The emotional response of the patient during illness is of extreme importance. The mind-body-spirit connection is well established; it is known, for example, that when a physiological response occurs, there is a corresponding psychological response. Also, there are physiological conditions that have a psychological component, for example, the emotional instability associated with steroid therapy or Cushing’s syndrome or the irritability of hypoglycemia.
Rapid growth in the field of psychoneuroimmunology is regularly providing new information about these issues.
With expanding technology in healthcare, ethical issues are hotly debated. Although the stress of illness is well recognized, the effect on the individual is unpredictable. It is not necessarily the event that creates problems, but rather the patient’s perception of and response to the event, which may result in unmet psychological needs that drain energy resources needed for healing. The caregivers’, patients’, and significant others’ (SOs) values, sensitivity to different cultures, and language barriers (including difficulties that people have in talking about their bodies) affect the care a patient expects and receives.
CARE SETTING
Any setting in which nursing contact occurs/care is provided.
RELATED CONCERNS
This is an aspect of all care and plans of care.
Assessment Factors To Be Considered
INDIVIDUAL
Age and gender
Religious affiliation: Church attendance, importance of religion in patient’s life, belief in life after death
Level of knowledge/education; how the individual accesses and incorporates information, i.e., auditory, visual, kinesthetic
Patient’s dominant language/literacy; knowledge and use of other languages; style of speech
Patterns of communication with SOs, with healthcare givers
Perception of body and its functions: In health, illness, this illness
How does patient define and perceive illness?
How is patient experiencing illness versus what illness actually is?
Emotional response to current treatment/hospitalization
Past experience with illness, hospitalization, and healthcare systems
Emotional reactions in feeling (sensory) terms: e.g., states, “I feel scared”
Behavior when anxious, afraid, impatient, withdrawn, or angry
SIGNIFICANT OTHERS
Marital status; SOs, nuclear family, extended family; recurring or patterned relationships
Family development cycle: Just married, children (young, adolescent, leaving/returning home), retired
What are the interaction processes within the family?
Patient’s role in family tasks and functions
How are SOs affected by the illness and prognosis?
Lifestyle differences that need to be considered: Dietary, spiritual, sexual preference, other community (e.g., religious order, commune, retirement center)
SOCIOECONOMIC
Employment; finances
Environmental factors: residence, work, and recreation; out of usual environment (on vacation, visiting)
Social class; value system
Social acceptability of disease/condition (e.g., sexually transmitted diseases [STDs], HIV, obesity, substance abuse)
CULTURAL
Ethnic background; heritage and residence/locale
Beliefs regarding caring and curing
Health-seeking behaviors; illness referral system
Values related to health and treatment
Cultural factors related to illness in general and to pain response
DISEASE (ILLNESS)
Kind/cause of illness; how has it been treated, how should it be treated? Anticipated response to treatment; patient’s/SO’s expectations
Is this an acute or a chronic illness? Is it inherited? What is the threat to self/others?
If terminal illness, what do patient and SO know and anticipate?
Is the condition “appropriate” to the afflicted individual, e.g., multiple sclerosis, diabetes mellitus (DM), cancer?
(Note: Some theories suggest certain personalities are prone to certain illnesses.)
Illness related to personality factors, such as type A (may be myth or valid relative to management of stressors); highrisk behaviors
NURSE-RELATED
Basic knowledge of human responses and how the current situation is related to response of the individual
Basic knowledge of biological, psychological, social, and cultural issues
Knowledge and use of therapeutic communication skills
Knowledge of own value and belief systems, including prejudices, biases
Willingness to look at own behavior in relation to interaction with others and make changes as necessary
Respect of patient’s privacy; confidentiality; human needs
NURSING PRIORITIES
1. Reduce anxiety/fear.
2. Support grieving process.
3. Facilitate integration of self-concept and body-image changes.
4. Encourage effective coping skills of patient/SO.
5. Promote safe environment/patient well-being.
DISCHARGE GOALS
1. Reports/anxiety/fear manageable.
2. Progressing through stages of grieving.
3. Patient/family dealing realistically with current situation.
4. Safe environment maintained.
5. Plan in place to meet needs after discharge.
Rapid growth in the field of psychoneuroimmunology is regularly providing new information about these issues.
With expanding technology in healthcare, ethical issues are hotly debated. Although the stress of illness is well recognized, the effect on the individual is unpredictable. It is not necessarily the event that creates problems, but rather the patient’s perception of and response to the event, which may result in unmet psychological needs that drain energy resources needed for healing. The caregivers’, patients’, and significant others’ (SOs) values, sensitivity to different cultures, and language barriers (including difficulties that people have in talking about their bodies) affect the care a patient expects and receives.
CARE SETTING
Any setting in which nursing contact occurs/care is provided.
RELATED CONCERNS
This is an aspect of all care and plans of care.
Assessment Factors To Be Considered
INDIVIDUAL
Age and gender
Religious affiliation: Church attendance, importance of religion in patient’s life, belief in life after death
Level of knowledge/education; how the individual accesses and incorporates information, i.e., auditory, visual, kinesthetic
Patient’s dominant language/literacy; knowledge and use of other languages; style of speech
Patterns of communication with SOs, with healthcare givers
Perception of body and its functions: In health, illness, this illness
How does patient define and perceive illness?
How is patient experiencing illness versus what illness actually is?
Emotional response to current treatment/hospitalization
Past experience with illness, hospitalization, and healthcare systems
Emotional reactions in feeling (sensory) terms: e.g., states, “I feel scared”
Behavior when anxious, afraid, impatient, withdrawn, or angry
SIGNIFICANT OTHERS
Marital status; SOs, nuclear family, extended family; recurring or patterned relationships
Family development cycle: Just married, children (young, adolescent, leaving/returning home), retired
What are the interaction processes within the family?
Patient’s role in family tasks and functions
How are SOs affected by the illness and prognosis?
Lifestyle differences that need to be considered: Dietary, spiritual, sexual preference, other community (e.g., religious order, commune, retirement center)
SOCIOECONOMIC
Employment; finances
Environmental factors: residence, work, and recreation; out of usual environment (on vacation, visiting)
Social class; value system
Social acceptability of disease/condition (e.g., sexually transmitted diseases [STDs], HIV, obesity, substance abuse)
CULTURAL
Ethnic background; heritage and residence/locale
Beliefs regarding caring and curing
Health-seeking behaviors; illness referral system
Values related to health and treatment
Cultural factors related to illness in general and to pain response
DISEASE (ILLNESS)
Kind/cause of illness; how has it been treated, how should it be treated? Anticipated response to treatment; patient’s/SO’s expectations
Is this an acute or a chronic illness? Is it inherited? What is the threat to self/others?
If terminal illness, what do patient and SO know and anticipate?
Is the condition “appropriate” to the afflicted individual, e.g., multiple sclerosis, diabetes mellitus (DM), cancer?
(Note: Some theories suggest certain personalities are prone to certain illnesses.)
Illness related to personality factors, such as type A (may be myth or valid relative to management of stressors); highrisk behaviors
NURSE-RELATED
Basic knowledge of human responses and how the current situation is related to response of the individual
Basic knowledge of biological, psychological, social, and cultural issues
Knowledge and use of therapeutic communication skills
Knowledge of own value and belief systems, including prejudices, biases
Willingness to look at own behavior in relation to interaction with others and make changes as necessary
Respect of patient’s privacy; confidentiality; human needs
NURSING PRIORITIES
1. Reduce anxiety/fear.
2. Support grieving process.
3. Facilitate integration of self-concept and body-image changes.
4. Encourage effective coping skills of patient/SO.
5. Promote safe environment/patient well-being.
DISCHARGE GOALS
1. Reports/anxiety/fear manageable.
2. Progressing through stages of grieving.
3. Patient/family dealing realistically with current situation.
4. Safe environment maintained.
5. Plan in place to meet needs after discharge.
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