Coping with Illness and Handicap By Dr. Ramez Bedwani

1. 6thlecture Coping with Illness and HandicapBy Dr. RamezBedwani (Patients’ reactionsردود فعل to stresses ضغوطof physical handicap)

2. Reasonsألاسباب behind خلف psychological Impact وطأة of disability in general* • Pain • Disfigurementتشوه الشكل • Repeated therapy sessions • Fear of expecting pain (from therapy or disease activity) • Need for Multiple surgical operations • Knowing it is a terminal or fatal illness • Regard of others (opinionآراء, avoidanceتجنب , sarcasmسخرية, labelingنعت ووصف جارح ) • Failed hopes and expectations

3. 1. Coping(التأقلم ) with physical illness A) patients’ perception إدراك(stress) of illness (Patients’ variables / illness variables social context) B) Demands imposed by illness C) Coping strategies D) Adverse emotional reactions E) Implications for helping 2. Coping with chronic illness 3. Coping with terminal illness • Communicating with dying patients • Psychological responses of dying patients

4. 1. Coping with physical illness • Physical illness = Health problems = Stressful events • Degree of stress depends on pt’s perception of the illness rather than the illness itself* To understand how pts cope, ask about*: A) How is the illness perceived? B) What demands (متطلبات)are imposed (فرض عليه)by the illness? C) what kinds of coping strategies براعة تكتيك التأقلم)) are used? D) Adverse emotional reactions affecting motivation to treatment and recovery E) Implications for helping pt’s to cope

5. 1) patients’ perception (response) of illness* • Patients’ variables • Age (children vary with development, old age) • Previous experience (reduce uncertainty) • Psychological state at time of illness (anxietyreduce pain tolerance, anxiety rather than symptom (أعراض)severity (شدة)or frequency تعدد)) in seeking medical care • Illness variables • Actual severity of illness less important than patients perception of threat in affecting patient’s psychological response • Cancer and heart diseases produce varied (تفاوت)psychological responses according to individual differences in interpretation • Body disfiguring operations i.e. mastectomy (breast) or hysterectomy (uterus) have their psychological effects through feeling less attractive • Social context • Reactions of the people surrounding the patient • Recovery is better in those having good social support • Specific social context causing environmental restriction as haemodialysis(غسيل كلوى)and ICU Intensive care units(العناية المركزة)

6. 2) Demands(المتطلبات) imposed (المفروضة)by illness • Dealingالتعامل معwith : • pain and incapacitating symptoms(أعجز ، أضعف، أقعد) • hospital environment • doctors and nurses • treatment procedures

7. 3) Coping strategies 1. Direct coping = Problem focused Dealing directly with the situation to make it more tolerable 2. Palliative(مسكن / مخفف ) coping = Emotion focused Managing the emotions generated by the illness 4) Adverse(مضاد / معاكس) emotional reactions affecting motivationحافز / دافع to treatment & recoveryالشفاء و التعافى • Depression (commonest) (from guilt = I am being punished for past behavior) • Anxiety (from Uncertainty غير محققabout cause سببand outcomeنتيجة ) • Paranoid (إرتيابى)behaviour(blaming someone else as relatives and doctors)

8. 5) Implications(أبعاد) for helping pt’s to cope • Health care staff acknowledging(الإقرار و التسليم به) that illness generates changes in emotions and behavior • Emotional Care Responding to pts’ questions and clarifying their misconceptions أخطاء التفكير عن المرض and preparing for future changes • Make the situation safeآمن • Help them recognize يتعرف على و يميز )) their own feelings • Facilitate expression يعبر)) of feelings • Communicateإتصال , understand فهمand acceptتقبل • Giving time وقتand support دعم و مساندة

9. 2. Coping with chronic illness(Recovery unlikely to happen, no change or progressive deteriorationتدهور ) 1st reaction is denial الإنكار protective as it gives time to adapt, then: 1)Direct Coping = seek info about the condition active in treatment and make adjustments in their life 2)Indirect coping = Distraction and denial persistتداوم • To minimize psychological impact 3) Social support = Group meetingspt’s having similar conditionvaluable in sharing worries and learning new coping strategies 4) Family support = involved in management, informed and prepared for dealing with long term demands

10. 3. Coping with terminal(أخير) illness • Communicating with dying patients • Should we tell them that they are dying or not??? • Most people do want to know the truth also with close relatives • Open and honest communication should be guided and tailored to the patient • Psychological responses of dying patients Varies from relief from uncertainty to shock according to situation, personality, expectation, preparation for the bad news. Concerns about pain, loneliness, unknown and clinical condition Distinct phases of adjustment in dying patients: 1. Denial • Rage and anger • Bargaining phase • Depression • Acceptance.