Chronic illness presents immense challenges to a persons sense of self-image and self-worth.

The physical symptoms, reduced abilities, financial woes and relationship challenges of chronic illness can breed strong feelings of self-doubt and worthlessness. The resulting decreased self-esteem leads to feelings of guilt and a tendency toward social isolation. Isolation and guilt, however, further damage a persons self-image, creating a vicious cycle of negativity that can be difficult to break. Negative emotions and feelings are very common in chronic illness. In fact, studies have identified ten basic emotions experienced frequently by patients with chronic illness: Helplessness Helplessness is often the result of necessary reliance on others and a loss of independence due to reduced abilities. Frustration Reduced abilities, persistent physical or mental symptoms and a general loss of control over life can all lead to extreme frustration. Hopelessness Chronic illness breeds hopelessness for the present due to symptoms and lost abilities, and hopelessness for the future due to uncertainty. Sadness People with chronic illness often experience both a sadness for what they are facing and a sadness for what they have lost. Resentment Resentment in chronic illness can be aimed at oneself due to inabilities, at others due to abundance of abilities, or both simultaneously. Anxiety A sense of fear and anxiety are common in chronic illness, both in terms of the present and in terms of the future. Irritability The frustration, resentment, anxiety and hopelessness of chronic illness can cause a person to be irritable with him or herself and with others. Tension Physical, financial, relationship and other challenges can cause physical and emotional tension that often further aggravates chronic illness. Stress External factors (physical symptoms, financial troubles, etc.) combine with internal factors (relationship and self-image challenges, etc.) to cause stress. Anger Those with chronic illness may feel angry at themselves for being ill, at others for not fixing things, or at a higher power for punishing them. These negative feelings and emotions are all a natural part of the grieving process experienced by many if not all individuals diagnosed with chronic illness. A diagnosis of chronic illness usually means a loss of some type for both the individual and his or her family. The normal human response to loss is to follow a grieving process that ends in an acceptance of the diagnosis and a willingness to make the most of life in spite of the illness or condition. Most peoples grief follows a progression that can be outlined in five basic steps: Step 1: At this stage, a person is unwilling to accept the diagnosis. He or she will often deny that the diagnosis is correct and may discount symptoms and even medical tests. He or she may refuse medication or treatment and try to maintain a previous standard of life or activity. Step 2: At this stage, a person has accepted the diagnosis as real and experiences a strong sense of the unfairness of the situation. He or she may be angry, irritable, frustrated or bittern and may display some degree of hostility, especially toward medical personnel and caregivers.

Step 3: At this stage, a person has moved past his or her sense of unfairness or injustice and has a temporarily renewed sense of hope. He or she may try to reason with doctors and other medical professionals about a cure, may throw him or herself into research of the illness or condition, or may try to make deals with God or another higher power. Step 4: At this stage, a persons bargaining, reasoning and dealing have all come to a screeching halt and the revived hope is completely deflated. He or she enters a period of extreme sadness and depression, often exhibiting hopelessness and a desire for isolation. Suicidal thoughts may also become evident at this stage. Stage 5: At this stage, a person finally comes to a sense of true acceptance of his or her diagnosis. He or she develops coping strategies and learns to live with and adapt to the specifics of his or her illness or condition. He or she may also be willing to offer support and encouragement to others at this stage. Powerlessness: Perception that ones action will not significantly affect an outcome; a perceived lack of control over a current situation or immediate happening. Defining Characteristics Severe Verbal expression of having no control of influence over the situation or outcome of self-care. Depression over physical deterioration that occurs despite patient compliance with regimen Apathy

Moderate Nonparticipation in care or decision making when opportunities are provided Expression of dissatisfaction and frustration over inability to perform previous task and/or activities Does not monitor progress Expression of doubt regarding role performance Reluctance to express true feelings, fearing alienation from caregivers Inability to seek information regarding care Dependence on others that may result in irritability, resentment, anger and guilt. Does not defend self-care practices when challenged. Low Passivity Expressions of uncertainty about fluctuating energy levels.

INTERVENTIONS Patients need to recognize that they are not helpless and that they can influence the direction of their lives and the outcomes of treatment. The nurse assess for factors contributing to a sense of powerlessness and intervenes accordingly: lack of knowledge and lack of opportunities to make decisions Taking time to listen actively to patient often encourages them to express their concerns and ask questions. Provide the patient with decision-making opportunities such as when activities are to occur or where objects are to be placed and increasing the frequency and significance of those opportunities over time.

Assist the patient to differentiate between factors that can be controlled and those that cannot. Hopelessness The subjective state in which an individual sees limited or no alternatives or personal choices available and cannot mobilize energy on own behalf. Defining Characteristics Major Passivity, decreased verbalization Decreased affect Verbal cues indicating despondency (I cant, sighing) Minor Lack of initiative Decreased response to stimuli Turning away from speaker Closing eyes Shrugging in response to speaker Decreased appetite Altered sleep pattern Lack of involvement in or passively allowing care

Nursing Interventions for enabling and supporting hope include: Listening attentively Encouraging sharing of feelings Providing accurate information (realistic hope that is specific to the patients and familys needs for information) Encouraging and supporting patient control over his or her circumstances, choices and environment whenever possible Assisting the patient to explore ways for finding meaning in his or her life Encouraging realistic goal Facilitating effective communication within the family Making referrals for psychosocial and spiritual counseling Assisting with the development of supports in the home or community when none exist

Sensory Deprivation Sensory deprivation is a state of reduced sensory input from the internal or external environment, manifested by alterations in sensory perception. Sensory deprivation generally means a lessening or lack of meaningful sensory stimuli, monotonous sensory input, or an interference the processing of information(Rodemich,1997) Sensory deprivation is the deliberate reduction or removal of stimuli from one or more of the senses (Wikipedia dictionary)

FACTORS CONTRIBUTING TO SENSORY DEPRIVATION Visual or auditory impairments that limit or prohibit perception of stimuli Drugs that produce sedative effect on the CNS and interfere with the interpretation of stimuli Trauma that result in the brain damage and decreased cognitive function

Isolation(either physical or social)that results in the creation of a non stimulating environment

TYPES OF SENSORY DEPRIVATION Reduced sensory input(e.g. visual or hearing loss) Elimination of order or meaning from input(e.g. exposure to strange environment) produces monotony and boredom

CLINICAL SIGNS OF SENSORY DEPRIVATION -Excessive yawning, drowsiness, sleeping -Decreased attention span, difficulty in concentrating, decreased problem solving -impaired memory -periodic disorientation, confusion, irritability -pre occupation with somatic complaints -hallucinations-visual, auditory, tactile, olfactory, gustatory -crying, annoyance over small matters -Boredom and apathy, emotional lability

Nursing Interventions for Clients with Sensory Deprivation Encourage the client to use aids such as eyeglasses and hearing aids Address the client by name and touch the client while speaking if this is not culturally offensive Communicate frequently with the client and maintain meaningful interactions (e.g. discuss current events) Provide a radio and/or TV clock and calendar Adjust the environment to provide meaningful stimulation (e.g. enable the client to look through a window) Encourage social interaction

Interventions for the understimulated client should address the etiology of the deprivation such as inadequate stimuli, inability to receive stimuli, or inability to process stimuli. Inadequate stimuli Providing the client with a variety of stimuli appropriate for the person is important (ex. newspapers, books, and TV can stimulate the visual and auditory senses. Providing objects that are pleasant to touch such as pet to stroke can provide tactile and interactive stimulation. Clocks that differentiate night from day by color can help orient a client to time. For the client who is inadequately stimulated, the nurse can arrange for people to visit and talk with the clients regularly.

Inability to Receive Stimuli The nurse should make extra effort to provide stimuli for the other senses.

Inability to Process Stimuli The nurse can provide suitable explanation and perhaps written notes to help them know what to expect.

For ex. The man who cannot remember to take his pills may be able to take them at the right time from a pill compartment is labeled with the date and time.

Sleeplessness A prolonged disturbance results in decrease in amount, quality and consistency of sleep. It produces a variety of physiologic and behavioral symptoms, the degree of which depends on the degree of deprivation. Clinical Signs Behavior Changes: increasing irritability, restlessness, listlessness, lethargy, decreased attention span, frequent daytime napping, disorientation. Physical Signs: dark circles under eyes, frequent yawning, postural changes, slight hand tremor, mild nystagmus and expressionless face. Difficulty performing ADLs

Nursing Interventions Assess the clients daytime and nighttime sleeping patterns Discuss possible causes that contribute to sleeplessness Explore sleep-promoting techniques. Provide clients desired comfort measures. Provide a quiet, peaceful environment during sleep periods. Inform the client of necessary care interruptions ahead of time. Implement measures as indicated to prevent frequent voiding at night such as decreasing fluid intake before the bedtime. Encourage the client o express concerns when unable to sleep.

Health Education Teaching Patients Self-care Patient and family teaching is one of the most significant aspects of nursing care and may make the difference in the ability of patients and their families to adapt to chronic health conditions. Well-informed, educated patients are more likely than uniformed px to be concerned about their health and do what is necessary to maintain it. Knowledge is the key to making informed choices and decisions during all phases of the chronic illness trajectory. Despite the importance of teaching the px and the family, the nurse must recognize that patients recently diagnosed with serious chronic conditions and their families need time to grasp the significance of their condition and its effect on their life. Teaching should be planned carefully so that it provides information that is important to the patients well-being at the time without being overwhelming. The nurse should assess each pxs knowledge about the illness and its management. The nurse cannot assume that a patient with a long-standing chronic condition has the knowledge necessary to manage the condition. A pxs learning needs change as the trajectory phase and his or her personal situation changes.

The nurse must also recognize that patients may know how their body responds under certain conditions and how best to manage their symptoms.

Role of Family As you treat your chronically ill patients, it is important to remember that their families are also dramatically impacted by diagnosis of and living with chronic illness. Illness can create a dependence on others that may not be welcomed by the patient or by his or her family members. It can also breed a negative attitude or sense of self-deprecation that can be discouraging to family members who are trying to be helpful and understanding.