Chronic Illness-A4

Vignette Analysis I

This  assignment focuses on vignette analysis and direct application of  course concepts to the persons and situations presented in the vignette  for each question. All discussions must take into account the legal and  ethical considerations, as well as issues of culture and human diversity  that may pertain to the situations presented below.
Use the reading assignments thoroughly in an integrative discussion.  Remember to reference all work cited or quoted by the text authors. You  should be doing this often in your responses
Please keep your responses focused on what is presented in the vignette.  Do not add information but use your creativity to support what you see  in the vignette as written. Avoid elaborations and assumptions. This  assignment MUST be typed, double-spaced, in APA style, and must be  written in graduate level English.

Your assignment should be 3-4 pages in length per vignette PLUS a title and reference page

Vignette One (3-4 page response)

Janie  is a 42-year-old African American, wife of Jake, and mother of  12-year-old Stacy. Once a vibrant business office manager, Janie is now  on disability and rarely leaves the house.  She was diagnosed with major  depressive disorder at age 20 when she reported feelings of  worthlessness, fatigue, insomnia, and loss of concentration to doctor at  her college health services. Janie stated that she had felt “blue and  emotionally needy.” She had a relationship with a guy who “deceived me  and physically and emotionally abused me for two years. I lost interest  and respect for myself and others.” She was prescribed an antidepressant  medication and referred to a counselor and support group. 

Janie’s  therapist stated that Janie’s depression is a chronic condition and  Janie is at risk for recurrent episodes of depression. She asked Janie  to identity triggers that might precipitate those episodes. Janie stated  these triggers: (1) fear that I might return to my “lowest low”  depression state, (2) anxiety that I want to spare my daughter the pains  that I have endured, (3) periodic “sense of dread” for Stacy’s future  in an uncertain world, and (4) wonder about what my “hormonal change”  menopause will look like. 

1. How  would you apply the “impaired-at-risk role” to Janie’s situation and  chronic condition?  Illness behavior is shaped by sociocultural and  social-psychologic factors. What are demographic and past experiences  that shape Janie’s illness behaviors? What are some examples of Janie’s  statements to support your responses?
2. Caring  for a client with chronic illness requires a framework or model for  practice that differs from that of caring for those with acute, episodic  disease. Illness frameworks and models address the illness experience  of the individual and family that occurs as a result of changing health  status. How can you use the chronic illness and quality of life, the  trajectory framework, and the shifting perspectives model of chronic  illness with Janie and her family?
3. Chronic  illness is fraught with unpredictable dilemmas. Dependency in chronic  illness may link with a sense of powerlessness. How can you incorporate  strategies to decrease Janie’s/her family’s feelings of powerlessness?  How do you think that Janie would describe self-management? How can her  healthcare team foster Janie’s sense of order and other themes  associated with self-management?

Vignette Two (3-4 page response)

Tom  is a 62-year-old Italian-American man who was diagnosed with Diabetes  Mellitus Type II about 10 years ago. He has chosen to live with little  diet control, weight gain, weekly elevated blood sugars of over 300,  sedentary lifestyle, and non-adherence to prescribed diabetes  medications. He freely admits that this disease “gets in the way of my  life.” “I like to eat whenever and whatever I please, especially while I  watch TV. You know, finger-sticks and doctors’ visits are not in my  game plan. Maybe all of that later.” Tom now faces increasing blood  pressure, increasing vision problems, unrelenting skin ulcers that will  not heal, and insulin therapy. His wife, Gilda, describes Tom as, “he’s  always been self-indulgent and does what he wants regardless of the  consequences. When we first met, he was smoking marijuana daily, but he  grew out of that”.  Gilda does not understand Tom’s decisions and says,  “If I had diabetes, I’d take care of myself by eating well, exercising,  and taking my medicines.” 

1. Use  Stanton and Revenson’s five attributes of adjustment to conceptualize  adjustment for Tom and his family.  Discuss Engel’s Biopsychosocial  Model in regard to Tom’s situation.
2. Coping  is a complex, multidimensional process. It is sensitive both to the  environment and its demands and resources, to personality traits that  influence the appraisal of stress (such as a chronic illness), and to  resources for coping. Project how Tom, his family, and his support  systems might use 4 of the 8 categories of coping skills that Moos and  Holahan identify.
3. Perhaps  a blend of cognitive-behavioral, self-management, emotional  intelligence, and self-help/support strategies might be helpful to the  client and family’s adjustment/adaptation. How might you facilitate  Tom’s cognitive processing of the implications and meaning of his  condition(s)? Describe two interventions to address Tom’s coping  effectiveness, individual-level change, self-efficacy, self-management,  and decision-making. Suggest interventions to bridge the gap between Tom  and Gilda’s thinking and approaches to adjustment/adaptation of living  with Diabetes Mellitus Type II.

Reference:

Larsen, P.D., Whitney, F.W.    (2016).   Chronic Illness: Impact and Intervention.   (9th edition).   Burlington, MA   Jones & Bartlett Learning.     ISBN: 978-1284049008

Video
Acceptance and Commitment Therapy: Addressing Chronic Illness with Steven C. Hayes, Ph.D.   https://www.youtube.com/watch?v=1KA0JjkB10k

Video
Dr Mark Morningstar – Chronic Pain – Auto Immune Disorders 2 of 6.   https://www.youtube.com/watch?v=LX89LfDKncA
Video
Dr Mark Morningstar Chronic Pain- Failed Back Surgery 6 of 6.   https://www.youtube.com/watch?v=EzogsQy1Z_I
Video
Dr Mark Morningstar Chronic Pain- Fibromyalgia- 5 of 6.   https://www.youtube.com/watch?v=MTPKEvD304s
Video
Dr Mark Morningstar- Chronic Pain- Lyme Disease 4 of 6.   https://www.youtube.com/watch?v=BKdfDEQ2TJM
Video
Dr Mark Morningstar Chronic Pain Workshop- Sources Of Pain 1of 6.   https://www.youtube.com/watch?v=GNNrAN_0F60
Video
Dr Morninstar Chronic Pain Workshop-Heavy Metal and Chemical Toxicity 3 of 6.   https://www.youtube.com/watch?v=KKmRMVzM8cc

Video
How to Live With a Chronic Illness.   https://www.youtube.com/watch?v=DYnUaX67VbU
Video
Jon Kabat-Zinn – “The Healing Power of Mindfulness”.   https://www.youtube.com/watch?v=_If4a-gHg_I

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