Patient View about Disease or Illness

Patient Knowledge About Diabetes 

Patient's response to illness described by nursing philosophical approach by self efficacy ,hardiness ,resilience , spirituality and religion.

Common Concept About Disease

    Nursing theoretical approach describes the person or individual as a biopsychic social being who possesses unique characteristics and responds to others and the world in various and diverse ways. This view of the individual as unique requires nurses to assess each person and his or her responses to plan and provide nursing care that is personally meaningful. 

    This uniqueness of response may partially explain why some people become ill and others do not. Understanding why two people raised in a stressful environment (eg, one with neglect or abuse) turn out differently is difficult: one person becomes reasonably successful and maintains a satisfying marriage and family, whereas the other feels isolated, depressed, and lonely; is divorced; and abuse alcohol. Although we do not know exactly what makes the difference, studies have begun to show that certain personal, interpersonal, and cultural factors influence a person's response.

    Culture is all the socially learned behaviors, values, beliefs, customs, and ways of thinking of a population that guide its members' views of lower doses of a drug to produce the desired effect (Purnell & Paulanka, 2008). In general, nonwhites treated with Western dosing protocols have higher serum levels per dose and suffer more side effects. 

    Although many non-Western countries report successful treatment with lower dosages of psychotropic drugs, Western dosage protocols continue to drive prescribing practices in the United States. When evaluating the efficacy of psychotropic medications, the nurse must be alert to side effects and serum drug levels in clients from different ethnic backgrounds.

Self-Efficacy & Mind 

    Self-efficacy is a belief that personal abilities and efforts affect the events in our lives. A person who believes that his or her behavior makes a difference is more likely to take action. People with high self-efficacy set personal goals, are self-motivated, cope effectively with stress, and request support from others when needed. 

    People with low self-efficacy have low aspirations, experience much self-doubt, and may be plagued by anxiety and depression. It has been suggested that focusing treatment on developing a client's skills to take control of his or her life (developing self-efficacy) so that he or she can make life changes could be very beneficial. Four main ways to do so follow:

    Experience of success or mastery in overcoming obstacles Social modeling (observing successful people instills the idea that one can also succeed)

Social Perspectives  (persuading people to believe in themselves)

    Reducing stress, building physical strength, and learning how to interpret physical sensations positively.Cutler (2005) reports a relationship between self-efficacy and the client's motivation for self-care and follow-up after discharge from treatment. 

    Clients returning to the community with higher self-efficacy were more confident and had positive expectations about their personal success. Cutler suggests that therapeutic interventions designed to promote the client's self-efficacy can have positive effects on inter-personal relationships and coping on return to the community.

    Hardiness is the ability to resist illness when under stress. First described by Kobasa (1979), hardiness has three components:

1. Commitment: active involvement in life activities

2. Control: ability to make appropriate decisions in life activities

3. Challenge: ability to perceive change as beneficial rather just stressful. 

    Hardiness has been found to have a moderating or buffering effect on people experiencing stress. Kobasa (1979) 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 occurrence of illness. Study findings suggested that stressful life events caused more harm to people with low hardiness than with high hardiness.

    Personal hardiness is often described as a pattern of attitudes and actions that helps the person turn stressful circumstances into opportunities for growth. Maddi (2005) found that persons with high hardiness perceived stressors more accurately and were able to problem-solve in the situation. tion more effectively. Hardiness has been identified as an important resilience factor for families coping with the mental illness of one of their members (Greeff, Vansteenween , & Mieke , 2006).

    Some believe that the concept of hardiness is vague and indistinct and may not help everyone. Some research on hardiness suggests that its effects are not the same for men and women. In addition, hardiness may be useful only to those who value individualism, such as people from some Western cultures. For people and cultures who value relationships over individual achievement, hardiness may not be beneficial.

Resilience and Resourcefulness

    Two closely related concepts, resilience and resourceful ness, help people to cope with stress and to minimize the effects of illness (Edward & Warelow , 2005). Resilience is defined as having healthy responses to stressful circumstances or risky situations. This concept helps to explain why one person reacts to a slightly stressful event with severe anxiety, whereas another person does not experience distress even when confronting a major disruption.

    Keyes (2007) found that high resilience was associated with promoting and protecting one's mental health, described as flourishing. Family resilience refers to the successful coping of family members under stress (Black & Lobo, 2008). Factors that are present in resilient families include positive outlook, spirituality, family member accord, flexibility, family communication, and support networks. Resilient families also spend time together, share recreational activities, and participate in family rituals and routines together.Resourcefulness involves using problem-solving abilities and believing that one can cope with adverse or novel situations. 

    People develop resourcefulness through inter actions with others, that is, through successfully coping with life experiences. Examples of resourcefulness include performing health-seeking behaviors, learning self-care, monitoring one's thoughts and feelings about stressful situations, and taking action to deal with stressful circumstances. Chang, Zauszniewski , Heinzer , Musil , and Tsai (2007) found building resourcefulness skills to be the key in reducing depressive symptoms and enhancing adaptive functioning among middle school children whose female caregivers were depressed.

Spirituality: 

    Spirituality involves the essence of a person's being and his or her beliefs about the meaning of life and the purpose for living. It may include belief in God or a higher power, The practice of religion, cultural beliefs and practices, and a relationship with the environment. 

    Although many clients with mental disorders have disturbing religious delusions, for many in the general population, religion and spirituality are a source of comfort and help in times of stress or trauma. 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 (Anthony, 2008).

Religious activities

    Such as church attendance and praying, and associated social support have been shown to be very important for many people and are linked with better health and a sense of well-being. These activities also have been found to help people cope with poor health. Hope and faith have been identified as critical factors in psychiatric and physical rehabilitation. Chaudry (2008) described patients who depended on their religious faith as significantly less depressed and anxious than those who are less reliant on their faith. 

    Religion and spirituality can also be helpful to families who have a relative with mental illness, providing support and solace to caregivers. Because spiritual or religious beliefs and practices help many clients to cope with stress and illness, the nurse must be particularly sensitive to and accepting of such beliefs and practices. Incorporating those practices into the care of clients can help them cope with illness and find meaning and purpose in the situation. Doing so can also offer a strong source of support ( Huguelet , Mohr, Borras, Gillieron , & Brandt, 2006).

Interpersonal Factors

Sense of Belonging

    A sense of belonging is the feeling of connectedness with or involvement in a social system or environment of which a person feels an integral part. Abraham Maslow described a sense of belonging as a basic human psychosocial need that involves feelings of both value and fit. Value refers to feeling needed and accepted. Fit refers to feeling that one meshes or fits in with the system or environment. This means that when a person belongs to a system or group, he or she feels valued and worthwhile within that support system. 

    Examples of support systems include family, friends, coworkers, clubs or social groups, and even health-care providers. A person's sense of belonging is closely related to his or her social and psychological functioning. A sense of belonging was found to promote health, whereas a lack of belonging impaired health. An increased sense of belonging also or talking on the phone. Thus, the primary components of satisfactory support are the person's ability and willingness to request support when needed and the ability and willingness of the support system to respond.

    Two key components are necessary for a support system to be effective: the client's perception of the support system and the responsiveness of the support system. The client must perceive that the social support system bolsters his or her confidence and self-esteem and provides such stress-related interpersonal help as offering assistance in solving a problem. The client must also perceive that the actions of the support system are consistent with the client's desires and expectations-in other words, the support provided is what the client wants, not what the supporter believes would be good for the client. 

    Also, the support system must be able to provide direct help or material aid (eg, providing transportation or making a follow-up appointment). Some people have the capacity to seek help when needed, whereas a lack of well-being may cause others to withdraw from potential providers of support. The nurse can help the client to find support people who will be available and helpful and can teach the client to request support when needed.

    Family Support Family as a source of social support can be a key factor in the recovery of clients with psychiatric illnesses. Although family members are not always a positive resource in mental health, they are most often an important part of recovery. Health-care professionals cannot totally replace family members. The nurse must encourage family members to continue to support the client even while he or she is in the hospital and should identify family strengths, such as love and caring, as a resource for the client (Reid, Lloyd, & de Groot, 2005) .

Cultural Factors

    According to the US Census Bureau, 33% of US residents currently are members of nonwhite cultures. By 2050, the nonwhite population will more than triple. This changing composition of society has implications for health-care professionals, who are predominantly white and unfamiliar with different cultural beliefs and practices (Purnell & Paulanka, 2008). Culturally competent nursing care means being sensitive to issues related to culture, race, gender , sexual orientation, social class, economic situation, and other factors.

    Nurses and other health-care providers must learn about other cultures and become skilled at providing care to people with cultural backgrounds that are different from their own. Finding out about another's cultural beliefs and practices and understanding their meaning is essential to providing holistic and meaningful care to the client

Beliefs About Causes of Illness

    Culture has the most influence on a person's health beliefs and practices. It has been shown to influence one's concept of disease and illness. Two prevalent types of beliefs about what causes illness in non-Western cultures are natural and unnatural or personal. Unnatural or personal beliefs attribute the cause of illness to the active, purposeful intervention of an outside agent, spirit, or supernatural force or deity. The natural view is rooted in a belief that natural conditions or forces, such as cold, heat, wind, or dampness, are responsible for the illness (Giger & Davidhizar , 2007). 

    A sick person with these beliefs would not see the relationship between his or her behavior or health practices and the illness. Thus, he or she would try to counteract the negative forces or spirits using traditional cultural remedies rather than taking medication or changing his or her health practices.Factors in Cultural Assessment Giger and Davidhizar (2007) recommended a model for assessing clients using six cultural phenomena: communication, physical distance or space, social organization, time orientation, environmental control, and biological variations.