Psychosocial Factors And Patient Education Essay
Sister Mary is a patient in Level 2 Emergency Department. She must have a neural examination, physical assessment, radiographs of her facial bones, and a computed tomography scan of the head. Taking into consideration that she is a Roman Catholic nun, what would be the ideal course of patient education as this woman progresses from department to department?
Psychosocial Factors Affecting the Patient and Health Care Professional
Every person is diverse in many ways. It is through their thoughts, encounters, and life experiences that make people who they are today. Health care professionals are impacted everyday with their psychosocial factors that they are aware of and unaware of.” Some may believe that considering psychosocial factors is impractical because of time constraints (Falvo, Pg 82).
There are health care professionals that ignore or try avoiding patient’s psychosocial factors because of feelings of being overwhelmed or incompetent because they don’t know how to handle the issue at hand. An example would be a doctor prescribing medication to a patient who does not believe in showing more content.
Patients with CHD have many risk factors that are unpredictable and unexpected. This illness can bring on tremendous stress that can bring out the worst in the disease.
“Patients have a set of norms and values—expressed or unexpressed—that are individually determined by their culture, socioeconomic status, ethnicity, gender, age, and life experiences”(Falvo, Pg 83). The patient needs more than medical therapy. According to James Blumenthal, PhD, “Psychosocially treated patients showed greater clinical improvement not only in psychological distress, but also in lower blood pressure, heart rate, and cholesterol levels.
More importantly, Linden et al. also concluded that patients who received psychosocial interventions were over 40% less likely to die and 65% less likely to have a recurrent coronary event than controls over a two year follow-up period” (Blumenthal, Pg.1). Guiding this type of patient to the right health care professional and reinforcing the right education can allow this patient to live an optimal life.
How does psychology affect one’s physical health? Several psychological factors including stress, behavior due to chronic pain, depression, and cultural beliefs can have adverse effects on the body’s physical condition. The treatment of both physiological and psychological aspects of poor health are crucial for patients to have successful treatment outcomes, maintain and improve wellness, and improve adherence to medical regimens.
Adding a team of five psychologists to a hospital’s staff and assigning specific job titles and duties to each psychologist would be immensely beneficial to the patients. The five job titles include substance abuse counselor, inpatient-only psychologist, child psychologist, adult psychologist, and pain psychologist.
Substance abuse counseling is a demanding and rewarding job that requires patience, a desire to help others, and compassion (The Princeton Review, 2008). Often, addicts are unaware of the services that can be provided to them. A substance abuse counselor can refer patients to other services such as family agencies, food pantries, a psychiatrist or physician, and welfare agents. Depending on the needs of the addict and their situation other services may be available as well (The Princeton Review, 2008).
The substance abuse counselor will be in charge of coordinating the use of recovery programs and structured programs for substance abuse, in conjunction with a social worker. Substance abuse counselors work with a variety of professionals in order to provide the best service to each patient.
Along with coordinating recovery programs, the substance abuse counselor will collaborate with local schools and provide information to children about substance abuse and how to abstain from using substances. He or she will provide information on programs for students who have already started using substances, and for those who have parents that abuse substances.
Motivational interviewing is another service that the substance abuse counselor may provide in order to keep the addict on track. With motivational interviewing, the patient becomes aware of potential problems caused, consequences experienced, and risks factors of their behavior. The counselor will help the patient envision a brighter future, while keeping him or her motivated to achieve set goals (Axia College of University of Phoenix, 2008).
Because substance abuse counselors can have as little as a high school diploma for their education, strict job limitations must be set. The counselor may not prescribe medicine, diagnose the patient, or provide psychological therapy. Instead, he or she may refer the patient to a specialist who can further help the patient with medical needs.
A substance abuse counselor will be very helpful to reduce hospital stays and increase adherence to medical regimens. Substance abuse counseling can be done on an outpatient basis and may help the patient to avoid a relapse which occurs most during the first weeks and months of treatment (Axia College of University of Phoenix, 2008).
Through the use of motivational interviewing, the counselor will be able to keep the patient motivated and on track with his or her medical regimens. Substance abuse counselors provide support toward the improvement and maintenance of health by keeping the patient motivated, referring him or her to other needed services, and helping him or her cope with their addiction.
Inpatient-Only Psychologist
Providing inpatient therapies and services to the patients who are admitted to the hospital is a necessity. An inpatient-only therapist will utilize various methods to facilitate adjustment and coping skills with patients suffering a chronic or terminal illness. A majority of the patients who are admitted to the hospital are there because they are seriously ill. The inpatient-only therapist will provide services such as teaching coping skills to help patients adjust to their illness, individual and family therapy sessions, and refer the patient to support groups if desired.
Although an inpatient-only psychologist may make decisions such as prescribing medicine, he or she can diagnose a psychological illness and decide an appropriate treatment plan. If he or she feels the patient needs medication, the inpatient-only psychologist may refer the patient to a psychiatrist for further evaluation.
An inpatient-only psychologist will decrease hospitalization time because he or she will aid in the coping and adjustment to a chronic or terminal illness. Once the patient has successfully adjusted to his or her illness, depending on the severity of the disease, he or she may be able to return home and continue regular activities. Having an inpatient psychologist will also improve the patient’s adherence to medical regimens.
According to Axia College of University of Phoenix (2008), using behavioral methods such as tailoring the regimen to make it compatible with the patient’s habits and rewarding him or her for following the given regimen, can help to improve compliance.
The role of the inpatient-only psychologist will support the improvement and maintenance of patient wellness by helping the chronically and terminally ill patients adjust to their illness and maintain their usual lifestyle in a way that keeps them complying with medical regimens.
Child Psychologist
Children react to and cope with illness very differently from adults. As a part of the team of psychologists working for the hospital, the child psychologist will collaborate with local schools to help children with medical conditions cope with being ill. In the hospital, he or she will provide psychological preparation methods for children prior to medical procedures.
According to Axia College of University of Phoenix (2008), over 2.5 million patients admitted to short-stay hospitals are under the age of 15. How much a child understands about being hospitalized and his or her illness depends on his or her age. The child psychologist will be responsible for providing informational techniques such as pamphlets, movies, puppet shows, and tours to help the child settle down and cope with the facility and his or her procedures. The psychologist may also work with parents to develop techniques to prepare the child for procedures and for adjusting to everyday life when the child returns home.
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For most hospitalized children who have a positive outcome, their stress level appears to be temporary and does not seem to produce long-term emotional problems (Axia College of University of Phoenix, 2008). Therefore, by having a child psychologist to improve a child’s hospital experience, the child may have shorter hospitalization and can understand his or her illness better in order to adhere to medical regimens.
The role of a child psychologist is supportive toward improvement and maintenance of wellness because the specialized training of the psychologists allows him or her to design treatment plans and preparation techniques that will better help the child understand what is wrong and how to treat the problem.
Adult Psychologist
Adult psychologists are similar to child psychologists except their target group would be people ranging from early adults to senior citizens. Like the child psychologist, the adult psychologist will provide psychological preparation methods to his or her patients before a medical procedure or surgery.
He or she will be responsible for diagnosing stress disorders in adults and aiding in stress interventions. Although the adult psychologist will not prescribe medicine he or she can determine patient diagnosis and treatment plans. If medications are needed then the psychologist may refer the patient to other specialists.
The Adult psychologist will provide services such as teaching stress relieving techniques which include cognitive therapy, problem-solving training, and stress-inoculation training (Axia College of University of Phoenix, 2008). If necessary, the psychologist may refer patients to a massage therapist to reduce muscle tension caused by stress.
Like children, adults with a positive hospitalization outcome are likely to experience reduced stress and anxiety which may cause a faster recovery. When the adult is able to address his or her concerns and get answers from the psychologist, he or she will likely adhere to medical regimens because his or her anxieties toward the regimen have been addressed. Improvement and maintenance of health will be supported by the Adult psychologist by mentally preparing patients for medical procedures, reducing stress and anxiety, and addressing the concerns of the patient.
Pain Psychologist
Pain can have adverse effects on both the physical and psychological health of a patient. When pain and discomfort derives from tissue damage it is called organic pain.
Pain perceived through psychological processes is called psychogenic pain (Axia College of University of Phoenix, 2008). The responsibilities of the pain psychologist include providing treatment for chronic pain, designing and implementing behavioral intervention plans, and teaching the patient and his or her family skills to meet future mental health needs. He or she will provide services such as behavioral and cognitive treatments to reduce pain.
Having a pain psychologist on staff will reduce hospitalization time by offering outpatient services and teaching the patients and their family how to alter their everyday lives in order to meet the needs of the patient. By addressing the patient’s psychosocial factors, such as making the patient state that he or she will comply with the regimen and involving family for social support, the patient is more likely to comply with medical regimens (Axia College of University of Phoenix, 2008).
Like the other psychologists, the role of the pain psychologist will be supportive toward improvement and maintenance of wellness by improving patient compliance and designing treatment plans that are individualized to the patient
Several hospitals have already implemented a team of psychologists as their staff. One hospital in central Connecticut has a staff with seven different psychologists specializing in many areas of psychology. Hospital physicians have stated that having the team of psychologists on hand to treat patients in need has improved attendance and compliance (APApractice.Org, n.d.). Each of the selected roles is very important for providing quality patient care.
By not implementing one of the roles, the psychologist may become overwhelmed with work and the patients will not receive the specialized care that is important to a successful diagnosis and treatment. Although some of the job duties overlap between the psychologists, this may be helpful to reduce the workload of each psychologist and keep a high-level of quality care.
Each of the psychologists is specialized in a certain area of psychological treatment, but some of them do perform similar job duties. Having an overlap in job duties may be beneficial for second opinions and covering shifts when one psychologist becomes ill or takes a vacation.
Many patients with a physical illness can suffer from emotional problems as well. Patients would be better off with the services provided by the psychologists because every aspect of their illness will be addressed and treated. Without psychological services available to the patient, the patient may never address his or her mental needs which can lead to more physical illnesses. According to APApractice.Org (n.d.), patients often present emotional problems that physicians do not know how to handle.
Therefore, adding a team of psychologists would be more beneficial to the patients than disregarding the option of psychological services within the hospital.
Overall, the implementation of psychological services in a hospital has proven to be beneficial for the hospitals who have already hired a team of psychologists. By adding a team of psychologists consisting of a substance abuse counselor, an inpatient-only psychologist, an adult psychologist, a child psychologist, and a pain psychologist; hospitalized patients will experience shorter hospitalizations, increased quality of care, and will adhere to medical regimens more often.
Not only will patients receive quality inpatient care, but they can continue their care on an outpatient basis which will help to keep them on track with their treatments.
Nursing practice is often associated with caring for the body (Sheridan & Radmacher 1992) and is underpinned by psychosocial care. The physiological disease is assessed upon patients’ admission into hospitals, Sheldon (1997) and Oliviere et al (1998) added that a holistic approach of care, that is, the psychosocial and spiritual health should be considered in order to inform nursing practice.
Furthermore, in this essay the psychological, being the emotions, self-awareness, self-efficacy and cognition; and social model of care will be briefly explored and discussed and its relation to nursing practice. Peplau (1952) suggested that good therapeutic communication is of paramount importance to prevent patients from experiencing stress, consequently, a model of stress and their own coping mechanism will be applied in supporting the patients through their stressful hospital experiences. Definition of key words will be given to facilitate understanding.
NCHSPCS (2000) defined psychosocial care as “concerned with the psychological and emotional wellbeing of the patients and their families/carers, including issues of self-esteem, insight into an adaptation to their illness and its consequences, therapeutic (sic) communication, social functioning and relationships” (NCHS PCS 2000) not excluding their spiritual wellbeing.
Sheridan & Radmacher (1992) suggested that the biomedical model assesses only patients’ physical ill-health and it may lead them to poorer health outcomes. Whereas, improvements of patients overall health is attributed far more to psychological, social and environmental changes than to medical skill.
Emotion as defined by Walker (2007) is a subjective feeling experienced and perceived by an individual and this affects the way the person behaves. Lazarus (1984a) argued that cognitive activity is a precondition for an individual to experience emotions; thereby no effect is experienced when the mind does not recognise emotions.
However, Zajonc (1984) challenged Lazarus views by stating that there is no empirical evidence to prove that cognitive appraisal is a precursor to emotional affect. However, Scherer (2005) agreed with Lazarus (1984a) and also referred to emotion and self-esteem as part of cognition or psyche.
According to Barry (1992) and Niven (2006) self-esteem is defined as one’s feeling regarding one’s self worth, values, showing of self respect or self-confidence.
Self-efficacy refers to a person’s belief, whether he/she can successfully engage in and execute a specific behavior. Therefore, emotions, self-esteem and self-efficacy are social cognitive processes that an individual acquires and it is influenced by attachment relationships (Bowlby1969) constructed by children in early years of development.
Research has shown that communicating and involving families/carers in a patient’s care plan not only improves the recovery process of patients, it also provides an insight into the family dynamics. It further provides nurses with information about the social background of patients which may assist in framing questions. Furthermore, nurses have knowledge of what the family/carers know about the illness that the patient is experiencing. It is important to seek patients’ consent before information is solicited, not forgetting the confidentiality clause.
Furthermore, health and class researchers agreed that there is a clear relationship between patterns of mortality and morbidity (illness) and the patients’ social class (DH 1980). There exist health inequalities between social classes; patients from middle class have higher propensity to visit doctors than patients from lower class.
Moreover, middle class patients possess better financial and other resources, (example, housing), to support them when discharged from the hospital, whereas patients in the lower class living in poorer, damp and overcrowded conditions are not able to draw on these resources to make a positive effect on their healing process. Furthermore, lower class patients might be living in a rough area hence may be reluctant to venture out to participate in their daily activities (Roper et al) and this is important for nurses to know so that adequate support is put in place before they are discharged.
The psychological and social factors are one of the two elements in psychosocial care. Additionally, spiritual well being refers to the possession of a belief in some unifying force that gives purpose or meaning to life or to a sense of belonging to a scheme of existence greater than merely personal, is another dimension of psychosocial care (reference). Furthermore, their religion also plays a key role especially when it comes to nutritional requirements and different customs.
The essence of nursing practice as it relates to patients’ psychosocial care is for nurses to understand patients’ feelings by perceiving it as if it was of their own. Caring is defined as involving concern, empathy and expertise making things better for others and is based on compassion (Smith 1992 & Niven 2006).
It is further based on the application therapeutic communication (Peplau1952) involving many familiar concepts, including maintaining eye contact, attentive listening to patient’s narratives and the use of silence, touch and humor appropriately, using empathy rather than sympathy and above all not to be judgemental. Therefore, warmth, acceptance, genuineness and empathy underpin the nursing ethos and this is the platform to focus away from the illness to that of the patient’s psychology (Baughan & Smith 2008) to create common ground in the midst of engaging or empowering the
patients in their care.
Consequently, empowering the patients is giving them information and increasing their understanding, enabling them to cope with and take control of their disease and also to psychologically support them, rapport-building, reassurance, empathy and promoting self-esteem and in the long term to build their self-confidence.
One should constantly maintain patients’ privacy and dignity (Faulkner 2000) and it involves getting the patients’ consent whilst preserving their confidentiality. Allen (2009) voiced the opinion of Wright (2004) that bad communication limits the extent that psychosocial care can be effectively given by the nurses to their patients, therefore, leading to stress.
Stress is an interaction between an event in a person’s life which is perceived as placing considerable demands on his physiological and psychosocial life and it mediates a behavioural change to either alter or manage the stress (Baum 1990 cited in Taylor 2003 pg 153). There are three models of stress, firstly, Holmes & Rahe (1967) referred to stress as a response to a social readjustment scale where life events are rated on a scale from more stressful to less stressful.
However, Ogden (2007) suggested that Seyles and Holmes & Rahe models only took into consideration the physiological external stressor and not the psychological factors such as their moods, emotions, thoughts and their behaviours and the environment.
Finally, the transactional model (Lazarus & Folkman 1984) of stress takes into consideration the wide range of factors that may influence the way a person copes with the demands of everyday life. So, instead of saying that a particular event is stressful, it considers that any event is potentially stressful; whether or not it is ultimately stressful for any one individual is likely to be mediated by a range of factors in the person’s own life.
Chronic pain if not properly sedated can cause stress, using the transactional model of stress, it suggests that when the pain occurs John’s reaction to it will depend on his primary appraisal. In this case, John concluded that it does experience sharper pain than he had ever experienced in his life. He is experiencing stress and this is termed secondary appraisal.
The resource he has available to cope with this stress is the analgesic drugs and secondly the nurse who always uses encouraging words is sufficient to allow him to cope effectively with the stressor. Sometimes it is not enough and as a result experiences a response that one would refer to as a stress response (Sheridan & Radmacher 1992).
The nurse used therapeutic communication especially whilst bathing him and changing his bed linen to gain additional information. John has only months to live after being diagnosed with lung cancer due to heavy smoking. It was his wife’s career ; it was not a priority to see a doctor then and she passed away two years ago (Holmes & Rahe 1967).
He has developed low moods, aggressiveness and low self-esteem which has led him to abuse alcohol (Baer et al 1987 & Colder 2001) though Conway et al, (1981) suggested that people smoked more than drink when they are highly stressed. He has lost his self-confidence and his abilities to focus on negative outcomes (Bandura 1994)
