Introduction to Situational Transitions

Question 1

What are the five types of transition?

Answer 1

1) Developmental (changes in life cycle)
2) Health-illness (health changes)
3) Situational (lifestyle)
4) Organizational
5) Multiple (more than one category)

Question 2

What concepts impact our ability to transition?

Answer 2

1) Vulnerability
2) Powerlessness
3) Empowerment
4) Resilience

Question 3

What is vulnerability?

Answer 3

• to wound, capable of being physically or emotionally wounded
• Vulnerability is also situational. A person who is not particularly vulnerable to illness/harm in one environment, may become highly vulnerable if placed in a different environment

Question 4

What risk factors increase vulnerability?

Answer 4

• Underlying predisposing problems (may lead to developing a health problem)
• May be time-limited (situational) or may continue over time
• Can derive from the individual, family, community, institutions or general environment
• Ex. chronic illness, personal crisis, gender (women), racism, refugees, etc.

Question 5

What are the dimensions of vulnerability?

Answer 5

• Limited control
• Victimization
• Disenfranchisement
• Disadvantaged status
• Powerlessness
• Health risk (ex. multiple co-morbidity’s)

Question 6

What are some vulnerable patient populations that we need to assess for?

Answer 6

• Violence
• Family situations
• Childhood risk factors
• Delinquent behaviour
• Suicidal behaviours
• Youth-at-risk

Question 7

What is the cycle of vulnerability?

Answer 7

Predisposing factors > No effective intervention > Poor health outcomes > Worsening situation > Return to predisposing factors

Question 8

What are some considerations when assessing vulnerability?

Answer 8

• Process of identifying vulnerability can be biased.
• If vulnerability is inappropriately identified, interventions may worsen the situation.
• Identifying vulnerability needs to focus on both strengths and limitations
• Clients and family must be involved in the assessment to ensure a holistic focus

Question 9

What are some effects of vulnerability?

Answer 9

• Physiological: Anxiety/depression
• Psychological: effects of oppression
• Social forces: marginalization and stigmatization
• Societal trends: increased numbers of vulnerable populations

Question 10

What is the definition of power?

Answer 10

• ‘to be able’
• The inherent ability to control behaviors surrounding life events, the freedom to make informed choices with authority and act on them, and the conviction to realize those choices

Question 11

What is the definition of powerlessness?

Answer 11

• The PERCEPTION that one lacks capacity or authority to affect an outcome
• Results in imbalance in power between the patient and the healthcare provider
• Imbalance of power may result in value decisions being forced on the recipient of care.

Question 12

What is empowerment?

Answer 12

• The process by which we facilitate the participation of others in decision making and taking action within an environment where there is equitable distribution of power.
• Process by which power is shared with colleagues & patients.

Question 13

What are the six philosophies of empowerment?

Answer 13

1) Health belongs to/is responsibility of the individual
2) The individual has the ability to make decisions and act on their own behalf
3) HCP’s can’t empower people, we provide the tools for self empowerment
4) HCP’s need to surrender control and develop a collaborative, cooperative relationship
5) HCP’s need to accept that people will make decisions that are different from what is ‘decided’ for them
6) Mutual respect and trust are necessary components for empowerment to occur

Question 14

What is resiliency?

Answer 14

• Tendency to rebound or recoil, to return to a prior state, to spring back, the power of recovery (Oxford dictionary)
• The process of, or having the capacity for successful adaptation despite challenging or threatening circumstances
• Adaptive, stress resistant personality that permits one to thrive in spite of adversity (Ahern, Ark, & Byers, 2008).
• More than simply springing back to a previous state – a dynamic process of adjustment, adaptation, and transformation in response to adversity. In adapting, the organism often changes the environment (Kirmayer, et al. 2011).

Question 15

What are the inherent qualities of resilience?

Answer 15

• Flexibility
• Adaptability
• Perseverance
• Optimism
• Balanced perspective of life
• Self-reliance, self-respect and autonomy
• Meaningfulness of experiences or life

Question 16

Describe the relationship between uniqueness and resilience:

Answer 16

• Can be compartmentalized into physical resiliency, emotional resiliency or resiliency to change
• It may have a spiritual dimension / religious dimension

Question 17

What are protective factors within the individual that increase resilience?

Answer 17

• Sense of responsibility
• Hx of competence or success
• Cognitive problem-solving and reading skills
• Positive self-esteem/self-efficacy/optimism
• Feeling of control over one’s life
• Planning for future events such as jobs and education

Question 18

What are familial and support factors in individual resiliency?

Answer 18

• Positive parent-child attachment & interactions
• Effective parenting
• Structure and rules within the household
• Responsibilities for all family members in the home
• Good family coping and family hardiness
• Strong extended family network

Question 19

What is hope?

Answer 19

• A state of being, characterized by anticipation of a continuous good state, an improved state or a release from perceived entrapment which may, or may not, be founded on concrete or real world evidence.
• It is an anticipation of a future that is good and is based on mutuality, sense of personal competence, coping ability, psychological well being, purpose and meaning in life as well as a sense of “the possible”. (Miller, 2000, p. 523)
• A multidimensional construct
• Arises from memories, beliefs and values that is believed to be a part of all activities and thoughts that strengthen the spirit
• Unique to each individual, yet universal to all
• Recognizing constructive possibilities in one’s life situation
• Believing in a life worth living during the present and in the future

Question 20

What are the three levels of hope?

Answer 20

1) Superficial wishes (ex. wanting a certain gift for Christmas)
2) Includes hoping for relationships, self-improvement and self-accomplishments (ex. hoping for work as an ESN)
3) Arises out of suffering, personal trial or state of captivity

Question 21

What are the critical elements of hope?

Answer 21

• Mutuality and affiliation (significant relationships)
• Sense of possibility
• Avoidance of absolutes
• Anticipation
• Establishing and achieving goals
• Freedom and feeling of choice
• Psychological well-being and coping
• Purpose and meaning of life - something to live for
• Reality surveillance (clues that hope is possible)
• Optimism (prerequisite)
• Mental and physical activation to combat despair

Question 22

What is despair?

Answer 22

• Despair, or giving up, occurs when relief is not imminent by the evaluation of the individual.
• Despair occurs when goals and the path of reaching goals are lost
• Despair leads to hopelessness

Question 23

What is Miller’s Hope-Despair model?

Answer 23

HOPE vs. DESPAIR:

• Establishes & modifies goals vs. unable to set goals
• Focuses on past successes vs. perceives not achieved outcomes as personal failures
• Plans for alternative actions vs. verbalizes self-doubt
• Motivates self to succeed vs. giving up

Question 24

How does despair trigger hopefulness? What are the five steps?

Answer 24

1) Enduring
2) Awareness without full comprehension (suspension of emotions; energy used to keep self together)
3) Uncertainty (recognition toward event; ready to make goals but unsure how to achieve them)
4) Suffering (reality assessment results in overwhelming feelings of despair, support groups beneficial)
5) Acceptance (eventually occurs, brings with it hope for a new path and new goal)

Question 25

What are consequences of despair and hopelessness?

Answer 25

• Increased symptoms and illness
• Disability
• Weakening (physically, mentally, emotionally, etc.)
• Impaired power of concentration
• Fluctuating moods, insomnia
• Being unable to receive information about illness
• Suicide

Question 26

What are some strategies to maintain hope?

Answer 26

• Cognitive strategies
• Determinism
• Philosophy of life and world view
• Spiritual strategies
• Relationship with caregivers
• Family bonds
• Being in control
• Goal accomplishment

Question 27

What is the biology behind hope?

Answer 27

• Anterior hypothalamus = calms emotions, increases immune capabilities
• Posterior hypothalamus = fight/flight mode, produces fighting cells to facilitate work of immune system
• Neuropeptides = translates emotions into bodily events
• Psychoneuroimmunology = study of psychological and emotional states influence disease resistance via interactions with the nervous, endocrine and immune system

Question 28

What are nursing interventions to inspire hope in patients?

Answer 28

• Sustaining relationships – “connectedness”, assist individual and family to identify goals and work together
• Relinquishing control
• Use life promoting framework
• Assist patient to expand coping repertoire
• Reality surveillance – search for cues to confirm that maintaining hope is feasible
• Devise and revise goals – recognize accomplishments, set realistic goals
• Foster renewed spiritual self (provide meaning in life)
• Establish inspirational resources such as literature, poetry, art and music, humor, nature
• Guard against despair