Chronicity Exam 1 Study Guide PDF

https://quizlet.com/876119478/chronicity-exam-1-flash-cards/?funnelUUID=3e347074-4e56-4e1 1-8fb1-361e24b2d351 Chronicity Exam 1 Study Guide Chronicity: ​ Explore the concept of chronicity o​ How do you define chronicity? ▪​ “Chronic illness is th...

https://quizlet.com/876119478/chronicity-exam-1-flash-cards/?funnelUUID=3e347074-4e56-4e1 1-8fb1-361e24b2d351 Chronicity Exam 1 Study Guide Chronicity: ​ Explore the concept of chronicity o​ How do you define chronicity? ▪​ “Chronic illness is the lived experience of the individual and family diagnosed with chronic disease. The individual’s and family’s values impact their perceptions and beliefs of the condition and thus their illness and wellness behaviors. Their values are influenced by demographic, socioeconomic, technological, cultural, and environmental variables. The lived experience is ”known” only to the individual and the family.” o​ Chronic Disease Key Points ▪​ Top 4 Noncommunicable Diseases (NCD’s) ​ Cardiovascular diseases (heart disease and stroke) ​ Cancer ​ Diabetes ​ Chronic Respiratory Diseases ​ Mental Health diseases are also significant o​ 75% of global deaths are related to NCDs o​ Summarize the impact of chronic disease in the United States and globally today. ▪​ More than 50% of the world lives with chronic disease ▪​ Impact: high mortality indicator ​ Economics: costs trillions of $$$ to care for chronic conditions ▪​ US ​ Affecting the quality of life of people ​ Increase cost for healthcare due to the increase need for treatment and longterm care ​ Increase of disease and death for people in the US ▪​ Globally ​ Increase in noncommunicable disease– HTN, diabetes, and obesity ​ Lifestyle changes due to chronic illness ​ Healthcare is not ready to take care of the chronic illness and increased mortality due ot all the chronic illnesses ​ There is a lot of money needed for chronic individuals in the healthcare system  ​ Identify influences that impact persons with chronic health conditions ▪​ Major Risk Factors for NCDs: ​ Tobacco use ​ Unhealthy diet/nutrition ​ Excessive alcohol use ​ Physical inactivity ​ Air pollution o​ Which factors and influences have led to the increased incidence of chronic disease in the United States and globally? ▪​ Cultural ​ Some cultures having stigma around mental health conditions ​ Diets with high processed foods, high in fat and low in fruits – this can lead to diabetes in patients ​ Some may have cultural barriers for working out or getting healthier ▪​ Environmental ​ When there is high air pollution this can put a patient at risk for COPD ▪​ Biologic ​ Increased inflammation that can lead to RA ​ May have high genetics for DMT2 or sickle cell disease ▪​ Technologic ​ Different advancements in medicine have helped with chronic conditions by having continuous glucose monitor in order to examine diabetes blood glucose constantly ▪​ Socioeconomic ​ People in lower socioeconomic status are more likely to suffere from chronic health conditions due to not having access to care, poor nutrition, or living in polluted areas ▪​ Demographic ​ Racial and ethnic minorities such as African Americans have an increased risk for HTN and diabetes with a combination of having trouble accessing and economic status ​ Younger populations are seeing an increase in noncommunicable disease ​ Discuss competencies needed for nurses caring for persons with chronic health conditions o​ Clinical expertise in the chronic condition ▪​ Knowledge of the disease process of COPD, diabetes, and health decline/failure  ​ Explore attitudes and values related to chronic health conditions. o​ Stigma ▪​ Chronic conditions, especially those less visible (mental health and autoimmune diseases), may carry stigma, leading to isolation or reluctance to seek help. o​ Empowerment, Acceptance, and Awareness o​ Empathy and compassion o​ Cultural interpretations ▪​ Cultural norms and beliefs shape how chronic conditions are understood and treated, such as attributing illness to lifestyle, fate, or spiritual causes. o​ Independence ▪​ Maintaining autonomy is often a priority for individuals with chronic conditions. o​ Quality of Life ▪​ Many patients value holistic well-being, emphasizing symptom management and emotional health over mere survival. o​ Cost-Effectiveness o​ Access and Equity ​ Identify various societal factors related to chronic health conditions. ▪​ o​ Why do NCD’s Matter? ▪​ Negatively impacts overall health ▪​ Lead individuals to be more at risk/vulnerable to other conditions ​ Examples: o​ Diabetes, respiratory, heart disease with COVID-19 o​ HTN - risk for stroke, heart disease, diabetes, kidney failure ▪​ Financial cost of NCD’s: Individual & Economy ​ Poverty– not able to access healthcare to treat chronic illness ​ Productivity– people are not able to work due to being ill ​ Education– not able to complete and not reached full potential (higher educated take better care of themselves) ​ Core Competencies for Health Professionals o​ What needs to be done: ▪​ Political Action ​ Visibility, Commitment to action o​ Funding - primary prevention ▪​ Policies ​ Ex: Affordable Healthcare Act  ​ Provide affordable and accessible healthcare for EVERYONE ▪​ Stronger Health Care ​ Preventive Care, Robust Screening, Treatment ​ Affordable ​ Accessible ​ Knowledge/Education of HCWF (Health Care Work Force) o​ At the center– crucial to provide patient-centered care ▪​ 3 areas around this: ​ Employ evidence-based practice ​ Utilize informatics ​ Apply quality improvements ▪​ Working with interdisciplinary teams around the whole circle as it can related with all the different parts of patient care ​ How do ACEs impact chronic health conditions? ▪​ Adverse Childhood Experiences (ACE’s) ​ Potentially traumatic events that occur in childhood (0-17 years) ​ Examples: o​ Experiencing/witnessing violence o​ Neglect, Abuse (physical, sexual, psychosocial) o​ Family member attempt or die from suicide o​ Family substance misuse o​ Instability ▪​ Homelessness ▪​ Food insecurity ▪​ Care providers changing a lot ▪​ Ex: Foster care system ​ School nurses and social workers can be helpful for children ​ Can lead to toxic stress and increase early death and mortality and chronic illness. o​ What does scoring indicate? ▪​ An ACE score is calculated by counting the different types of traumatic events a person experienced during childhood (before 18 years old), with each type of ACE adding a point to the score, which ranges from 0 to 10. Higher scores reflect more severe childhood adversity and are linked to an increased likelihood of  developing various health issues, such as mental health disorders and heart disease, due to the long-term effects of trauma and toxic stress on the body. A score of 10 suggests a childhood marked by multiple traumatic experiences, while a score of 0 indicates a lack of these experiences. ▪​ Higher scores indicate have a variety of negative outcomes in adulthood such as- chronic health conditions (diabetes, heart disease, cancer, and stroke), mental health issues, substance abuse, risky behaviors, social and relationship problems. ▪​ ACE suggest the exposure to childhood trauma, that can have effects of brian development, stress response system, and relationships ▪​ Scoring is important due to seeing how much treatment is needed and target interventions. o​ What is the Impact of ACES on Chronic Illness? o​ Preventing ACE could potentially reduce a large number of health conditions o​ Some children are at greater risk than other– women and several racial/ethnic minority groups are at greater risk o​ ACE’s are costly — the economic and social costs to families, communities, and society are millions each year o​ Preventing ACE’s ▪​ Strengthen economic supports to families ▪​ Promote social norms that protect against violence and adversity ▪​ Ensure a strong start for children ▪​ Teach skills  ▪​ Connect youth to caring adults and activities ▪​ Intervene to lessen immediate and long-term harms ​ Proper screening tools / standardized tools ​ After school programs and clubs ▪​ Assess for support systems– family or friends around the child Stigma: ​ What is stigma? o​ Stigma can be defined as “a mark of shame” (“Stigma,” 2007) o​ “Stigma is a response to any physical or social attribute or characteristic that devalues a person’s social identity and disqualifies them from full social acceptance OR "an attribute that is deeply discrediting within a particular social interaction" (Goffman, 1963) o​ Link and Phelan (2001) describe stigma as involving the co-occurrence of components of labeling, stereotyping, cognitive separation into “us” and “them” groups, status loss, social rejection, and discrimination, in the context of power differentials that allow one group to successfully devalue another. ▪​ Tested on this definition ​ Conditions most likely to be stigmatized o​ Mental Health Conditions ▪​ Ex: Bipolar Disorder, Schizophrenia o​ Obesity ▪​ Example of a visible condition with avoidable risk factors o​ HIV/AIDS ▪​ Example of a condition NOT visible to most people and with avoidable risk behaviors o​ Physical Disability ▪​ Example of a visible disability (cerebral palsy, down syndrome, parkinsons)  ​ Stigma-Impact on Client Experience ▪​ How do family reactions impact the stigma experiences? ​ Negative feelings, shunning, feelings of isolation ▪​ How do community /societal reactions impact the stigma experience? ​ Make people feel bad or ashamed of their illness ▪​ How do HCP reactions impact the client’s experience? ​ Medical gas-lighting, dismissing people’s feelings and symptoms o​ Be able to give examples based on lecture ▪​ Obesity ​ Isolation, feelings of shame, judging on eating or exercise, can get judments and looks ▪​ Mental Health Illness/Conditions ​ Disbelief, family just blew off symptoms, men not wanting to get help and label in community ▪​ HIV/AIDS ​ Some very supportive and others not, community can be negative and judgy ​ Identify disparities in stigmatization of chronic health conditions o​ Negatively labeled persons are somehow fundamentally different o​ Why is it easier to mistreat “them”? ▪​ Vulnerable populations ▪​ Having different troubles o​ How are persons with chronic illness socially marginalized? ▪​ Stigma ▪​ Misunderstanding - some people may not understand the extent of the chronic illness, challenges at work, troubles with healthcare o​ If a person suffering from Schizophrenia is a Schizophrenic – what is a person suffering from Heart Disease? ▪​ The term "schizophrenic" is often used as a label to describe someone with schizophrenia, but this usage is problematic and reflects a reductionist view of the individual. It defines a person solely by their illness rather than recognizing them as a whole person. By contrast, when we talk about a person with heart disease, we typically don't label them as a "heart diseased" person. This discrepancy reflects an important difference in how society views mental health versus physical health. ​ Why is stigma complex ▪​ Population targeted ​ LGBTQ+ ​ Obesity ​ Mental Disorders ​ Learning disabilities  ​ Ageism o​ Inter-related types of stigma ▪​ Structural - type of stimga that is when somebody does not fit into structural norms ​ Healthcare, policies, social inequality ▪​ Public ​ General population feels certain about things, negative attitudes and beliefs (community) ▪​ Self ​ Internal of the person (stressful / shame) o​ Influence individuals’ decisions to seek help ▪​ Impacts health outcomes o​ “Stigma Complex” ▪​ Multidimensional ​ Link and Phelan Stigma considerations o​ What traits might be noticed, distinguished or labeled? ▪​ Similar to stereotyping o​ What traits might be associated with negative qualities? o​ What traits might result in the client being or feeling separated? ▪​ Family, community, from healthcare providers, job ▪​ Isolation o​ What traits might result in the loss of social status? ▪​ Definition: how they interact with everyone around them (like go out?) o​ What traits might result in discrimination? ▪​ Have you ever felt discrimination against? ▪​ Healthcare setting, on the street, my friends o​ What circumstances might result in the stigma being reinforced by people of authority or power? ▪​ Doctors, spouse, child ​ Consider the nurse's role in impacting outcomes for clients o​ Put Stigma to Shame ▪​ Shame promotes shame ▪​ Don’t try to mitigate shame o​ HCW’s can take stand against stigma with these key actions: ▪​ Main confidentiality/privacy of our patients ▪​ Correct false language ▪​ Speak out against negative language/behaviors ▪​ Suggest/provide useful resources for those experiencing stigma ▪​ Promote diversity and avoid stereotypes  ​ Identify communication strategies related to persons experiencing stigma o​ Active listening and showing empathy o​ Normalize conversations about chronic health conditions o​ Respect privacy and confidentiality o​ Educate the patient and raise awareness o​ Foster strength and empowerment o​ Remove self-stigma ​ STIGMA: Discrimination o​ Personal Discrimination – loss of privilege, opportunity or equal access o​ Structural Discrimination – a disabling environment limits participation o​ Architectural Barriers ▪​ Disability Access (ex: wheelchair access in buildings) ▪​ Elevators o​ Funding Barriers ▪​ Money and dollars to individuals with chronic illnesses ▪​ Research centers ▪​ Autism centers o​ Treatment Barriers ▪​ Medications ▪​ Providers Quality of Life: ​ Describe QOL ▪​ WHO defines WOL “as individual’s perception of ther position in life in the context of culture and values system in which they live and in relation to their goals, expectations, standards, and concerns.” o​ What is HRQOL ▪​ Physical/disease of QOL ▪​ Focus on life quality impacted by physical and mental disease ▪​ Cella (1995) “the extent to which one’s usual or expected physical, emotional, and social well-being are affected by a medical condition or its treatment” o​ WHO QOL Domains ▪​ Physical Health ▪​ Psychological Health ▪​ Level of Independence ​ Tasks for yourself ​ Moving around in the home ​ Getting groceries ▪​ Social Relationships ▪​ Environment ​ Things around you such as weather ​ Air or water pollution ​ Living next to a plant ▪​ Spirituality, Religion, and Personal Beliefs ​ Identify methods to measure QOL ▪​ Functional ability (basic ability to get around and function in everyday life) ▪​ Individual experience o​ Why is it difficult to measure QOL ▪​ Everyone has a different outlook on QOL - multidimensional and highly subjective concept ▪​ Subjective: ask about their QOL / pain level ▪​ Objective: functional ability – see if having troubles walking or getting around in everyday life ▪​ Satisfaction component ( life or health) o​ Why is it important to measure QOL ▪​ Measuring quality of life (QOL) is important because it provides a holistic understanding of well-being beyond traditional metrics like income or physical health.  ▪​ Treat the patient for patient-centered care ▪​ Holistic care ▪​ Tracking progress and comparing different interventions ▪​ QOL acknowledges that well-being is about more than just physical health; it integrates emotional, social, and environmental factors into a comprehensive view of life satisfaction. o​ Pros of measuring QOL ▪​ Holistic Understanding: Captures physical, emotional, social, and environmental well-being. ▪​ Patient-Centered Care: Improves treatment planning by addressing patients’ overall needs. ▪​ Informed Decision-Making: Guides healthcare providers, policymakers, and individuals. ▪​ Identifies Disparities: Highlights inequities to address marginalized populations. ▪​ Evaluates Interventions: Tracks the effectiveness of treatments or public health programs. ▪​ Advocacy Tool: Strengthens the case for funding and resources in areas of need. ▪​ Tracking progression of disease (a dip in QOL shows the disease is taking over) ▪​ Track adherence of the patient ▪​ Determine illness burden ▪​ Check client satisfaction and improve satisfaction o​ Cons of measuring QOL ▪​ Subjectivity: Varies greatly between individuals, making standardization difficult. ▪​ Cultural Bias: Tools may not account for differences in cultural values or norms. ▪​ Complexity: Requires balancing multiple dimensions (e.g., health, finances, environment). ▪​ Dynamic Nature: QOL changes over time, making consistent measurement challenging. ▪​ Measurement Issues: Self-reported data can be biased or unreliable. ▪​ Resource-Intensive: Can be costly and time-consuming to assess thoroughly. ▪​ Limited accuracy ​ Mainly subjective ​ Everyone has a different experience ▪​ Hard to measure ▪​ Implementation — not good at implementing QOL instruments / interventions  o​ Example QOL questions (be familiar with) ▪​ QOL Example Questions 1 ​ How satisfied are you with your hearing, vision or other senses overall? ​ How satisfied are you with your heath? ​ How satisfied are you with yourself? ​ How satisfied are you with your ability to perform you daily living activities? ​ How satisfied are you with your personal relationships? ​ How satisfied are you with the conditions of your living place (your home)? ​ How satisfied are you with the way you use your time? ▪​ QOL Example Questions 2 ​ Do you have enough energy for everyday life? ​ How much control do you have over the things you life to do? ​ To what extent are you satisfied with your opportunities to continue achieving in life? ​ Do you have enough money to meet your needs? ​ How satisfied are you with your intimate relationships in your life? ​ Compare and contrast QOL instruments (instruments discussed in class/lecture) o​ Healthy Days ▪​ Developer: CDC (Centers for Disease Control and Prevention). ▪​ Focus: Measures perceived physical and mental health over the past 30 days. ▪​ Structure: Includes 4 core questions: ​ During the past 30 days, for about how many days did PAIN make it hard for you to do your usual activities, such as self-care, work, or recreation? ​ During the past 30 days, for about how many days have you feld SAD, BLUE, or DEPRESSED? ​ During the past 30 days, for about how many days have you felt WORRIED, TENSE, or ANXIETY? ​ During the past 30 days, for about how many days have you felt you did NOT get ENOUGH REST or SLEEP? ▪​ Strengths: Simple, quick to administer, population-level data. ▪​ Limitations: Limited scope—does not assess broader dimensions like social relationships or environment. ▪​ Best Used For: Public health surveys, community health assessments. ▪​ 4 domains: pain, sad/depressed, anxiety, sleep ▪​ Assesses adequate health over a 30 day period of time o​ WHOQOL-BREF ▪​ Developer: World Health Organization (WHO).  ▪​ Focus: Measures overall QOL across 4 domains—physical health, psychological, social relationships, and environment. ​ The WHOQOL-BRIEF assesses quality of life (QOL) within the context of an individual’s culture, value systems, personal goals, standards and concerns. ▪​ Structure: 26 items derived from the larger WHOQOL-100. ▪​ Strengths: Multidimensional, internationally validated, culturally adaptable. ▪​ Limitations: Longer and more complex than Healthy Days, subjective responses may vary. ▪​ Best Used For: Cross-cultural studies, individual or community-level QOL assessments. ▪​ HCP cannot be in the room while the patient completes this ▪​ Looks at the time period over the last 2 weeks ▪​ Intended Population ​ Specific populations or groups with a particular disease, or general populations. ​ The WHOQOL-BRIEF is a self-administered questionnaire comprising 26 questions on the individual’s perceptions of their health and well-being over the previous two weeks. o​ PROMIS ▪​ Developer: NIH (National Institutes of Health). ▪​ Focus: Measures physical, mental, and social health using a bank of items tailored to specific conditions. ​ Physical (health & functioning) ​ Mental (psychological & spiritual) ​ Social (social roles and economic status) ▪​ Structure: Adaptive (tailored to the respondent) with computerized assessments or fixed short forms. ▪​ Strengths: Customizable, precise, and condition-specific; suitable for clinical and research settings. ▪​ Limitations: Requires technology and training to implement; not always comparable across populations. ▪​ Best Used For: Individual-level assessments, clinical trials, and healthcare research.  ▪​ Used a lot in community health resources and is a lot easier to use ▪​ *only tool that can be used for pediatric patients* ▪​ Core: PROMIS profile domains ▪​ Nurses can add more questions in the PROMIS additional domains ​ Consider nursing implications pertaining to QOL when caring for clients with chronic conditions o​ Interventions should be individualized ▪​ Using educational and cognitive approaches o​ Focus on wellness and health promotion o​ Empower the individual o​ Primary outcome should be health behaviors and QoL o​ Home-based ▪​ Visiting pt at home (VNA), telehealth, phone calls o​ Assist individuals in determining own needs and goals Adherence: ​ What is adherence? o​ The extent to which a person’s behavior– taking medications, following a diet, and/or executing lifestyle changes– corresponds with agreed recommendations from a health care provider. o​ Definition of Adherence for Chronic Disease: ▪​ “Diseases which have one or more of the following characteristics: they are permanent, leave residual disability, caused by irreversible pathological alteration, require special training of the patient for rehabilitation, or may be expected to require a long period of supervision, observation, or care.” ​ Differences b/t adherence and compliance Adherence Compliance Definition: “the extent to which a person’s Definition: “the extent to which the patient’s behavior– taking medications, following a behavior matches the prescriber’s diet, and/or executing lifestyle changes– recommendations.” corresponds with agreed recommendations from a health care provider.” Focus: Partnership between the patient and Focus: Emphasizes obedience to the provider, emphasizing collaboration and provider’s recommendations shared decision-making. Perspective: Patient-centered, acknowledging Perspective: Provider-centered, often individual autonomy and preferences. assuming the provider knows best without as much input from the patient. Connotation: Positive and respectful, Connotation: Can feel paternalistic or implying an active, engaged role for the judgmental, implying the patient has little role patient. in decision-making. Active-role Passive-role o​ Important to note that adherence and compliance are sometimes used INTERCHANGEABLY, and that is INCORRECT! o​ When patients do not follow-through with their treatment regimen, they are actually nonadherent NOT non-compliant. o​ Be aware of labeling patients ​ Quality of treatment relationship o​ Regimen is negotiated o​ Alternative therapies explored  o​ Adherence is discussed ▪​ What does this mean to the patient? To the provider? o​ Follow-up is planned o​ Consider if nonadherence ▪​ Unintentional or intentional ​ unintentional- can’t afford the medications, don't show up for the follow up due not having a ride, not understanding what you said to them ​ intentional- patient understands the plan but chooses not to follow it due to side effects with a lot of behavioral health medication ​ What are nursing implications pertaining to adherence to long term treatments? o​ How can adherence be measured or judged? ▪​ Understanding the perception of adherence ▪​ Objective ​ assessment information-ask the patient about the medication and have them bring it into the office and count how many pills are in the bottle ​ electronic monitoring like getting the data from insulin pump ▪​ Biochemical Markers ​ Taking blood test to see how much medication is in the patient blood o​ Factors that contribute to adherence ▪​ Psychological ​ Perceived illness, barriers to the illness, benefits of illness ▪​ Physical ​ Opening the medication bottle, getting to appointments ▪​ Social support ​ Family and friends ▪​ Prior Health Behavior ​ Health promotion and health belief model ▪​ Somatic ​ Symptoms of the disease ▪​ Regimen characteristics ​ Complexity of treatment regimen ▪​ Economic ​ Socioeconomic status seen as an independent predictor o​ transportation, money, food, lower economical status ​ Choosing between priorities o​ Needs of the family ▪​ Spouse ▪​ Children ▪​ Parents ▪​ Grandchildren  ​ Organizational Variables o​ Ex: health insurance o​ Insurance benefits, healthcare systems, continuity of care ​ Limited resources and needing to choose the priority- choosing between mortgage and medication. ▪​ Cultural ​ Conflict between culture, does not speak english ▪​ Patient-Provider Interactions/Relationships ​ Trusting the provider ▪​ Adherence is MULTIDIMENSIONAL and is also MISUNDERSTOOD o​ Theoretical models to guide change and adherence ▪​ HBM (Health Belief Model) ​ Core Idea: Behavior change occurs when individuals perceive a threat to their health and believe the benefits of action outweigh the barriers. Key Components: ​ Perceived Susceptibility: How likely am I to get this condition? ​ Perceived Severity: How serious are the consequences? ​ Perceived Benefits: What do I gain by following the treatment? ​ Perceived Barriers: What are the obstacles (e.g., cost, side effects)? ​ Cues to Action: External triggers (e.g., reminders, education). ​ Self-Efficacy: Confidence in one’s ability to adhere. Application: Used for educating patients about health risks and motivating behavior change by reducing barriers and enhancing perceived benefits.  ▪​ TTM (Transtheoretical Model of Change) ​ Core Idea: Behavior change is a process that occurs in stages, and interventions should match the individual’s current stage. Stages: 1.​ Precontemplation: No intention to change; unaware of the problem. 2.​ Contemplation: Aware of the problem; thinking about change but ambivalent. 3.​ Preparation: Ready to take action and planning specific steps. 4.​ Action: Actively making changes to adhere to the treatment plan. 5.​ Maintenance: Sustaining behavior and preventing relapse. 6.​ Termination: Behavior becomes permanent; no temptation to return to old habits. Application: Tailor interventions based on a person’s stage, like raising awareness for those in precontemplation or providing support for action and maintenance. ▪​ HPM (Health Promotion Model) ​ Core Idea: Health behaviors are influenced by individual characteristics, experiences, and specific factors that promote or hinder adherence. Key Components: ​ Personal Factors: Biological (e.g., age, gender), psychological (e.g., motivation), and socio-cultural factors (e.g., social norms). ​ Perceived Benefits of Action: Positive outcomes associated with adherence. ​ Perceived Barriers to Action: Factors that make adherence difficult. ​ Perceived Self-Efficacy: Confidence in one’s ability to perform the behavior. ​ Interpersonal Influences: Social support, family, and healthcare provider encouragement. ​ Situational Influences: Environment and accessibility of resources. Application: Focuses on empowering individuals through education, support, and creating an environment conducive to adherence.  Model Focus Key Strengths Best For HBM Preceptions of health Clear framework for Educating and threats addressing barriers motivating patients TTM Stages of behavior Tailored interventions Long-term behavior change by stage change HPM Promoting positive Holistic view of Empowerment and health behaviors influences on prevention behavior o​ Interventions to enhance adherence ▪​ Education and coaching ​ Health literacy ​ Health Numeracy o​ Teach-back o​ Plain language and visual aids o​ Provide tools ▪​ Behavioral strategies ​ Manageable steps ​ Positive reinforcement ▪​ Tailoring ​ Meet patient needs and wants middle ground. ​ Individualized interventions ​ Include family members or caregivers ▪​ Simplifying the regimen ​ Reduce the complexity of treatments ▪​ Providing reminders ​ Text reminders, alarms, or app notifications ​ Sticky notes or calendar markings ▪​ Ethnocultural interventions ​ Respect cultural beliefs, values, and practices ​ Offer culturally relevant education ​ Provide care in patient’s native language ​ Consider nursing implications pertaining to QOL when caring for clients with chronic conditions o​ Patient-Related Factors ▪​ Resources  ▪​ Knowledge ▪​ Attitudes ▪​ Beliefs ▪​ Perceptions ▪​ Expectations o​ Condition Related Factors ▪​ Severity of Symptoms ▪​ Level of Disability ▪​ Rate of Progression ▪​ Severity of Disease ▪​ Availability of Effective Treatments Grief and Loss: ​ Explore concept of grief and loss related to care of chronically ill persons o​ Loss ▪​ “Something or someone of value is rendered inaccessible or drastically changes” o​ Grief ▪​ “Combination of various psychological biological and behavior responses to a loss” ▪​ Psychological loss of grief: stages of grief (denial, anger, bargaining, depression, acceptance) ▪​ Grief should NOT be avoided – a lot of issues with your physical and psychosocial health ▪​ Grief– typically 0-3 months o​ Bereavement ▪​ “Is the response to having lost another through death” o​ Mourning ▪​ “Involves the processing and resolution of grief, generally through cultural or spiritual beliefs and practices” ▪​ Takes about 1-2 years ​ Compare and contrast types of loss and grief o​ Identify characteristics related to loss ▪​ Actual loss  ​ Lost something that is social recognized ​ Someone is actually losing someone ​ others can see it ​ a pet or person dies ▪​ Anticipatory loss ​ Expecting to lose someone ​ chronic illness- cancer diagnosis ​ ALS ▪​ Perceived loss ​ Somebody has lost somebody but it is NOT a socially recognized as a loss ​ Ex: affair where you lose someone but socially no one really knows about it (other people don’t recognize that as a loss for you) o​ Loss of independence o​ Loss of self-esteem/self concept ​ Opposite of actual loss no one else really knows about it, felt by the individual but can not be visualized. o​ Identify characteristics related to loss ▪​ Anticipatory ​ Before event occurs ​ Might experience grief twice; once while someone is dying and after death ​ Know of an event before it actually happens ▪​ Disenfranchised ​ Not socially recognized ​ Ex: pregnant and put up for adoption and no one knows and the mother is grieving the loss for the rest of her life ▪​ Complicated ​ Extends beyond a 6-month period ​ Tends to be debilitating to individuals ​ Difficult to complete ADLs, work, etc. ​ Theories related to grieving. o​ Kubler-Ross ▪​ Stages of Grief ​ Denial ​ Anger ​ Bargaining  ​ Depression ​ Acceptance o​ George Engel ▪​ Shock ▪​ Disbelief ▪​ Awareness ▪​ Restitution ▪​ Idealization ▪​ Outcome o​ Catherine Sanders ▪​ Shock ▪​ Awareness ▪​ Conservation ▪​ Healing Renewal o​ Nurse application: explain the stages of someone who is actively dying but tend to use them for both the person dying and someone grieving to the death  ​ Manifestations of Grief o​ Normal v. maladaptive Normal Manifestations Maladaptive Manifestations Normal grief reactions difficult to define Complicated Grief: extends beyond a 6-month -​ All individuals grieve differently period -​ Difficulty resuming daily life, withdrawal, or inability to function. -​ Persistent sadness or overwhelming emotions that prevent moving on. Can get to the point where individuals are hallucinating or having illusions ➔​ Extreme risk of suicide ➔​ Low self esteem/low support system: higher risk for complicated grief Common Manifestations: Common Manifestations: -​ Sadness -​ Prolonged intense mourning -​ Anxiety -​ Inability to accept the loss -​ Guilt -​ Denial & disbelief -​ Anger -​ Difficulty moving on -​ Confusion -​ Stuck in the past -​ Sleep disturbances -​ Avoidance of reminders -​ Loss of appetite -​ Physical pain -​ Emotional numbness -​ Loss of purpose -​ Self-blame / obsessive overthinking -​ Survivor’s guilt -​ Difficulty resuming ADLs -​ Isolation -​ Difficulty finding meaning or hope -​ Not sleeping and having chronic depression, avoiding or engaging in risky behaviors ​ Factors affecting the grieving process o​ Take into account the nature of the individual’s loss and support system o​ Cumulative loss ▪​ Several losses over a short period of time ▪​ How much loss someone has suffered throughout their life ▪​ Never-ending cycle of loss o​ Age  ▪​ Children, Adults, Older Adults ▪​ Adolescents tend to be more in your face about grief/anger ▪​ Children under 8 don’t understand permanence of death, adolescent tend to be angry, young/middle adult all over the place, older adult silent grief lack of resources and possible isolation o​ Gender ▪​ Can vary – Female tend to show more emotions o​ Resilience ▪​ Relates to self esteem usually do better o​ Asking for help ​ Identify nursing care implications related to grief and loss o​ Grief and loss assessment o​ Complete medical history- this will give a better background on patient and looking for extensive history of loss of patient, current loss, history of loss, lifestyle and how it could impact the patient o​ Support system is key o​ Substance abuse- alcohol or prescription history if the patient will go back to that or have used that in the past  o​ Interventions ▪​ Independent ​ Teaching patient about grieving process, its progression ​ Discussing benefits of different forms of therapy, differences between them ​ Informing patient about warning signs of intense depression, suicidal thoughts ​ Teaching patient about healthy coping mechanisms ​ Providing judgment-free area for patient to discuss experiences, fears ​ Encouraging patient to share emotions, fears with close family member, friends ​ Providing referral to resources to help patient maintain independence ▪​ Helping the patient cope with dying ​ Dying person experiences stages of grief ​ Preparing for one’s own death is unique process ​ Some nurses might be uncomfortable talking with dying person ​ Let dying person lead the conversation ​ Be honest about patient’s health status unless that is not culturally acceptable to patient and family ▪​ Collaborative ​ Facilitate meetings for patient, family with hospital chaplain ​ Referral to social worker for guidance on coping with loss ​ Group therapy, bereavement group, grief therapy ​ Hospice ​ Pharmacological Therapies ​ Components of loss in chronic conditions o​ Self & identity o​ Time o​ Work o​ Loss of touch o​ Physical losses o​ Environment o​ Chronic sorrow **There will be questions based on the assigned reading from The Spirit Catches You and You Fall Down (Ch 1-8) and linking to class concepts and exemplars.