Donna R. Falvo, refers to the term chronic as “symptoms that last indefinitely and are attributed to a case that may or may not be able to identified”. With this said, people who suffer from a chronic illness go for long periods of time in pain with possibly no answer. Chronic illness has the ability to alter an individuals everyday life with consequnces that can be considered severe. It is also recognized that many of the health impacts clients living with chronic illness face, extend to ones family.
Whether it be financial burdens, caretaker burn out or simply stress, it is almost inevitable that some impact from the chronic illness will affect surrounding family members. In this paper I will discuss my clients chronic illness, how they and there family are affected by said illness, copying strategies/resources used as well as identify and discuss a resource in our community that I have visited that is linked with this illness. The Chronic Illness The chronic illness that has impacted the life of my client is endometriosis. Endometriosis (EM) is defined as functional endometrial glands and stroma tissue that are located outside the uterine “ (Wang, Yufeng , & Bin , 2016, p. 1).
This illness is said to affect “approximately 2-17% of woman in their reproductive years (Wang, Yufeng , & Bin , 2016, p. 1) and “has never had a full-term pregnancy” (Sharon, Dirksen, Heitkemper, Bucher, & Camera, 2016, p. 1554). The etiology for this condition is poorly understood however, the most accepted view is that the endometrial tissues that flow through the fallopian tubes during retrograde menstrual flow attaches to various sites (Lewis et al. 2016). When endometrial tissue sheds, blood can collect in cystilike nodules.
These cysts, (cysts on the ovaries for my client) can in turn cause acute pain when they rupture. Apart from the painful cysts, “the most commom symptoms are [pelvic pain,] dysmenorrhea, dyspareunia, and low back pain that worsen during menses” (Agarwal & Subramanian, 2010, p. 1). Infertility is also seen with this illness, which is a major stressor for my client. KN describes this illness as terrible and is frustrated due to the fact she feels this illness has no real answer. Definitions
Understanding the client’s definition of certain terms can give us, health care providers, baseline knowledge around how they view these definitions and what it means to them. I first asked KN and MF their definition of family. KN described this term as people who love and support you no matter what. MF defined family as people who you grew up with. With this, I understood that family goes beyond just blood relatives for these two but is extended to people who are there for you and ones that have a strong connection with. I then explored the concept of health.
KN defined health as a person without a mental/physical condition, and MF defined health as a state of not being sick. This allowed me have an understanding that both partners in the relationship identified KN not being a state of health. Furthermore, the couple defined ‘chronicity’. KN defined this as excruciating pain that never goes away and that it is absolutely ridiculous. MF’s definition was pain that doesn’t go away. From this, it is clear that KN has very upset/frustrated feelings toward her chronic pain that she deals with everyday.
Overview of my client and her family and their roles in the home My client is twenty four year old female (KN) who lives in Fruitvale and was raised here her whole life. She has a very big family that live close by, with her chronic illness also present in other members of her family. She lives with her boyfriend (MF), who is twenty-nine. They have a dog, three bunnies and a cat. I choose this family due to the fact that I am interested in getting a deeper understanding of the illness, endometriosis, and the effects of this illness on ones life.
After exploring the roles of each family member, it is evident that KN and MF have distinct roles in the home, which works for both of them. KN’s role is primarily cleaning. She is responsible for tidying up around the home, doing the dishes and keeping the house in order. She is also responsible for getting the groceries and paying half the bills. In regards to her illness, KN finds herself frequently unable to fulfill these tasks. When it comes to housework, usually KN is in a great deal of pain and just cannot bring herself to clean. Usually, she is able to tidy up however finds it difficult to do a great deal of work.
I questioned if MF takes on this role when KN is unable to and it appears he does not which adds to a bit of conflict between the couple. This couple however, works through this by talking and both trying to tidy up here and there when possibly. Another thing that hinders KN from doing her part is not being able to work all the time, which in turn makes it hard for her to pay half the bills. KN was unable to go to work for two and half months, and recently has gone back however, is now contemplating going back off due to the pain that she experiences.
With KN being a labourer at porcupine saw mill, she finds a lot of the work difficult due to the fact she usually is in pain or fatigued. She is in the process of completing her nursing unit clerk training online, however has had to put a hold on this due to the expense. MF’s roll in the home is to pay his half of the bills as well as complete the outside work (mowing the lawn/watering/whipper snipping etc. ). When KN is unable to fulfill her role of paying half the bills, MF takes on this role for he has a high paying job as an ironworker.
MF has no restraints that delay his ability to partake in his roll and try’s to help KN when she isn’t able to fulfill her role. Effects on the Family Since KN has developed this illness, it has played a significant part in this couples relationship. KN expressed to me that the illness affects there relationship badly, which MF also agreed. KN finds it difficult due to the fact that MF doesn’t understand what she is going through and he often states he doesn’t know what to do (in regards to how to make her feel better).
KN appreciates that he tries but it often puts stress more than anything on the relationship. With KN often feeling depressed it makes it very hard to communicate with MF and gets angered easily. However, the couple copes with this by walking away and having there own space and then coming back to one another and making up/apologizing which has always worked for them. In MF’s perspective, its hard for him to deal with KN’s illness at times because on top of his own problems, he then has to deal with hers which is the main thing that he finds puts a strain on there relationship.
Both partners in this relationship are fairly laid back and feel that when KN isn’t able to fulfill her role in the home, it doesn’t much of an affect on the relationship because her role will get done eventually. Effects on the individual KN finds herself distressed for she feels she has lack of answers about this illness, which is very hard for her to cope with. KN was always an active individual and enjoys doing things in the outdoors as well with her animals. Since this illness has been present in her life it has taken major tole on her everyday life for mainly, she isn’t able to do things she likes to do.
The biggest restraint for KN is pain and frequently feeling fatigue. KN usually has a hard time sleeping due to pain and stress, which in turn results in the fatigue. When she doesn’t sleep at night, the following day all she wants to do is just rest and feels little motivation to do much of anything. When KN is not feeling fatigue, usually the pain hinders her from bettering her health, fulfilling her role in the house as well as things she enjoys. With this, KN finds herself usually in a depressive state which also plays a roll her little motivation to do things.
Overall, this condition has played a major role in KN’s everyday life in an unfortunately, negative way. Developmental Stages Erik Erickson’s theory of psychosocial stages is composed of eight categories ranging from infancy to maturity. KN and MF fall into the sixth stage of intimacy vs. isolation (ages 18-40). Erickson describes that during this stage of life, “we explore relationships leading toward longer term commitments with someone other than a family” (McLeod, 2013).
In this stage, a comfortable relationship including love and safety will be accomplished however on the other hand, one can avoid intimacy and fear relationships, which can lead to depression, loneliness and isolation (McLeod, 2013). Due to the fact that KN is usually in an ideal amount of pain, her chronic illness plays a major role in this couples relationship. This illness is constantly taking a toll on KN’s everyday life, especially the physical aspects. KN finds herself usually tired for she is frequently up during the night due to pain and stress.
The effects of lack of sleep/change in sleep partners can cause a variety of things such as: anxiety, confusion, compromised/ineffective copying, fatigue, disturbed sensory perception (Potter, Perry, Stockert, & Hall, 2014). KN also expressed to me that she feels little willingness to go out and exercise and be active due to being tired, depression and catching up on house work that she isn’t able to complete when the pain is to much to handle. This can play a huge roll on ones view of their body image causing depression, self-insecurities and lack of engagement in physical contact with her partner.
Although this is a risk, KN feels confident in her body, which is a great characteristic to have. Another factor that is affecting this couple is the possibility of KN being infertile. This is causing stress on the couple which usually ends up in an argument due to the fact KN wants to try and have children now while she can, however MF does not feel ready to take on the responsibility of a child. Barriers/ Coping Strategies/ Resources accessed One of the greatest barriers for KN, is her pain and the fact that she feels she has no answers.
With answers, KN would feel empowered to try and act on her health challenges or change something in her lifestyle that could possibly change or have positive effects on her chronic illness but as of right now with no answers, she feels lost and a sense of defeat. The other barriers that effect KN are her feelings of fatigue, and depression. KN feels her motivation to do things she enjoys has decreased in regards to her fatigue and depression. The barrier MF faces is having to observe KN in this state and not feeling educated around things he can do to make her more comfortable and just help her in general.
MF feels that he has to cope with her being sick. He uses copying in this content because he has to get used to and somewhat normalize KN’s frequent state. KN copes with her pain with using analgesics such as tramadol, she also just started taking visanne which mimics effects of progesterone in the body. She also finds that taking a moment, closing her eyes and bringing herself to a “good place” helps her cope with any negative thoughts as well as takes her mind off any pain she is experiencing.
I was surprised that with KN dealing with feelings of depression she does not take any medication for this. She is suppose to go see a counselor but has yes to do so due to her feeling that when she is able to go, she would rather take that time to catch up on house work and do things she enjoys. KN also visits, besides her family doctor in Fruitvale, the gynecologist in Trail Dr. Hale/ Dr. Dobson, who assists her with her illness. She expressed to me that she is in the process of exploring resources in Kelowna that could help her find answers to this illness.
