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CONCEPT OF ACUTE,
CHRONIC ILLNESS ANDDISABILITY IN PEDIATRIC
Nursing Science ProgramHealth Science Fakulty
Respati UniversityJakarta
Sugeng Hadisaputra, M.Kep
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Acute
Acute illness, any illness
characterized by signs and
symptoms of rapid onset and shortduration. It may be severe and
impair normal functioning.
Sometimes, the health of a patient
in hospital may get worse suddenly(Mosby's Medical Dictionary, 8th
edition. 2009, Elsevier)
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Acute
Acute often also connotes an
illness that is of short duration,
rapidly progressive, and in need ofurgent care.
Acute is the medical term for an
illness or medical problem that
begins and progresses rapidly. Itmay also refer to an illness that
begins and ends quickly.
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Emergencies
A sudden unforeseen crisis
(usually involving danger) that
requires immediate action A life threatening condition.
An emergencyis a situation which
poses an immediate riskto health,
life, propertyor environment.Most
emergencies require urgent
intervention to prevent a worsening
of the situation
http://en.wikipedia.org/wiki/Healthhttp://en.wikipedia.org/wiki/Lifehttp://en.wikipedia.org/wiki/Propertyhttp://en.wikipedia.org/wiki/Natural_environmenthttp://en.wikipedia.org/wiki/Natural_environmenthttp://en.wikipedia.org/wiki/Propertyhttp://en.wikipedia.org/wiki/Lifehttp://en.wikipedia.org/wiki/Health -
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Support system
friends and family members
wanting to support a patient or
family member dealing with anacute illness is to be available to
listen and to fully support a family
member
Information should be appropriatefor family anxiety
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Parentsfeeling relatively
disempowered when dealing with
acute illness
in their children. Their experiences of seeking
advicefrom professionals could
leave them feeling uncertain and
uninformed.
Communiction is very important.
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Nursing consideration
Nurse should have competencies
in monitoring, measurement,
interpretation and prompt responseto acutely ill patient, as they need.
Focus to primary prevention and
developmental care.
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CONCEPT OF CHRONIC:
A. DefinitionB. Features (Characteristics) ofchronic illness
C. Theories and ModelsD. Power Resources
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A. DefinitionRefers to an alteredhealth state that willnot be cured by asimple surgicalprocedure or shortcourse of medicaltherapy
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pain was originally defined
as pain that has lasted 6
months or longer. It is nowdefined as pain that persists
longer than the normal
course
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B. Features (Characteristics) ofChronic Illness
1. interfere many normal activitiesand routines2. medical regimen is limited in its
effectiveness3. treatment contributes
substantially to the disruption ofthe usual patterns of living
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1. Risk Factors
* Disease and disabilities
* Genetic Disorders* IUGR, Prematurity, LBW* Teratogens* Disease Severity
* Functional Independence* Psychosocial Stressors
C. Theories and Models
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2. Resistance Factors* Intrapersonal Factors(hope, self-confidence,values)
3. Social-ecological Factors* Family Functioning
* Financial Resources* Stress Processing
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D. Power Resources
1. Physical Strength(individuals ability foroptimal physical functioning
and to physical reserve/ theability of the body tomaintain physical balance
when confronted withthreats or extra demands)
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2. Psychological Stamina (uniqueresiliency present in humans): Social support (relationshipqualities of attachment, socialintegration, opportunity fornurturance, reassurance of worth,sense of reliable alliance, and
guidance from a trustworthy,caring person (Weiss, 74) andtangible support (instrumentalsupport such as help withactivities of daily living),
emotional support, andinformational support(Schaefer,Coyne & Lazarus,1981)
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3. Positive Self Concept: self-
concept is the individuals totalthoughts and feelings about
self (Rosenberg, 1979)
Components: physical self /body image; functional self/
role performance; personal
self/ moral self-self ideal; andself-expectancy (Driever,
1984); and self-esteem /self-
worth.
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4. Energy
(The capacity of a system fordoing work; energy potential is
stored energy; energy also
spent for growth through
learning, work, and play(Ryden, 1977)).
Energy resource include
nutrients, water, rest, andmotivation.
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5. Knowledge and Insight (Havingknowledge and insight aboutwhat is happening to them
enables clients to feel more incontrol and helps to alleviate theanxiety of uncertainty.Knowledge is one structure
provider that decreasesuncertainty (Mishel, 1988) andenables development of acognitive map for ongoing
interpretation of events,enabling persons to findmeaning in illness-relatedevents (Turk, 1979)
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6. Internal awareness(Kinsman et al, 1976)is a
concept for discussion inrelation to the power ofknowledge and insight. IA isthe ability to detect and
interpret physical andpsychological cues so as totake appropriate action tocontrol symptoms and
maintain psychologicalbalance (Miller, 1982)
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6. Motivation (based oncompetence and self-
determination (Deci, 1985).Competence theory refers to theindividuals ability to dealeffectively with the environment
by manipulating the environmentnot only to meet basic needs butalso to have a feeling of efficacy.
That intrinsically motivated (thoseseeking stimulation and thosereducing incongruity/dissonance)behaviors enable persons to feel
competent and self determining
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7. Belief System (encompasses
belief in God to provide strength
and ability to cope with stress
and overcome it; belief in
therapeutic regimens, with the
accompanying autosuggestionthat therapy will be effective;
belief in caregivers; and belief in
self, that is confidence in onesown capabilities.
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E. Analysis of Coping View coping as a stable personality-
based emotional and behavioral modeof responding; learning escape andavoidance of threatening stimuli (Roch& Cohen, 1986).
As cortical and subcortical stimulationby the hypothalamus resulting inactivation of the pituitary andadrenocortical system (Physiologicalperspective)
As context-specific behavioral andemotional processes in which anindividual appraises, encounters, andrecovers from contact with stressor,whether a monir daily hassle or a majorlife change (Lazarus andFolkman(1984))
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Deals with social environmentaldemands (Mechanics, 1974)
Problem solving: confronting therealities of the problem whilemaintaining integrity offunctioning (Brunner, 1966)
Is the constantly changingcognitive and behavioral effortsused to manage specific externaland/ or internal demands that
are appraised as taxing and thatexceed the resources of theperson (Lazarus and Folkman,1984)
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F. Contingency Model of LongTerm Care
Assumptions:
People behave according to thefacts as they perceive them, not as
the facts are perceived by others All systems have both unique and
common responses and
characteristics All family members should have the
opportunity to be active participantsin health care
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The needs of people with chronic
conditions, and their families, arecomplex and require a team
approach
The patient and family are integralparts of the health care team
It is possible to influence a persons
internal motivation
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Components:
Systems (a complex of elements or
components that interact with eachother in amore or less stable waywithin any particular period oftime)Buckley, 1967; VonBertalanffy, 1968).
Contingency variables (mediatorsinfluencing the impact a chroniccondition has on system
functioning; they affect or may beaffected by it. These variables arethe systems orientation to life,stressors, coping strategies,strengths, and needs)
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Level of functioning (refers to
the systems currentperformance and is determined
by the extend to which it is
accomplishing its developmental
and situational tasks
Nursing Care (refers to
deliberate activities of a nurse to
help the individual and family
systems meet their needs)
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G. Quality of Life
Palliative care Palliative care is any form of medical
care or treatment that concentrates onreducing the severity of the symptoms
of a disease or slows its progressrather than providing a cure.
It aims at improving quality of life, byreducing or eliminating pain and other
physical symptoms, enabling thepatient to ease or resolvepsychological and spiritual problems,and supporting the partner and family..
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Early palliative care can reduce the
length of stay for seriously ill
patients in the medical intensivecare unit by more than seven days
without having an impact on
mortality rates, Patients with terminal illnesses
reach a time when they are faced
with a very difficult choice---whether to take part in
experimental research or enter a
hospice program.
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CONCEPT OF DISABILITY with respect to an individual(A) a
physical or mental impairment thatsubstantially limits one or more ofthe major life activities of suchindividual;
handicap as a disadvantage for agiven individual, resulting from animpairment or a disability, that limitsor prevents the fulfillment of a role
that...
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The Social Security Act defines
disability as the "inability to engagein any substantial gainful activity byreason of a medically determinablephysical
as any restriction or lack (resultingfrom an impairment) of ability toperform an activity in the manner orwithin the range considered normal
for a human...
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(ADA) defines disability as a
physical or mental
impairment that substantially
limits one or more of the
major life activities of the
individual
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Impairment is defined as any loss or
abnormality of psychological,
physiological, or anatomical structure
or function; disability as any
restriction or...
economy by reason of any medicallydeterminable physical or mental
impairment that can be expected to
result in death or that has lasted or is
expected...
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Rehabilitation
As needed
Apropriate
Health education Information
Team work
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TERIMA
KASIHSugeng Hadisaputra, M.Kep