1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 54...

1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.

Chapter 54

Psychological Responses to Illness


Learning Objectives

• Define mental health.• Discuss the concepts of stress, anxiety, adaptation, and

homeostasis.• Discuss how age and cultural and spiritual beliefs affect

an individual’s ability to cope with illness.• Identify some basic coping strategies (defense

mechanisms).• Discuss the concepts of anxiety, fear, stress, loss, grief,

helplessness, and powerlessness in relation to illness.• Describe several factors that may precipitate adaptive or

maladaptive coping behaviors in response to illness.• Discuss implementation of the nursing process to enhance

a patient’s mental health as the patient deals withthe stresses of illness.


Definition of Mental Health

• A dynamic process in which a person’s physical, cognitive, affective, behavioral, and social dimensions interact with one another and the environment

• Mentally healthy individuals are able to• Perceive reality accurately• Manage how emotions are experienced and expressed• Think clearly and logically• Communicate effectively• Anticipate events and solve problems• Initiate and maintain meaningful relationships• Develop a positive self-concept• Behave in ways that promote personal growth and

development


Stress

• Stress is caused by a stressor • Anything that necessitates person’s adaptive response

• Necessary for growth and development • Mild stress produces mild anxiety and enables people

to use energy focused exclusively on the problem • Result can be successful problem solving, which in turn

promotes self-esteem • Can also be harmful

• Examples: loss of a job or the death of a family member


Stress

• Adaptation to stress affects whole organism • The dimensions of the person—physical,

cognitive, affective, behavioral, and social—are not separate entities

• These dimensions interact, resulting in the development of a unique human being


Homeostasis

• Stress, response, and adaptation a process of maintaining homeostasis or equilibrium

• If stressors are mild and the person is able to respond and adapt, mental health is maintained

• If the person is overwhelmed by many stressors or cannot cope, illness or crisis may ensue • Results in inner tension and anxiety, which may

affect an individual’s ability to function


Growth and Development

• Process of evolution from conception until death • As human beings move through sequential stages of

development, they become increasingly complex • Each individual shaped throughout life by all of the

events and perceived interactions with others, the community, and the environment

• Development stages correspond to a specific age-group

• Developmental tasks: moving through each stage • In part, successful development depends on how

individuals negotiate each stage



• Infancy and early childhood: nurturing is critical and exploration of the world begins

• Preschoolers must learn to handle joint decision making and interpersonal conflicts

• Middle childhood: learning to deal with frustration and unfavorable events while also celebrating good things and feeling pleasure

• Teenagers learn to develop as individuals, become independent, and begin to think for themselves



• In early adulthood, most people find a life partner and life work and may begin a family

• Adults progressing through middle age look at the effect their lives have had or could have

• Older age: time of introspection, when elders look back on their lives, accept what has been, and attempt to face increasing frailty with grace


Behavioral Theory

• All behaviors are learned responses • Conditioning is one type of learning • Theorists such as B.F. Skinner, Albert

Bandura, and Joseph Wolpe have based their theories on the idea that all behavior is learned and is a series of habitual responses to familiar stimuli


Psychological Responses to Illness


Coping with Illness

• Factors that affect coping with illness• Age

• Illness can interfere with developmental progress, and the patient’s developmental stage can influence how he or she responds to illness

• Differences in the way people of different ages respond to illness

• Illness not only disrupts the developmental process of the individual but also has a traumatic effect on spouses, children, and other loved ones


Coping with Illness

• Cultural beliefs • Can affect attitudes toward health and illness, diet

and eating practices, reaction to pain, and death and dying

• Not all people who look as if they belong to a specific ethnic group because of language, surname, or physical characteristics necessarily identify with any specific group


Coping with Illness

• Spirituality • Patients often turn to their spiritual beliefs and

values to find meaning in the experience • Patients who perhaps had not thought of

themselves as being religious may suddenly have a need to visit with a spiritual counselor

• Many experience spiritual distress when under the stress of an illness


Coping with Illness

• Self-concept• Affected by changes in self-esteem as well as

changes in body image • Perception of these changes and ability or inability

to cope with them result in stress, fear, and anxiety • Adolescents especially vulnerable to changes in

body image because they have a strong need to look like their peers


Coping with Illness

• Family and community resources • Family’s ability to provide support for the patient

depends on quality of relationships among family members and the family’s ability to access needed resources

• Because of increasing stresses on the family unit, many families are not able to provide as much support as the patient may need


Coping with Illness

• Emotions• Stress: any physiologic or psychological tension that

threatens a person’s total equilibrium • Fear: denotes a response to a specific threat• Anxiety: vague/intense sense of impending doom or

apprehension that may appear to have no clearly identifiable cause

• Loss: related to the involuntary separation from the self of someone or something loved or treasured

• Grief: subjective, emotional response that evolves from sense of loss. Mourning is the process through which grief is faced and ultimately resolved or altered


Defense Mechanisms

• Compensation: attempt to make up for real or imagined weakness

• Denial: refusal to acknowledge a real situation• Displacement: transferring the feelings associated from

one source to another that is considered less threatening

• Identification: the emulation of admirable qualities in another to enhance one’s self-esteem

• Rationalization or intellectualization: use of logic, reasoning, and analysis to avoid unacceptable feelings

• Introjection: internalizing or taking on the values and beliefs of another person


Defense Mechanisms

• Isolation: separation of emotion from an associated thought or memory

• Projection: unacceptable feelings or impulses transferred to another

• Reaction formation: avoidance of unacceptable thoughts/behaviors by expressing opposing thoughts/behaviors

• Regression: withdrawing to an earlier level of development to benefit from the associated comfort levels of the previous level

• Repression: unconscious defense mechanism in which unacceptable ideas, impulses, and memories are kept out of consciousness


Defense Mechanisms

• Somatization: transfer of painful feelings to body parts, thus person’s feelings expressed as a physical symptom

• Sublimation: transformation of unacceptable impulses or drives into constructive or more acceptable behavior

• Suppression: conscious or voluntary inhibition of unacceptable ideas, impulses, and memories

• Undoing: actually or symbolically attempting to cancel out an action that was unacceptable

• Substitution: individual replaces a highly valued, unattainable object with a less valued, attainable object


Defense Mechanisms

• Conversion: emotional conflict is turned into a physical symptom, which provides the individual with some sort of benefit

• Ideally, unhealthy defense mechanisms are shed and replaced by more realistic and efficient methods of adaptation as the individual matures


Conscious Coping Strategies

• Purposeful behaviors used to make an unfamiliar situation into one that is perceived as more controllable and predictable

• They are attempts to help people feel less stressed and anxious about their illness

• Some methods provide only temporary relief, whereas others provide more permanent results


Conscious Coping Strategies

• Relaxation techniques: imagery, relaxation strategies, therapeutic touch, and music therapy

• Provide clients with self-control during stress

• Elicit the relaxation response that reduces the effects of stress and decreases anxiety

• Relaxation strategies: biofeedback, meditation, deep breathing exercises, yoga, and Zen

• Therapeutic touch: environmental and universal energy through the therapist’s mental concentration

• Music therapy may help the patient cope by enhancing the relaxation response and facilitating positive imagery


Maladaptive Coping Mechanisms and Strategies

• Helplessness • Occurs when individuals have had repeated

exposure to events they perceive as being uncontrollable

• Leads to loss of motivation, feelings of despair or anxiety, and cognitive impairment

• The individual may begin to express anger as a means of diminishing feelings of helplessness

• Can be prevented by allowing individuals to control as many events as possible within the constraints imposed by treatment and their energy level



• Powerlessness • A feeling that one’s actions cannot affect an

outcome or that one lacks personal control over certain events or situations

• Characteristics of powerlessness: passivity; nonparticipation in care and decision making; dependence on others, which may lead to anger, resentment, or guilt; and verbal expression of loss of control over situations or outcomes



• Denial • Subconscious blocking out of emotional

experiences • Several forms: verbal denial, minimizing severity of

the illness, displacing symptoms onto another organ system, and engaging in behaviors contrary to medical advice

• Can lead to negative consequences if people fail to engage in appropriate problem-focused behaviors

• Maladaptive when patient’s behavior interferes significantly with obtaining appropriate care


The Nursing Process in Illness


Assessment

• Effectiveness of individual coping strategies― seek answers to the following• Do individuals see themselves as effective in coping

with their illness? • What efforts have individuals made to seek

information about their situation? • How skillful are individuals in caring for themselves? • What resources do individuals believe are available

to them in dealing with their illness? • Do individuals effectively adhere to their medical

regimen?


Assessment

• Questions • Do individuals feel they have been able to keep a

sense of normality in their life despite their illness? • How have individuals and their families been able to

cope with any role modification that the illness has brought about?

• Have individuals been able to maintain a sense of hope in spite of the demands of the illness?

• Do individuals feel that the important relationships in their life remain intact?


Nursing Diagnoses

• Interrupted Family Processes • Delayed Growth and Development • Ineffective Role Performance • Ineffective Sexuality Pattern • Anxiety • Disturbed Body Image• Caregiver Role Strain • Defensive Coping • Decisional Conflict • Grieving


Nursing Diagnoses

• Fatigue • Fear • Impaired Adjustment • Ineffective Coping • Disabled Family Coping • Ineffective Denial • Disturbed Personal Identity• Powerlessness • Risk for Loneliness


Nursing Diagnoses

• Risk for Situational Low Self-Esteem • Sexual Dysfunction • Disturbed Sleep Pattern• Social Isolation • Spiritual Distress


Nursing Goals, Outcome Criteria, and Interventions

• Goal of nursing care is to help people manage and successfully cope with their illness

• With coping strategies, patients can manage their illness and adapt to a new lifestyle that incorporates healthy behaviors and realistic goals

• Patients should emerge from the process with a positive self-concept and self-esteem

1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 54...

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