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