N110

Care is based on continuous health relationships.

Care is customized according to patient needs and values.

The patient is the source of control.

Knowledge is shared and information flows freely

◦The ability of the health care team members to provide patient-centered care to each patient.

◦The ability of an organization to operate as a patient-centered health care organization

◦The ability of the health system at the local, state, and national levels to allow for patient-centered health care

Macro Consumers

◦The government and health insurance companies

◦Major purchasers of health care

Micro Consumers

◦Patients and their families/friends/significant others

◦Severe symptoms

◦Relatively short-lived in duration

◦Can be fatal without intervention or non life-threatening – not require any treatment at all

◦Usually return to return to previous level of health

◦Complications may result in chronic conditions

◦Often develop gradually

◦Require ongoing treatment

◦Continue for the duration of the patient’s life

◦Major shift in health care to focus on chronic illness

• ◦In U.S., increase of chronic illness related to sedentary lifestyles, obesity, and
• aging population

◦Conditions vary in severity and outcomes

◦Generally not an end point of regained health

◦May occur as periods of exacerbation and remission

◦In U.S., more people die from chronic illness than acute illness

• Many times health care providers focus too much on only the physical aspects of
• illness

• Emotional responses by the patient and family may be a greater challenge to manage than
• the illness

Severe emotional responses may impair treatment

Disbelief and Denial

Irritability and Anger

Attempting to Gain Control

Depression and Despair

Acceptance and Participation

Culture often influences how a person responds to illness

Response to illness is learned as a child through observing parents

• The nurse must be able to provide culturally competent care to patients from many
• different cultural backgrounds

The nurse must remain non judgmental about the patient’s choices

• The patient’s perception of illness often influences the patient’s decisions to
• follow a prescribed treatment regimen.

◦Can be frustrating for the health care providers and the patient’s family

◦“Noncompliant” is not an acceptable term for patients

Caring for the chronically ill is a challenge

The focus of health care has long been to cure every ailment

The inability to cure the chronically ill is difficult for the health care provider

The nurse must recognize his/her own feelings in order to maintain a good nurse-patient relationship

Internal Influences

External Influences

Dependence vs. Independence

Coping ability

Hardiness

Resilience

Spirituality

Past experiences

Culture

Communication patterns

Personal space norms

Role Expectations

Values

Reaction to prescribed medications

◦Ethnopharmacology


Ethnocentrism

Behavioral and Emotional Changes

Changes in Family Roles

Disturbed Family Dynamics

Results in increased patient and family stress

Affected by:

◦Illness severity

◦Personality before illness

◦Suddenness

◦Extent and duration of lifestyle changes

◦Individual and family resources

◦Life-cycle stage of patient and family

◦Previous illness experiences

◦Social support

◦Religion

Guilt

Anger

◦Safety concerns

Anxiety

◦Levels

–Mild, Moderate, Severe, Panic

Stress

Response to an actual or perceived threat

Signs and Symptoms

◦Increased heart rate, respiratory rate, blood pressure

◦Insomnia

◦Nausea and Vomiting

◦Fatigue

◦Sweat palms

◦Tremors

◦Restlessness

◦Irritability

◦Hopelessness

◦Inattention to surroundings

◦Forgetfulness

Nurse must be aware of his/her own feelings – anxiety is contagious!

Results from factors that cause stress (stressors)

◦External (e.g. noise, heat, cold)

◦Internal (e.g. personal unrealistic expectations)

◦Interpersonal (conflicts with others)

The result of interactions between the individual and the environment

Illness is just one of many stressors that patients experience

Can result in physiologic responses

A factor that may result in the development of illness

Stress may result in prolonged illness/delayed healing

Recognize stressors

Eliminate as many stressors as possible

Relaxation techniques

◦Deep breathing

◦Muscle relaxation (massage)

◦Guided imagery

Patient Education

Assess the dynamics of the family

Recognize anxiety within families and attempt to reduce it

Keep the patient and family well informed

Some families may benefit from support groups

Assist the family in finding ways to manage guilt, anger, and resentment

• The nurse should recognize that families may express anger and distrust toward the
• health care team for being unable to cure the illness or eliminate negative
• outcomes

Common in families of patients with prolonged illnesses

Becomes difficult for family members to care for their ill family member

• Symptoms include: denial, anger, social withdrawal, anxiety, depression, irritability,
• lack of concentration, health problems

◦Increased family closeness

◦Teamwork

◦Newly recognized individual and family strengths

◦New meanings and personal values

◦Increased flexibility in lifestyle

◦Changes in life priorities

The priority of health care (nursing) is the patient (which includes the patient’s family, friends, significant other)