Review the clinical scenario presented and respond to questions.

Sue Jones is a 28-year-old thin, single mother of three young children who has recently been hospitalized and diagnosed with hepatitis C. Ms. Jones is a recovering heroin addict, having been free of illegal drug use for 2 years. She currently is maintained on methadone 80 mg daily, which she receives at a methadone clinic located approximately 20 minutes from her home. Ms. Jones is currently experiencing severe fatigue, nausea, and abdominal pain. Today her physician advised her to begin interferon treatments in an attempt to slow down the virus's assault on her body. Ms. Jones appears withdrawn and depressed, expressing remorse because, "I caused my own illness. If only I had never gotten so wrapped up in drugs. I was so stupid." Ms. Jones lives with her divorced mother, Jane Brown. Mrs. Brown is supportive of her daughter and devoted to her grandchildren, but admits feeling overwhelmed and angry that Sue's past drug use is causing yet more turmoil in their lives.

The initial nursing assessment based on Roy's Adaptation Model indicates that Ms. Jones is exhibiting ineffective behaviors in all four response modes. More specifically, assessment of physiologic mode responses reveals that Ms. Jones has a very poor appetite and is below average weight. She is also experiencing abdominal pain, fatigue, and difficulty sleeping. Assessment of self-concept mode responses indicates that Ms. Jones is struggling with shame about her past lifestyle and drug use, powerlessness about her current situation, and guilt for causing her mother more trouble. Assessment of role function mode responses reveals that Ms. Jones feels like a failure as a mother and provider for her children. She expresses concern about her children's future and their opinion of her as a mother. Assessment of the interdependence mode responses indicates that Ms. Jones is fearful that she may have finally pushed her relationship with her mother to the edge and is distraught about the prospect of losing her mother's love. Ms. Jones also expresses sadness about the lack of a significant other and states that she is lonely.

When Ms. Jones meets with the nurse case manager assigned to her, they agree that Ms. Jones's primary goal is to convert ineffective responses to adaptive ones, thereby contributing to her personal health and quality of life. Learning how to manage her hepatitis C and improving her parenting skills are goals made by Ms. Jones. Together, the case manager and Ms. Jones begin to identify specific behaviors that need to be modified or developed. They work to develop a timetable of short- and long-term goals for behavioral changes. Nursing intervention for Ms. Jones focuses on increasing the focal stimulus of social support through individual counseling, participation in a support group for hepatitis C patients and their families, and weekly Narcotics Anonymous meetings.