CHAPTER 7: Clients Response To Illness

Chapter 7: Clients Response to Illness

Key Terms:
o Culturally Competent: being sensitive to issues related to culture, race, gender, sexual orientation, social
class, economic situation, and other factors
o Culture: all the social learned behaviors, values, beliefs, and customs, transmitted down to each
generation, as well as a populations ways of thinking that guide its members views of themselves and
the world
o Environmental Control: refers to a clients ability to control the surroundings or direct factors in the
environment
o Ethnicy: concept of people with one another based on a shared heritage
o Hardiness: the ability to resist illness when under stress
o Race: a division of humankind possessing traits that are transmitted by decent and sufficient to identify it
as a distinct human type
o Resilience: defined as having healthy responses to stressful circumstances or risky situations
o Resourcefulness: involves using problem-solving abilities and believing that one can cope with adverse or
novel situations
o Self-efficacy: a belief that personal abilities and efforts affect the events in our lives
o Sense of Belonging: the feeling of connectedness with involvement in a social system or environment of
which a person feels an integral part
o Social Networks: groups of people whom one knows and with whom one feels connected
o Social Organization: refers to family structure and organization, religious values and beliefs, ethnicity,
and culture, all of which affect a persons role and, therefore, his or her health and illness behavior
o Social Support: emotional substance that comes from friends, family members, and even health-care
providers who help a person when a problem arises
o Socioeconomic Status: refers to ones income, education, and occupation
o Spirituality: a clients belief about life, health, illness, death, and ones relationship to the universe;
involves the essence of a persons well-being and his or her beliefs about the meaning of life and the
purpose for living
o Time Orientation: whether or not one views time as precise or approximate; differs among cultures
Objectives:
o Discuss the influences of age, growth, and development on the clients illness.
Persons age seems to affect how her or she copes with illness
Age at onset of schizophrenia is a stronger predictor of the prognosis of the disease
Younger age of onset has poorer outcomes, such as negative signs (apathy, social
isolation, and lack of volition) and less effective coping skills, than do people with later
age at onset
Age also influences how he or she expresses illness
Young children with ADHD may lack the understanding and ability to describe their
feelings, which make management of the disorder more challenging
Erik Erikson described psychosocial development across the life span in terms of developmental
tasks to accomplish at each stage
Eriksons Stages of Psychosocial Development Table 7.1 pg 121
In each stage, the person must complete a critical life task that is essential to well-being
and mental health
Failure to complete the critical task results in a negative outcome for that stage of
development and impedes completion of future tasks
Adult Growth and Developmental Tasks Table 7.2 pg 122
People may get stuck at any stage of development
Failure to develop identity can result in role confusion or an unclear idea about who one
is as a person
Lack of success may result in feelings of inferiority, doubt, lack of confidence, and
isolation- all of which can affect how a person responds to illness

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CHAPTER 7: Clients Response To Illness
o Identify the roles that physical health and biologic makeup play in a clients emotional responses.
Genetic and Biologic Factors:
Heredity and biologic factors are not under voluntary control
Research has identified genetic links to several disorders
Specific gene links have not been identified for several mental disorders (bipolar
disorder, major depression, alcoholism), research has shown that these disorders tend to
appear more frequently in families
Genetic makeup tremendously influences a persons response to illness and even
treatment
Family history and background are essential to nursing assessment
Physical Health and Health Practices:
Physical health can also influence how a person responds to psychosocial stress or illness
Poor nutritional status, lack of sleep, or a chronic physical illness may impair a persons
ability to cope
How a person lives and takes care of themselves can alter many factors
Exercising is one self-help intervention that can diminish the negative effects of
depression and anxiety
o Explain the importance of personal characteristics, such as self-efficacy, hardiness, resilience,
resourcefulness, and spirituality, in a clients response to stressors.
Self-Efficacy:
Those with high self-efficacy set personal goals, are self-motivated, cope effectively with
stress, and request support from others when needed
Those with low self-efficacy have low aspirations, experience much self-doubt, and may
be plagued by anxiety and depression
Suggested that treatment focuses on developing skills to take control of life
Developing self-efficacy can be very beneficial, 4 main ways to do so:
o Experience of success or mastery in overcoming obstacle
o Social modeling (observing successful people instills the idea that one can also
succeed)
o Social persuasion (persuading people to believe in themselves)
o Reducing stress, building physical strength, and learning how to interpret
physical sensations positively (ex: viewing fatigue as a sign that one has
accomplished something rather than as a lack of stamina)
Hardiness:
First described by Kobasa
Three components:
o Commitment: active involvement in life activities
o Control: ability to make appropriate decisions in life activities
o Challenge: ability to perceive change as beneficial rather than just stressful
Kobasa found that male executives who had high stress but low occurrence of illness
scored higher on the hardiness scale than executives with high stress and high
occurrences of illness
Personal hardiness is often described as a pattern of attitude and actions that helps the
person turn stressful circumstances into opportunities for growth
Identified as an important resilience factors for families coping with mental illness of one
of their members, as well as characteristics that assist veterans to deal with psychological
sequelae following deployment
Some believe its vague and indistinctive, may not help everyone
Some believe its not the same for men and women
Resilience and Resourcefulness:
Two closely related concepts, help people to cope with stress and to minimize the effects
of illness

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CHAPTER 7: Clients Response To Illness
The concept of resilience helps explain why one person reacts to a slightly stressful event
with severe anxiety, whereas another person doesnt experience distress even when
confronting a major disruption
People develop resourcefulness through interactions with others, that is, through
successfully coping with life experiences
Spirituality:
May include belief in God or a higher power, the practice of religion, cultural beliefs and
practices, and a relationship with the environment
Studies have shown that spirituality is a genuine help to many adults with mental illness,
serving as a primary coping device and a source of meaning and coherence in their lives
or helping to provide a social network
Hope and faith have identified as critical factors in psychiatric and physical rehabilitation
Religion and spirituality can also be helpful to families who have a relative with mental
illness, providing support and solace to caregivers
Nurse must be particularly sensitive to and accepting of such beliefs and practices,
incorporating these into care of clients can help them cope with illness and find meaning
and purpose in the situation
o Explain the influence of interpersonal factors, such as sense of belonging, social networks, and family
support, on the clients response to illness.
Sense of Belonging:
Abraham Maslow described a sense of belonging as a basic human psychosocial need
that involves feeling both value and fit
o Value: refers to feeling needed and accepted
o Fit: refers to feeling that one meshes or fits in within the system or environment
Closely related to his/her social and psychological functioning
Was found to promote health
Social Networks and Social Supports:
Studies have found that having a social network can help reduce stress, diminish illness,
and positively influence the ability to cope and to adapt
Its different from social contact, which doesnt always provide emotional support
Persons who are supported emotionally and functionally have been found to be healthier
than those who are not supported
Two key components are necessary for support systems to be effective: the clients
perception of the support system and the responsiveness of the support system
Nurse can help client to find support people who will be available and helpful and can
teach the client to request when needed
Family Support:
Family as a source of social support can be a key factor in the recovery of clients with
psychiatric illnesses
Health-care professionals cannot totally replace family members
Nurses must encourage family members to continue to support the client even while they
are in the hospital and should identify family strengths, such as loving and caring as a
resource for the client
o Describe various cultural beliefs and practice that can affect mental health or illness.
Diversity of the U.S population has resulted in, larger ethno-cultural groups, rather than moving
toward the concept of the melting pot
Nurses and other healthcare providers must learn about other cultures and become skilled at
providing care to people with cultural backgrounds that are different from their own
Cultural Beliefs About Health and Illness Table 7.3 pg 126
Beliefs About Causes of Illness:
Culture has the most influence on a persons health beliefs and practices, and is shown to
influence ones concept of disease and illness
Two prevalent types of beliefs about what causes illness in non-Western cultures:
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o Unnatural or Personal: beliefs attribute the cause of illness to the active,
purposeful, intervention of an outside agent, spirit, or supernatural force or deity
o Natural View: is rooted in a belief that natural conditions or forces, such as cold,
heat, wind, or dampness, are responsible for the illness
o Explain the cultural factors that the nurse must assess and consider when working with clients of different
cultural backgrounds.
Giger identifies a model for assessing clients using six cultural factors: communication, physical
distance or space, social organization, time orientation, environmental control, and biologic
variations
Important Factors in Cultural Assessment Box 7.1 pg 126
Cultural Assessment Factors of Various Cultures Affecting Response to Illness Table 7.4 pg 127
Communication:
Nurse should be aware that nonverbal communication has different meanings in various
cultures
Asian Women: avoid shaking hands with one another and men
Native American Tribes: believe that vigorous hand shaking is aggressive
Spain and France: a firm hand shakes considered a sign of strength and good character
Western Cultures: view direct eye contact as positive
Native American and Asian: find eye contact rude and will avoid looking into eyes of
strangers
Middle Eastern: can maintain intense eye contact, which may appear to be glaring to
those from different cultures
Physical Distance or Space:
U.S and many Western Cultures: 2-3 feet is a comfortable distance
Latin Americans and Middle East: stand closer to one another than people in Western
cultures
Asians and Native Americans: comfortable with distances greater than 2-3 feet
Nurse should be conscious of these cultural differences in space and should allow enough
room for clients to be comfortable
Social Organization:
Western: people seek the advice of friend or family member to may make most decisions
independently
Chinese, Mexican, Vietnamese, and Puerto Rican Americans: strongly value role of
family in making health-care decisions, may delay making decisions until they can
consult appropriate family members
Time Orientation:
Western: focuses on urgency of time, valuing punctuality and precise schedules
Healthcare providers can become resentful and angry when clients miss appointments or
fail to follow specific treatment such as taking medications at prescribed times
When possible nurse should be sensitive to the clients time orientation, as with follow up
appointments, when timing is essential with some medications the nurse can explain the
importance of more precise timing
Environmental Control:
People who believe they have control of their health are more likely to seek care, to
change their behavior, and to follow treatment recommendations
Those who believe that illness is a result of nature or natural causes are less likely to seek
traditional health care because they do not believe it can help them
Biologic Variations: exist among people from different cultural backgrounds, and research is just
beginning to help us understand these variations
o Explain the nurses role in assessing and working with clients of different cultural backgrounds.
Knowledge of expected cultural patterns provides a starting point for the nurse to begin to relate
to people with ethnic backgrounds different from his or her own

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Being aware of the usual differences can help the nurse know what to ask or how to assess
preferences and health practices
Knowledge seeking about patients cultural values, beliefs, health practices
Patient as best source of information
General knowledge not replace for patient assessment
Wide variations in individuals in culture
The nurse must:
Maintain genuine, caring attitude
Ask how nurse can promote or assist with spiritual, religious, health practices
Recognize own feelings, possible prejudices
Remember that patients response to illness is complete, unique
African Americans:
Different Terms: Afro Americans, Blacks, persons of color; patient preference for term is
important
Family support; maintenance of patient independence
Comfortable with public demonstration of affection
Conversation possible animated, loud
Handshake for greeting
Direct eye contact shows interest and respect
Silence possibly indicated lack of trust
Church important support; prayer for healing
View mental illness as spiritual imbalance or punishment for sin
Use of fold remedies with Western medicine
American Indians or Native Americans
Older prefer American Indians, younger prefer Native Americans
Communication slow with may pauses- rushing speaker or interrupting is view negatively
Flexible orientation to time
Reluctance of family members to provide patient information (violation of patient
privacy)
Greeting by light-touch handshake, minimal direct eye contact
Patients typically quiet, stoic
Mental illness as due to ghosts, breaking taboos, or loss of harmony with environment
Medicine bag or healing objects not to be removed or touched
Arab Americans:
Greet with smile, direct eye contact, social comment about family or parent
Family as collective decision makers (father, eldest son, uncle, husband as family
spokesperson)
Human concerns valued more than adhering to schedule
Mental illness due to fear, manipulation, Gods will, or loss of country, family or friends
Mental illness has stigma; treat sought only when all other remedies fail
Prayer is very important to Muslims: strict Muslims pray 5X a day, wash before every
prayer, and pray in silence
Cambodians:
Handshake or slight bow with palms together, fingers pointed upward as greeting; no
contact with person being greeted
Politeness highly valued; silence common; eye contact acceptable (lower of eye by
women to be polite)
Inappropriate to touch head without permission
Family members included for decision making
Flexible orientation to time
Passive role when ill; mental illness due to war or brutalities
Chinese:

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Shy in unfamiliar surroundings
Avoid eye contact with authority figures
Silences respectful
Asking questions signs of disrespect
Time urgency not highly valued
Respectful distance important
Eldest male may be family decisions maker, spokesperson
Mental illness due to disharmony of emptions or evil spirits
Cubans:
Outgoing, animated in conversation
Direct eye contact as sign of respect or honesty
Extended family important
Mental illness inherited or caused by stress; stigma for family
Ill person submissive, helpless, dependent
Filipinos:
Smile rather than handshake for greetings
Animated facial expressions
Little direct eye contact with authority figures
Disagreement rarely voiced
Mental illness due to religious, mystical causes- disruption in harmonious function of
whole person, spiritual world
Ill person passive; eldest male as decision maker after conferring with family
Haitians:
Handshake as formal greeting
Polite but shy, especially with authority figures
Smile, node even when not understanding
Mental illness not well accepted; due to supernatural causes
Home, folk remedies used first
Japanese Americans:
Formal greetings, light touch, minimal eye contact especially with authority figures
Self-disclosure unlikely, use opened questions
Promptness important
Mental illness shameful, reluctance in seeking help
Mental illness due to evil spirits as punishment for bad behavior or failure to live good
life
Mexican Americans:
Touching prevalent among family, not always welcomed by strangers
Handshake acceptable as polite greeting
Avoidance of direct eye contact with authority figures
Silence often signs of disagreement
Flexible time orientation
No clear separation of physical and mental illness- due to imbalances between person and
environment
Puerto Ricans:
Elders less direct eye contact
Younger people preference for direct eye contact
Religious, spiritual practices important
Gratitude by homemade cooking-refusal is an insult
Psychical illness hereditary or punishment
Mental illness hereditary or due to suffering, highly stigmatized
Russians:
Formal greeting or handshake with direct eye contact
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Touching, embracing, kissing on check for close friends and family
Mental illness due to stress, moving to new environment
Ill persons on bed rest
Home remedies tired first
Reluctant to take medications
South Asians:
Oral greetings, gestures
Handshakes among men
Touching not common
Feelings expressed by eyes, facial expressions
Direct eye contact, loudness disrespectful
Silence indicates approval, acceptance, tolerance
Mental illness due to spells cast by enemies or evil spirits
Vietnamese:
Greeting with smile, bow
Touch limited among older, traditional people
Head is sacred, feet profane
Avoidance of eye contact with authority figures, elders
Mental illness due to disharmony or punishment by ancestral spirits for past bad behavior
Ill persons passive

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