Individual in Society: The Biopsychosocial Model in Nursing - Term Paper Example

INDIVIDUAL IN SOCIETY: THE BIOPSYCHOSOCIAL MODEL IN NURSING INTRODUCTION The biopsychosocial model is a holistic approach to nursing based on theories related to biologic, psychological and social sciences. Though the domains are separate, each with its own knowledge and focus of treatment, they are also mutually interdependent. This holistic method emphasizes the importance of fully understanding the whole individual with physical, mental or emotional problems. The biopsychosocial model provides theoretical background to nursing processes (Boyd 2007). Thesis Statement: The purpose of this paper is to investigate the reason for developing the biopsychosocial nursing care model from the biomedical approach, and to determine both the social cause of disease as well as health and illness behaviour in relation to the biopsychosocial model. Further, the same approach pertaining to stress, and disadvantages to health during life course and end of life will be discussed. DISCUSSION THE BIOPSYCHOSOCIAL MODEL Definition: The biopsychosocial model of nursing is based on the importance of meeting biological, psychological and social needs of patients for maintaining good health, and does not focus only on illness and the physical body. The biopsychosocial model considers both health and illness, taking multiple factors into account, not considering illness as a deviation from a steady physical state (Taylor 2006). The Shift from Biomedical to Biopsychosocial Model The biomedical model of medicine helps to treat individuals only on the biological aspects of the illness or disease, while the psychological and social factors are not taken into consideration. The biomedical model does not explain why a particular set of somatic conditions need not necessarily lead to disease in every case. “Criticisms of the biomedical model led to the development of the biopsychosocial model of western medicine” (Butler et al 2004, p.219). The recognition that all illnesses have both mental and physical components gave rise to the general systems theory based on the dynamic relationship between components of systems, as in the biopsychosocial model. The biopsychosocial model formed the basis of the concept of triple diagnosis, or diagnoses at three levels: the biological or physical, the psychological or mental, and the social or contextual. This relates to the systems theory approach to health and illness. This theory maintains that all levels in any entity are linked to each other hierarchically, and that change at any one level affects change at all the other levels. This means that microlevel processes such as cellular changes form part of the macrolevel processes such as societal values, and that “changes on the microlevel can have macrolevel effects and vice versa” (Taylor 2006, p.13). The Difference between Biomedical and Biopsychosocial Models The disease model most commonly used is biomedical, which is developed on the foundation of molecular biology as the basic scientific discipline. The biomedical model is reductionist in its approach, reducing illnesses to low level “aberrant somatic processes, such as biochemical imbalances or neurophysiological abnormalities” (Taylor 2006, p.11). It does not recognise the importance of more general social and psychological factors, and assumes mind and body to be separate entities. The biomedical model is disease-centred, and focuses on the illness rather than on health, on the physical “aberrations that lead to illness, rather than on the conditions that might promote health” (Taylor 2006, p.12). On the other hand, Engel’s biopsychosocial model is patient-centred, emphasizing the various causes and multiple effects. In the biopsychosocial model, disease is considered to be “a deviation from the norm of measurable variables” (Yarbro et al 2005, p.600) where social, psychological and behavioral dimensions of illness are included in the diagnosis and treatment. Two Theorists who Support the Two Models in Relation to Nursing Practice The biopsychosocial model was developed by G.L. Engel in 1977, and was supported by G.E. Schwartz, 1982. The theory is relevant to nursing practice because it advocates treating a patient in a holistic manner at multidimensional levels, for achieving the best possible outcomes. On the other hand, the biomedical model “has governed the thinking of health practitioners for over 300 years” (Taylor 2006, p.11) in both medical treatment and nursing care. The emphasis of this model is on excellence in physical care with a focus on the disease process alone, and in the routinisation of nursing work. According to Pearson et al (2005), these factors protect nurses against the stress involved in their work, by narrowing down the areas of nursing care. THE SOCIAL CAUSES OF DISEASE The Relationship of Social Causes of Disease with the Biopsychosocial Model Most diseases relate to social factors. According to Cockerham (2007, p.1), “social context can shape the risk of exposure, the susceptibility of the host, and the disease’s course and outcome” irrespective of whether the disease is infectious, genetic, metabolic, malignant, or degenerative in origin and nature. The biopsychosocial model of nursing includes the identification of psychological stress in the patient, and the causes of the condition. If it is found to be based on a social factor, implementation of the best nursing care techniques to reduce the patient’s distress. By focusing only on biological factors such as “germs, viruses, cancer cells, coagulated clots of blood that clog arteries” (Cockerham 2007, p.2) does not account for all the essential factors in a disease’s pathogenesis. This is particularly true for social behaviours and conditions that create the possibility of the disease, such as cancer caused by smoking. Class and gender are significant determinants of smoking and other risky behaviour. Additionally, smokers are also prone to having less healthy lifestyles as compared to non-smokers, with poorer diets, drinking problems, and less regular exercise. Further, decline in cardiovascular health has now been recognized by the public, to be caused by smoking, poor diet, obesity, and lack of exercise. The biopsychosocial approach to nursing practice helps the patient to improve his lifestyle. Examples of Social Causes of Disease Some examples of social causes of disease are: “stress, poverty, low socioeconomic status, unhealthy lifestyles and unpleasant living and work conditions” (Cockerham 2007, p.1). Social interactions may give rise to conflict situations resulting in stress, or an offender or even innocent person may be targeted through “labeling” which is the derogatory terminology attached permanently to an individual on the basis of wrongful actions such the commiting of crime. According to Phelan et al (2004), social variables are usually not taken into account when treating illness or disease. However, their significance in achieving cure through biopsychosocial care is now acknowledged. Two Theorists who Support the Model in Nursing Practice Labelling theory is based on social causes of disease, and its application to nursing has been supported by Virginia Oleson and Fred Davis (Cockerham 2007). Nursing care that helps to alleviate a patient’s psychological distress and consequent illness caused by being categorised or labeled with a detrimental term such as “thief”, facilitates their early recovery. It is a biopsychosocial approach to nursing practice. HEALTH AND ILLNESS BEHAVIOUR The biopsychosocial approach involves the use of interdisciplinary treatment plans, in which the components related to nursing care are easily identified. Collaboration with other professionals may be required in all settings, including hospital and community, particularly in cases of patients with mental health issues. “Usually it is the nurse who coordinates the delivery of the care of these different disciplines” (Boyd 2007, p.52). The Relationship of Health and Illness Behaviour to the Biopsychosocial Model Diseases such as cancer are traditionally associated with the biomedical model, but this theory does not encompass all the different aspects of the disease diagnosis. In contemporary medicine, the biopsychosocial model is considered to be holistic, perceiving the relationship between emotional distress and immune and neuroendocrine measures in patients with diseases such as cancer. Recent expansion of the model include facets related to “culture, health-related quality of life, spirituality, dignity, hope, peer function, environmental stimuli, emotional function, role function, self concept, interdependence, and social support” (Yarbro et al 2005, p.600). Taylor (2006) includes an effective patient-practitioner relationship for optimal outcomes of treatment. Evidence from numerous research studies support the biopsychosocial theory as an important model of care (Currid 2004; Borrell-Carrio et al 2004; Boydell et al 2003). On the other hand, Butler et al (2004) argue that the biopsychosocial model is not adequate in explaining the mental or social source of disease or illness. The biopsychosocial model apparently resolved the mind-body split, and the three levels of stresses influence each other according to the systems theory. However, the biopsychosocial model is “still based on the Cartesian notion of physical and psychological duality” (Butler et al 2004, p.222). Hence, in illnesses pertaining to psychosomatic reasons, health care professionals should get patients to recognize the error in interpretation, and find the correct level in the system where the problem is truly located. Examples of Health and Illness Both health and illness are relative to the experiencing person’s perspectives. Health is a sense of well-being. Health includes an ability to adapt generally to the environmen and, and denotes an absence of illness. Most importantly, it is the ability to function physically, mentally and socially at a high level; and relate to others in the world (Pearson et al 2005). Thus, health is perceived to be multidimensional, and operates at several levels, physical, mental and social. For this reason, the biopsychosocial model of nursing is most effective in restoring normal health to a person with disease or illness. Illness refers to the disharmony between the inner person and the experiencing person. The disharmony may be caused by disease, or may relate to inner factors. “Inner problems such as guilt, distress, worry or sadness can lead to illness which in turn may cause disease, or may allow a predisposition” (Pearson et al 2005, p.217) such as a genetic weakness to become evident. For example, a person who has a hereditary predisposition for cardiac problems, may hasten its onset due to inner problems such as anxiety, worries, stress or other harmful factors. In most cases holistic nursing practice that takes the patient’s spiritual, emotional, and social needs into account, results in the desired health outcomes. Two Theorists on Health and Illness Behaviour Related to Nursing Practice Roper et al (1996) developed a model for nursing in 1990, based on promoting independence in routine activities of daily life, through the processes of comforting, preventing and related components of nursing. The assessment of the outcome focuses on the shift towards or away from the goals of care, and since they are in measurable terms, the effectiveness of the care is clearly evident (Pearson et al 2005). Another theorist for health and illness behaviour was Dorothea Orem, who in 1971 developed the Self Care model of nursing, based on the theory of human needs. Self care is a process by which a lay person functions on their own behalf, not only in health promotion and disease prevention, but also in disease detection and treatment. The idea of self care appears a simple concept, but in reality it is “complex with social, economic, moral and political ramifications” (Pearson et al 2005, p.103). The model provides care for all individuals with nursing requirements at the different levels. However, it is particularly useful in the area of disease prevention and health promotion because of the significance given to individual responsibility. The self care model encourages individuals and families to take the initiative, accept responsibility, and develop their own potential in issues concerning their health. STRESS AND STRESSORS The Relationship of Stress to the Biopsychosocial Model Stress is the body’s physiological reaction to any stimulus that causes a change to occur (Daniels 2004). Often a certain amount of stress is necessary for survival. However, high levels of anxiety can cause stress manifested as discomfort and pain. Anxiety is the psychological response to a threat; it can cause stress and can also be the result of stress. Illness and impairment of the immune system may result from a person’s unsuccessful attempts to adapt to stress. A stressor is a stimulus that threatens an individual’s security, fuels the need to adapt, and may be internal or external in origin. A headache exemplifies an internal stressor, while a difficult test is an external stressor. Stressors may be physical such as an injury, psychological such as anxiety, or physiological such as an illness. Stressors are neutral, neither good nor bad, and individuals’ perception about them determines their effect. In the area of stress management for the patient with heart disease, diabetes, or any other chronic condition which is exacerbated by stress, the nurse has to discuss with the patient the importance of coping with stress and anxiety and resolving them. Nursing care includes identifying factors contributing to stress and evaluating the role of stress in the illness. The internal factors may be biophysical, spiritual or mental, while external factors may be stress due to change, inadequate comfort or cleanliness (Pearson et al 2005). Teaching the patient the health impacts, the vital need for removing the stressors and changing one’s perceptions on stressors that cannot be eliminated, form part of the nurse’s responsibilities (Daniels 2004). This is supported by Pearson et al (2005, p.217), who states that “nursing is essentially a transpersonal communication of human caring” and in this bonding of two individuals, the improved health outcomes and well-being of the patient is of primary importance. Further, promoting positive adaptation to stress through nursing interventions that help the patient to relax mentally and physically, is a crucial requirement for achieving optimal outcomes from treatment and care (Daniels 2004). Promoting positive life patterns, nurturing aspirations, developing life purposes, devoting oneself to spirituality and working towards achievement are important. Thus, nursing care related to stress is biopsychosocial in nature, where the patient is cared for in a holistic manner, with a full understanding of the adverse health impacts caused by psychological factors such as stress, and the consequent physiological response of the body often leading to illness and disease. Two Theorists on Stress and Stressors Related to Nursing Practice In the case of stress related to a lack of adaptation to life changes or other occurrences, Roy’s Adaptation Model, 1984 can be used effectively by nursing staff. According to Tomey and Alligood (2005, p.365), the nursing model consists of six steps: “1. Assess the behaviours manifested from the four adaptive modes. 2. Assess the stimuli for those behaviours and categorize them as focal, contextual or residual stimuli. 3. Make a nursing diagnosis of the person’s adaptive state. 4. Set goals to promote adaptation. 5. Implement interventions aimed at managing the stimuli to promote adaptation. 6. Evaluate whether the adaptive goals have been met”. The above model complies with the biopsychosocial approach to nursing, dealing at the psychological level, to treat stress in the patient towards achieving sustained improvements in disease conditions such as cardiac arrest, hypertension and others. A second theory, the Nursing Judgment Model outlined by McDonald and Harms, 1966 helps to select the best intervention for modifying a particular stimulus. Each possible intervention is evaluated for the expected results from modifying a stimulus, the probability that a consequence will occur: high, moderate or low, and whether the change will be desirable or not (Tomey and Alligood 2005). LIFE COURSE AND END OF LIFE The Relationship of Life Course and End of Life to the Biopsychosocial Model An individual’s development through the life course is based on loss, state Walter and McCoyd (2009). This paradoxical fact is true since progress is possible only through losing or changing a previous life style, behaviour pattern, or other mode of activity. Even in change and development towards improved conditions or functions, losses are inherent, which are experienced though they may not be recognized. The normative, destabilizing impact of loss also fuels self reflection and growth, especially where the mourner’s sentiments are validated and supported. By an understanding of loss and grief theory, loss is seen as a normal though destabilizing experience, and the developmental aspects of grief are explained from a biopsychosocial approach to nursing practice. The biopsychosocial approach to loss and grief is based on the ways in which the mind and body interact in a social context. Nursing care that helps an individual overcome his suffering from loss and grief, includes the biological impacts of psychosocial factors. Mortality due to bereavement is acknowledged to be in high proportions; and the rates are higher for widowers than widows. Emotions are known to affect physical health, and psychosocial factors such as stress, grief, depression and anxiety have been found to impact the immune system, cardiovascular system and neurological systems (Walter and McCoyd 2009). Salovey et al (2000) reiterates that negative emotions reduce secretory immunoglobulin A (S-IgA) which caused individuals to be more susceptible to infections such as the common cold. Knapp et al (1992) state that natural killer cells related to good immune system functioning reduce in number in the presence of negative moods and adverse affective states. Since bereavement adversely impacts physical health, causing morbidity and mortality the nurse in the role of a grief counselor should promote physical health through improved diet, increased physical exercise and other factors (Zisook and Shuchter 2001). Examples of Disadvantages to Health During Life Course Health conditions that are below the norm occur at various stages of the life span, since physiological changes occur with the occurrence of psychological traumatic effects. Each loss that occurs during the life course, affects the health of the individual. The death of an infant soon after birth causes deep psychological depression in the mother and other close members. In the toddler stage losses experienced by thre child may include loss of caregiver or loss of the child’s own health. Caring for a small child by the mother is followed by the gradual loss of complete care. In the elementary school years the child may experience the loss of a pet, loss due to parental divorce, or loss due to the military. Parents may experience loss of their vision of a healthy child, when caring for a challenged child. During the teen years, losses may occur such as maturation losses, childhood continous chronic health conditions, and sibling loss. During young adulthood, some of the losses experienced are chronic illness, maturational losses, death of a spouse, loss of spouse to war, or loss of parent. Similarly, in middle adulthood death of a sibling, facing a chronic illness, the maturational losses of midlife adults; and during retirement, the losses experienced such as identity, financial resources, belief system, etc. Older adults experience losses through social, psychological and biological changes, besides death of friends, death of spouse, and loss of home through relocation (Walter and McCoyd 2009). Two Theorists on Life Course and End of Life Related to Nursing Practice To overcome the grieving stage and move to a healing period the bereaved is required to take the initiative to move through the process. According to the theory of Lloyd, 2002 to support the bereaved at this time, the health practitioner such as the nurse should firstly explore the bereaved’s attitudes towards death and dying, taking into consideration the various aspects pertaining to psychological, sociological, physiological and religious perspectives, “explore and analyse the bereaved’s construction of life, and explore the processes of adjustment to the world without the lost entity” (Walter and McCoyd 2009). In this biopsychosociological approach, the focus should be on the bereaved rebuilding identity, redifining roles, negotiating transitions, surviving trauma and carry on with sustained spirit. Another framework for intervention is McCoyd’s 1987 model for use with perinatal loss, but it may be applied in the case of other losses also. This model is called the Five Vs, and provides guidelines that the practitioner can use without resorting to structured, predetermined tasks. This model facilitates exploration as well as interventions. The five Vs are: “Validating, Valuing, Verifying, Ventilation, and being Visionary” (Walter and McCoyd 2009, p.24). Verifying helps the bereaved collect concrete mementos to make the loss real. Ventilation is the encouragement given to the bereaved to express themselves emotionally. Thus, providing grief support through the life course may be a part of the nurse’s responsibilities. The biopsychosocial models of nursing intervention would prove to be helpful in achieving the required results. CONCLUSION This paper has highlighted the importance of the biopsychosocial model of nursing care, as compared to the biomedical model earlier used. How the biopsychosocial model relates to various factors such as the social cause of disease, health and illness behaviour, stress, and illnesses in the life course and end of life have been discussed. Theorists who have developed the concepts, and the theories’ application to nursing practice have been discussed. The challenges to providing effective nursing are increasing in contemporary society. Nursing practice grows more specialized and autonomous, with advanced research giving rise to new knowledge, and technology improving health care in various dimensions. The evidence indicates that the biopsychosocial model is ideal to meet the growing challenges to providing optimal nursing care. It enables multi-dimensional nursing practice, taking into account all the factors that play an important part in an individual’s health condition. Thus the patient-centred clinical method of treatment and nursing care depends on understanding health, illness and medical care as interrelated processes; and including the interractions of relevant factors at all levels. REFERENCES Boyd, M.A. (2007). Psychiatric nursing: contemporary practice. Edition 4. 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