This is a guest post by Cedric Loiselle.
A critical illness is a sudden, unexpected, and often life-threatening occurrence for both the patient and the family. It threatens the steady state of internal equilibrium usually maintained in the family unit. It can be an acute illness or trauma, an acute exacerbation of a chronic illness, or an acute episode of a previously unknown problem.
A family member’s involvement in the life-death sick role of a loved one threatens the well-being of the family and can trigger a stress response in both the patient and the family. The family enters this unplanned situation with its unexpected outcomes and often is forced into the role of decision maker.
The Effects of Stress
Studied initially by Selye in 1956, stress was defined as a specific syndrome that was nonspecifically induced. Selye also discussed the role of stressors, the stimuli that produced tension and could contribute to disequilibrium. Stressors can be physiological (trauma, biochemical, or environmental) and psychological (emotional, vocational, social, or cultural). The critical care environment is rich in both physiological and psychosocial stressors that threaten the state of well-being in the patient and family.
In response to a stressor, the “fight-or-flight” mechanism is activated, releasing through the sympathetic nervous system the catecholamines norepinephrine and epinephrine. These hormones are responsible for the increased heart rate, increased blood pressure, and vasoconstriction that comprise the physiological response to the “alarm stage,” the initial stage of the general adaptation syndrome to stress described by Selye.
The alarm stage is followed by the “stage of resistance,” which attempts to maintain the body’s resistance to stress. According to the theory, all individuals move through the first two stages many times and become adapted to the stressors encountered during ordinary life. If the individual is unsuccessful at adaptation, or if the stressor is too great or prolonged, alarm and resistance are followed by the “stage of exhaustion,” which can lead to death, the result of a wearing down of the human body.
The Impact of Critical Illness on the Family
After the initial fear and anxiety over the possible death of the family member, other considerations affect the family, including a shift in responsibilities and role performance, unfamiliarity with the routines of a Catholic hospice or the ICU, and a lack of knowledge concerning the course and outcome of the disease. These issues can develop and persist over the duration of the patient’s stay in the facility or unit.
The Patient is no longer Active in Family Life
Contributions to the family unit previously covered by the patient are added to the responsibilities of others. Financial concerns are usually major and daily activities that were of little consequence before become important and difficult to manage. Chores such as balancing a checkbook, contributing to car pools, and shopping for groceries can become critically significant if left undone. This issue means that the responsibilities of the patient are added to the responsibilities of others.
The social role that the patient plays in the family is absent during the critical illness. Comforter, organizer, mediator, lover, friend, and disciplinarian are examples of important roles in family functioning that may be, under normal circumstances, fulfilled by the patient. When that role function is unfulfilled, havoc and grief may ensue.
The Nature of the Critical Event
The circumstances surrounding the nature of the patient’s illness can also be a stressor for the family. In a sudden, unexpected event, such as a blunt trauma or an acute myocardial infarction, the life of the family can be brought to a halt in a matter of minutes. Having little or no time to prepare for such an event, the family is overwhelmed with a massive amount of unmanageable stress and can be thrown into crisis. Such stress often can manifest itself as anger toward the caregiver.
In other instances, the critical event is an acute exacerbation of a chronic but life-threatening illness. Such an episode brings with it a different set of stressors, reminding the family of difficult and painful times in the past when they have faced similar circumstances. Prolonged critical illness can present emotional difficulties for the family, which may increase the likelihood of crisis.
Coping Mechanisms – Means of Maintaining Equilibrium
Coping mechanisms, defined as an individual’s response to a change in the environment, can either be positive or negative. A sense of fear, panic, shock, or disbelief is sometimes followed by irrational acts, demanding behavior, withdrawal, perseveration, and fainting. The family attempts to obtain some sense of control over the situation, often demonstrated by refusing to leave the bedside or, alternatively, by minimizing the severity of the illness.
Reactions to crisis are difficult to categorize because they depend on the different coping styles, personalities, and stress management techniques of the family. The following are four generalizations about crisis:
- With the onset of a crisis, old memories of past crises may be evoked. If maladaptive behavior was used to deal with previous situations, the same type of behavior may be repeated in the face of a new crisis. If adaptive behavior was used, the impact of the crisis may be lessened.
- People are more open to suggestions and help during an actual crisis.
- Whether people emerge stronger or weaker as a result of a crisis is based not so much on their character, as on the quality of help they receive during a crisis state.
- The primary way to survive a crisis is to be aware of all its implications on family life.
Author Bio: Cedric Loiselle is an experienced writer who enjoys imparting useful information to many readers. The topics he usually writes about include business and finance, home improvement, and health.