knr 273 contemporary issues / changing concepts shank & coyle, 2002
TRANSCRIPT
KNR 273
Contemporary Issues /
Changing ConceptsShank & Coyle, 2002
CONTEMPORARY ISSUES
Changes in Health & Human Services
Not the same as 5 years ago Not the same 5 years from now Do these changes represent a threat or
opportunity to TR? While TR may be challenged to reinvent
itself, profession must remember its purpose
Changes in…
Technology Demographics Economic forces Structural changes in health care Consumer’s voice Ethical challenges
Technology
Regional information networks & data banks Computerized medical records New surgical procedures Innovations in assistive technology Use of internet
Demographics
Changes in racial & ethical composition of US
Communication barriers Aging population, especially women Range of care
Economic Forces
Increased cost of health care Lack of assess to health care without
insurance Insurance companies deciding on treatment
instead of doctors Downsizing staff
Structural Changes in Health & Human Services
New venues for service delivery Shift from inpatient to outpatient or in-home
care Decreased length of stay
Consumer’s Voice
Active participants in health care Able to read own records Confidentiality Consumer Bill of Rights & Responsibility
Ethical Challenges
Billing & insurance claims Commercialization of health care
Big business Economic pressures lead TR to survival
mode
OTHER ISSUES?????
Are these issues a threat or challenge to
TR?
Changing Concepts within Health & Human Services
Changing Concepts
Contemporary issues affect Changes in service delivery structure Challenges to science paradigms
Conceptual shifts Move from disease model to holistic model Move toward self-determination Emphasis on quality of life as outcome
Rehabilitation? Habilitation?
Habilitation Helping clients acquire abilities & skills associated
with normal development Rehabilitation
Helping clients restore or regain functioning lost or altered from illness or disability
Also adjustment & social / community integration
Medical Model
Assumes that the impairment or condition a person has is the key problem
The response is to “cure” or “care” Health is opposite of disability/disease If an individual has a disability they are not
capable of being healthy Little emphasis on how illness/disease
effected life or overall health
Health Model
Health is defined in WHO's Constitution as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity
Recognizes that PWD can be healthy
(Will discuss World Health Organization more in KNR 279)
Social Model
Impairment is seen as much less important It is the environment, attitudes of others, and
institutional structures that are the problems requiring solution Prejudice, discrimination, inaccessible buildings
and transportation, segregation, lack of employment, etc.
Social Model (Cont.)
Disability is not a fixed condition but a social construct and is open to change or modification
A person may have an impairment, but in the right setting with the right aids and attitudes, s/he may not be disabled
Social Model (Cont.)
The Social Model was enthusiastically received by the Disability Movement
It was connected to their own experiences Became the basis for disability awareness
Self-Determination
Consumer activism – stronger consumer voice
Recognizes consumer as partner “Nothing about me without me.” Person-centered planning
Looks to client to Identify & express needs & interests Set goals Select strategies to meet goals
Wellness
Approach to personal health that emphasizes an individual is responsible for own well being through practicing health promoting behaviors
High level wellness Maximizing individual’s potential within the
environment where the person functions Progression to higher functioning Integration of the whole person
Quality of Life
Define quality of life Rate quality of life? What factors affect QofL now? How has QofL changed over the years? How does leisure fit into QofL? What role does stress play on QofL? How cope with stress?
Quality of Life
Increased focus on quality of life as the ultimate outcome of services
Cure is not the ultimate intention of care Shift in philosophy for curing to caring and
comfort Being, belonging, and becoming
Pallative Care
Meet physical, emotional, spiritual needs and practical issues of people with life threatening or terminal illness
Help meet end of life with dignity Relieve suffering Increase quality of life Hospice
Stress & Coping
Stress & Coping
What is stress? Stimulus: stroke Response: depression
Fight or flight Tend or befriend
Relationship between person & environment that is appraised by the person as taxing or exceeding his or her resources or endangering his or her well-being.
Lazarus & Folkman, 1984
Stress & Coping (cont.)
When stress is perceived, people engage in a cognitive appraisal process Appraise the risk or threat posed by stressor
Primary appraisal Appraise options for responding
Secondary appraisal
Cognitive Appraisal
Primary appraisal When stress first occurs Evaluates stress as threatening, harmful, or
challenging Threat: Anticipated harm or loss Harm: Perception that damage has already occurred Challenge: Perceived potential to gain or grow from
event. Usually if person has sense of control over situation.
Permits anticipatory coping
Cognitive Appraisal (cont.)
Secondary appraisal Cognitive evaluation of what can be done What coping options are available? Likelihood that a given coping option will do what
it is supposed to do Similar to self-efficacy
Reappraisal Changed view based on new information from the
environment
Coping
What is coping? Process of dealing with stress Response to stress Constantly changing cognitive & behavioral
efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of a person
Lazarus & Folkman, 1984
Coping (cont.)
Situation specific Deliberate effort vs. response Aimed at managing stressful conditions 2 functions of coping
Problem-focused coping Emotion-focused coping
Problem-Focused Coping
Aimed at managing or altering the problem causing stress
More likely to be used if situation can be changed Seeking information Problem-solving Arrange for assistance
Emotion-Focused Coping
Aimed at regulating emotional responses to the problem
Often used if situation appears unalterable Look at bright side Prayer or mediation Exercising Talking to a friend Humor
Factors Influencing Coping Process
Coping styles Avoidant
Works better with short-term stress Diversional activities to distract
Confrontative Strategies for long-term threats
Optimism Show greater persistence in face of stress
Factors Influencing Coping Process (cont.)
Social support Coping assistance (gain new perspectives,
receive assistance) Social network (size, density, frequency of
contact) Social relationships (number & type of
relationships) Social support (emotional assistance, aid,
assistance)
Coping
Leisure can help cope with stress Diversion Adaptation Resumption of normalcy Sense of being in control
Carruthers & Hood (TR model) Reduce negative stress Increase positive aspects to bring joy & resiliency
Factors Influencing Coping Process
Klitzing Types of stress
Daily hassle Negative event Trauma Chronic stress
Leisure as coping strategy & context Celebrate strengths