KNR 273

1. KNR 273 Contemporary Issues / Changing Concepts Shank & Coyle, 2002

2. CONTEMPORARY ISSUES

3. 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

4. Changes in… • Technology • Demographics • Economic forces • Structural changes in health care • Consumer’s voice • Ethical challenges

5. Technology • Regional information networks & data banks • Computerized medical records • New surgical procedures • Innovations in assistive technology • Use of internet

6. Demographics • Changes in racial & ethical composition of US • Communication barriers • Aging population, especially women • Range of care

7. 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

8. Structural Changes in Health & Human Services • New venues for service delivery • Shift from inpatient to outpatient or in-home care • Decreased length of stay

9. Consumer’s Voice • Active participants in health care • Able to read own records • Confidentiality • Consumer Bill of Rights & Responsibility

10. Ethical Challenges • Billing & insurance claims • Commercialization of health care • Big business • Economic pressures lead TR to survival mode • OTHER ISSUES?????

11. Are these issues a threat or challenge to TR?

12. Changing Concepts within Health & Human Services

13. 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

14. 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

15. 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

16. 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)

17. 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.

18. 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

19. 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

20. 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

21. 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

22. 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?

23. 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

24. 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

25. Stress & Coping

26. 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

27. 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

28. 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

29. 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

30. 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

31. Coping (cont.) • Situation specific • Deliberate effort vs. response • Aimed at managing stressful conditions • 2 functions of coping • Problem-focused coping • Emotion-focused coping

32. 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

33. 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

34. 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

35. 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)

36. 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

37. Factors Influencing Coping Process • Klitzing • Types of stress • Daily hassle • Negative event • Trauma • Chronic stress • Leisure as coping strategy & context • Celebrate strengths