Introduction to Medical-Surgical Nursing, 6th ed.
55
Lesson Plans for
Psychologic Responses to Illness
CHAPTER LESSON PLANS & OBJECTIVES
Lesson 55.1:
2. Discuss the concepts of stress, anxiety, adaptation, and homeostasis.
4. Identify some basic coping strategies (defense mechanisms).
6. Describe several factors that may precipitate adaptive or maladaptive coping behaviors in response
to illness.
7. Discuss implementation of the nursing process to enhance a patient’s mental health as the patient
deals with the stresses of illness.
CHAPTER TEACHING FOCUS
• In this chapter, students will be introduced to topics related to psychologic responses to illness.
• Students will have the opportunity to become acquainted with the definition of mental health,
psychologic responses to illness, coping mechanisms and strategies, factors affecting those strategies,
and maladaptive coping mechanisms.
• Furthermore, students will have the opportunity to learn about the nursing process in illness.
CONCEPTS
The following conceptual themes and specific concepts match those presented in Giddens, J. R. (2013).
THEME: Coping and Stress Tolerance
• Concept: Coping
• Exemplar: Coping with Illness, p. 1274
• Patient Teaching: Helping Patients and Their Families Cope with a Serious Diagnosis, p. 1275
• Cultural Considerations: What does Culture Have to do with Illness, p. 1275
• Exemplar: Coping Mechanisms and Strategies, p. 1278
THEME: Attributes and Resources
• Concept: Family Dynamics
• Exemplar: Family and Community Resources, p. 1276
• Patient Teaching: Helping Patients and Their Families Cope with a Serious Diagnosis, p. 1275
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Introduction to Medical-Surgical Nursing, 6th ed.
CHAPTER PRETEST
Have the students answer these questions prior to covering this chapter to understand where they stand
in relation to the content.
1) An individual’s ability to formulate thoughts, process information, and solve problems is the
__________.
a) physical dimension
b) cognitive dimension
c) affective dimension
d) behavioral dimension
2) Something that is positive or negative and requires an adaptive response by a person is known as
a(n) __________.
a) adaptation
b) conflict
c) stressor
d) crisis
3) A developmental task of middle adults is __________.
a) looking at the impact their lives have had
b) accepting what has been
c) learning to handle interpersonal conflicts
d) learning to handle joint decision-making
4) When a patient feels that his illness is caused by God’s betrayal, he is experiencing __________.
a) anxiety
b) fear
c) anger
d) spiritual distress
5) A vague sense of impending doom or apprehension that has no apparent identifiable cause is
__________.
a) fear
b) anger
c) anxiety
d) stress
6) The sense of loss that is experienced by a wife before her terminally ill husband dies is __________.
a) anxiety
b) anticipatory grieving
c) grief
d) denial
7) A toddler who was previously toilet-trained begins to wet his pants after he has been hospitalized.
This is an example of which defense mechanism?
a) Projection
b) Isolation
c) Repression
d) Regression
8) Purposeful behaviors that are used to make a stressful situation more familiar and comfortable are
__________.
a) conscious coping strategies
b) maladaptive behaviors
c) usually unsuccessful
d) unconscious coping strategies
9) The purpose of relaxation techniques is to __________.
a) comfort a patient’s family
b) distract a patient
c) reduce maladaptive behaviors
d) promote adaptation
10) Feelings of helplessness typically occur when individuals __________.
a) believe they are in partial control of the outcome
b) believe there is some hope
c) have had repeated exposure to events perceived as uncontrollable
d) experience stress
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Chapter Pretest Answers
1) b
6) b
CHAPTER BACKGROUND ASSESSMENT
Discuss these questions with your students prior to covering this chapter to understand where they stand
in relation to the content.
Question: What are the five dimensions that make up a person? Define each dimension.
Answer: The five dimensions that make up a person are the physical, cognitive, affective, behavioral,
Question: What is mental health? What makes a mentally healthy person?
Answer: Mental health is a dynamic process in which a person’s physical, cognitive, affective,
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 55.1
Instructor Preparation
Textbook Objectives Covered
2. Discuss the concepts of stress, anxiety, adaptation, and homeostasis.
4. Identify some basic coping strategies (defense mechanisms).
6. Describe several factors that may precipitate adaptive or maladaptive coping behaviors in
response to illness.
7. Discuss implementation of the nursing process to enhance a patient’s mental health as the
patient deals with the stresses of illness.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying psychologic responses to illness, including:
• Psychologic responses to illness
• Factors that affect coping with illness, such as age, cultural beliefs, and spirituality
• Emotions experienced by patients and their families
• Coping mechanisms and strategies
• Nursing care
• Assemble materials and supplies needed for each lesson as indicated below.
Materials and Supplies
• computer and PowerPoint
projector
Key Terms
• adaptation (p. 1273)
• anxiety (p. 1277)
• conflict (p. 1274)
• coping (p. 1278)
• crisis (p. 1274)
• personality (p. 1273)
• self-esteem (p. 1276)
• stress (p. 1273)
• stressor (p. 1273)
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 55.1
Student Preparation
Assignments 2 hours
1
READ – Textbook (pp. 1272-1273)
ANSWER – Text
• Review Questions for the NCLEX Examination: 1 (p. 1281)
ANSWER – Study Guide
• Part IC: 1, 2 (p. 380)
2
READ – Textbook (pp. 1273-1274)
ANSWER – Text
• Review Questions for the NCLEX Examination: 2, 11 (pp. 1281-1282)
ANSWER – Study Guide
3
READ – Textbook (pp. 1274-1277)
ANSWER – Text
• Review Questions for the NCLEX Examination: 3 (p. 1282)
ANSWER – Study Guide
• Part IIE: 2, 4, 8 (pp. 380-381)
4
READ – Textbook (pp. 1278-1278)
ANSWER – Text
• Review Questions for the NCLEX Examination: 7, 8 (p. 1282)
ANSWER – Study Guide
• Part IA: 1-8 (p. 379)
• Part IB: 1, 2 (p. 380)
• Part IIE: 1, 10, 16 (pp. 380-381)
5
READ – Textbook (pp. 1278-1280)
ANSWER – Text
• Review Questions for the NCLEX Examination: 4, 5, 10 (p. 1282)
ANSWER – Study Guide
• Part ID: 1 (p. 380)
• Part IIE: 7, 11, 13, 15 (p. 381)
6
READ – Textbook (pp. 1278-1280)
ANSWER – Study Guide
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 55.1
7
READ – Textbook (pp. 1280-1281)
REVIEW
• Box 55-1: Sample Nursing Care Plan for a Patient Ineffectively Coping with Illness (p. 1281)
ANSWER – Text
• Review Questions for the NCLEX Examination: 6, 9 (p. 1282)
ANSWER – Study Guide
• Part IIE: 3, 12 (p. 382)
• Part IIIF: 1 (p. 382)
• Part IIIG: 1, 2 (p. 382)
Lecture Outline 20 minutes
Slide 1
Chapter 55
Psychologic Responses to Illness
1
Slide 2
Definition of Mental Health
• A dynamic process in which a person’s physical, cognitive, affective, behavioral, and
social dimensions interact with one another and the environment
• Mentally healthy individuals are able to
• Perceive reality accurately
• Manage how emotions are experienced and expressed
Slide 3
Definition of Mental Health (cont.)
• The physical dimension includes the biologic and physiologic aspects of a person, and it
is integrated with cognitive, affective, behavioral, and social dimensions
• The cognitive dimension involves an individual’s ability to formulate thoughts, process
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 55.1
Slide 4
Definition of Mental Health (cont.)
• Maslow’s hierarchy of needs
• Physiologic needs
• Safety needs
TALKING POINTS:
• How does the nurse apply Maslow’s hierarchy of needs when caring for patients?
2
Slide 5
• How is a person’s level of health related to stress?
Stress
• Stress is caused by a stressor
• Anything that necessitates person’s adaptive response
• Necessary for growth and development
• Mild stress produces mild anxiety and enables people to use energy focused exclusively
on the problem
• Result can be successful problem-solving, which in turn promotes self-esteem
• Can also be harmful
• Examples: loss of a job or the death of a family member
TALKING POINTS:
• Stressors can originate in any or all of the dimensions of the self.
Slide 6
Stress (cont.)
• Adaptation to stress affects whole organism
• The dimensions of the person—physical, cognitive, affective, behavioral, and social—are
not separate entities
• These dimensions interact, resulting in the development of a unique human being
Slide 7
Homeostasis
• Stress, response, and adaptation a process of maintaining homeostasis or equilibrium
• If stressors are mild and the person is able to respond and adapt, mental health is
Slide 8
Growth and Development
• Process of evolution from conception until death
• As human beings move through sequential stages of development, they become
increasingly complex
• Each individual shaped throughout life by all of the events and perceived interactions with
others, the community, and the environment
• Development stages correspond to a specific age-group
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LESSON 55.1
Slide 9
Growth and Development (cont.)
• Infancy and early childhood: nurturing is critical and exploration of the world begins
• Preschoolers must learn to handle joint decision-making and interpersonal conflicts
TALKING POINTS:
• What developmental tasks must teenagers learn?
Slide 10
Growth and Development (cont.)
• In early adulthood, most people find a life partner and life work and may begin a family
• Adults progressing through middle age look at the effect their lives have had or could
have
• Older age: time of introspection, when elders look back on their lives, accept what has
been, and attempt to face increasing frailty with grace
Slide 11
Behavioral Theory
• All behaviors are learned responses
• Conditioning is one type of learning
• Theorists such as B.F. Skinner, Albert Bandura, and Joseph Wolpe have based their
theories on the idea that all behavior is learned and is a series of habitual responses to
familiar stimuli
TALKING POINTS:
• What behavioral theory is demonstrated by Pavlov?
3
Slide 12
Coping with Illness
• Factors that affect coping with illness
• Age
• Illness can interfere with developmental progress, and the patient’s
developmental stage can influence how he or she responds to illness
TALKING POINTS:
• Age affects the coping ability of children and adults alike.
• What adult roles may be affected by the onset of illness?
• You will play an essential role in helping patients and their loved ones cope with an illness
and the changes that result.
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 55.1
Coping with Illness (cont.)
• Cultural beliefs
• Can affect attitudes toward health and illness, diet and eating practices, reaction to
TALKING POINTS:
• Culture is transmitted from each generation to the next and is influenced by other social
contexts as well.
• Culture provides many of the underlying values and beliefs on which behavior is based.
• How are culture and ethnicity different?
• Effective nursing interventions can be determined only when we understand the patient as
a unique individual.
Slide 14
Coping with Illness (cont.)
• Spirituality
• Patients often turn to their spiritual beliefs and values to find meaning in the
experience
• Patients who perhaps had not thought of themselves as being religious may suddenly
have a need to visit with a spiritual counselor
• Many experience spiritual distress when under the stress of an illness
TALKING POINTS:
• Sometimes people feel that the illness is a punishment from God for some transgression
they believe they have made.
with their spiritual connectedness.
Slide 15
Coping with Illness (cont.)
• Self-concept
• Affected by changes in self-esteem as well as changes in body image
• Perception of these changes and ability or inability to cope with them result in stress,
fear, and anxiety
• Adolescents especially vulnerable to changes in body image because they have a
strong need to look like their peers
TALKING POINTS:
• Self-esteem develops from individuals’ own evaluations of their competence and of the
value others place on them.
• What is body image?
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 55.1
Coping with Illness (cont.)
• Family and community resources
• Family’s ability to provide support for the patient depends on quality of relationships
TALKING POINTS:
• The basic functions of the family include providing for physical needs, giving love,
providing a sense of belonging, and strengthening the self-esteem of its members.
• Many of the functions once provided by families are increasingly being assumed by social
institutions within the community.
• How can the nurse assist the patient with community resources?
Slide 17
Coping with Illness (cont.)
• Emotions
• Stress: any physiologic or psychologic tension that threatens a person’s total
equilibrium
• Fear: denotes a response to a specific threat
• Anxiety: vague/intense sense of impending doom or apprehension that may appear to
have no clearly identifiable cause
TALKING POINTS:
• Some changes involve permanent alterations in lifestyle, frequent visits to health care
providers, frequent hospitalizations, financial problems, and increased social isolation.
• What effect may ineffective coping strategies have on a patient?
4
Slide 18
Defense Mechanisms
• Compensation: attempt to make up for real or imagined weakness
• Denial: refusal to acknowledge a real situation
• Displacement: transferring the feelings associated from one source to another that is
considered less threatening
TALKING POINTS:
• Defense mechanisms are used in an effort to diminish anxiety; however, when used
excessively or inappropriately, they can hinder the developing personality.
• According to Freud, what does the body do to cope with stress?
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 55.1
Slide 19
Defense Mechanisms (cont.)
• Isolation: separation of emotion from an associated thought or memory
• Projection: unacceptable feelings or impulses transferred to another
• Reaction formation: avoidance of unacceptable thoughts/behaviors by expressing
opposing thoughts/behaviors
Slide 20
Defense Mechanisms (cont.)
• Somatization: transfer of painful feelings to body parts, thus person’s feelings expressed
as a physical symptom
• Sublimation: transformation of unacceptable impulses or drives into constructive or more
acceptable behavior
Slide 21
Defense Mechanisms (cont.)
• Conversion: emotional conflict is turned into a physical symptom, which provides the
individual with some sort of benefit
• Ideally, unhealthy defense mechanisms are shed and replaced by more realistic and
efficient methods of adaptation as the individual matures
4
&
5
Slide 22
Conscious Coping Strategies
• Purposeful behaviors used to make an unfamiliar situation into one that is perceived as
more controllable and predictable
• They are attempts to help people feel less stressed and anxious about their illness
• Some methods provide only temporary relief, whereas others provide more permanent
results
Slide 23
Conscious Coping Strategies (cont.)
• Relaxation techniques: imagery, relaxation strategies, therapeutic touch, and music
therapy
• Provide patients with self-control during stress
TALKING POINTS:
• What is imagery?
• Musical selections should match a patient’s mood and musical taste.