Attitudes towards Health and Illness and How These Affect the Work of a Practicing Nurse - Essay Example

Attitudes Towards Health and Illness and How These Affect the Work of a Practicing Nurse Social psychologists define attitude as a complex tendency of persons to behave in positive or negative ways, or to respond to social objects in their environment in a favorable or unfavorable manner. It comes from the Latin word “aptitudo” meaning fitness to engage in the execution of a given task. Attitudes are formed through our own experience and contact with the world around us. As individuals grow and develop, they acquire a set of attitudes and beliefs that in part influence how they interact. Attitudes are formed through a learning process which can occur in four ways: classical conditioning, operant conditioning, observational learning and imitation. Psychologists list three components of attitude: 1) Effective – refers to positive or negative emotions about something. 2) Behavioral – involves intentions to act in certain ways that are somehow related to one’s attitude. 3) Cognitive – refers to one’s process of thinking and interpreting that goes into forming or using an attitude. There is a right and wrong attitude toward health and illness and use of a specific set of ideals has “important clinical implications.” An ideal is the motivational standard by which to evaluate our goals and our reasons for pursuing these goals. The “goal is the what; the ideal is the why.” (“The Edgar Cayce Primer,” Bantam Books, New York 1982.) The ideal attitude gives people a greater sense of purpose and meaning in life, making them look at illness as more of a challenge than a tragedy. Those bereft of such a lofty ideal are prone to depression and self-condemnation in the face of disease which provokes fear in them and a feeling of being victimized by something outside and beyond their control. This attitude of weakness and surrender stunts a person’s psychological initiative and weakens his/her will power to render healing more difficult and painful. Our thoughts, feelings, behavior and purpose in life contribute a great deal to health or illness, Edgar Cayce declares. To develop the ideal attitude for combating disease, we have to take some degree of responsibility for our situation by defining a course of action that takes all aspects of our experience – spiritual, mental and physical – into consideration. People who are able to make such an attitude adjustment feel more empowered to deal with their illness. (“Meditation and the Mind of Man,” H.B. Puryear & M.A. Thurston, A.R.E. Press, Virginia Beach 1987.) Functionalists believe that attitudes are “enduring systems.” Once attitude is acquired, it becomes virtually impervious to change. The reason is, attitudes serve a particular motivational function related to the ego and to change them you need to change what motivates the individual as well. This school of thought moreover holds the view that an attitude change is made more difficult by the fact that what lies behind motivation is usually unknown even to the individual as it often exists in the subconscious level. If attitudes toward health and illness are difficult to change, and both ailing person and the one entrusted with his care and treatment fall short of the spiritual and mental ideals, this puts the patient’s chances for recovery all the more at risk. But it is believed that one tasked to nurse a diseased person back to health can influence the latter in a positive way if the former has the ideal attitude for healing. This brings us to the topic at hand, which is how attitudes toward health and illness affect the work of a practicing nurse. Nursing, we must remember, is the “therapeutic interpersonal relationship which facilitates the growth and development of both patient and healer.” This nurse-patient relationship is considered vital to medicine as applying mechanical techniques or other procedures. The unique function of the nurse “is to assist the individual, sick or well, in the performance of those activities which contribute to health, to recovery, or to peaceful death, that would be performed by the patient if he had the necessary strength, will or knowledge, and to do this in such a way as to help him gain independence as rapidly as possible.” (“Interpersonal Relations in Nursing,” H. Peplau, Putnam New York 1988; “Theory of Cognitive Dissonance,” L. Festinger, Stanford University Press 1957.) But in many parts of the world, nurses have been found lacking of the ideal attitude for healing, especially as it concerns caring for patients of communicable diseases that remain largely incurable and thus carry a social stigma. Such a disease is HIV-AIDS, which has generated so much hysteria unmatched even by the tuberculosis epidemic before an effective cure was developed. A study at the University College Hospital in Nigeria sought to find the prevailing attitude of nurses towards caring for AIDS patients. Of 200 male and female nurses interviewed, 52.4 per cent said their reaction was one of anxiety; 26.4 per cent of fear; 6.7 percent skepticism. Only 7 per cent managed to stay neutral and 6.7 per cent remained calm. The nurses who confessed to a less desirable attitude believed that AIDS sufferers were responsible for their illness themselves and thus deserve their dire health condition. Many confessed to having increased anxiety levels and even experiencing nightmares. The same attitude was noted by A. H. Ghodse on British nursing staff towards drug overdose patients (“The Attitude of Casualty Staff and Ambulance Personnel towards Patients of Drug Overdose 1978). Because the nurses had the preconceived notion that drug overdose patients were responsible for their condition, the latter received less sympathy and medical effort than those deemed by the nurses to be blameless for their condition. In some cases, nurses betray negative attitude towards patients of stigmatized diseases because of lack of knowledge. Another study on the attitude of Canadian nurses towards AIDS patients revealed that they are overcome by anxiety, uncertainty and fear because they know next to nothing about the disease. Also cited were the lack of in-service training and experience, the need to keep up with current trends and the availability of resources for the proper treatment of AIDS patients. For these reasons, the nurses were found overcautious in dealing with said patients. Such an attitude is certainly no way to bring hope and comfort to sufferers from stigmatized diseases who see their diagnosis as tantamount to a death sentence. Hope is an essential factor for the afflicted to maintain and regain his health as it enhances his ability to cope with illness. It is a given that the nurse’s friendliness, empathy and understanding of the patient is conducive to the “therapeutic relationship” between nurse and patient. To be faithful in their own version of the Hippocratic oath, the nurses should accept patients for what they are and not attribute characteristics on them based on their illness or its source because majority of them, in the case of AIDS sufferers, are abandoned by family and friends and often have to rely on the nurses for care and support. (“The Discipline of Nursing,” M.A. Laoye, Nigerian Journal of Nursing Education 1988.) According to S.C. Baird and N.O. Bearslee (“Developing an In-Service Program on AIDS,” Journal of Nursing Staff Development 1990) this could “blur judgment and compromise the quality of nursing care.” It would not do if, in interacting with friends, acquaintances, family members and colleagues and thus exposing themselves to the same influences as the general public, they exhibit the same attitude that stigmatizes and looks down on AIDS patients. But the fear of nurses on the risk of infection is not entirely unjustified. In Nigeria, it was found that nurses attending to AIDS patients do so without adequate protection in terms of education and appropriate hospital equipment. The health workers are necessarily scared of this condition and think they can feel comfortable if they are assured of their own protection. Another factor that puts them on guard are actual incidents of infection involving health workers. In 1987, for example, the US Center for Disease Control reported that 12 health care workers became HIV positive due to work-related exposure to infected blood. This heightened the level of fear among nurses such that despite the availability of appropriate medical equipment in the US, many expressed the view that AIDS patients should be identified and isolated. And so although nurses in the US are generally knowledgeable about HIV-AIDS, a good number still show inappropriate behavior and reluctance to undertake essential nursing duties for AIDS patients. This is not to say that nurses as a whole are unfeeling, lack dedication or any less concerned with patient care. On the contrary, they want and demand participation and respect. It is just that in the rapidly changing health care patterns of today, the nurses find themselves in a precarious, threatened and frustrating situation. Nurses have in fact shown the capability to change attitudes and thereby overcome fear and the feeling of discomfort through what psychologists call “cognitive dissonance,” which is done by rationalizing their feelings and sets of belief and behavior. This nurses’ attitude may be altered by helping them acquire new knowledge, experiences and skills relevant to tackling the multi-disciplinary problem of AIDS care and prevention. The Nigerian study has demonstrated that this can be done. Although the result of the study is disturbing for the most part, it however arrived at the conclusion that majority or 68.4 per cent of the nurses interviewed actually expressed willingness to provide proper care for AIDS patients if their work could be carried out in a well-equipped hospital setting. An equal number of the nurses felt that HIV-AIDS patients should not be blamed for catching the disease. And an even larger majority (82.4 pr cent) agreed that such patients should not be left to die alone just because there is no known cure. It is imperative that this process of cognitive dissonance among nurses be exploited and a change in the popular attitudes be effected to keep pace with the expanding role in society of this important health care sector. In many places, the role of nurses has undergone major changes from that of being a mere doctor’s assistant/helper to the frontline of the primary care system. In the United Kingdom, for example, nurses now occupy the lead role in primary care clinics in place of doctors. One practical reason for this is the perceptible shortage of general practitioners and doctors. But even in places without a noticeable shortfall of doctors, there is growing agreement that nurses can offer more cost-effective care than doctors since they provide each patient with just the right level of health care – no more, no less. Thus, British nurses are now taking on specialist work in areas like diabetes, heart failure and stroke care. Since 1998, nurses in UK have been undergoing additional training to be able to prescribe medicines under a certain formulary. Nurses in Sweden and some other Scandinavian countries are also being entitled to prescribe medicines, and in many other European countries, nurses are now serving as “gatekeepers” in place of doctors. Even in Portugal, where nurses still generally work under the employ of GPs, health centers or clinics, they are now the main actors outside institutional settings. They provide direct health care in different fields like pregnancy and child health, family planning or care for other vulnerable population/patient groups like the aged. (“European Forum for Primary Care,” Aaldert Mellema, http://83.149.72.10/smart stie -dws?id=184) The expanded functions of nurses in Hong Kong are even more impressive. Today, Hong Kong nurses can: - Order diagnostic investigations, including pathology and x-rays. Make and receive referrals direct to other health professionals such as therapists and pain consultants. Admit and discharge patients for specific conditions and within agreed protocols. Manage certain caseloads for diabetes, clinical depressions and similar conditions. Run certain clinics such as ophthalmology and child development. Prescribe medicines and treatments. Carry out a wide range of resuscitation processes such as defibrillation. Perform minor surgeries and out-patient procedures. Take the lead in organizing and running local health services. The practicing nurses in Hong Kong are now regarded as “mega-nurses” since more new roles seem to be created for them almost every other week. The word from the Nursing Council of Hong Kong is that “even more work is coming the nurses’ way, further expanding their roles.” (http://www.nch.org. hk/paper/core comp English.doc) As for the quality of work of nurses doing the traditional job of doctors, randomly controlled trials using that yardstick were conducted in UK. The trials showed that nurses, given the right training and attitude, proved capable of providing care on the same satisfaction level as doctors. In some cases, the quality of the nurses’ work was even better than that of the doctors. (Aaldert Mellema NU 1991.) It goes without saying that the nurses in general would not have scaled the heights of their job’s potentials in this manner without adjusting their attitudes to the needs of the times. References: Baird, S. & Bearslee, N. Developing an In-Service Program on AIDS. Journal of Nursing Staff Development, 6:269-274. 1990 Effa-Heap, G. The Attitude of Nurses to HIV/AIDS patients in Nigeria 539. The Attitude of Nurses to HIV/AIDS patients in a Nigerian University Teaching Hospital. Available from: http://www.codesria.org/Links/Publications/aids/effa_heap.pdf [accessed 1 March 2006] Festinger, L. Theory of Cognitive Dissonance. Stanford: Stanford University Press. 1957 Jones, A. The Changing Role of Nurses. Pharma Times. April 2004. Available from: http://www.allaboutmedicalsales.com/articles_nurse_advisors/nurse_practitioners_nurse_advisors_aj_010604.html [accessed 1 March 2006] Laoye, A. The Discipline of Nursing. Nigerian Journal of Nursing Education, 1(1):1-4. 1988 Mellema, A. The Changing Role of Nurses in Primary Healthcare in Europe. European Forum for Primary Care. 1991. Available from: http://83.149.77.10/smartsite.dws?id=184 [accessed 1 March 2006] Peplau, H. Interpersonal Relations in Nursing. New York: Putnam. 1988 Puryear, H. The Edgar Cayce Primer. New York: Bantam Books. 1982 Puryear, H. & Thurston, M. Meditations and the Mind of Man. Virginia Beach, VA: Association for Research and Enlightenment Press. 1987 The Nursing Council of Hong Kong. Core-Competencies for Registered Nurses. Available from: http://www.nchk.org.hk/paper/core_comp_english.doc [accessed 1 March 2006] Read More