Chronicity

Question 1

Define chronicity.

Answer 1

It is an ongoing health condition that at the time of diagnosis, or during the expected trajectory of the condition, will produce one or more of the following current or long term sequelae:

• limitation of functions appropriate for age and development
• dependency on meds, technology, diet
• disfigurement

Question 2

What are the six characteristics of chronic illness.

Answer 2

1) person experiences impaired functioning in more than one dimension
2) dependency on meds and technology
3) unpredictability and uncertainty
4) ongoing diseases symptoms and treatment can interfere with norm activities
5) individuals experience multiple losses
6) unpredictability and uncertainty

Question 3

Describe the things that are associated with the diagnosis of a chronic illness.

Answer 3

Emotional experience
- may involve relief that symptoms are legitimized

HC professionals may be unaware of the impact of the illness

Can signal a scientific dead end

Question 4

What is the emotional response to chronic illness?

Answer 4

FEAR

GRIEF

ANXIETY

GUILT

Question 5

How might an individual feel prior to being diagnosed with a chronic condition?

Answer 5

Uncertain b/c they have no cause

Question 6

What might happen to symptoms when someone has an undiagnosed chronic illness?

Answer 6

symptoms may be minimized or misdiagnosed by health care professionals

Question 7

How do individuals typically respond emotionally to a diagnosis of chronic illness?

Answer 7

Often feel relief that symptoms are legitimized

Highly varied response: depends on the impact of the illness

Question 8

What are the two ways that fear can be a response to chronic illness?

Answer 8

ADAPTIVE: drives you to act, learn, and adapt

MALADAPTIVE: paralyze you, create anger, withdrawal, and strain on relationships

Question 9

Why might individuals experience grief in response to a chronic illness?

Answer 9

Loss of….

• activities
• function
• independence
• career
• relationships
• dreams
• income

Question 10

Why might individuals anxiety in response to chronic illness?

Answer 10

over uncertainty and treatment

Question 11

Why might individuals experience guilt in response to chronic illness?

Answer 11

Feel like it is there fault

Self blame

Not catching it earlier

Not complying earlier (ex exercise and diet)

Question 12

What is the most common manifestation of chronic illness?

Answer 12

Fatigue

Question 13

What is the non-pharmacological therapy for fatigue?

Answer 13

Exercise, at a level that is manageable

Question 14

What is one of the things that can disrupt or interfere with social relationships?

Answer 14

the stigma associated with the illness

ex: diabetics don’t eat properly, blaming the patient, etc

Question 15

What could the visibility of the disease cause?

Answer 15

Diminished social credibility (seen as invalid)

Stereotyping.

results from altered appearance, restricted mobility, unusual behaviours

Question 16

What are the 4 things that make up the invisible side of the disease?

Answer 16

Fatigue

Pain (b/c HCP often rely on visual confirmation of pain b4 meds)

Limited sympathy and empathy for chronic pain

Emotional turmoil

Question 17

What did Thorne define as the goals/tasks of individuals regarding chronic illness

Answer 17

1) prevent acute episodes
2) manage treatment regimes, meds, and procedures
3) to access HCP
4) to pace and plan activities to reduce fatigue
5) to protect self from anxiety and depression

Question 18

What are three concepts regarding living with chronicity?

Answer 18

POWERLESSNESS: (use power resources) uncertainty

ADAPTATION:

• normalization
• shifting perspectives

COPING STRATEGIES:

• approach
• avoidance

Question 19

Who developed the concept of power resources? What are they?

Answer 19

Miller

strengths that individuals possess to manage living with a chronic disease

Question 20

List the 7 power resources

Answer 20

1) Knowledge of disease
2) Motivation
3) Positive self concept
4) Physical str and energy
5) Spirituality
6) Psychological stamina and social support
7) Energy

Question 21

At what points does uncertainty occur in chronic disease?

Answer 21

at all points: leading up to diagnosis, treatment, and prognosis

Question 22

What are some factors that influence uncertainty. (MISHEL)

Answer 22

Severity of illness

Diagnosis and lack of information

Personality factors

Social support

HCP

Demographic variables

Question 23

how does uncertainty vary in chronic vs acute illness?

Answer 23

ACUTE: self limiting

CHRONIC: constant.
may dissolve with adaptation

Question 24

What are the 6 attributes of situations leading to uncertainty (McCormick)

Answer 24

1) Ambiguity: more than one interpretation
2) Inconsistency
3) Vagueness
4) Unpredictability
5) Lack of information
6) Unfamiliarity

Question 25

List and explain three sources of uncertainty in parents with sick children.

Answer 25

DIAGNOSIS: lack of knowledge, impact on future, etc SYMPTOMS: management, interpretation, prioritization HCP: lack of confidence in them, too much jargon, no validation

Question 26

List three ways to resolve uncertainty.

Answer 26

Acknowledge the circumstances Seek information Engage in the transition

Question 27

List three ineffective ways of dealing with uncertainty

Answer 27

EMOTIONAL FOCUSED COPING: anxiousness, angry, instant gratification AVOIDANCE DENIAL

Question 28

What can a nurse do for a patient experiencing uncertainty?

Answer 28

Assist pt to interpret illness events Provide psychosocial support Provide information including alternatives Advocate for pt Foster hope (success stories, encouragement, recognize strengths) Enhance spiritual well being

Question 29

What is normalization?

Answer 29

altering one's sense of normal by constructing a new sense of normal. find ways to live as normal as possible to minimize social effects

Question 30

What is one of the negative things that normalization can cause?

Answer 30

denial or delayed request for assistance. may cause individual not to follow treatment

Question 31

Describe the shifting perspectives theory by Patterson

Answer 31

It explains that wellness and illness shift from foreground to background constantly, especially in chronic illness Wellness in the foreground: don't see self as sick Illness in the foreground: focused on symptoms and management until new norm is achieved

Question 32

List the adaptive tasks for parents who have children with chronic illnesses

Answer 32

Accept the child's condition Manage the illness on a day to day basis Meet normal developmental needs Meet developmental needs of other family members Cope with ongoing stress and periodic crises Educate others about the illness Establish a support system

Question 33

Describe approach coping strategies

Answer 33

Behaviours that indicate a willingness to confront the realities of the illness, awareness of personal reactions, and an attempt to deal with them

Question 34

Give some examples of approach coping strategies

Answer 34

``` seeking information enhancing spiritual life self distraction expressing feelings seeking social support ```

Question 35

Describe what avoidance coping strategies are.

Answer 35

Behaviours that protect the individual from conscious confrontation with the threat

Question 36

Give some examples of avoidance coping strategies

Answer 36

denial, suppression, minimizing symptoms, withdrawal, talking about self, passive acceptance

Question 37

What are some things that help with acceptance of the chronic illness

Answer 37

recognition of the illness by HCP faith in higher power put illness in context of other losses find some good in an otherwise neg experience

Question 38

Can mechanical items like a w/c, crutches, or walker be a part of body image?

Answer 38

yes

Question 39

What are the 4 phases of readjustment to body image disturbances?

Answer 39

1) psychological shock 2) withdrawal 3) acknowledgement 4) integration

Question 40

Explain how chronic illness effects sexuality.

Answer 40

fatigue, pain, disability, meds, altered body image, dec self esteem all impact fearful of intimate relationships need time to grieve the losses and gradually adjust

Question 41

List the three phases of the relationship development between families living with chronic illness and the HCP

Answer 41

1) Naïve trust 2) Disenchantment 3) Guarded alliance