the health condition requires and cope with their emotions

Question 4

Initial reactions to having a chronic illness

Answer 4

• First reaction is usually shock- feeling bewildered or behaving in an automatic and detached fashion
• Shock may only be short term or continue for a few weeks and is likely to be most pronounced when the crisis comes without warning
• After a period of using emotion-focused strategies (e.g. denial) reality begins to intrude; the symptoms remain or get worse, additional diagnoses confirm the original one and it is clear that adjustments need to be made
• People who use denial and other avoidance strategies do so to control their emotional responses to a stressor, especially when they believe they can do nothing to change the situation
• Chronic illness patients require families to make permanent behavioural, social, financial changes or adjustments
• Chronic illness may alter how a person views themselves; healthy people tend to take their health for granted
• Crisis theory→ describes factors that influence how people adjust

Question 5

Illness- related factors: Chronic Illness

Answer 5

• Some health problems present a greater threat to the person than do others- they may be more disabling, painful or life threatening
• Patients also have difficulty coping with illness related factors that involve annoying or embarrassing changes in bodily functioning or that draw attention to their conditions
• People with some illnesses may need artificial devices for excreting or urinary wastes that are noticeable either visibly or by odours
• Many people with chronic illnesses feel self- conscious about their health problems- or even stigmatized by them and want to hide them from others
• Various aspects of treatment regimens can make adjustment very difficult too→ e.g. some treatments are painful or involve medications that may produce side effects
• Other regimens may have schedules and time commitments that require patients and their families to make substantial changes in their lifestyles and make it difficult for the person to find or hold a job

Question 6

Background and personal factors: Chronic Illness

Answer 6

• People who cope well with chronic health problems tend to have hardy or resilient personalities that allow them to see a good side or find meaning in difficult situations
• People with chronic diseases can often find purpose and quality in their lives and maintain their self esteem with resisting the feeling of helplessness and hopelessness
• May also depend on age, gender, social class, religious commitments, emotional maturity and self esteem
• Men are more likely than women to have difficulty with health problems that restrict their vigor or personal abilities
• The timing of a health problem in the person’s life span also affects the impact→ young children aren’t likely to understand the nature of their illnesses, the treatment they must follow and the long term implications of their conditions
• Adolescents can understand info about their illnesses and treatment but their need to be liked and feel accepted by their peers can lead to difficulties in coping with their health problems
• When people develop disabling or life-threatening illnesses or injuries in early adulthood, they tend to resent not having had the chance to develop their lives in the direction they planned- to get married, to have children or enter a particular career
• People who believe they are personally responsible for developing chronic illness and its symptoms tend to cope poorly

Question 7

Physical and environmental factors: Chronic Illness

Answer 7

• The physical aspects of a hospital environment are usually very dull and confining for patients, thereby depressing the overall morale and mood; for some the home environment may not be better
• Many patients have difficult getting around their houses or performing self-help tasks, such as buttoning clothes or opening food containers and lack special equipment that can help them to do this and be more self- sufficient
• The presence of social support generally helps patients and their families and friends cope with the illness→ people who live alone and have few friends or have poor relationships with the people they live with tend to adjust poorly to chronic ill health
• The primary source of social support for most people who are ill typically comes from their immediate families, but friends and neighbours also help and patients may join support groups

Question 8

Tasks and skills of coping

Answer 8

• Tasks related to the illness or treatment which involve
  learning to cope with the symptoms or disability the health problem causes,
• Adjust to the hospital environment and medical procedures or regimens needed to treat the problem
• Develop and maintain good relationships with their practitioners
• Tasks related to general psychosocial functioning which involve
• Striving to control negative feelings and retain a positive outlook for the future
• Maintain a satisfactory self image and sense of competence
• Preserve good relationships with family and friends
• Prepare for an uncertain future

Question 9

Long term adaptation to chronic illness

Answer 9

• The term adaptation refers to the process of making changes in order to adjust constructively to life’s circumstances.
• As the focus of coping moves from a crisis or recent change in health to dealing with permanent changes, successful adjustment for people with chronic medical conditions involves several major adaptive tasks that continue indefinitely:
• Mastery of demands directly related to on going management of the disease (e.g. adherence to medical regiment and self care)
• Minimising physical limitations and disability
• Preserving as much positive functioning as possible in important domains like work, relationships and recreation
• Avoiding significant emotional distress
• Maintaining an overall positive quality of life
• Quality of life refers to the degree of excellence people appraise their lives to contain

Question 10

Adherence to treatment

Answer 10

• Compliance→ the extent to which the patient’s behaviour in terms of taking medication, following diets or other lifestyle changes, coincides with medical or health advice.
• Adherence→ A term that focuses more on patient commitment to the regimen. It is based on reasonable negotiations and more patient empowerment than compliance
• Concordance→ The patient being an equal
• The scale of non-adherence is high - 70% if patients don’t take their medication as prescribed or follows doctors orders

Question 11

Factors that contribute to adherence:

Answer 11

• Patient related factors: age, gender, denial of need for medication, lifestyle and health beliefs, forgetfulness, feeling stigmatised, inability to afford treatment
• Illness related factors: Co-morbidities that compound difficulty, learning disability, physical impairments that make it difficult to take medicine without assistance, mental problems
• Medication related factors: high dose frequencies, polypharmacy, side effects of drugs, fear of side effects , taste and texture of drugs, difficulty with packaging
• Physician related factors: doctor/patient relationship, poor communication, distrust
  Improving adherence: encourage patient to ask questions, relate medical regimens to everyday life, patient-centered focus and care, meet personal requests, medication boxes, blister packs, calendar entries
• Listen to the patient, ask the patient to repeat what has been said, give instructions in writing, give assistance, emphasise they really need to take medicine, reward them when they get it right
• Involve significant others, short words and short sentences, improve medication adherence