Illness and Hospitalization PDF

Illness and Hospitalization October 22, 2024  OBJECTIVES At the end of the session, the student will be able to: ﹡ Define the concept of illness; ﹡ Explore the health-illness concept; ﹡ Discuss the concerns of the ill patient and family; ﹡ Describe the effects of illness on...

Illness and Hospitalization October 22, 2024  OBJECTIVES At the end of the session, the student will be able to: ﹡ Define the concept of illness; ﹡ Explore the health-illness concept; ﹡ Discuss the concerns of the ill patient and family; ﹡ Describe the effects of illness on the individual and family 2  OBJECTIVES CONT’D ﹡ Discuss the patient's reactions to the confirmation of illness; ﹡ Explain the physiological, psychosocial and environmental forces influencing illness; ﹡ Discuss the nature of illness; ﹡ Examine the patient's behaviours exhibited during illness; ﹡ List the behavioural changes, which appear because of illness  OBJECTIVES CONT’D ﹡ Define hospitalization ﹡ Discuss the concept of hospitalization and the role of the hospital staff ﹡ Demonstrate skills in the admission and discharge of patients ﹡ Explain how to transfer a patient ﹡ Explain the impact of illness on the individual and family; ﹡ Examine the effects of hospitalization on the ill patient, family and significant other.  Disease Alteration in body functions resulting in a reduction of capacities or a shortening of the normal life span. Multiple factors interact to cause disease and determine an individual’s response to treatment. Berman et al, 2022  Definition  “Illness is a highly personal state in which the person’s physical, emotional, intellectual, social, developmental, or spiritual functioning is thought to be diminished”.  It is not synonymous with disease-and may or may not be related to disease  Illness is highly subjective Berman et al, 2022  Cont’d ﹡ An individual can have a disease and not feel ill ﹡ An individual can feel ill and yet have no discernible disease Berman et al, 2022  Definition  “ An illness is the response of the person to a disease: it is an abnormal process in which the person’s level of functioning is changed when compared with a previous level.”  Influenced by self-perceptions, perceptions of others, effects of changes on roles and relationships, cultural and spiritual values and beliefs. Taylor, Lillis, Lemone and Lynn, 2018  Types of illness  Acute  Chronic  ACUTE  Onset is rapid and lasts a relatively short time. The symptoms appear abruptly and subside quickly.  Depending on the cause it may or may not require interventions by medical professionals.  Taylor et al, 2018; Berman et al., 2022  CHRONIC  Permanent change  Causes or caused by irreversible alterations in normal anatomy and physiology  Requires special patient education for rehabilitation  Requires long period of care and support  Includes remission and exacerbation Berman et al, 2022; Taylor, 2018  Illness behaviours  When people become ill, they behave in certain ways that sociologists refer to as “ illness behaviour”.  Illness behaviour is a coping mechanism, involves ways individuals describe, monitor and interpret their symptoms, take remedial actions and use the healthcare system. Berman et al, 2022  Cont’d  How people behave when they are ill is highly individualized and affected by many variables such as age, sex, occupation, socioeconomic status, religion, ethnic origin, psychological stability, personality, education and modes of coping. Berman et al, 2022  Suchman (1979):Stages of illness Stage 1 Experiencing symptoms Stage 2 Assuming the sick role Stage 3 Medical care contact Stage 4 Assuming a dependent role Stage 5 Achieving recovery and rehabilitation  1 Of the following statements, which is most true of health and illness? a) Health and illness are the same for all people b) Health and illness are individually defined by each person c) People with acute illnesses are actually healthy d) People with chronic illnesses have poor health beliefs  2 Your friend tells you, “ I have a high temperature, feel awful, and I am not coming to class.” What stage of illness behaviour is your friend exhibiting? a) Experiencing symptoms b) Assuming the sick role c) Assuming a dependent role d) Achieving recovery and rehabilitation Effects of the illness 17 How does illness affect an individual  Privacy  Autonomy  Lifestyle  Roles  Finances  Relationships  Diet, activity, sleep  Impact on the client  Anxiety  Fear  Anger  Withdrawal  Denial  Changes in self-concept and body image  Sense of hopelessness Berman et al, 2022  Impact on the family The kind of effect depends on: Member who is ill Seriousness and length of the Illness Cultural and social customs of the family  Impact on the family  Role changes  Task reassignments and increased demands on time  Increased stress due to anxiety about the outcome of the illness  Financial constraints  Loneliness  Change in social customs Berman et al, 2022  Applying the Nursing Process: Classwork Maladaptive Coping Excessive caregiving burden Situational low self-esteem “Having strong support systems enhances resilience and widens access to coping strategies. Access to community agencies, family, and friends eases the burden of coping with chronic illness, as do prayer and strong religious faith.” Coping with chronic medical illness: Falcone, 2014.  Summary ﹡ Chronic medical illnesses challenges patient's coping skills. ﹡ The effectiveness of coping is determined by premorbid (baseline) coping strategies, current illness burden including comorbid psychiatric disorder(s), and availability of support mechanisms Falcone, 2014  Summary ﹡ Common indicators of ineffective coping include nonadherence to treatment, denial or minimization of illness, substance abuse, and high use of health care. ﹡ In addition to empathic listening and support, the physician should mobilize other sources of support including family, religious, and illness- oriented support groups. Falcone, 2014  Research Link ﹡ https://teachmemedicine.org/cleveland- clinic-coping-with-chronic-medical-illness/  Adherence  The extent to which an individual’s behaviour e.g. (taking medications, following diets, or making lifestyle changes) coincides with medical or health advice.  Another term used synonymously with adherence is conformance Berman et al, 2022  Factors influencing adherence o Client motivation to become well o Degree of lifestyle changes necessary o Perceived severity of the health problem o Value placed on reducing the threat of illness o Beliefs that the treatment will or will not help o Complexity, effects and duration of the proposed therapy o Cost of therapy or lifestyle change o Cultural beliefs that support or conflict with the regime Berman et al, 2022  Medication Nonadherence o Past experience o Taste and size o Cost o Number of doses o Side effects o Forgetfulness o Hopelessness Berman et al, 2022  Role of the nurse  Establish why the client is not following the regimen  Demonstrate caring  Encourage healthy behaviours through positive reinforcement  Use aids to reinforce teaching  Establish a therapeutic relationship of freedom, mutual understanding and responsibility with the client. Berman et al, 2022 Factors that affect health and illness  Basic human needs  Human Dimensions (Physical, Emotional, Environmental, intellectual, Spiritual, sociocultural)  Self-Concept Taylor, 2015 Basic human needs ﹡ HumanHuman Dimensions Dimensions Physical Spiritual Emotional Sociocultural Intellectual Environmental  Self-Concept  Self-esteem  Body image  Risk factors for illness A risk factor is something that increases a person’s chances for illness or injury.  Can be modifiable or non-modifiable  As the number of risk factors increase so does the possibility of illness.  Health promotion and illness prevention then becomes mandatory Taylor et al., 2018  Major areas of risk factors  Age  Genetic factors  Physiologic factors  Health habits  Lifestyle  Environment Taylor et al., 2018. ﹡.  Summary o The health status of a person is affected by many internal and external variables o Nurses can enhance health care adherence o Illness is usually associated with disease but may occur independently of it o Illness is a highly personal state in which the person feels unhealthy or ill o An individual’s usual pattern of behaviour changes with illness o Nurses need to be aware that the illness of one member of a family affects all other members.  3 A client with HIV is scheduled to begin several medications to manage the infection, thus the nurse will need to provide client education. Which client characteristics are most likely to predict adherence with the treatment program? Select all that apply. 1. Educational level 2. A trusting relationship with the health care provider 3. An expectation that the medications will help 4. Being able to take the medications twice daily instead of four times daily 5. Gender  4 Which one of the following might be the best way to measure adherence to a prescribed medication regime? a) Direct observation of medication administration b) Evidence of illness complications or exacerbations c) Monitoring laboratory values of elements influenced by the medication d) Questioning the client about his or her medication routine  5 A married mother of three small children has frequent immobilizing headaches of unknown cause. The nurse anticipates that the woman may have which of the following possible reactions? Select all that apply. 1. She feels guilty when unable to perform her usual activities 2. She is angry and acting out 3. She shifts some responsibilities to her spouse 4. She takes on a job to help pay for medical expenses 5. She has fewer social interactions with her friends  Hospitalization The act of placing a person in a hospital as a patient. The condition of being hospitalized. www.dictionary.com/browse/hospitalization  ADMISSION  Hospitalizing an individual for 24hrs or longer  Emergent usually happens when a patient seen in the emergency department is subsequently admitted to the hospital.  Elective hospital admissions occur when a doctor requests a bed be reserved for a patient on a specific day. www.emedicinehealth.com/hospital_admissions/arti cle_em.htm  Roles of the Nurse Administrator or manager – Assess and monitors patient’s health status – Provides direct care – Coordinates the care provided by others – Teaches patients and families – Plans, implements and evaluates the plan of care – Provides staff information – Coordinates discharge planning to ensure continuity of care – Provides specialized care – Makes referrals Nurse Practitioner Clinical Nurse Specialist Researcher Admissions to a Health care setting: Important concepts ﹡ Entering and leaving a healthcare setting are experiences that produce anxiety for both patients and family members. ﹡ Two concepts in nursing care: ○ Continuity of care ○ Community-based care ﹡ consider patient’s needs in his transition from the acute care setting to care at home  Admission: Important Concepts Anyone who enters a healthcare setting takes on a new role. They also enter an environment in which they are surrounded by strangers. Admission period corresponds to the orientation phase of the helping relationship. Nurses must provide holistic care and establish an effective nurse-patient relationship. Nurse acts as an advocate. Taylor, 2018 Establishing Effective Relationship Recognize and take steps to reduce the patient’s anxiety. Remember that the medical or surgical condition for which the patient is being treated is only one part of the patient’s life. Communicate with the patient as an individual so that he or she can maintain his or her own identity. Take time to learn who the patient being admitted is. Encourage the patient’s family to participate. Berman et al, 2022  Evaluation Check “Explains the admission procedure to a patient.” The nurse’s role which most appropriately describe this action is: A. Educator B. Clinician C. Advocate D. Researcher Admission to a Hospital Setting ○ Full name ○ Address ○ Date of birth ○ Name of admitting physician ○ Gender ○ Marital status ○ Nearest relative ○ Occupation & employer ○ Religious /Dietary Preferences ○ Allergies to food, medication, other ○ Medical and surgical history  Common Activities for Admission ﹡ Identification bracelet is made ○ contains: Identification number Patient’s name Physician’s name ○ important safety component during patient’s stay ○ identify patients who are irrational, comatose or young  Common Activities for Admission ﹡ Initial interview is done by the nurse. ○ Provides other information about legal and ethical components of care. ○ Patient asked to sign forms for consent to treatment and allow hospital to contact healthcare insurance companies or public agencies  Cont’d ﹡ During the initial interview: ○ Patient is asked for any advance directives (will or power of attorney) ○ Disclosure of health information ○ Patient is also asked to provide names of family members or friends as next of kin. ﹡ Patient’s Bill of Rights is given and explained to the patient.  Preparing the Unit for Admission ﹡ Position bed ○ For ambulatory patients, the bed should be in its lowest position. ○ For stretcher-borne patients, place the bed in its highest position. Ensure room is arranged to allow easy access to the bed.  Preparing the Unit for Admission ﹡ Open the bed by folding back the top linens. ﹡ Assemble routine equipment and supplies ○ Equipment for vital signs (stethoscope, sphygmomanometer and thermometer) ○ Height & weight equipment ○ Container for specimen( if needed) ﹡ Assemble special equipment and supplies ﹡ Adjust physical environment of the room.  Welcoming the Patient to the Unit ﹡ The nurse is responsible for ensuring comfort and well-being of the patient upon arrival in the unit. ﹡ Nurse completes: ○ Admission assessment ○ Inventory of personal belongings(per institution ○ Documents the information on the admission database Information is used to develop nursing care plan. Also used as database for discharge planning and home care.  Welcoming Cont’d ﹡ Patient should be welcomed to the unit in a courteous manner. ﹡ Nurse needs to assess the needs of the patient and family accompanying the patient. ○ They must mutually agree about whether family should be present during admission.  Transferring within and between Healthcare Settings ○ from ER to a hospital room ○ from an ICU to a hospital room ○ from one floor to another ○ From one room to another room on the same floor ﹡ Transfers to and from acute care settings and long-term settings ﹡ Transfers from acute care settings to their homes  Transfer Within the Hospital ﹡ All patient’s belongings must be transferred. ﹡ Ensure that belongings are not misplaced or lost. ﹡ Patient’s chart, Kardex, care plan and medications are re-labeled. ﹡ Ensure patient’s comfort and safety.  Transfer Within the Hospital ﹡ Nurse must report care to the other nurse in the new area. ﹡ Report includes patient’s name, age, physicians, admitting dx, surgical procedures, current condition and manifestations, allergies, medications, treatments, laboratory data and any special equipment. Nursing care priorities and advance directives are noted.  Discharge Planning ﹡ Nurses must consider that the patient may be expecting a change from dependent role to a more independent role. ﹡ Purpose: to ensure that patient and family needs are consistently met as the patient moves from acute care setting to care at home  Essential Components of a Discharge Plan ﹡ Assess strengths and limitation of the patient, the family or support person and the environment ﹡ Implementing and coordinating plan of care ﹡ Considering individual, family and community resources ﹡ Evaluating effectiveness of care  Essential Components of a Discharge Plan ﹡ Planning for discharge begins on admission. ﹡ Key: an exchange of information among the patient, caregivers, and those responsible for care while patient is in acute care setting and after the patient returns home ﹡ Nurse must ensure that family members are taught the necessary knowledge and skills. ﹡ Referrals to agencies to provide support and assistance are essential. Guidelines for Discharge Planning ﹡ Assessing and identifying Healthcare Needs ﹡ Setting goals with the patient ﹡ Teaching ﹡ Providing home healthcare referrals ﹡ Evaluating discharge planning effectiveness ﹡l  Assessing and identifying Healthcare Needs ﹡ Collect and organize data about the patient ○ include the family ﹡ Assess the patient for discharge. ○ Factors to assess: Health data – establish a database (age, gender, height/weight, etc.) Personal data – Language to use, feelings about being discharged, expectations for recovery, things to help in coping with stress Assessing and identifying Healthcare Needs Caregivers – caregiver’s age, gender, relationship, past experiences w/ illness or treatment, values & beliefs, cultural practices Environment Financial and support resources  Setting Goals with the Patient ﹡ Expected goals of the discharge plan are set mutually and must be realistic. ﹡ If not mutually agreed on, plan may fail. ﹡ Example: a diet plan that is mutually agreed on by patient  Teaching ﹡ Important teaching topics: ○ Self-care techniques ○ Medications Drug name, dosage, effects, purpose, frequency and S/E. ○ Procedures and treatments Demonstrated, practiced and provided in writing (e.g., wound dressing) ○ Diet Purpose and expected outcomes; write diet plan  Teaching ○ Referrals Appointments to first visit w/ physician; follow-up care ○ Health status Physical and emotional effects of illness ﹡ Teaching must always be documented.  Leaving against medical advice ﹡ Patient must sign a form that releases the physician and healthcare institution from any legal responsibility for his or her health status. ﹡ Patient is informed of any possible risk before signing the form. ﹡ Patient’s signature must be witnessed, and the form becomes part of the patient’s record. Berman et al, 2022  References ﹡ Berman A., Snyder S. & Frandsen G. (2022). Fundamentals of nursing. concepts, process and practice. Englewood, New Jersey: Prentice-Hall ﹡ Falcone, T. (2014). Retrieved at:www.clevelandclinicmeded.com/medic alpubs/diseasemanagement/psychiatry- psychology/coping-with-chronic-medical- illness/  References Taylor, C.; Lillis, C; LeMone, P.; & Lynn, P. (2018) Fundamentals of Nursing: 7th Edition: Lippincott Williams & Wilkins Ministry of Health Policy Manual 2008