Concept of Health & Illness Definitions A.World Health Organization HEALTH – purposeful adapti!e response ph"sicall" #entall" e#otionall" and sociall" to the e$ternal sti#uli in order to #aintain sta%ilit" and co#fort .Health'illness continuu# (d"na#ic changes )ith ti#e* it includes states of high le!el )ellness health precursors for illness illness and se!ere illness ' an indi!idual #a" e$perience an" of these states across the lifespan and its #o!e#ent #a" %e d"na#ic in lesser direction as indi!idual adapt to opti#u# le!el of health.
Wellness odel +re#ature Death
High'le!el Wellness Disa%ilt" ,"#pto#s ,igns A)areness Education -ro)th
Treat#ent Tr eat#ent odel
/eutral +oint
C.Concept of high'le!el )ellness including holis# – an integrated #ethod of functioning that is oriented to)ard #a$i#izing the potential of )hich the indi!idual is capa%le )ithin the en!iron#ent )here he or she is functioning. D./ational -oals (Health" +eople 0121 3, Dept HH,*4 2. Increase Increase 5ualit" 5ualit" and "ears "ears of health" health" life Life e$pectancies in "ears4 67.8 #ale9 6:.; fe#ale 0. Eli#inate Eli#inate health disparitie disparitiess
#a>eu eup p (pr (pred edis ispo posi siti tion on to spec specif ific ic illnesses4 geno#e pro?ect* . Cogn Cognit iti! i!ee a%i a%ili liti ties es and and edu educa cati tion on (r (res espo pons nsee to to health teaching* C. @ace @ace ethn ethnic icit it" " cul cultu tura rall %ac> %ac>gr grou ound nd D. Age Age gend gender er de de!e !elo lop# p#en enta tall le! le!el el E. Life st"le "le en!iron#ent <. ,ocio'econo#ic status -. -eographic area Health and the /ursing +rocess A. Assess#ent of clients health status and identifia%le health ris>s related to factors affecting health status @is> – refers to ali>elihood that a health pro%le# #ight occur.
T"pes of @is>4 2. Inherited @is> refer to those deter#ined %" %iological characteristics of age fa#il" histor" or genetic endo)#ent that ha!e predicta%le conse5uence for illness. 0. En!iron#ental @is> includes ph"sical social and econo#ic stressors 7. eha!ioral @is> refers to those related to health ha%it lo) !alues for health practice or self e$a#ination and health appraisals . Inter!entions include client teaching regarding status and pre!entati!e actions E$a#ple4 o!er)eight 7B'"ear'old )o#an )ith a strong fa#il" histor" of dia%etes t"pe II changes to lo) fat diet and adds 7 thirt"'#inute )al>s per )ee> C. E!aluation4 i#pro!e#ent of leading indicators Health" +eople 0121 Concept of Illness A. Differentiation fro# disease Illness is defined as the #aladaptation to internal and e$ternal en!iron#ents. Disease or health pro%le#s are #ore o%?ecti!e description of illness ' failure of a persons adapti!e #echanis#s to ade5uatel" counteract sti#uli and stresses resulting in functional and structural distur%ances
Deter#inants of Health and Illness 2. Heredit" – includes the non #odifia%le factors of age se$ racegenetic endo)#ent and fa#il" histor" as a foundation of health 0. Lifest"le – includes factors #odifia%le %" choice Health and Illness eha!ior Health eha!ior refers to an acti!it" an indi!idual engages in to #aintain health pre!ent disease or treat health pro%le#s Illness eha!ior are responses to a%nor#al %od" signals. @esponses #a" include4 2. #onitoring %od" signals 0. ta>ing action to deal )ith signals 7. using health care facilities Illness %eha!iors #easured in stages +rogression through stages halts if re!erts to health" state B ,tages of ,IC @OLE in client4 2. E$periencing s"#pto#s 0. Assu#ing the sic> role 7. ,ee>ing #edical care ;. Assu#ing dependent role B. Achie!ing reco!er" and reha%ilitation T"pes of Illness4 Acute illness4 characteristics4 rapid onset self' li#iting Chronic illness4 characteristics4 re5uires long period of care includes per#anent disa%ilit" 2. 7'fold increase in incidence in future
0. Clients adaptation to illness 7. Effect on fa#il" #e#%ers and de!elop#ental tas>s ;. /ursing inter!entions focus on education to pro#ote client independence i#pro!ed 5ualit" of life reha%ilitation ,tages of Illness 2. Incu%ation +eriod – the ti#e elapsed fro# the entrance of the #icroorganis# in to the %od" to the appeareance of clinical signs and s"#pto#s 0. +eriod of Illness T"pes4 a.
2. +ri#ar" pre!ention >e" concept4 health" li!ing to pre!ent disease E$a#ple4 Dietar" inta>e4 B': ser!ings of fruits and !egeta%les dail" 0. ,econdar" pre!ention >e" concepts4 earl" diagnosis treat#ent of disease E$a#ple4 lood pressure screening 7. Tertiar" pre!ention >e" concepts4 pre!ention of co#plications9 reha%ilitation E$a#ple4 E$ercise progra# post hip fracture Adult Client Health ,tatus and @is>s4 Di!ided according to age A. Foung adult (age 2G to ;1* 2. +ea> ph"siologic de!elop#ent to age 0B 0. ,pecific age health ris>s4 accidents se$uall" trans#itted diseases su%stance a%use ph"sical and ps"chosocial stressors . iddle adult (age ;1 to 8B* 2. +h"sical changes 0. ,pecific age health ris>s4 o%esit" cardio!ascular disease cancer su%stance a%use (nicotine alcohol prescri%ed drugs* ps"chosocial stressors C. Older adult (o!er age 8B* 2. +opulation increasing at faster rate than an" other 0. +h"sical changes 7. ,pecific age health ris>s4
a. Chronic illness (includes arthritis h"pertension hearing i#pair#ents cardio!ascular diseases cataracts* o%esit" cardio!ascular disease cancer %. In?uries #ainl" falls fires #otor !ehicle accidents c. +har#acologic effects due to predisposition to drug to$icit" d. +h"sical and ps"chosocial stressors Chapter 8 Ho#eostasis ,tress and Adaptation ,tead" ,tate ' a sta%le condition that does not change o!er ti#e or )hen change in one direction is %alanced %" change in an opposite direction Each person as a li!ing s"ste# has %oth an internal and an e$ternal en!iron#ent %et)een )hich infor#ation and #atter are continuousl" e$changed. +athoph"siologic processes result )hen cellular in?ur" occurs at such a rapid rate that the %od"s co#pensator" #echanis#s can no longer #a>e the adapti!e changes necessar" to re#ain health". Claude ernard a 2:th'centur"
Walter Cannon used the ter# ho#eostasis to descri%e the sta%ilit" of the internal en!iron#ent )hich he said )as coordinated %" ho#eostatic or co#pensator" processes that responded to changes in the internal en!iron#ent Ho#eostasis ' a stead" state )ithin the %od" @ene ules Du%os (2:8B* pro!ided further insight into the d"na#ic nature of the internal en!iron#ent )ith his theor" that t)o co#ple#entar" concepts ho#eostasis and adaptation )ere necessar" for %alance. ,tress ' a disrupti!e condition that occurs in response to ad!erse influences fro# the internal or e$ternal en!iron#ents ' percei!ed as challenging threatening or da#aging to a persons d"na#ic %alance or e5uili%riu#. •
Adaptation ' a change or alteration designed to assist in adapting to a ne) situation or en!iron#ent ' the desired goal or ad?ust#ent to the change so that the person is again in e5uili%riu# and has the energ" and a%ilit" to #eet ne) de#ands. •
,tress is a threat to the stead" state T"pes of ,tressors +h"sical E$a#ples4 cold heat and che#ical agents +h"siologic •
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E$a#ples4 pain and fatigue +s"chosocial E$a#ples4 de!elop#ental tas>sJchanges an$iet"' producing e!ents such as losing ?o% –
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,tressors ha!e also %een classified as (2* da"'to'da" frustrations or hassles9 (0* #a?or co#ple$ occurrences in!ol!ing large groups e!en entire nations9 and (7* stressors that occur less fre5uentl" and in!ol!e fe)er people. Duration #a" also %e used to categorize stressors as in the follo)ing list4 An acute ti#e'li#ited stressor such as stud"ing for final e$a#inations A stressor se5uenceKa series of stressful e!ents that result fro# an initial e!ent such as ?o% loss or di!orce A chronic inter#ittent stressor such as dail" hassles A chronic enduring stressor that persists o!er ti#e such as chronic illness a disa%ilit" or po!ert" •
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,tress as a ,ti#ulus for Disease Lin>s %et)een stress and illness ' people under constant stress ha!e a high incidence of ps"choso#atic disease. Life e!ent scales •
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Hol#es and @ahe (2:86* ' de!eloped life e!ents scales that assign nu#erical !alues called life'change units to t"pical life e!ents. @ecent Life Changes uestionnaire (2:G0* ' 22G ite#s such as death %irth #arriage di!orce pro#otions serious argu#ents and !acations. The ite#s include %oth desira%le and undesira%le e!ents. –
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Each persons appraisal and response to an e!ent or stressor )ill !ar". •
+ri#ar" appraisal results in the situation %eing identified as either nonstressful or stressful. A nonstressful situation is irrele!ant or %enign (positi!e*. A stressful situation #a" %e one of three >inds4 (2* one in )hich har# or loss has occurred9 (0* one that is threatening in that har# or loss is anticipated9 and (7* one that is challenging in that so#e opportunit" or gain is anticipated. ,econdar" appraisal is an e!aluation of )hat #ight and can %e done a%out the situation. @eappraisal When a person endures prolonged or unrelenting suffering the outco#e is fre5uentl" the de!elop#ent of a stress'related illness. /urses possess the s>ills to assist people to alter their distressing circu#stances and #anage their responses to stress. •
After recognizing a stressor a person consciousl" or unconsciousl" reacts to #anage the situation. This is ter#ed the #ediating process. +h"siologic @esponse to ,tress The ph"siologic response to a stressor )hether it is ph"sical or ps"chological is a protecti!e and adapti!e #echanis# to #aintain the ho#eostatic %alance of the %od". When a stress response occurs it triggers a series of neurologic and hor#onal processes to %e acti!ated )ithin the %rain and %od" s"ste#s. The duration and intensit" of the stress can cause %oth short'ter# and long'ter# effects. A stressor can disrupt ho#eostasis to the point )here adaptation to the stressor fails and a disease process results. ,el"es -eneral Adaptation ,"ndro#e Theor" of adaptation to %iologic stress. A s"ndro#e consisting of enlarge#ent of the adrenal corte$9 shrin>age of the th"#us spleen l"#ph nodes and other l"#phatic structures9 and the appearance of deep %leeding ulcers in the sto#ach and duodenu#. He identified this as a nonspecific response to di!erse no$ious sti#uli. •
Three phases4 (-eneral Adaptation ,"ndro#e* 7 ,tages of @esponse 2. ,tage of Alar#4 ,/, fight'or'flight response9 catechola#ines released onset of ACTH response self' li#iting
It occurs )hen a threat ha!e %een percei!ed and the ner!ous s"ste# and the endocrine s"ste#s ha!e %een notified of the e#ergenc" 0. ,tage of @esistance4 adaptation occurs to the stressor9 cortisol acti!it" is still increased /er!es and glands are aiding the %od" tissues in resisting the stress 7. ,tage of E$haustion4 endocrine acti!it" continues and the %od" )ill fail if e$posure to the stressor is prolonged. Has negati!e effect on the %od" s"ste#. Occurs )hen the tissues surrender to stress Local Adaptation ,"ndro#e A local response to an in?ur". Includes the infla##ator" and tissue repair process. If the in?ur" is se!ere enough -eneral Adaptation ,"ndro#e )ill also %e acti!ated. •
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TALE 8'2 ,"#pathetic–Adrenal–edullar" @esponse to ,tress Effect +urpose echanis# Increased etter Increased cardiac output heart rate and perfusion of due to increased %lood pressure !ital organs #"ocardial contractilit" and heart rate9 increased !enous return (peripheral !asoconstriction* Increased Increased Increased li!er and %lood glucose a!aila%le #uscle gl"cogen le!el energ" %rea>do)n9 increased %rea>do)n of adipose tissue trigl"cerides ental acuit" Alert state Increase in a#ount of %lood shunted to the %rain fro# the a%do#inal !iscera and s>in Dilated pupils Increased Contraction of radial a)areness #uscle of iris Increased +reparedness E$citation of #uscles9 tension of for acti!it" increase in a#ount of s>eletal decreased %lood shunted to the #uscles fatigue #uscles fro# the a%do#inal !iscera and s>in
Increased +ro!ision of !entilation o$"gen for (#a" %e rapid energ" and shallo)* Increased +re!ention of coagula%ilit" of he#orrhage in %lood e!ent of trau#a
,ti#ulation of respirator" center in #edulla9 %ronchodilation Masoconstriction of surface
aladapti!e @esponse to ,tress
- are chronic recurrent responses or patterns of response o!er ti#e that do not pro#ote the goals of adaptation. - include fault" appraisals and inappropriate coping ,el"e (2:68* proposed a list of disorders that he called diseases of #aladaptation4 high %lood pressure diseases of the heart and %lood !essels diseases of the >idne" h"pertension of pregnanc" rheu#atic and rheu#atoid arthritis infla##ator" diseases of the s>in and e"es infections allergic and h"persensiti!it" diseases ner!ous and #ental diseases se$ual d"sfunction digesti!e diseases #eta%olic diseases and cancer.
Indicators of ,tress Chart 8'24 Assessing for ,tress e on the alert for the follo)ing signs and s"#pto#s4 @estlessness Depression Dr" #outh O!erpo)ering urge to act out or dizz" Increased %od" tension Tre#ors /er!ous ha%its /er!ous laughter ru$is# (grinding of teeth* Difficult" sleeping •
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E$cessi!e perspiration 3rinar" fre5uenc" Headaches +ain in %ac> nec> or other parts of the %od" Increased use of to%acco ,u%stance use or a%use
/ursing I#plications - realize that the opti#al point of inter!ention to pro#ote health is during the stage )hen a persons o)n co#pensator" processes are still functioning effecti!el". - earl" identification of %oth ph"siologic and ps"chological stressors. - relate the presenting signs and s"#pto#s of distress to the ph"siolog" the" represent and identif" a persons position on the continuu# of function fro# health and co#pensation to pathoph"siolog" and disease. ,tress at the Cellular Le!el TALE 8'0 Cellular Adaptation to ,tressors Adaptation ,ti#ulus E$a#ple H"pertroph"K Increased Leg #uscles of increase in cell size )or>load runner leading to increase Ar# #uscles in in organ size tennis pla"er Cardiac #uscle in person )ith h"pertension
Atroph"K Decrease in4 shrin>age in size of 3se cell leading to lood suppl" decrease in organ /utrition size Hor#onal sti#ulation Inner!ation H"perplasiaK Hor#onal increase in nu#%er influence of ne) cells (increase in #itosis*
D"splasiaKchange in the appearance of cells after the" ha!e %een su%?ected to chronic irritation
etaplasiaK transfor#ation of one adult cell t"pe to another (re!ersi%le*
,econdar" se$ organs in aging person E$tre#it" i##o%ilized in cast
reast changes of a girl in pu%ert" or of a pregnant )o#an @egeneration of li!er cells /e) red %lood cells in %lood loss @eproduction of Alterations in cells )ith epithelial cells of resulting the s>in or the alteration of cer!i$ producing their size and irregular tissue shape changes that could %e the precursors of a #alignanc" ,tress applied to Changes in highl" epithelial cells specialized cell lining %ronchi in response to s#o>e irritation (cells %eco#e less specialized*
Cellular In?ur" In?ur" is defined as a disorder in stead"'state regulation. An" stressor that alters the a%ilit" of the cell or s"ste# to #aintain opti#al %alance of its ad?ust#ent processes leads to in?ur".
H"po$ia Inade5uate cellular o$"genation (h"po$ia* interferes )ith the cells a%ilit" to transfor# energ". H"po$ia #a" %e caused %"4 A decrease in %lood suppl" to an area A decrease in the o$"gen'carr"ing capacit" of the %lood (decreased he#oglo%in* A !entilationJperfusion or respirator" pro%le# that reduces the a#ount of o$"gen a!aila%le in the %lood A pro%le# in the cells enz"#e s"ste# that #a>es it una%le to use the o$"gen deli!ered to it •
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/utritional I#%alance /utritional i#%alance refers to a relati!e or a%solute deficienc" or e$cess of one or #ore essential nutrients. +h"sical Agents 2. Te#perature 0. @adiation and Electrical ,hoc> 7. echanical Trau#a Che#ical Agents
Che#ical in?uries are caused %" poisons such as l"e )hich ha!e a corrosi!e action on epithelial tissue or %" hea!" #etals such as #ercur" arsenic and lead each of )hich has its o)n specific destructi!e action. Infectious Agents iologic agents >no)n to cause disease in hu#ans are !iruses %acteria ric>ettsiae #"coplas#as fungi protozoa and ne#atodes. Disordered I##une @esponses The i##une s"ste# is an e$ceedingl" co#ple$ s"ste# the purpose of )hich is to defend the %od" fro# in!asion %" an" foreign o%?ect or foreign cell t"pe such as cancerous cells. -enetic Disorders Cellular @esponse to In?ur"4 Infla##ation Infla##ation is a defensi!e reaction intended to neutralize control or eli#inate the offending agent and to prepare the site for repair. It is a pathoph"siological response that ser!es to defend the tissues against #icroorganis#s and to prepare the tissue for repair.
T"pes of Infla##ation 2. Acute infla##ation is characterized %" the local !ascular and e$udati!e changes descri%ed earlier and usuall" lasts less than 0 )ee>s 0. Chronic infla##ation de!elops if the in?urious agent persists and the acute response
is perpetuated. ,"#pto#s are present for #an" #onths or "ears 7. ,u%acute infla##ation falls %et)een acute and chronic infla##ation. T"pes of Infla##ator" @eactions 2. Local Infla##ator" @esponse 2. Increased !ascular per#ea%ilit" 0. Infiltration of Leu>oc"tic cells 7. Cell @epair 0. ,"ste#ic Infla##ator" @esponse – occurs )hen %acterial in!aders cannot %e successfull" localized and destro"ed. oc"tosis herald the onset of a s"ste#ic infla##ator" response Cellular Healing @egeneration The a%ilit" of cells to regenerate depends on )hether the" are la%ile per#anent or sta%le. @eplace#ent Depending on the e$tent of da#age tissue healing #a" occur %" pri#ar" intention or %" secondar" intention. /ursing I#plications - 3se of /ursing +rocess
Assess#ent %oth o%?ecti!e signs and su%?ecti!e s"#pto#s are the pri#ar" indicators of e$isting ph"siologic processes. The follo)ing 5uestions are addressed4 Are the heart rate respirator" rate and te#perature nor#al= What e#otional distress #a" %e contri%uting to the patients health pro%le#s= Are there other indicators of stead"'state de!iation= What are the patients %lood pressure height and )eight= Are there an" pro%le#s in #o!e#ent or sensation= Are there an" pro%le#s )ith affect %eha!ior speech cogniti!e a%ilit" orientation or #e#or"= Are there o%!ious i#pair#ents lesions or defor#ities= •
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Assess#ent ,u%?ecti!e s"#pto#s O%?ecti!e s"#pto#s Include indicators of stress response such as an$iet" increased pulse and increased respirations. Also consider potential indicators for stress such as life e!ents de!elop#ental tas>s and health ris> appraisal. ,ee Chart 8'0. •
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Chart 8'04 Infor#ation Addressed in Health @is> uestionnaires
De#ographic data4 age gender race ethnic %ac>ground +ersonal and fa#il" histor" of diseases and health pro%le#s Lifest"le choices Eating sleeping e$ercise s#o>ing drin>ing se$ual acti!it" and dri!ing ha%its ,tressors at ho#e and on the ?o% @ole relationships and associated stressors •
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+h"sical #easure#ents lood pressure Height )eight %od" #ass inde$ (I* La%orator" anal"ses of %lood and urine •
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+articipation in high'ris> %eha!iors
/ursing Diagnosis An$iet" I#paired ad?ust#ent Ineffecti!e coping ,ocial isolation @is> for po)erlessness @is> for spiritual distress Decisional conflict ,ituational lo) self'estee# •
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Inter!entions
,tress #anage#ent inter!entions4 is directed to)ard reducing and controlling stress and i#pro!ing coping. •
The fi!e predo#inant )a"s of coping )ith illness identified in a re!ie) of B6 nursing research studies )ere as follo)s (alo)iec 2::7*4 Tr"ing to %e opti#istic a%out the outco#e 3sing social support 3sing spiritual resources Tr"ing to #aintain control either o!er the situation or o!er feelings Tr"ing to accept the situation •
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Chart 8'74 Coping Enhance#ent4 /ursing Inter!entions Definition Assisting a patient to adapt to percei!ed stressors changes or threats that interfere )ith #eeting life de#ands and roles Acti!ities Appraise a patients ad?ust#ent to changes in %od" i#age as indicated. Appraise the i#pact of the patients life situation on roles and relationships. Encourage the patient to identif" a realistic description of change in role. Appraise the patients understanding of the disease process. Appraise and discuss alternati!e responses to the situation. 3se a cal# reassuring approach. •
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+ro!ide an at#osphere of acceptance. Assist the patient in de!eloping an o%?ecti!e appraisal of the e!ent. Help the patient to identif" the infor#ation that he or she is #ost interested in o%taining. +ro!ide factual infor#ation concerning diagnosis treat#ent and prognosis. +ro!ide the patient )ith realistic choices a%out certain aspects of care. Encourage an attitude of realistic hope as a )a" of dealing )ith feelings of helplessness. E!aluate the patients decision'#a>ing a%ilit". ,ee> to understand the patients perspecti!e of a stressful situation. Discourage decision #a>ing )hen the patient is under se!ere stress. Encourage gradual #aster" of the situation. Encourage patience in de!eloping relationships. Encourage relationships )ith persons )ho ha!e co##on interests and goals. Encourage social and co##unit" acti!ities. Encourage the acceptance of li#itations in others. Ac>no)ledge the patients spiritualJcultural %ac>ground. Encourage the use of spiritual resources if desired. E$plore the patients pre!ious achie!e#ents. E$plore the patients reasons for self'criticis#. Confront the patients a#%i!alent (angr" or depressed* feelings.
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Arrange situations that encourage the patients autono#". Assist the patient in identif"ing positi!e responses fro# others. Encourage the identification of specific life !alues. E$plore )ith the patient pre!ious #ethods of dealing )ith life pro%le#s. Introduce the patient to persons (or groups* )ho ha!e successfull" undergone the sa#e e$perience. ,upport the use of appropriate defense #echanis#s. Encourage !er%alization of feelings perceptions and fears. Discuss the conse5uences of not dealing )ith guilt and sha#e. Encourage the patient to identif" his or her o)n strengths and a%ilities. Assist the patient in identif"ing appropriate short' and long'ter# goals. Assist the patient in %rea>ing do)n co#ple$ goals into s#all #anagea%le steps. Assist the patient in e$a#ining a!aila%le resources to #eet the goals. @educe sti#uli in the en!iron#ent that could %e #isinterpreted as threatening. Appraise the patients needs and desires for social support. Assist the patient to identif" a!aila%le support s"ste#s. Deter#ine the ris> of the patients inflicting self' har#.
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Encourage fa#il" in!ol!e#ent as appropriate. Encourage the fa#il" to !er%alize their feelings a%out the ill fa#il" #e#%er. +ro!ide appropriate social s>ills training. Assist the patient to identif" positi!e strategies to deal )ith li#itations and #anage needed lifest"le or role changes. Assist the patient to sol!e pro%le#s in a constructi!e #anner. Instruct the patient in the use of rela$ation techni5ues as needed. Assist the patient to grie!e and to )or> through the losses of chronic illness andJor disa%ilit" if appropriate. Assist the patient to clarif" #isconceptions. Encourage the patient to e!aluate his or her o)n %eha!ior.
@ela$ation techni5ues (2* a 5uiet en!iron#ent (0* a co#forta%le position (7* a passi!e attitude and (;* a #ental de!ice (so#ething on )hich to focus ones attention such as a )ord phrase or sound*. +rogressi!e #uscle rela$ation in!ol!es tensing and releasing the +r #uscles of the %od" in se5uence and sensing the difference in feeling. It is %est if the person lies on a soft cushion in a 5uiet roo# %reathing easil".
ensons @ela$ation @esponse enson (2::7* descri%es the follo)ing steps of the enson @ela$ation @esponse4 +ic> a %rief phrase or )ord that reflects "our %asic %elief s"ste#. Choose a co#forta%le position. Close "our e"es. @ela$ "our #uscles. eco#e a)are of "our %reathing and start using "our selected focus )ord. aintain a passi!e de#eanor. Continue for a set period of ti#e. +ractice the techni5ue t)ice dail". •
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-uided i#ager" ,i#ple guided i#ager" is the #indful use of a )ord phrase or !isual i#age for the purpose of distracting oneself fro# distressing situations or consciousl" ta>ing ti#e to rela$ or reenergize. A nurse can help a person select a pleasant scene or e$perience such as )atching the ocean or da%%ling the feet in a cool strea#. •
Assist and support coping and ad?ust#ent Coping enhance#ent9 see Chart 8'7 Enhance social support9 support and therap" groups
+ro#ote a health" lifest"le A health'pro#oting lifest"le pro!ides internal resources that aid in coping and it %uffers or cushions the i#pact of stressors.
