Lecture 12: Understandig health, illness and coping - childhood & adolescence Flashcards
What is health promotion?
health education for chronic illnesses
What are the major chronic illnesses listed?
Cystic fibrosis nut allergies asthma juvenile rheumatoid arthritis HIV aids risk of substance abuse/dependence
What is the importance of cognitive development for understanding health, illness and coping during childhood and adolescence?
important to always check in to see what someone understands about their illness but also where they are in their thinking
need to be a good listener and ask important questions about their understanding
what is the importance of cognitive level of understanding for preparation of medical procedures in children? (surgery)
Research suggests the people with more knowledge cope better with medical procedyres
What factors should be considered in public health promotion?
The level of understanding of the public as you are targeting them to receive your health message
How long has preparing children from hospitalisation and medical procedure programmes been going on for?
since 1980s
What is now current practice with children hospitalisation preparation programmes?
parents can stay in the hospital or nearby
this makes a huge difference to children
What are problems with the programmes that prepare children from hospitalisation and medical procedure?
They are often not well attended
or they are targeted at a wide age group (from 3-12)
and what a child understands at 3 is different to what they understand at 12
need a more specific targeted programme for younger and older children as they are at different levels of cognitive development and understand differently about their illness
What are some of the things you need to do for children to prepare them for a medical procedure? Applies to out patient procedures as well
Individual one on one preparation
to Establish cognitive level of patient,
determine illness experience, (positive? negative?)
establish experience of specific treatment
check understanding of explanations
What usually happens to people going into the health setting for the first time?
stress levels are high, so memory probably isnt very good because they are focusing more on the environment, and not someone whos talking to them.
why should you check in with child patients?
a lot of terms misunderstood for children
e.g. odema in stomach may be heard as demon
may be distressing to know they have iron inside them, or IV (ivy), or bugs.
becareful what you say, also with metaphors you use especially with young children e.g. lungs = balloon
What does effective preparation include?
depends on developmental level
type/acuity of surgery - the more age appropriate knowledge, the better it is for them
relevant past experiences (prior surgeries)
cultural / ethnic background (avoid unnecessary stressful situations)
family composition and dynamics (happy or conflict. Some times better if one parent isnt around e.g. overemotional mother)
available support systems
How can you prepare a parent for their child’s surgery?
make sure they are calm and confident around child,
make sure they understand anything and know they can ask you for clarification
Why might a surgeon be intimidating to a child?
they do not see people with masks on every day.
What are the best ways some programmes have done before to prepare children forsurgery?
tours of theatre and related places
videos,slides, movies about surgical procedures
Interactive materials – colouring books – Ipad?
•Puppet shows
•Medical play using actual hospital equipment (not appropriate for very young children)
•Books using popular figures children can identify with such as “Big Bird” or “Dora the Explorer”
•Board games
•Art therapy
•Relaxation techniques & coping
How do children and adolescents respond to chronic illness & how do they cope?
Emotional responses: denial, anxiety, depression, positive
What are the implications of denial?
a common reaction
can help people cope
But may interfere with treatment and adherence
What are the implications of anxiety?
Crisis, anxiety & disorientation
Focus on symptoms
Fearful of continuing daily activities
Recurring anxiety about the future and possible complications of the illness
What are the implications of depression?
25% affected by depression Often sets in later when full consequences are realised Can be long term Affects functioning Often goes untreated
What are the implications of a positive emotional response?
Children may feel empowered Escaped death Examine priorities Improved relationships Healthy lifestyle changes
What are the 4 common signs of psychosocial distress?
- Unexplained medical symptoms
- Poor adherence to treatment
- School Refusal
- Engagement in risky behaviours involving sex and drug use
What do coping responses to chronic illness depend on?
Appraisal of the degree of threat posed by illness
Resources available
What are the two types of coping strategies?
Problem focused coping strategies (alter the situation)
Emotion focused coping strategies (regulating emotional response to situation)
Both useful but need to be matched to the situation
avoiding coping is often linked to poorer outcomes
what are factors that influence coping?
Perceptions of the illness: its identity, cause, controllability, timeline, and consequences
Social support: instrumental or emotional support. Usually positive effects, but can be negative
Individual differences: e.g. optimism, age, education
what are factors which determine the impact of chronic illness on adolescents?
- Type & degree of physical impairment
- Visibility of illness
- Uncertainty about prognosis
- Irregular and unpredictable effects of illness
- Treatment & pain associated to disease & treatment
What are factors that might impact treatment for acute and chronic illnesses?
Social & emotional development
•Biological functioning
•Mental age rather than Chronological Age better for determining developmental aspects of adherence (illnesses can change how you mature)
•Family functioning
What is the importance of family during a child’s illness/treatment/hospitilisation?
Children present for treatment with family member
•Child’s understanding of illness & treatment limited
•Child reliant on family for care
•Families must manage a range of problems
•Families must address impact of all these issues on family functioning
What are the 2 constrcuts that piaget talked about?
Egocentrism and personal fable
adolescent have an imaginary audience where they think everyone looks at them. believe their appearance is so important
What affects coping?
your developmental stage.
Younger children are more focused on problems
more maturity - emotion focused.
e.g. using cognitive abilities to say, just need to get through this procedure
What are some biological issues which arise with chronic illness in children?
may go through puberty earlier
certain drugs given for treatment e.g. chemotherapy, can affect your hearing, may make them sterile so often take eggs from ovary and semen to freeze for other options
What is the relationship between self management and chronic illness?
good self management = better outcomes
What are some causes of non-adherence ?
Poor doctor-patient communication
•Complex treatments
•Beliefs about illness and medications
•Adherence is lower for non-medicinal regimes
What are some approaches to treatment adherence for children and adolescents?
educational approaches modelling incentives multi family training multi component interventions adolescent orientated interventions
Why are educational approaches a good adherence intervention?
Good for treatment that involves complex directions & skills – Factor Replacement Therapy
Good for short-term medication regimen
Important at time of diagnosis
What is the advantage of modelling?
Good for complex treatments that require parents to administer treatment Parents of diabetic children taught how to administer insulin
How are incentives used as an intervention for non-adherence?
Reinforcement contingencies for:
- Medication
- Complex chronic treatments
- Lifestyle changes, exercise, diet
- Improved parental participation in treatment
- Reinforcement for symptom reduction
How does multi family training help to support adherence?
Communications skills
Problem-solving strategies
Family support for adolescent self-care
How do multicomponent interventions help to maintain adherence?
Education + reinforcement contingencies
Increase parental supervision + reinforcement
Diabetes Intervention – for newly diagnosed
How are adolescent oriented interventions for nonadherece carried out?
Anticipate adolescent’s inadequate compliance with treatment
•Promote autonomy and decision-making in the context of illness management
•Actively follow-up with questions about adherence pattern
