Psychosocial Adjustment

In previous editions, this chapter was titled “Adaptation.” The literature uses the terms “adaptation” and “adjustment” interchangeably. Although either term could be used, this author prefers the term “adjustment,” as the term better describes a process as well as a final outcome. Adjustment refers to the changes in life that are made continuously when one has a chronic illness. Adjustment is not static, but dynamic. What is interesting about the terms “adaptation” and “adjustment” is that psychologists describe these terms as psychological adjustment or adaptation, whereas in nursing the more common phrase is psychosocial adjustment or adaptation. “Psychosocial” is a broader term and takes into account the social environment as well as the psychological state of being, that one cannot be separated from the other. “Psychosocial” is, therefore, a more inclusive term, while “psychological” is one-dimensional. Thus, in the discipline of psychology, studies describe psychological adjustment, while psychosocial adjustment is encountered more frequently in nursing. However, to be true to each author’s intent in the studies and articles described in this chapter, whatever term the author has used in the article—“adjustment” or “adaptation”— will be used to describe the study. Individuals with chronic illness unconsciously or consciously chart a course to navigate the challenges of a chronic disease. Throughout the course of their illness, they must rely on a healthcare system in which pharmaceuticals and technology are the hallmarks of quality health care. Although a disease focus may be appropriate to meet the physical needs of the individual, particularly in the acute phase, this perspective does not meet the social, psychological, and emotional needs of patients with chronic conditions. In other words, the disease focus of the healthcare system does not and cannot manage the illness experience of the patient and family. This chapter builds on the previous chapter, “The Illness Experience.” Classic work by Visotsky, Hamburg, Goss, and Lebovits (1961), in studying patients with polio, posed an initial question regarding adaptation. The researchers asked their patients how it was possible to deal with this stressor, polio, and which coping behavior(s) assisted them with achieving a successful outcome. Decades later, researchers continue to ask the same question. Although progress in understanding certain components of adjustment has been made, many questions remain unanswered.