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 e perienced fre!uently by patients with chronic illness" # Helplessness $elplessness is often the result of necessary reliance on others and a loss of independence due to reduced abilities. # Frustration %educed abilities, persistent physical or mental symptoms and a general loss of control over life can all lead to e treme frustration. # Hopelessness Chronic illness breeds hopelessness for the present due to symptoms and lost abilities, and hopelessness for the future due to uncertainty. # Sadness &eople with chronic illness often e perience both a sadness for what they are facing and a sadness for what they have lost. # Resentment %esentment in chronic illness can be aimed at oneself due to inabilities, at others due to abundance of abilities, or both simultaneously. # Anxiety ' sense of fear and an iety are common in chronic illness, both in terms of the present and in terms of the future. # Irritability The frustration, resentment, an iety and hopelessness of chronic illness can cause a person to be irritable with him or herself and with others. # Tension &hysical, financial, relationship and other challenges can cause physical and emotional tension that often further aggravates chronic illness. # Stress ( ternal 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 +fi ing, things, or at a +higher power, for punishing them. These negative feelings and emotions are all a natural part of the grieving process e perienced by many - if not all - individuals diagnosed with chronic illness. ' 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. .ost peoples grief follows a progression that can be outlined in five basic steps"

/tep 0" 't this stage, a person is unwilling to accept the diagnosis. $e or she will often deny that the diagnosis is correct and may discount symptoms and even medical tests. $e or she may refuse medication or treatment and try to maintain a previous standard of life or activity. /tep 1" 't this stage, a person has accepted the diagnosis as real and e periences a strong sense of the unfairness of the situation. $e or she may be angry, irritable, frustrated or bittern and may display some degree of hostility, especially toward medical personnel and caregivers. /tep 2" 't this stage, a person has moved past his or her sense of unfairness or in3ustice and has a temporarily renewed sense of hope. $e 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 4od or another +higher power., /tep 5" 't this stage, a persons bargaining, reasoning and dealing have all come to a screeching halt and the revived hope is completely deflated. $e or she enters a period of e treme sadness and depression, often e hibiting hopelessness and a desire for isolation. /uicidal thoughts may also become evident at this stage. /tage 6" 't this stage, a person finally comes to a sense of true acceptance of his or her diagnosis. $e or she develops coping strategies and learns to live with and adapt to the specifics of his or her illness or condition. $e or she may also be willing to offer support and encouragement to others at this stage. Powerlessness: &erception that ones action will not significantly affect an outcome7 a perceived lack of control over a current situation or immediate happening. Defining /evere 8erbal e pression of having no control of influence over the situation or outcome of self-care. 9epression over physical deterioration that occurs despite patient compliance with regimen 'pathy !ara"teristi"s

.oderate Nonparticipation in care or decision making when opportunities are provided ( pression of dissatisfaction and frustration over inability to perform previous task and:or activities 9oes not monitor progress ( pression of doubt regarding role performance

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%eluctance to e press true feelings, fearing alienation from caregivers Inability to seek information regarding care 9ependence on others that may result in irritability, resentment, anger and guilt. 9oes not defend self-care practices when challenged.

&assivity ( pressions of uncertainty about fluctuating energy levels.

INT(%8(NTI<N/ &atients need to recogni=e 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 e press their concerns and ask !uestions. &rovide the patient with decision-making opportunities such as when activities are to occur or where ob3ects are to be placed and increasing the fre!uency and significance of those opportunities over time. 'ssist the patient to differentiate between factors that can be controlled and those that cannot. Hopelessness The sub3ective state in which an individual sees limited or no alternatives or personal choices available and cannot mobili=e energy on own behalf. Defining !ara"teristi"s

.a3or &assivity, decreased verbali=ation 9ecreased affect 8erbal cues indicating despondency )+I cant,, sighing* .inor ;ack of initiative 9ecreased response to stimuli Turning away from speaker Closing eyes /hrugging in response to speaker 9ecreased appetite 'ltered sleep pattern ;ack of involvement in or passively allowing care

#ursing Inter$entions for enabling and supporting hope include" ;istening attentively (ncouraging sharing of feelings

&roviding accurate information )realistic hope that is specific to the patients and familys needs for information* (ncouraging and supporting patient control over his or her circumstances, choices and environment whenever possible 'ssisting the patient to e plore ways for finding meaning in his or her life (ncouraging realistic goal >acilitating effective communication within the family .aking referrals for psychosocial and spiritual counseling 'ssisting with the development of supports in the home or community when none e ist

Sensory Depri$ation /ensory deprivation is a state of reduced sensory input from the internal or e ternal environment, manifested by alterations in sensory perception. /ensory deprivation generally means a lessening or lack of meaningful sensory stimuli, monotonous sensory input, or an interference the processing of information)%odemich,0??@* /ensory deprivation is the deliberate reduction or removal of stimuli from one or more of the senses )Aikipedia dictionary* %#TRI&'TI#( T% S)#S%R* D)PRI+ATI%#

FA T%RS

8isual or auditory impairments that limit or prohibit perception of stimuli 9rugs that produce sedative effect on the CN/ 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

T*P)S %F S)#S%R* D)PRI+ATI%# %educed sensory input)e.g. visual or hearing loss* (limination of order or meaning from input)e.g. e posure to strange environment* produces monotony and boredom

,I#I A, SI(#S %F S)#S%R* D)PRI+ATI%# -( cessive yawning, drowsiness, sleeping -9ecreased 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 /ensory 9eprivation (ncourage the client to use aids such as eyeglasses and hearing aids 'ddress the client by name and touch the client while speaking if this is not culturally offensive Communicate fre!uently with the client and maintain meaningful interactions )e.g. discuss current events* &rovide a radio and:or T8 clock and calendar 'd3ust the environment to provide meaningful stimulation )e.g. enable the client to look through a window* (ncourage social interaction

Interventions for the understimulated client should address the etiology of the deprivation such as inade!uate stimuli, inability to receive stimuli, or inability to process stimuli. Inade-uate stimuli &roviding the client with a variety of stimuli appropriate for the person is important )e . newspapers, books, and T8 can stimulate the visual and auditory senses. &roviding ob3ects 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. >or the client who is inade!uately stimulated, the nurse can arrange for people to visit and talk with the clients regularly.

Inability to Re"ei$e Stimuli The nurse should make e tra effort to provide stimuli for the other senses.

Inability to Pro"ess Stimuli The nurse can provide suitable e planation and perhaps written notes to help them know what to e pect. >or e . 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

' prolonged disturbance results in decrease in amount, !uality and consistency of sleep. It produces a variety of physiologic and behavioral symptoms, the degree of which depends on the degree of deprivation. Clinical /igns Behavior Changes" increasing irritability, restlessness, listlessness, lethargy, decreased attention span, fre!uent daytime napping, disorientation. &hysical /igns" dark circles under eyes, fre!uent yawning, postural changes, slight hand tremor, mild nystagmus and e pressionless face. 9ifficulty performing '9;s

Nursing Interventions 'ssess the clients daytime and nighttime sleeping patterns 9iscuss possible causes that contribute to sleeplessness ( plore sleep-promoting techni!ues. &rovide clients desired comfort measures. &rovide a !uiet, peaceful environment during sleep periods. Inform the client of necessary care interruptions ahead of time. Implement measures as indicated to prevent fre!uent voiding at night such as decreasing fluid intake before the bedtime. (ncourage the client o e press concerns when unable to sleep.

Healt! )du"ation Teaching &atients /elf-care &atient 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. Aell-informed, educated patients are more likely than uniformed p to be concerned about their health and do what is necessary to maintain it. Cnowledge is the key to making informed choices and decisions during all phases of the chronic illness tra3ectory. 9espite the importance of teaching the p and the family, the nurse must recogni=e 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 p s 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.

' p s learning needs change as the tra3ectory phase and his or her personal situation changes. The nurse must also recogni=e that patients may know how their body responds under certain conditions and how best to manage their symptoms.

Role of Family 's 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.