Caring after a Hard Patient to Give Her Necessary Support - Assignment Example

Psychosocial Write a 2500 essay on the psychological and social needs of a patient you have cared for in your placement and include a related public policy. Introduction In care experiences, it is often said that for each physiological response, there is a psychological response. The emotional response to suffering and illness is a fact in all care settings, and this arises from the well-established mind-body-spirit connection. In that sense, all physiological responses in a disease state has some psychological component that must be considered during any care. All care professionals recognise the importance of addressing the stress of illness throughout any patient journey in any clinical event of care; however, the true impact is fathomable through the consideration of the fact that these responses have a social dimension and the gravity of such issues are better interpreted from the perspective of the patient. This means the illness-associated events that create problem through the patient’s perception and responses may lead to care needs of addressing unmet psychosocial needs in order to ensure healing. In this assignment, I will discuss and critically analyse a care incident delivered by me to a patient. I was assigned the care of the patient in my placement in a hospital ward. This assignment will frequently refer to this patient, whose identity will remain undisclosed throughout this work. Thus, this patient will be referred to anonymously, although to facilitate ease of discussion, a pseudonym, Mrs. Jennings, will be used to address her. This requirement of confidentiality and identity nondisclosure is an ethical requirement in healthcare associated professional and academic documentation as prescribed and required by NMC (Nursing and Midwifery Council) guidelines, competency standards, and practice ethical standpoints to respect the client confidentiality (NMC, 2008). As suggested this assignment would very closely examine the episode of care provided by me from the psychosocial angles, mainly to see if the care provided by me during her hospitalization took adequate care of the psychological and social needs of this patient. These can be examined more closely from the policy perspectives of the need for adding psychosocial elements in care. Therefore, relevant policy will also be examined in order to justify conformity in practice. Definitions Haralambose and Holborn (2008) defined sociology to be a science involving study of human being in the context of society where impact of relevant economics, psychology, and demography is given due consideration in the endeavour to explain and understand the human behaviour in the societal scenario. From that point of view, sociology is a broad discipline where various methods of empirical investigations and critical analyses are deployed to define a body of knowledge and theory about human and social activities, with a goal often being application of such knowledge in the pursuit of social welfare (Haralambos and Holborn, 2008). On the other hand, psychology has been defined by Michael (1998) to be a discipline that studies mind and behaviour of individuals in different life contexts which also seeks to understand and explain thought, emotion and behaviour (Michael, 1998) in response to different experiences that they encounter. Main Body Psychological and social factors have been known to play important roles in initiation and progression of any disease process. As a care provider, the nurse must understand their nature and intensity. Since these are known to affect motivation, these will affect the outcome of care. Longstanding suffering or advanced illnesses disturb the psychosocial milieu sufficiently so the patient may be disturbed motivationally. These could cause psychological maladjustment and affect the course of the disease in a profoundly negative way. A thorough assessment of these situations and the factors is therefore necessary, and being in a position of provider of care the nurse must assess these factors keeping the patient at the centre. As suggested by Alexander and colleagues (2000), even as a student nurse, I have obligation to perform a holistic assessment as the first step of the professional nursing process to collect, analyse, and research information to facilitate the identification of the care needs so a care plan can be devised. Assessment of biomedical parameters as relevant to disease process and pathophysiology and their effects on the patient's physique only thus seems to be constricted in its scope, since only biomedical angle is just a part and would thus be essentially incomplete and would result in less than optimal care through a defunct care plan. Scenario After being assigned to her care, when I walked into her room, Mrs. Jennings, apparently in her late fifties, looked very slim, pale, and frail. When I introduced myself, she looked straight at me with teary eyes, which immediately provoked sympathy. She asked me if she will ever get better. I understood her concerns and reassured her that we are doing all the best possible for us to ensure that she gets all the support and treatment that she needs so she can recover as soon as possible. Description Mrs Jennings was a married lady. She lives with her husband and one of their children. Her two other children had moved after marriage. She has two grandsons. She was attached to them very much and she said she "adored them so much." As a young girl, she thinks herself to be privileged since she could attend a good public school, went to university at the Oxford, secured good educational qualifications, and was trained to be a lawyer. Her present occupation is that of a legal counsel and working as a consultant in her own soliciting firm. During our conversations I learned that Mrs. Jennings did experience a lot of trying moments in her life recently. First, she had been involved in a Road Traffic Accident (RTA) some two years ago from which she sustained multiple injuries. The most significant was that she had a compound fracture of her right lower leg. Over the top of that as she confided, she had been diagnosed with carcinoma of the breast six months following the accident and currently been undergoing chemotherapy for carcinoma breast and is on a variety of other medications. Reason for Admission The reason for her admission on this occasion was because of some of the side effects of the chemotherapy which had left her with an infected skin wound over the internal fixation site on the right tibia and had subsequently progressed to osetomyelitis. Mrs. Jennings’ concerns were that she will not be able to walk and carry on with work or even look after her husband who was entirely relying on her. Discussion It is apparent from the above discussion like any other human being, Mrs. Jennings is going through several worrying concerns at this time. These traumatic and anxiety provoking experiences must have implications for her. The anxiety of having a cancer and fear of having a chronic osetomyelitis, the concerns of not being able to walk, the sense of failure that she would never be able to function like she did before, would generate some psychological and sociological care needs in her. I was able to assess some of these needs by talking to her, asking her, and listening and observing her nonverbal cues. Psychological needs, as discussed by Bach (1995), are expression of psychological functioning that characterizes a person’s longing, want or wish in response to deprivation or inadequacy. Furthermore, Bach suggested that such functioning includes the patient’s perception, coping skills, tolerance of stress, social and familial relationship patterns, values, beliefs and religious beliefs (Bach, 1995 p 31). Sociological needs, on the other hand, are related to the wider society including her relationships, social status, and her family at large. Cancer patients are vulnerable to these symptoms at all stages of the illness, from appearance of the first symptoms of cancer to the time of diagnosis, during treatment, palliative care, and even after remission or cure. Sadness and worry for the future are normal responses, partly because of the meaning attached to cancer, such as the fear of disability or death. In many advanced cancer patients psychological symptoms such as apathy, dependency, irritability, and loss of sleep are very common irrespective of the cancer that the patient is suffering (Garssen, 2004). It has been stated that these may be manifestations of motivational disturbances due to advanced illness or longstanding suffering. It has also been suggested that physical changes associated with advanced and life-threatening illness associated with considerable suffering such as occurs in any patient with cancer may strongly influence the psychological adjustment of the patient in both positive and negative ways. This is an important factor in management of patients with cancer since the patient's perspective of cancer as a terminal illness strongly influences the care process. This also means that these responses indicate the psychological determinants of patient responses. Many cancer patients suffer from hopelessness, and this is regarded by the care professionals as conducive to illness, death, and suffering and the opposite psychological reaction may lead to a favourable outcome (Kunkel et al., 2000). As with most cancer patients, Mrs. Jennings confessed from the moment her condition was informed to her, the thought of death was practically recurring, and she felt as if her life had come to a standstill. When I probed further, I came to know that since that time her thought is filled with fear, anxiety, and profound distress about the matter. She was worried about her social status, how the family will come in terms with the disease, and help and support with her financial needs now that she could not be able to practice. The chemotherapy was another additional need. After each session of chemotherapy, she said she felt tired all the time, experienced diarrhea, and had sense of disturbed body image since had started to lose her hair. Because of these side effects, she sometimes felt isolated and could not enjoy life as she used to. Another and a major side effect for her was the infection on a small skin wound over the internal fixation site over the right tibia, which she was reported, had subsequently progressed to osetomyelitis. Although there are multiple concerns, the two psychological and sociological elements that I will consider in this essay are mobilisation and fear of death & dying (Mason, et al. 2003). I found that Mrs. Jennings was an intelligent and accomplished woman who wanted to know all about her condition and the elements of her treatment. She was frequently asking questions, some of which were surprisingly technical. This made her rather unpopular with the nurses on the ward, as some of them felt vulnerable and threatened by her manner and attitude (Pyne, 1997). Sociological needs Mobilisation Mobilisation is an important goal in the majority of patients who pass through a period of hospitalisation (Hogston, et al. 2002). In this specific case of Mrs. Jennings, this element was particularly complex as not only had the original accident left her with a degree of muscle damage and wasting in her right leg, due to associated damage to her lateral peroneal nerve, there is a a degree of instability of her ankle. This was a major sociological element for her as this limited her socializing and caring for her husband as she always did. Quite as expected, as Hornby (2000) had suggested the management of such conditions through multidisciplinary team approach always target full mobilisation as one of the prime outcomes (Hornby, 2000). Physiotherapists take a leading role in such endeavours, who were responsible for the delivery of the daily care and mobilisation package. Subsidiary inputs also came from the occupational therapists who advised and implemented a number of home environment modifications to be put in place to assist Mrs. Jennings when she would be eventually discharged from the hospital. Social workers also advised her on the availability of benefits such as attendance allowance which was designed to allow Mrs. Jennings some physical help at home in the immediate post-discharge period (Leathard, 2003). The psychosocial elements of the assessments of mobilisation status and concerns were complex, as outlined above. It became clear that Mr. Jennings at home was really only interested in having his wife home when she was fully mobile and able to care for him. It became obvious that he was not prepared to assist her in any of the household duties such as washing, ironing and cleaning. Mrs. Jennings appeared to accept that this was her role in life and that it was unrealistic for her to consider going home until she was fully mobile and able to care for her husband. The healthcare professionals involved in her assessment became aware of this element in her case and therefore, her treatment plan was subsequently modified to try to accommodate her needs in this respect. It should be noted that a decision was taken to confront Mr Jennings and try to embark on a programme of empowerment and education so that he could fully understand his wife’s situation and needs. Although this was tried, Mr. Jennings was so intransigent and resistant to any moves in this direction that the plan was abandoned. Psychological Needs Fear of Death and Dying The fear of death and dying was an unexpected and surprising element emerging from Mrs. Jennings’s case. In a normal situation of a case of uncomplicated osetomyelitis, death and dying are never apprehended. Mrs. Jennings, however, was very concerned about her husband’s clear dependence on her and her recent diagnosis of breast malignancy with its poor prognosis was clearly having a toll on her. It became clear that Mrs. Jennings had not had an opportunity or perhaps had not been ready to discuss such matters in any degree of depth with a healthcare professional and many unconfounded apprehensions during her period of hospitalisation had shaped this feeling in her mind (Hewison, 2004). It is to be noted that Mrs. Jennings were never vocal about her needs, and during routine conversations with her, I identified them during a routine conversation with her, which were sensitively explored. Because of the nature of her case, it was agreed that her needs should be discussed at the multidisciplinary team meeting and that an appropriate healthcare professional from the oncology team should be asked to speak with her on these issues. The psychosocial requirements were that Mrs. Jennings clearly recognised that she had a highly dependent and controlling husband. It was perhaps urgently recognised by her that she has the requirement to manage any illness herself that she might experience so as to minimise the social implications for her husband. She was clearly a very intelligent woman and had read a number of books on the subject and referred several times to her requirement for a “good death” (Girgis, et al. 2005). The assessment of her situation had identified all these elements as potential needs, and a psychologist was also requested to discuss the matter with her. Although she was not terminal, she was also empowered to speak to the MacMillan nurses, which she requested so that she could get further information relating to her eventual management of cancer or possible death (Gilbert, 1995). Sociological Theory Mrs. Jennings is part of a larger society and will have sociological needs. Max Webner (1985) identified different aspects of social structure, class, parties, status, groups, and bureaucracies. In his view, all these groups are made up of individuals carrying out social actions. According to psychologist, Gordon Allport, social psychology is a discipline that uses scientific methods "to understand and explain how the thoughts, feelings, and behaviours of individuals which are influenced by the actual, imagined or implied presence of other human beings" (1985). Social psychology, thus theoretically looks at a wide range of social topics including group behaviour, social perception, leadership, nonverbal behaviour, conformity, aggression, and prejudice. It is important to note that social psychology is not just about looking at social influences. Study of social perception and social interaction is also vital to the understanding social behaviour. From the nursing angle, it is important to understand how social psychology differs from other disciplines. Social psychology is often confused with folk wisdom, personality psychology, and sociology. What makes social psychology different is that unlike folk wisdom, which relies on anecdotal observations and subjective interpretation, social psychology employs scientific methods and empirical study of social phenomena. While personality psychology focuses on individual traits, characteristics, and thoughts, social psychology is focused on situations and situational experiences. Thus social psychology deals with the impact that social environment and interaction have on human attitudes and behaviours in response to different situations. Finally, it is important to distinguish between social psychology and sociology. While there are many similarities between the two, sociology tends to look at social behaviour and influences at a very broad-based level. Sociologists are interested in the institutions and culture that influence social psychology. Psychologists instead focus on situational variables that affect social behaviour. While psychology and sociology both study similar topics, they are looking at these topics from different perspectives. Psychological Theory From Mrs. Jennings' case it can be stated that what she was experiencing is a Freudian slip, which are misstatements believed to reveal underlying, unconscious thoughts or feelings. According to psychoanalytic theory, there are inner forces outside our awareness that direct our behaviour. For instance in Mrs. Jennings' case, the fact that she was asking many questions could be expressions of the conflicts in inner feelings. It could also be due to the fact that her attachment to her usual household chores was strong enough to raise concerns about her mobility, and she might be anxious that she might not fulfill her responsibilities as her husband expected. The psychoanalytic theory founded by Sigmund Freud continues to create debate and controversy even this time despite having profound influence on a number of disciplines, including psychology, sociology, anthropology, literature, and art. According to Freud’s theory of personality, organization of mind can be directly applied to Mrs. Jennings. Our direct physical experiences lead to the feelings in our conscious mind leading to awareness, in turn generating mental processing based on rationally, a part of which is memory, which although is not always part of consciousness but can be retrieved easily at any time and brought back into our awareness. His second view was on the unconscious mind which serves as a reservoir of feelings, thoughts, urges, and memories outside the realm of our conscious awareness. Most of the contents of the unconscious are unacceptable or unpleasant, such as feelings of pain, anxiety, or conflict. According to Freud, the unconscious continues to influence our behaviour and experience, even though we are unaware of these underlying influences. Related health Policy As a student nurse, I was required to understand and work within an environment that will enable me to provide adequate care while acknowledging the existing guidelines to aid a quick recovery process for my patients. The National Health Service policy that helped me in developing a care plan for Mrs. Jennings was the Cancer Reform Strategy (CRS). The aims of the CRS is to improve the cancer prevention, speed up the diagnosis and treatment of cancer, reduce inequalities, improve the experience of people living with and beyond cancer, and to ensure care is delivered in the most appropriate settings so the patients can access effective new treatments quickly. Conclusion The good elements of this care experience included the fact that I had the opportunity to closely observe a complex case as it evolved and how the management goals and objectives changed as further information became available. I had been able to assess the psychological and sociological needs and also worked with the multidisciplinary team to ensure that Mrs. Jennings gets all the advice and support she needs throughout her hospital stay and after she lives hospital. One bad element was the decision to confront Mr. Jennings with regard to his wife’s probable needs. It was not bad that he was confronted, as it was clear that his expectations were both unrealistic as well as being very inconsiderate. The bad element arose from the fact that the confrontation did not have a positive outcome. In my humble opinion, Mr Jennings is not an easy man to manage and it is my belief that Mrs. Jennings realised this and therefore did not want to leave the hospital until she is fully mobile. In terms of interprofessional skills I felt that I had learned a great deal in getting to interact with physiotherapists, social workers, occupational therapists, dieticians, oncologists and pharmacists as well as with the medical team on the ward. I certainly became aware of the fact that each professional discipline will assess the same patient, but describe them in terms of their own specific discipline and often with a vocabulary which is also specific to that discipline. References Alexander, M. F., Fawcett, J. N. and Runciman, P. J. (eds.) (2000). Nursing practice – Hospital and home: The adult. Edinburgh: Churchill Livingstone. Foster, E. and Harrison, M. (2000) Setting up a collaborative care plan. Nursing Standard, 15 (6), 40-43. 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