Response to Illness: Individual Factors

• Three key areas influence a client's response to illness: individual, interpersonal, and cultural factors

Individual Factors and Illness

• Individual characteristics such as age, growth, development, genetics, biology, hardiness, resilience, resourcefulness, self-efficacy, and spirituality play a role
• Age and development affect coping and expression of illness
• Psychosocial development according to Erikson is important, with each stage building on the successful completion of the previous one
• Physical health and health practices impact reaction to illness, where a healthier lifestyle facilitates better coping with stress
• Responses to drugs vary among ethnic groups due to differences in metabolism, potentially requiring lower doses for those with slower metabolism
• Self-efficacy, the belief in one's ability to influence life events, plays a role
• Hardiness consists of commitment, control, and challenge
• Resilience and resourcefulness enable healthy responses to stressful or risky situations
• Spirituality involves internal values, morality, and one's view of life's purpose, which may or may not be connected to organized religion
• Religion entails beliefs within organized worship and rituals facilitating insight into potential support systems.

Interpersonal & Cultural Factors and Illness

• Interpersonal factors such as belonging and social networks offer social and emotional support
• Sense of belonging is determined by value and fit
• The perception and responsiveness of the support system
• Family support can influence a client's response to illness
• Cultural factors greatly shape health beliefs and behaviors
• Cultural assessment factors include communication styles, physical distance preferences, and social organization
• Socioeconomic status and social class need to be considered
• Knowledge of cultural patterns is a starting point

Erickson's Stages of Psychosocial Development

• Trust vs. Mistrust (infant) involves seeing the world as safe and nurturing relationships as reliable
• Autonomy vs. Shame/Doubt (toddler) involves achieveing a sense of control
• Initiative vs. Guilt (preschool) involves developing a consiense
• Industry vs. Inferiority (school age) involves building confidence
• Identity vs. Role Confusion (adolescence) involves formulating a sense of self
• Intimacy vs. Isolation (young adult) involves forming relationships and being productive
• Generativity vs. Stagnation (middle adult) involves establishing the next generation.
• Ego Integrity vs. Despair (maturity) involves taking responsibility for oneself

Nurse's Role

• Ascertain cultural values, beliefs, and health practices
• Recognize the patient is is the primary source of information
• Culture guides initial interactions
• Preferences, health practices and beliefs vary among members of cultural groups
• Distinguish between the patients culture vs Ethnicity

Self awareness

• Maintain a genuine and caring attitude, inquire about spiritual needs and values
• Confront personal feeling and potential biases
• Recognize the complexity of each patient

Psychosocial Assessment

• Step one in nursing, dynamic and ongoing
• Includes history, appearance, motor behavior, mood, affect, thought process/content, sensorium, intellectual processes, judgement, insight, self-concept, roles, relationships, physiologic and self-care concerns

Key Terms

• Mood signifies a pervasive emotional state while affect mirrors the outward expression of it
• Common terms can describe affect such as blunted, broad, flat, inappropriate or restricted
• Thought process is how a the patient thinks, thought content is what they are saying

Assessment of Cognition

• Sensorium indicates orientation, memory, concentration, and the ability to think abstractly
• Hallucinations constitute false sensory perceptions
• Judgement is the ability to interpret and adapt
• Insight indicates the comprehension of one's situation
• The psychosocial assessment intends on capturing their emotional and mental state, plus their behavior
• The patient's participation, health, experiences influence the assessment

Therapeutic Interview

• It's key to establish a safe, private environment
• Consider the patient's comfort, limit distractions
• Open-ended questions initiate assessement
• Focus questions guide patients challenged with organizing thoughts

Relevant History

• Collect data on a patient's age, development, culture, spirituality and past
• Note that appearance, hygiene, posture, and eye contact offer data
• Automatisms indicate anxiety
• Psychomotor retardation and waxy flexibility may indicate issues with speech and neologisms

Thought Process and Content

• Circumstantial thinking eventually answers with excessive detail
• Delusions involve fixed, false beliefs
• Thought blocking includes cessation of thought mid-sentence
• "Word salad" includes an illogical flow of content

Suicide Assessment

• Directly inquire
• Note anger and specific threats
• "Duty to warn" includes potential plan, method, access, place and timing

Mental Status Examination

• It's essential to assess orientation, memory, and concentration Abstract thinking and sensory perception should be evaluated
• Self-concept, encompassing personal value and body image needs to be considered
• Assess roles, relationships, and family dynamics
• Evaluate health behaviors, habits, and medication compliance

Psychological Testing

• Intelligence and personality tests are objective measurements
• Projective methods can reveal coping styles plus one's perception and thought organization

Rights of Patients

• Patients retain all civil rights unless involuntarily admitted, civil commitment processes are governed by each state
• Patients should have the least restrictive environment
• Restraints require food, drink, and offered opportunities for the restroom
• Restraints can be physical or chemical, they restrict movement

Restraints

• Short-term restraints require face-to-face assessment within 1 hour, physician order
• Continuous monitoring with documented safety checks are key

Duty to Warn

• Mandated if a patient is expressing intent to harm an imminent 3rd party
• Negligence and malpractice entail breaches of duty that cause client harm

Patient Rights

• Patients retain all standard civil rights unless civilly committed, the state governs these processes
• Forced medication and treatment can be mandated as an outpatient

Conservatorship

• Protects those with grave disability or incompetency
• Legal guardians manage affairs and provide consent

Least Restrictive Enviroment

• Patients have the right to treatment and freedom from restraint, and or seclusion, can be used for safety
• Restraints require direct application of force and strict monitoring
• HIPPA aims to safe guard patient information

Nursing Considerations

• Practice within scope and follow practice standards, assess to reduce liability
• Torts can be wrongful-unintentional like neglegence
• Torts can be intentional like assult, battery, or imprisonment

Unitarianism

• Moral decsions should be made based and evaluated by how the majority perceive
• Respect patient rights - autonomy, beneficence, do good, justice, be fair, veracity be truthul, and fidelity keep obligations

Grief

• It's the emotional response to loss
• Kubler-Ross's stages involve denial, anger, bargaining, depression, and acceptance
• Resolution often occurs within 6 months

Uncomplicated Grief

• Pt goes through stages with somatic complaints, and acceptance can be reached within 6 months

Disenfranchised Grief

• Grief that cannot be shared is not socially acceptable

Assess Grief

• Dimensions of human response
• Grief can cause suicidal ideation, which must be addressed

Management Considerations

• Promote coping and be empathetic
• Explore and use available techniques

Anger

• When appropriately managed, it is considered normal and is a positive force
• Inappropriate expression is negative force
• It follows patterns of identifiable stages
• Can be sudden and unexpected

Hostility

• Expressed through verbal abuse
• Involves violation of the rules

Management

• Ensure staff is involved and provide a safe space
• De-escalate and follow patient reintegration

Abuse

• Abuse spans wrongful, physical, emotional, sexual, neglect, financial exploitation
• Consider IPV: intimate partner violence with controlling traits
• Review risk factors for abuse
• Review stages of grief cycle

Interventions in Response to Abuse

• Report if suspected
• Restraining orders can serve as interventions
• Rape is a violent crime - provide testing and referrals

Traits of Abuse

• Abused are often victims of those they know
• Can be physical, psychological and emotional abuse, that presents as fear, that are seen in partners, the elderly, and or children
• The abuscive cycle includes violoence, honeymoon, and tension - abuse escalates
• Domestic violence is present across the age, race and culture
• When assessing, patients must be made to feel safe and victims do not commonly seek help
• Remember those from other countries face legal and social issues
• Assess all patients - if they feel safe in the relationship

PTSD:

• Can stem from experiencing intense overwhelming extraordinary circumstances

Symptoms

• Disturbed pattern of behavior, avoidance, increased risk of suicide, D/A abuse, poor social support and poor physical health can all play a role

Related to PTSD

• Adjustment, acute stress, and dissociative.
• There are similar incidence related to age, gender, type and repeated trauma

Subconscious Events

• Are used to prevent recognition
• The essential feature is to be disruptive
• The treatment options are counseling with meds

Traits of Stress

• There are intrusive thoughts and a negative cognition
• Can be a precursor to PTDS that takes place three months post trauma
• Personality factors can increase risk

Assessment Considerations

• Watch for suicidal idealation, self mutalation or ineffective coping
• Use effective coping and trauma exposure and create outcomes versus intervetions
• Use safe guard interventions
• Ensure to follow medication guidelines.