Competency 4 and 5: Chronic & Acute Illnesses and Client and Customer Service Developed by: Dede Carr, BS, LDA Karen Neu, MSN, CNE, CNP.

Awareness & Sensitivity to Client’s Health Care Needs

Competency 4 and 5: Chronic & Acute Illnesses and Client and Customer Service

Developed by: Dede Carr, BS, LDA

Karen Neu, MSN, CNE, CNP

U.S. Department of Labor Grant“This workforce solution was funded by a grant awarded by

the U.S. Department of Labor’s Employment and Training Administration. The solution was created by the grantee and does not necessarily reflect the official position of the U.S. Department of Labor. The Department of Labor makes no guarantees, warranties, or assurances of any kind, express or implied, with respect to such information, including any information on linked sites and including but not limited to, accuracy of the information or its completeness, timeliness, usefulness, adequacy, continued availability, or ownership. This solution is copyrighted by the institution that created it. Internal use, by and organization and/or personal use by an individual or non-commercial purposes, is permissible. All other uses require the prior authorization of the copyright owner.”

2

Competency 4: Chronic & Acute Illness

Competency:Explain how chronic & acute diseases

can influence the functioning behaviors & attitudes of clients including dementia/Alzheimer’s Disease.Describe how chronic illness affects an

individual’s coping & behaviorsDescribe how acute illness affects an

individual’s coping & behaviorsReview the Vocabulary List

DefinitionsIllness is a state in which a person’s physical,

emotional, intellectual, social, developmental, or spiritual functioning is diminished or impaired compared with previous experience (Potter & Perry, p. 79)

Illness may be defined as the highly individualized response a person has to disease (Ramon & Niedringhaus, p. 10)

Restoring health means focusing on the ill client from early detection through the recovery period

Wellness a state of well-being while engaging in attitudes & behavior that enhance quality of life & maximize personal potential (Ramon & Niedringhaus, p. 10)

Definitions Acute illness is a health problem of short

duration in which the condition improves or resolves completely; symptoms appear abruptly, are intense, & often subside in a relatively short period (Potter & Perry, p. 79)

Chronic illness persists usually longer than 6 months & can affect functioning in any dimension (Potter & Perry, p. 79)

Acute IllnessAcute IllnessAlthough acute illness is by nature, short-lived, it can

be a crisis & stress families, especially if it involves hospitalization; it can impact families’ financial & time resources

Many stressor that families experience in chronic illness can apply to acute illness

It is important for the healthcare worker to realize that the person in crisis may act in ways that are not his/her normal behavior, because he/she feels a loss of control due to the illness

Many times the person’s behavior in crisis is in the form of anger at the health care system

Chronic IllnessChronic illness has certain characteristics:It is caused by disease that produces signs & symptoms

within a variable time periodIt develops slowly & runs a long course (usually 6

months & longer)It allows only a partial recoveryIt can impose an enormous financial burden on a family

(Ramon & Niedringhaus, p. 305)

Chronic illness affects a person’s ability to meet one’s basic needs for self-actualization

Priority is given to meeting the alterations in physical or emotional health that the illness affects

(Ramon & Niedringhaus, p. 305)

Chronic Illness ExamplesSome examples of chronic diseases are:Heart diseaseDiabetesCancerChronic obstructive lung diseaseStrokeAlthough the symptoms & general reactions caused by

chronic disease may subside with proper treatment and care, the disease remains. This period during which the disease is controlled is called remission.

Reactivation of the disease & increase in severity of symptoms is known as exacerbation.

Exacerbation causes the client to seek medical attention & may lead to hospitalization (Ramon & Niedringhaus, p. 305)

Risk Factors for Illness&

How Client’s & Family’s Behaviors

Affect Illness

Risk Factors for Acute & Chronic Illness

Predisposing risks:Age:

Chronic illness can occur at any age, but the elderly are more likely to have long, drawn-out chronic diseases & there is an increase as people age

Genetics: Sometimes an inherited trait or gene puts a person at a

greater risk for certain diseasesRace & Ethnicity:

There is an association between disease occurrence & race; some diseases are more prevalent in certain groups

(Ramon & Niedringhaus, p. 305)

Behavioral Risk Factors for IllnessBehavioral risk factors are factors that people can

control or change to prevent or delay chronic disease

Behavioral Risk FactorsLifestyle: Way individuals live & work put one at risk Stress: Different types of stress can lead to chronic high

blood pressure, chronic depression, & headaches; stress can be physical, psychological, or emotional

Poor Nutrition: Can lead to high blood pressure, obesity, & high cholesterol

Physical Inactivity: Insufficient or low physical activity can lead to obesity, heart disease, diabetes, & other chronic diseases (Ramon & Niedringhaus, p. 305)

Risk Factors for Chronic IllnessBehavioral Risk FactorsTobacco, Alcohol, & Substance Use: Use of these is a

risk for cardiovascular disease & other multiple chronic illnesses

Physiologic Factors: May include high blood pressure, high blood cholesterol, & obesity

Environmental Factors: Pollution or exposure to chemicals, pesticides, etc. put one at a greater risk for cancer

Socioeconomic Status: Those at a lower socioeconomic level have increased chronic disease

(Ramon & Niedringhaus, p. 305)

Illness BehaviorPeople who are ill generally act in a way known as

“illness behavior” Illness behavior involves how people monitor their

bodies, define & interpret symptoms, take remedial actions, & use the health care system (Mechanic, 1982, as cited in Potter & Perry, p. 79)

Personal history, social situations, social norms, & opportunities & constraints of community institutions can affect health behavior (Mechanic, 1995, as cited in Potter & Perry, p. 79)

If people perceive themselves to be ill, illness behavior can be a coping mechanism because as a result the client can be released from roles, social expectations, or responsibilities (Potter & Perry, pp. 79-80)

Influencing Variables on IllnessWhat influences illness & illness behavior?Just as health & health behaviors are affected

by internal & external variables (factors) so are illness and illness behaviors

Influences of these variables & the stage of illness behavior the client is in will affect:The likelihood of the client seeking health care,Complying with therapy (following recommended

treatment) Health outcomes

Influencing Variables on IllnessInternal Variables (Within person)The client’s perception of symptoms & the nature of

illness (what kind of illness does the client have & how serious is it?)

If a person believes that the symptoms of the illness disrupt normal routine, he/she will more likely seek healthcare assistance than if the symptoms are not disruptive

Example: if one is awakes with crushing chest pain in the middle of the night, one would perceive this to be serious & life-threatening & are more likely to see healthcare or if client fears serious illness the client may react by denying it & not seek healthcare assistance (Potter & Perry, p. 80)

Influencing Variables on IllnessInternal VariablesNature of illness, either acute or chronic, affects client’s

illness behaviorClients with acute illness are more likely to seek

healthcare & readily comply with therapyClients with chronic illness in which symptoms cannot be

cured, but only partially relieved, may not be motivated to comply with therapy

Chronically ill clients may become less active in their care, may experience greater frustration, & may comply less with care

Client’s coping skills & locus of control affect the way the client behaves when ill (Potter & Perry, p. 80)

Influencing Variables on IllnessLocus of ControlA locus of control orientation is a belief about whether

the outcomes of our actions are contingent on what we do (internal control orientation) or on events outside our personal control (external control orientation)" (Zimbardo, 1985, p. 275 as cited by Neill)

Internal Locus of ControlIndividual believes that his/her behavior is guided by

his/her personal decisions and efforts. External Locus of ControlIndividual believes that his/her behavior is guided by

fate, luck, or other external circumstances

Influencing Variables on IllnessExternal VariablesExternal variables influencing a client’s illness

behavior include the visibility of symptoms, social group, cultural background, economic variables, accessibility of the health care system, & social support (Potter & Perry, p. 80)

Visibility of symptoms affect body image & illness behavior & thus the client is more likely to seek health care assistance

Client’s social group (family, friends, & coworkers) may assist client in recognizing the threat of illness or support the denial of potential illness & influence the client’s illness behavior

Influencing Variables on IllnessExternal VariablesCultural & ethnic background teaches a person

how to be healthy, how to recognize illness, & how to be ill

Effects of disease & its interpretations vary according to cultural circumstances

Ethnic differences can influence decisions about healthcare & the use of diagnostic & health services

Dietary practices among ethnic groups, occupations held by certain cultural groups, & cultural beliefs are factors that contribute to illness & the distribution of disease

Influencing Variables on IllnessEconomic VariablesEconomic variables influence the way a client reacts to illnessBecause of economic constraints a client may delay treatment &

in many causes continue to carry out daily activitiesAccess to health care system is closely related to economic factorsHealthcare system is a socioeconomic system that clients must

enter, react with, & exitFor many clients the healthcare system may be complex &

confusing & some clients may see non-emergency medical care in an emergency department, because they do not know how to obtain health services

How close one is to a health care agency often influences how soon clients enter the system after deciding to seek health care

(Potter & Perry, p. 80)

Illness Factors that Affect Clients & Families

Illness Factors Impacting Family Dynamics

How does illness impact the family dynamics?The nature of the illness, whether acute or chronic, can

range from minor to life threateningThe duration of illness, ranges from short-term to long-termThe residual effects of the illness, including none to

permanent disabilityThe meaning of illness to the family & its significance to

family systemsThe financial impact of the illness, which is influenced by

factors such as insurance & the ability of ill member to return to work

The effect of the illness on future family functioning (for instance, previous patterns may be restored or new patterns may be established) (Berman et al., p. 437)

Chronic Illness StressorsChronic illness includes stressors that impact the client &

family:Emotional stress over a period of time can lead to other

chronic conditions such as depression, isolationPhysical stress depends on the body systems affected by

disease & can gravely impact family, as well as client (example: chronic pain or limited mobility)

Social stress may result in isolation from friends & community activities

Financial: Healthcare costs for the disease impacts the client’s financial resources or in some cases, the disease impacts the client’s ability to work to earn monies to pay for treatments needed (Biggest health problem affecting developed nations)

(Duffy, p. 1213)

Family dynamics may be affected by the type of illness or injury, its duration, & illnesses effects on client’s ability to fulfill a specific family role (Juliar)

Illness Factors Impacting Family Dynamics

Illness impacts the family dynamics by causing stress & client & family react to those stressors, which may result in changes of behavior.

Some areas that illness affects or impacts areBehavioral & emotional changesBody ImageSelf-ConceptFamily Roles (Potter & Perry, pp. 80-81)

The following slides explain how illness may impact the client/family that may result in changes of behaviors.

Impact of Illness on Client & FamilyBehavioral & Emotional ChangesPeople act differently to illness or the threat of illness &

behavioral & emotional reactions depend on nature of illness, client’s attitude toward it, reactions of others to it, & variables of illness behavior

Short-term, non-life-threatening illnesses evoke few behavioral changes in functioning of client & family

Example if husband/father has a cold, he may lack energy & patience to spend time with family activities & may be irritable & prefer not to interact with family (normal response to illness)

Severe illness can result in more extensive changes, such as anxiety, shock, denial, anger, & withdrawal (common responses to the stress of illness) (Potter & Perry, p. 80)

Impact of Illness on Client & FamilyImpact on Body Image (Subjective concept of physical

appearance) as some illnesses result in physical changes & clients/families react differently to these changes

Reactions depend on the type of changes (loss of limb or an organ), their adaptive capacity, the rate at which changes take place, & support services available

When body image changes occur, as amputation for example, client generally adjusts in following phases: shock, withdrawal, acknowledgement, acceptance, & rehabilitation (natural process); client & family move through a period of grieving as they acknowledge the loss

(Potter & Perry, p. 80-81)

Impact of Illness on Client & FamilyImpact on Self-ConceptSelf-concept is a mental self-image of strengths &

weaknesses in all aspects of personality; self-concept depends on body image & roles, but also on aspects of psychology & spirituality

Impact of illness on self-concepts of clients/family members may be more complex & less readily observed than role changes

Client’s self-concept changes because of illness may no longer meet family expectations, leading to tension or conflict; as a result family members may change their interactions with the client (Potter & Perry, p. 81)

Impact of Illness on Client & FamilyImpact on Family RolesPeople have many roles in life, such as wage earner,

decision-maker, professional, child, sibling, or parentWhen illness occurs, parents & children try to adapt to

major changes resulting from a family members illnessIf a parent of an adult becomes ill & cannot carry out usual

activities, the adult child often assumes many of parent’s responsibilities & in essence becomes a parent to the parent. Such a reversal of the usual situation can lead to stress, conflicting responsibilities for the adult child, or direct conflict over decision-making

Change may be subtle & short-term or drastic & long-termLong-term changes require an adjustment process similar

to the grieving process (Potter & Perry, p. 81)

Impact of Illness on Client & FamilyImpact on Family DynamicsFamily dynamics is the process by which the family:

functions, makes decisions, gives support to individual members, & copes with everyday changes & challenges

If a parent becomes ill, family activities & decision making often come to a halt, as the other family members wait for the illness to pass. Or they delay action because they are reluctant to assume the ill person’s roles or responsibilities

Illness often changes the family dynamics (Potter & Perry, p. 81)

Physical IllnessPhysical illness is any illness that affects the

bodyAny illness that causes pain, physical

discomfort, or mood problems, such as anxiety & depression, often result in sleep problems too (Potter & Perry, p. 1031)

Prevention of Chronic IllnessBecause chronic disease evolves over time & changes

may become irreversible so the goal is to detect risk factors as early as possible

Prevention: Interrupting or stopping the development of a disease before it occurs

Primary Prevention: Health promotion & specific prevention against disease

Secondary Prevention: Early detection of disease & prompt intervention to halt disease progression

Tertiary Prevention: Rehabilitation (for those with disease) to prevent complications, & restoring independent functioning to the highest level

(Ramon & Niedringhaus, p. 305)

Customer & Client Services & Satisfaction

Competency #5Describe selected client service strategies, including customer service, their impact on quality client care and the importance of client participation in group/family activities.

Customer & Client ServicesClient Service StrategiesGoal is customer services satisfactionWho are the healthcare services customers?There are internal & external customersInternal customers are those who work in the

healthcare industry & external customers are those who come to the healthcare provider for services, such as customers, clients, & patients.

Patients & clients come to the healthcare provider for a number of reasons: sudden illness, an emergency situation, to obtain information about preventative measures to avoid future health problems, or a routine evaluation or physical examination. Whatever the reason, patients/clients/families expect high quality professional services (Juliar, p. 292)

Customer & Client ServicesCustomer satisfaction & quality of care must be a goal of the healthcare worker

What are some ways healthcare workers can promote high quality patient/client services?

Stay focused on the client’s needsListen attentively to the clients & their families & report any concerns to your supervisor in a timely mannerClients/families may have positive outcomes of their medical treatment, but may be dissatisfied with the experience due to a cold food tray, delay in answering a call light, waiting for tests, delayed treatments, an un-emptied bedpan, or delayed pain medications

How can healthcare workers promote quality healthcare services?

Healthcare workers should recognize the client’s stage of development & how this impacts the client’s needs

Recognize the impact of family in the client’s receiving of healthcare services

Remember that in every healthcare setting, the client/family has feelings of vulnerability & may be in crisis (expect changes in usual behaviors)

Customer Satisfaction

Maintain good relationships with internal & external customers

1. Look for & praise coworker for a job well done2. Respect & show courtesy 3. Give a quick response to a situation or in providing assistance to another

4. Arrive at work on time & ready to provide client-focused care

5. Leave personal problems at home6. Seek professional development opportunities to promote one’s own development (Juliar, pp. 294-295)

Customer ServiceHealthcare workers should:Value seeing health care situations ‘through the patients’ eyes’

Respect & encourage individual expression of patient’s values, preferences & expressed needs

Value the patient’s expertise with their own health & symptoms

Honor learning opportunities with patients who represent all aspects of human diversity (QSEN, 2011)

Customer Service

Healthcare workers should:Seek to understand one’s personally held attitudes

about working with patients from different ethnic, cultural & social backgrounds

Willingly support patient-centered care for individuals & groups whose values differ from one’s own

Value cultural humility Seek to understand one’s personally held values &

beliefs about the management of pain or suffering Value shared decision-making with empowered

patients and families, even when conflicts occur (QSEN, 2011)

Common Expectations for ServiceHealthcare services should be done in a timely manner

Services should be client-centered or family-centered

Service should include caring & compassion (Juliar)

References Berman, A., Snyder, S.J., Kozier, B., & Erb, G. (2008). Promoting family

health. In A. Berman, S.J. Snyder, B. Kozier, & G. Erb (Eds.). Kozier & Erb’s Fundamentals of nursing: Concepts, process, and practice (8th ed.) (pp.428-441). Upper Saddle River, NJ: Prentice Hall

Duffy, S.K. (2006). Rehabilitation nursing. In B.L. Christensen & E. O. Kockrow (Eds.). Foundations and adult health nursing (5th ed.) (pp. 149-187). St. Louis, MO: Elsevier, Mosby

Juliar, K. (2003) Minnesota Healthcare Core Curriculum (2nd ed.). Clifton Park, NY: Delmar Publishers

Maurer, F., & Smith, C. (2009). Community/public health nursing practice: Health for families and populations (4th ed.). St. Louis, MO: Elsevier.

Neill, J. (2006, December 6). What is locus of control? Retrieved from http://wilderdom.com/psychology/loc/LocusOfControlWhatIs.html

Polan, E.U. (2006). Life span development. In B.L. Christensen & E. O. Kockrow (Eds.). Foundations and adult health nursing (5th ed.) (pp. 149-187). St. Louis, MO: Elsevier, Mosby

Ramon, P.R. & Niedringhaus, D. M. (2008). Promoting culturally proficient care. Fundamental nursing care (2nd ed.) (pp. 16-26). Upper Saddle River, NJ: Person Prentice Hall