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1. Prepared by Deepa Manandhar Lecturer

2. introduction Is an abnormal process in which any aspect of a person`s functioning is diminished or imparted as compared with his previous condition. Illness is a subjective state of the person who feels aware of not being well. It goes through certain stages, which may occur slowly and are highly individualized.

3. Stages of illness Illness behaviour involves how people interpret symptoms, take remedial actions and use the health care system. Following are the stages of illness.

4. Transition of health to illness Last from the time the person considers that he/she might be ill until and others acknowledge that the person is ill. Symptoms are experienced according to patient’s perception of illness, other’s acknowledgement, type of illness, disruption to normal life, previous experience and adoptive skills in crisis situation.

5. Transition of health to illness… Recognition of symptoms (unpleasant sensation)- pain, fever, rashes, indigestion Loss of stamina and sensation Sense of pain Indigestion, headache anxiety Fear of diagnosis and treatment

6. Acceptance of illness This stage occurs as the person stops denying illness and takes on a ‘sick role’. Shift to the period of accepting illness and admit the help from others.

7. Acceptance of illness… Define himself/herself as being sick Seeks validation of this experience from others Gives up normal activates and assume sick role On the basis of health belief and practice, the person may choose to do nothing, takes medication to relieve symptoms, and seeks medical care.

8. Acceptance of illness… Express anger, guilt towards own illness. Accepts the diagnosis. Increased dependency.

9. Acceptance of illness… Person needs assistance in activities of daily living, needs emotional support through acceptance, approval, physical closeness and protection.

10. convalescence Convalescence is the gradual recovery of health and strength after illness. Both physical and emotional resolution of the illness. Gradual increase in satisfying experiences. The new sense of worth and decrease anxiety increase ability Return of health and physical strength

11. Convalescence… Giving up dependency. Reassessing the meaning of life and is becoming independent, stable, outward looking and involve in decision making

12. Task of Convalescence

13. 1. Reassessment of Life’s Meaning Client redefines the life’s meaning and tries to set a goal for maximum productive potential. Tries to question himself as: Who am I? Why am I here? Where am I going? What is my future plan? If someone cannot adequately construct any sense of meaning in life, then one would likely be suicidal.

14. 2. Reintegration of the Body Image This is a successful adaptation stage in which the client accepts his/her new body image positively. It depends in functions and significance of the part of body e.g., a client after amputation of leg has to accept his/her changed body image.

15. 2. Reintegration of the Body Image He/she tries to integrate his/her quality of life with another person who is carrying healthy life using the crutches.

16. 3. Resolution of the Role Changes The client’s role change may depend upon the severity of illness and support system that influence client family and society. The client may assume sick role, dependent role or independent role.

17. 3. Resolution of the Role Changes… The person’s self concept and body image ability to recognize and cope with reality and response to dependency, pain and uncertainty will influence this overall reaction. A nurse has a great role in the adjustment of a person with his different stages of illness.

18. 3. Resolution of the Role Changes… A nurse accepts client as an individual, provide nursing care based on priority needs and facilities recovery through physical care, emotional support and health.

19. Edward Suchman Five Stages of Illness According, Edward Suchman in 1965, there are five Key Stages of Illness Experience: - Symptom Experience - Assumption of the Sick Role - Medical Care Contact - Dependent Patient Role - Recovery and Rehabilitation  

20. stage 1: Symptom Experience The illness experience is initiated when an individual first senses that something is wrong—a perception of pain, discomfort, general unease, or some disruption in bodily functioning.

21. Symptom Experience… Suchman states that three distinct processes occur at this time: the physical pain or discomfort, cognitive recognition that physical symptoms of an illness are present, an emotional response of concern about the social implications of the illness, including a possible disruption in ability to function.

22. STAGE 2: ASSUMPTION OF THE SICK ROLE; ILLNESS AS DEVIANCE If the individual accepts that the symptoms are a sign of illness and are sufficiently worrisome, then the transition is made to the sick role, at which time, the individual begins to relinquish some or all normal social roles.

23. STAGE 3: MEDICAL CARE CONTACT/SELF‐CARE the point at which an individual sought professional medical care. There is variety of options available to persons who have entered the sick role, the increasingly common practice of self‐care , and the importance of the individual’s social and cultural environment in shaping the action taken.

24. STAGE 4: DEPENDENT‐PATIENT ROLE AND STAGE the patient is expected to make every effort to get well. Some people, of course, enjoy the benefits of this role (e.g., increased attention and escape for work responsibilities) and attempt to malinger.

25. STAGE 4: DEPENDENT‐PATIENT ROLE AND STAGE The following list identifies the major concerns people have during stage 4: 1. Impairments of personal cognitive functioning. 2. Loss of personal independence. 3. Changes in body image 4. Withdrawal from key social roles. 5. The future.