Professional Documents
Culture Documents
Objectives
Differentiate between illness and disease Determine the reasons why study the impact of disease on family Learn the stages of the family illness trajectory and the responsibilities of the physician on each stage
Interaction are dependent on: Setting of care Type of cure Ability to pay Responsiveness of health care system
Illness (prolonged and complicated) results in structural change within family system to the point that leads to different roles and functions
Disease vs Illness
Disease Primary biologic and psycho physiological dso Illness
Includes sufferers experience of the dse Deeply embedded in the social, cultural and family context of the person who is ill
Investigate Dse Examining clinical and laboratory evidences of biologic and psycho-physiologic dysfunction
Investigate Illness Exploring the meaning of illness to the patient and the patients family
Explores the patients perception, reaction to symptom Investigate the broader set of experiences and concerns that patients associate with their illness
Case
Arnold, 35, father of 3 small children, worked as OFW 1 year ago. After 6months of being far away from his family, he died of fatal arrythmia while on his work.
Characteristics of illness Provide little time for physical and psychological adjustment Short period between onset, dx and mx thereby leaving little time to remain in state of uncertainty
Impact on family
Caught up in suddenness Deal with immediate decision Often with little support from within and outside the family unit
Gradual onset
Vague apprehension and anxiety Fearful fantasies over denial of seriousness of symptoms and possible implications
Case #1
Nature of illness Nature of onset Characteristic of experience Impact on family Acute, rapid Rapid, clear onset Provide little time for physical and psychological adjustments Caught up in suddenness Immediate decision
Responsibilities of the Physician Explore routinely the explanatory model and fear that patients bring to the clinic set up With inappropriate label of illness, acknowledge and explore conflict the patient maybe experiencing Explore several aspects of pre-diagnostics phase of patients and families
Stage II Reaction to Diagnosis: Impact Phase Disease can be described accdg to the patients level of comprehension and understanding Give small doses of information over time
If diagnosing is confusing
Provide support, and continuity of care Interpret findings which are misunderstood Offer advice and encouragement And clarify meaning of specialists message & outcome of illness and operation
Emotional Plane
Denial, disbelief, anxiety (mins to hrs) Emotional upheaval such as anger, anxiety, and depression (weeks) Accomodation and acceptance
Cognitive Plane
Phase 1 tension and confusion, ;ack of capacity for problem solving Phase 2 repeated failure to deriving the diagnosis leading to increased distress
Phase 3 receptivity of the family to new approach for relief of distress Phase 4 eventual acceptance of diagnosis
Case #2
Lyn, 22, with an 18month old child was diagnosed with lymphoma 6months ago. Due to lack of funds, her mother who is also the caregiver, has tried several faith healers to comfort Lyns syndrome.
Lyns father was died due to liver cancer in the hospital where Lyn was diagnosed lymphoma. She expressed her fears regarding the management and the appropriateness in the hospital.
Lyn continued to have anorexia, vomiting, cough, back pain, and difficulty breathing. Also she has been depressed for the last three months because aside from her illness, her husband has a rumored to be having another girl, limiting his time for Lyn.
Phase 2 to 3 Failure to derive the diagnosis Trial of different approaches to relieve stress
Responsibilities of Physician
Anticipate problems and help family cope and adapt thru family meetings Assess the capability of the family to cope with stress
Make clear about the nature of illness by helping the family maintain openness that allows sharing and support.
Critical Issues in Choosing Therapeutic Plan 1. Psychological state and preparedness of the patient and family determine the choice of therapeutic plans as well as the alternative choices
2. Assumption of responsibility for care of very early in the treatment plan. 3. Economy of Therapeutic plan 4. Life style and cultural characteristics of a family are important in choosing a therapeutic plan
Stage V- Adjustment to the permanency of the outcome Points to the familys adjustment to crisis 2nd crisis occurs as family realizes that they must accept and adjust to a permanent disability Coping mechanism is developed during earlier stage of family adjustment
For acute illness: Emotions are high and can lead to anger especially if the family perceives that the care given by the doctor is not satisfactory
The physician can Assist the patient and family in relating to health care system Aid the patient and the family in efficient and functional readjustment
Provide quality care. Home care is the best and most accepted and the last demanding thus it should be facilitated
Emotional Plane
Cognitive Plane
Emotional upheaval charac by strong emotions such as anger, anxiety and depression
Accommodation during which the patient and the family learn to accommodate and accept the diagnosis
Phase l : Initially there is tension & confusion with probable lack of capacity for problem solving Phase II : repeated failure in deriving the diagnosis may lead to exacerbation of tension & increased distress Phase III: increasing assessment and receptivity of family to new approach for relief of distress Phase IV: eventual acceptance of diagnosis will enable them to mobilize resources and recognize the family
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