Stages of Illness and Medical Care Discussion

Stages of Illness and Medical Care Discussion ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Stages of Illness and Medical Care Discussion The experience of illness can reach beyond the patient and impact the family system considerably. Patients experience illness through the lenses of their personal emotions, past experiences, stage of life, familial role, social relationships, responsibilities, stressors, and cultural and spiritual beliefs. Other factors, including the nature of the illness and comorbid conditions, also influence how the patient perceives illness. Together, these factors impact how and whether patients seek care, utilize health resources, and receive and adhere to treatment—all of which eventually impact the outcome of the illness. Walden SOCW 8205 University Week 1 Stages of Illness and Medical Care Discussion To prepare for this Discussion: Think about a patient’s emotional or psychological response to illness and the factors (e.g., depression, stress, anxiety) that might contribute to this response. Select two factors that you believe are important and might critically affect a patient’s course of life beyond family (e.g., at work, school, social life, role in the community). Consider the stages of an illness—diagnosis, treatment, adherence to treatment, worsening of condition, complications, and survival. Walden SOCW 8205 University Week 1 Stages of Illness and Medical Care Discussion BY DAY 4 Post a description of the two factors you selected. Explain how these factors influence illness and a patient’s life beyond his or her family. Then, explain how these factors might present themselves during at least two stages during the course of illness. Finally, explain how a medical social worker might intervene to ensure that the patient receives the services he or she needs to cope best during each of these stages. Be sure to support your postings and responses with specific references to the resources and the current literature using appropriate APA format and style. Stages of Illness and Medical Care Discussion .pdf .pdf .pdf .pdf .pdf Stages of Illness and Medical Care Discussion. The Role of Family Caregivers for People with Chronic Illness Arnold Goldberg, MD, and Kim Sallotvay Rickler, MSW A chronic disease (e.g., diabetes, cardiovascular disease, stroke, hypertension, dementia, some cancers, rheumatological diseases, human immunodeficiency virus) can occur and cycle in flare ups throughout the lifetime. Chronic illnesses, with their effect on the patient’s symptoms, mood, and need for emotional and physical support, exert a burden on family members.’”” Additionally, families influence a patient’s psychological adjustment and management of the illness, adoption of behaviors that influence recovery, functioning and adherence to treatments. ‘ or friend, who has been diagnosed with a serious illness or chronic disability. Duties: Make medical decisions, negotiate with insurance companies or Medicare; pay bills; legal work; personal care and entertainment in hospital and rehab. Aftercare at home: Substitute for skilled nurse if injections, IV’s, oxygen, wound care or tube feedings as required. Longterm care: Medication management, showering, toileting, lift:ing, transporting, etc. Hours: On demand. Salary and benefits: 0 ” The authors, a family physician and a clinical social worker, have been counseling patients and families in a variety of health care and educational settings for 30 years. We have led psycho-educational and medical groups involving patients (and their caregivers) with cancer, chronic pain, diabetes, cognitive impairment and childhood congenital and genetic illnesses. We have seen how the involvement of families and caregivers improves the quality of life for the patient, eases caregivers’ burden, encourages adherence to treatments and increases patients’ ability to cope with the illness. The clinician’s attention to the caregiver can potentially improve family relationships and, therefore, decrease anxiety in the patient and his/her caregiver. Without positive reinforcement from physicians and emotional support, these, essential people might not be able to function as caregivers. Family caregivers function as advocates and provide physical, emotional and financial support, frequently without any training, often without recognition or support, and rarely with financial reimbursement. Many people living with chronic illness could not live independently without family caregivers. Cail Sheehy, in Passages in Caregiving: Turning Chaos Into Confidence, described a want ad for a family caregiver in her wry yet poignantly accurate style: “HELP WANTED: Untrained family member or friend to act as advocate, researcher, care manager, emotional support for a parent or spouse, sibling An 85-year old, married woman, who had been seen by herprimary care physician fi)r 5 years, suffers from chronic pain, fibromyal^a, anorexia and weight loss, multiple chemical sensitivity syndrome, chronic gastric problems with severe gastroesophageal refiux disease, irritable bowel andfatigue. She reports feeling helpless and emotionally overwhelmed. Walden SOCW 8205 University Week 1 Stages of Illness and Medical Care Discussion Stages of Illness and Medical Care Discussion. She and her husband do not have children or living siblings, hut she reports she has a positive, long-term marriage and relies heavily on her husband for support. Her provider has diligently responded to her concerns and treated her illness appropriately However, thephysician had never met thispatient’s husband and had no understanding about his actual care-taking responsibilities and the impact of his wife’s chronic illness on their relationship. The physician encouraged his patient to bring her husband to her next appointment. During that visit, conducted with the couple, the physician learned more about their devotedness and heard his confusion regardingher various illnesses and his consequent feelings of anxiety and helplessness. An in-depth discussion and medical educational session provided crucial information and tremendous relief for the patient’s husband. Additionally, he expressed some of his own difficulty coping with his wife’s condition and she in tum shared her appreciationfor his consistent support. The husband continues to attend his wife’s medical appointments and participate fidly in her care. While thepatient’s physical condition has not improved, their ability to share the experience and express their love for each other impires both to continue their battle together. A literature search yielded 139 articles and reviews of caregivers of chronically ill persons, including previous reviews and controlled studies from 19962010.” There are very few well-designed randomized controlled quantitative studies documenting the outcomes of interventions for the caregivers.^ The effect on family caregivers across most chronic illrvesses can be grouped into changes in social, economic, physical and mental status.^”‘” The burden of care is one of the main consequences for family caregivers with chronic or progressive illness.””” This burden may lead the caregiver to postpone his/her own needs.” The patient’s close family members may experience poor psychological well-being (depression, anxiety), decreased satisfaction in relationships, caregiver burden and poorer physical health.’ A recent large retrospective cohort study concluded that male partners of women breast cancer patients had a significant increase in major depression, resulting in psychiatric hospitalization. This study emphasized the importance of screening for depression and providing psychological treatment for the caregivers of breast cancer patients, and may have implications for family caregivers of people with other chronic illnesses.”‘ Poor self-esteem, difficulty with intimacy, criticism and over-protective or solicitous behaviors have been linked with consequent changes in the family structure when a family member has a chronic illness. These have been observed in heart disease and stroke.’ In patients with cardiovascular disease, hypertension, myocardial infxirc41 VOLUME 94 No. 2 FEBRUARY 2 0 1 1 tion, dementia or stroke, Campbell and Patterson found that the most promising family interventions were psychosocial approaches. In patients with dementia and stroke, caregiver interventions may help the mental health of caregivers and delay nursing home placement.” Walden SOCW 8205 University Week 1 Stages of Illness and Medical Care Discussion Stages of Illness and Medical Care Discussion. Other reviews have been descriptive not quantitative, focusing on family member outcomes of frail adults and patients with dementia. Quantitative reviews have generally revealed minimal effect on reducing caregiving burden andnegative mood.’ In a literature review from 19972007, Clasdam et al looked at caregivers for adults with strokes, diabetes, cardiovascular disease and cancer; they found 32 controlled studies with 29 of them randomized. In 10 ofthe 32, the interventions had no effect. In 22 the interventions had some effect on burden reduction, increased knowledge and mastering skills.^ In another review, family members felt less burdened, depressed and anxious when the intervention focused on the relationship between the patient and the caregiver. ‘ The vast majority of family interventions combined psychosocial or behavioral approaches. The most common combinations were education with emotional support and emotional support combined with skills training. ‘•’ Overall, more work is necessary to track longitudinal outcomes for family members, including the greater risk for mortality in caregivers.”* In each illness studied, the impact on the female caregivers was greater than on male caregivers,^-‘” per. haps because men more readily accepted help from family members and also relied on community resources.”-” Without the multitude of unpaid family caregivers, many people would live in institutions. How can we as a society provide education and support for these caregivers? We’d like to propose some intervention tools to assist the medical team in assessing the needs of family caregivers. First, the team should include the patient and her/his support system as active members. Initiating a discussion with the patient regarding the specifics ofher/ his care out of the office setting and encouraging the patient to include Identified family/friend caregivers in future visits can be a first step. It may also be important to assess the patient and caregiver’s cultural and spiritual connections and 42 MEDICINE & HEALTH/RHODE ISLAND beliefs, community organizations she/he’s involved with, and hobbies. Conducting family meetings, referring to community support groups, web-based education, computerized chat rooms and referral for concrete resources (e.g. financial, medications, respite, etc.) as well as suggesting basic relaxation techniques, visualization, massage, or a referral to psychotherapy should also be considered. 4. In the many instances where the family physician also treats the caregiver, that physician may already know about the caregiver’s support network and coping strategies. But what should the physician’s role be with the caregiver who is not his/ her patient? By asking the caregiver how she/he’s doing (coping, managing) the physician demonstrates empathy and acknowledges the role ofthe caregiver. The physician needs to help the caregiver identify the importance of maintaining her/ his own well-being by learning effective self-care techniques, to reduce caregiver burden, stress and burnout. 9. The shortcomings regarding the evidence-based studies should drive fliture research for randomized controlled designs, but should not diminish the body of qualitative and observational studies that do address the impact of illness on caregivers. Walden SOCW 8205 University Week 1 Stages of Illness and Medical Care Discussion Stages of Illness and Medical Care Discussion The current studies are inconclusive about what interventions are most effective for caregivers. The most common interventions described combine education with emotional support, einotional support with skills training, and education with emotional support and skills training. Other approaches have been health care planning, structured exercise programs and temporary transfer of patient care to a community care setting, home visits by nurses or social workers, telephone contact, education and teaching, counseling and videotaped information about community resources and coping techniques.* Clearly, however, for as many different diseases, family constellations and situations, there are at least as many options for intervention. 5. 6. 7. 8. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. Lyons RF, Sullivan MJL, et al. (Eds). Relationships in Chronic Illness and Disability.Thousand Oaks, CA: Sage, 1995. Martire LY, Lustig AP, et al. Is it beneficial to involve a family member. Health Psychol 2004;23:599-611. PubMed US National Library of Medicine National Institutes of Health. Glasdam S, Timm H, Vittrup R. Support efforts for caregivers of chronically ill persons. Clin Nurs Res 2010;19:233-65. Johansson S Fahlstrsm G. Good intention.s. Vardi Norden 1993; 13:15-22. Oehlenslaeger B. You miss the one you still got. SpecialPoedagogik 1998;18:104-l 13. Soubhi H, Forrin M, Hudson C. Perceived contlict in the couple and chronic illness management. BMCFamPract 2006;7:59. Manne SL, Zautra AJ. Couples coping with chronic illness. J Behavior Med ]990;3:327-42. Reesj, O’BoyleCA, MacDonagh R. Quality of life. 7 Royal Soc Med 2001;94:563-6. Riemsma RP, Taal E, et al. The burden of care for informal caregivers of patients with rheumatoid arthritis. Psychol Health 1999; 14:773-94. Tessler R, Gamache G. Continuity of care, residence, and family burden in Ohio. Milhank Quarterly 1994;72:149-69. Baanders AN-, Heijmans MJWM. The impact of chronic disease. Fam Community Health 2007ú30:505-7. Nak.iya N, Saito-Nakaya K, et al. Increased risk of severe depression in male partners of women with breast cancer. Cancer 2010;Published in Wiley online. Campbell TL, Patterson JM. The effectiveness of tan-lily interventions in the treatment of physicil illness. J Marriage Family Therapy 1995;21:545-84. Schulz R, Beach S. Care giving as a risk factor for mortality. JAMA 1999;282:2215-9. Lutzky SM, Knight BG. Explaining gender differences in care giving distress. Psychol Aging 994;9:53-9. Arnold Goldberg, MD, is Medical Director, Family Care Center, Memorial Hospital of RI, and Associate Professor of Family Medicine (Clinical) at The Warren Alpert Medical School of Brown University. Kim Salloway Rickler, MSW, is Clinical Teaching Associate of Family Medicine, Memorial Hospital of Rhode Island. Disclosure if Financiai interests The authors and/or spouses/significant others have no financial Interests to disclose. CORRESPONDENCE REFERENCES Arnold Goldberg, M D 1. AkamatsuTJ, Stephen MAP, etal. (Eds). FamDepartment of Family Medicine ily Health Psychology. Washington, DC HemiMemorial Hospital of Rhode Island sphere, 1992. 2. Turk DC, Kerns RD, (Eds). Health, Illness 111 Brewster St. and Families: A Life Span Perspective. New Pawtucket, RI 02860 York: Wiley, 1985. Phone: (401)729-2237 3. BurgMM, SeemanTE. Families and health. Ane-mail: [email protected] nals Behavior Med 1994; 16:109-15. Copyright of Medicine & Health Rhode Island is the property of Rhode Island Medical Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder’s express written permission.Walden SOCW 8205 University Week 1 Stages of Illness and Medical Care Discussion However, users may print, download, or email articles for individual use. NIH Public Access Author Manuscript Psychosom Med. Author manuscript; available in PMC 2012 January 1. NIH-PA Author Manuscript Published in final edited form as: Psychosom Med. 2011 January ; 73(1): 67–74. doi:10.1097/PSY.0b013e3182002116. Modeling Social Influences on Human Health Kate Karelina, Ph.D.1 and A. Courtney DeVries, Ph.D.1,2 1 Department of Neuroscience, The Ohio State University, Columbus, OH 43210 USA 2 Institute of Behavioral Medicine Research, The Ohio State University, Columbus, OH 43210 USA Abstract NIH-PA Author Manuscript Social interactions have long-term physiological, psychological and behavioral consequences. Social isolation is a well recognized but little understood risk factor and prognostic marker of disease, and can have profoundly detrimental effects on both mental and physical well-being, particularly during states of compromised health. In contrast, the health benefits associated with social support (both reduced risk and improved recovery) are evident in a variety of illnesses and injury states; however, the mechanisms by which social interactions influence disease pathogenesis remain largely unidentified. The substantial health impact of the psychosocial environment can occur independently of traditional disease risk factors and is not accounted for solely by peer-encouraged development of health behaviors. Instead, social interactions are capable of altering shared pathophysiological mechanisms of multiple disease states in distinct measurable ways. Converging evidence from animal models of injury and disease recapitulates the physiological benefits of affiliative social interactions and establishes several endogenous mechanisms (inflammatory signals, glucocorticoids and oxytocin) by which social interactions influence health outcomes. Taken together, both clinical and animal research are undoubtedly necessary in order to develop a complete mechanistic understanding of social influences on health. Keywords Social interaction; health; experimental models; oxytocin Social influences on health NIH-PA Author Manuscript Social interactions shape humans from early development through senescence and have a strong impact on many aspects of physiology and behavior. Indeed, social interaction is essential for proper cognitive, affective and behavioral development (1). Among adults, the social environment remains an important determinant of health and well being; ample evidence suggests that positive social support accelerates and improves patient recovery from cancer, cerebrovascular and cardiovascular disease (CVD), atherosclerosis, and other chronic diseases with an inflammatory component (2–5). This has led to a substantial interest in the capacity to which the social environment affects physiological systems, particularly during health challenges. The benefits of a positive social environment are particularly salient in chronic disease states, in which emotional social support can be perceived as being equally or more important than instrumental and informational support Correspondence should be addressed to: Kate Karelina, Ph.D., Department of Neuroscience, The Ohio State University, 750 Biomedical Research Tower, 460 W 12th Ave., Columbus, OH 43210, Fax: 614-292-3464, Phone: 614-688-4665, karelina. [email protected] Conflict of interest: All authors declare that they have no conflicts of interest in publishing this manuscript Karelina and DeVries Page 2 NIH-PA Author Manuscript (6). In contrast, social isolation and loneliness can have profoundly detrimental effects on mental and physical health (7). Walden SOCW 8205 University Week 1 Stages of Illness and Medical Care Discussion Stages of Illness and Medical Care Discussion. While this observation is not novel in the medical community (8–10), it has only relatively recently begun to gain momentum in both clinical and animal research. The addition of evaluating patients’ social, along with cognitive and physical states, while not yet considered common practice, is gaining acceptance in hospitals and clinics worldwide (11–12); however, despite growing evidence implicating the social environment as a modifying factor in disease outcomes, little is known regarding the mechanisms through which psychosocial factors influence disease pathogenesis. Converging evidence from experimental research suggests that socially isolated animals mount a quantitatively and qualitatively different pathophysiological response to disease and physical trauma compared to socially housed animals. Moreover, the benefits of social housing in animal models are remarkably consistent with clinical findings, and are evident in a diverse set of disease and injury models. The aim of this review is to further illustrate the need for integrative clinical and experimental research that encompasses a more complete understanding of the qualitative and quantitative consequences of social experiences on disease physiology. NIH-PA Author Manuscript Chronic diseases such as cardiovascular and cerebrovascular disease, diabetes, cancer, and autoimmune disorders accounted for 70% of all deaths in the United States in 2005 (13). A substantial research effort has elucidated a number of risk factors (e.g. smoking, alcohol consumption, high blood pressure, cholesterol, etc) that are common across most chronic disease states, as well as identified causal relationships and mechanisms by which these factors influence disease onset and outcome. Interestingly, even after statistically controlling for these risk factors, there still exists substantial inter-individual variability in susceptibility to disease and recovery. This naturally occurring variability can be accounted for in part by an additional class of risk factors: psychological stress (including social isolation or perceived lack of social support), that is predictive of disease outcome independently of other traditional risk factors (14–15). Importantly, the impact of the social environment is not only evident during the course of disease, but also influences the development of potentially debilitating consequences such as chronic pain, long-term physical disability, and psychological distress such as anxiety/depression (16). NIH-PA Author Manuscript A prevailing hypothesis is that social support improves health by promoting healthy behaviors. Indeed, social support is associated with better medical compliance, increased physical exercise, improved nutrition and low-to-moderate tobacco and alcohol consumption (17). While it is not surprising that social and peer support increases the likelihood of engaging in health behaviors (whether because of the pressure to conform to social norms or a potential increase of tangible resources), statistically controlling for these behavioral changes indicates that the b … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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