1. Illness and Hospitalization
Chapter 19
Illness and Hospitalization
Copyright © 2013 by Elsevier Inc. All rights reserved.

2. Copyright © 2013 by Elsevier Inc. All rights reserved.
Learning Objectives
Explain the difference between health and illness.
Outline the five stages of illness.
Identify how denial is used as a protective mechanism during illness.
Explain why hospitalization is considered a situational crisis.
Describe the three stages of the hospitalization experience.
Copyright © 2013 by Elsevier Inc. All rights reserved.

3. Copyright © 2013 by Elsevier Inc. All rights reserved.
Learning Objectives
Compare hospitalization for psychiatric problems with hospitalization for physical problems.
Discuss how emotional support of significant others affects the outcome of a client’s illness.
Identify three nondrug methods for managing pain.
Examine the importance of discharge planning for hospitalized persons.
Copyright © 2013 by Elsevier Inc. All rights reserved.

4. The Nature of Illness (p. 216)
Health
Dynamic state of physical, mental, and social well-being as well as the absence of disease or abnormal conditions
Illness
State of imbalance
Body’s way of communicating its need for attention
Has strong psychosocial aspects
Discuss different definitions of health and illness.
Discuss some cultural views of illness (e.g., evil eye, curse, punishment from God).
Discuss how the client’s beliefs about health and illness can affect his or her health-seeking behaviors.
Copyright © 2013 by Elsevier Inc. All rights reserved.

5. The Nature of Illness cont’d. (p. 216)
Stages of the illness experience
Stage 1: Symptoms
The illness experience begins when a person becomes aware that something is not right.
If symptoms are mild, one may self-medicate with various over-the-counter drugs, visit a local cultural folk healer, pray or meditate, or ignore the situation.
Stage 2: The sick role
Sickness is confirmed by talking with other people.
The social group supports the presence of an illness, and the individual either assumes the sick role or continues to deny the illness.
List and define the five stages of illness.
Copyright © 2013 by Elsevier Inc. All rights reserved.

6. The Nature of Illness cont’d. (p. 217)
Stages of the illness experience
Stage 3: Medical care
If symptoms persist and home remedies fail, the person usually seeks medical intervention.
Health professional confirms illness and provides treatment.
Stage 4: Dependency
The individual is relieved of obligation, is allowed to be passive and dependent, but is expected to get well.
Individuals at this stage have a particular need to be informed and emotionally supported.
Stage 5: Recovery and rehabilitation
The individual gradually gives up the sick role and resumes his or her normal obligations and duties.
Are the five stages of illness the same in a chronic condition?
Copyright © 2013 by Elsevier Inc. All rights reserved.

7. The Nature of Illness cont’d. (p. 217)
The impact of illness
Illness affects the activities of the individual and of those who come in contact with the sick person.
Individuals may react to illness with anxiety, anger, denial, shock, or withdrawal.
Illness has a psychosocial impact on the family.
Illness involving changes in physical appearance will affect body image.
Copyright © 2013 by Elsevier Inc. All rights reserved.

8. The Nature of Illness cont’d. (p. 218)
Illness behaviors
Denial can be useful or paralyzing.
Most people experience illness, recover to previous levels of functioning, and move on with their lives.
Nurses should remember that illness is the most important priority for the individual who is experiencing it.
How is denial used as a protective mechanism during illness?
Copyright © 2013 by Elsevier Inc. All rights reserved.

9. The Hospitalization Experience (p. 218)
Situational crisis
Relates to external or environmental problems
People generally are hospitalized in one of two ways.
Admission planned in advance
Emergency requiring special health care resources
Stages of hospitalization
Sense of being overwhelmed
Stabilization
Adaptation
Explain why hospitalization is considered a situational crisis.
List and describe the stages of the hospitalization experience.
Copyright © 2013 by Elsevier Inc. All rights reserved.

10. The Hospitalization Experience cont’d. (p. 219)
Common reactions to hospitalization
Clients respond to the stresses of being hospitalized in how they react to other threats or crises.
Attitudes and meanings regarding inpatient treatment for clients with mental health problems differ from those related to institutional stays for those with physical problems.
Discuss how you as a caregiver can make clients feel more comfortable in the hospital environment.
Copyright © 2013 by Elsevier Inc. All rights reserved.

11. The Hospitalization Experience cont’d. (p. 219)
Psychiatric hospitalization
Differs from hospitalization for physical reasons
Individual and family must cope with stigma of mental illness.
Friends may feel awkward about offering support.
Employers may question an individual’s fitness for the job.
Admission may be seen as confirmation that one is truly crazy.
Recall differences between voluntary and involuntary admission.
Discuss the symbolic meaning of psychiatric hospitalization (e.g., equated with imprisonment; shame, guilt attached).
A client is in a situation filled with uncertainty—the client does not know when he or she will be able to leave, or what new diagnoses will be made.
Copyright © 2013 by Elsevier Inc. All rights reserved.

12. Therapeutic Interventions (p. 220)
Psychosocial attention is as important as good physical care.
Psychosocial care
Good physical care is always the first place to start in meeting the emotional needs of ill persons.
Begins with an assessment of the client’s coping status
Creating an accepting environment gives clients permission to share themselves and helps to build trust in the therapeutic relationship.
Assess how the client and family perceive the current situation, how they have approached other stressors in the past, and what additional stressors they may be experiencing.
Assess the client and family literacy level, communication skills, and family dynamics.
Request appropriate referrals to social work and community services once additional stressors and stressors after the discharge are assessed.
Copyright © 2013 by Elsevier Inc. All rights reserved.

13. Therapeutic Interventions cont’d. (p. 221)
Supporting significant others
Care providers should be alert to how the family’s interactions affect the client.
Family members should be included and consulted for details about the client’s care.
All family members should be kept informed about the client’s progress.
Remember that family members are in crisis as well.
How does emotional support provided by significant others affect the outcome of a client’s illness?
Copyright © 2013 by Elsevier Inc. All rights reserved.

14. Therapeutic Interventions cont’d. (p. 221)
Pain management
Associated with many illnesses and hospital stays
Subjective
Can be felt only by the individual who is experiencing it
Must discover clients’ expectations of pain if pain is to be managed effectively
Natural remedies may decrease discomfort before the provider resorts to pain medications.
Set realistic goals for pain management together with the client and family.
Pick age-appropriate education and pain assessment tools.
Identify the nondrug methods used to manage pain.
Copyright © 2013 by Elsevier Inc. All rights reserved.

15. Therapeutic Interventions cont’d. (p. 222)
Discharge planning
Early identification of and intervention for clients’ problems following hospitalization are essential.
New anxieties about the individual who is returning home must be addressed before he or she is released from the hospital.
For people who live alone, especially older adults, discharge planning is vital.
Why is discharge planning important for hospitalized persons?
What are some changes that might need to be made in daily routines, or to the home itself upon discharge? (instituting new therapy regimen; installing hand rails in bathrooms or along stairs; elimination of throw rugs, clutter)
Copyright © 2013 by Elsevier Inc. All rights reserved.

16. Copyright © 2013 by Elsevier Inc. All rights reserved.
Question 1
An illness consists of five stages. If an individual acknowledges the presence of an illness, discusses it with family and friends, and is given permission to focus on restoring health, the individual is at what stage?
Stage one
Stage two
Stage three
Stage four
Correct Answer: 2
Copyright © 2013 by Elsevier Inc. All rights reserved.

17. Copyright © 2013 by Elsevier Inc. All rights reserved.
Question 2
At what stage do people have a particular need to be informed and emotionally supported?
Stage one
Stage two
Stage three
Stage four
Correct Answer: 4
Copyright © 2013 by Elsevier Inc. All rights reserved.

18. Copyright © 2013 by Elsevier Inc. All rights reserved.
Question 3
During each stage of illness, people are faced with several emotional choices and reactions that frequently involve all of the following except:
Denial
Anger
Helplessness
Elation
Correct Answer: 4
Copyright © 2013 by Elsevier Inc. All rights reserved.

19. Copyright © 2013 by Elsevier Inc. All rights reserved.
Question 4
A client who has been hospitalized recently is gradually gaining the strength to reestablish some personal identity. He is self-centered at the moment. He is at what stage in the hospitalization?
Stage one
Stage two
Stage three
Stage four
Correct Answer: 2
Copyright © 2013 by Elsevier Inc. All rights reserved.

20. Copyright © 2013 by Elsevier Inc. All rights reserved.
Question 5
When clients are experiencing pain, it is important to try to provide other interventions before medication. These include all of the following except:
Massage
Visualization
Communication
Distraction
Correct Answer: 3
Copyright © 2013 by Elsevier Inc. All rights reserved.