Description of Rheumatoid Arthritis - Essay Example

Social Science: A Patient Journey Introduction Besides the physical problems that the sick people go through, the social and psychological challengesthat associate with illnesses cannot be undermined. For a patient to recover and restore their health, they need to have caring people around them who show them love and compassion. However, in the practical world, this has not been the case with most patients especially those suffering from chronic illnesses as they have always reported numerous challenges that are socially and psychologically generated. This makes their journey towards recovering a tiring one that is characterised by despair and desolation. The environment in which people live extensively influences their heath. The interplay between socio-cultural and the psychological factors that influence an individual are significant determinants of a person’s health. According to Ayers (2007: 88), illness is not just an accident that people trip over. There are so many factors that are socially/ environmentally constructed that predisposes one to fall sick and facilitate or delay their recovery. Exploring a patient’s journey, therefore, should be contextual and conscious to the social and psychological dynamics in their surroundings. This paper will survey Racheal’s journey as a Rheumatoid Arthritis patient and explain her situation in relation to the existing theoretical framework. Description of Rheumatoid Arthritis Before embarking on Racheal’s case, it is essential to describe what this disease is and how it is diagnosed. This will help to relate accurately to the case of the patient under study. Rheumatoid Arthritis (RA) is a chronic disease that is, understandably, incurable. It is the condition in which a person’s immune system invades their body tissue and end up causing severe pain on joints of the hand and legs (Isaacs and Moreland 2011: 122). It is usually inflammatory, and the patients do feel a lot of pain in the lining joints. It is worth noting that the pains can be felt in other parts of the body; not only the hands and the legs. Naturally, RA causes swelling of the tissues they attack which is likely to transform the outlook of the joints, as well as fracturing of the bone (Chamberlain 2014: 73). In most cases, the disorder is diagnosed in people who are above forty although it can also be noticed in persons below that age. It is prevalent in females than in males, and a higher percentage of patients being diagnosed with it around the world are women (Hochberg 2009: 87). Among the commonly noticeable signs and symptoms include: small swellings of joints, problems in the early hours of the day in which a person feel stiffness, rheumatoid nodules are observed in which an individual senses blisters in some of their body parts, constant exhaustion and headache among others. As this condition advances, the problems also proliferate to other parts of the body (Hochberg 2009: 99). The symptoms usually begin by affecting one side by late spread to other parts. With time, the ankles, shoulders, knee among other parts of the body become severely infected making the pain so serious for an individual to sustain. Observably, the degree or scale of pain that patients diagnosed with RA feel during the early stages varies from one individual to the other. There are times when pain may disappear and one may feel relieved although the condition still exists. Pain comes more when the condition is at its peak of activities. These are called flares and during this time, one may extremely be weak and in great danger. As already mentioned, RA is caused by an immune system attack on the tissues. The disease is, therefore, managed and controlled by medications. Patient’s Narratives In the medical field, evaluating a patient’s narrative is an exercise that every aspiring health professional must conduct. According to Charon (2006: 102), narratives provide comprehensive information healthcare providers about the patient’s social beliefs and psychological positioning about their health status. It becomes possible to comprehend the condition a patient is going through and how it is influencing their lives; who the key people influenced by the illness are and their impact on the recovery of the patient. Narratives provide a deeper understanding of the dynamics and nuances that revolves around individuals who are suffering from chronic illnesses and inform on how these can be controlled to enable the patients suffering lead and appropriate life (Rudnytsky and Charon 2008: 119). The variations evidenced in the society from place to place present challenges to the healthcare providers and unless every single case is treated as unique, an appropriate healthcare may not be delivered. For example, a person suffering from HIV/AIDS may have different social and environment factors affecting their lives that are entirely unique from that of another. Approaching these two cases similarly may not work out properly hence the need for sociocultural and psychological considerations from diverse angles (Bunton 2006: 344) According to Berkenkotter (2008: 133), to provide a holistic medical care that has every aspect considered, a patient’s narrative becomes a prerequisite. Through the narrative, Racheal can share both her hopes of recovering or her fears and anticipations that might have developed having had different encounters and engaged in diverse interpersonal relations that could have shaped her beliefs and feelings. It is regarded by nurses as a reflective therapy that helps the caregivers to analyse the past life course and inform about the best future practices that can bring life to the patient. Due to the ethical obligations involved, it is important to be cautious about privacy and confidentiality so the honest information shared by the patient does not end up in the public domain or the hands of the unwarranted persons. This explains why the pseudo name, Rachael, has been used instead of the patient’s real name. This case is reported after the patient consented having been guaranteed anonymity and confidentiality. Fortunately, the patient shared all information that was needed. As Whitaker (2006:144) puts it, most clients/ patients will only narrate their illness journey once they gain trust and confidence without which they may be quite hesitant. Rachael’s Current Situation There are many issues that can be learnt from Racheal’s situation. The view of herself and her self-esteem, as well as the attitude she has formed towards the world are quite salient. Understanding the interactions and relationships she has with her family members and the overall society becomes simple. Rachael has two children and is married to a famous businessman. Her condition has widely affected her life; socially, psychologically and emotionally. The patient reports she is not the same beautiful independent woman she used to be. Her charm has faded away, and she deeply regrets why the condition had to strike her especially in an age she had settled down to enjoy her life. She was diagnosed with RA one year ago when she was 41 years old. Since then, she says, her life has transformed to become miserable. She no longer has a close relationship with the world, and it is like she is living in her society where she feels accepted. There is no doubt that she has not accepted her condition. What worries her most is the mystery about the incurability of the disorder she is suffering from. She is deeply immersed in the sea of denial. Many things can be gleaned from evaluating Racheal’s stories. Racheal is a worried woman whose main concerns are not the physical changes she has gone through but the psychosocial effects the disease has caused her. She has been away from her husband, who is apparently busy running his businesses, for about three weeks (in reference to the time the information was collected). She finds the healthy marriage they had interrupted and claims the husband could be directing his attention elsewhere. She is equally depressed about the future of her two children in case she dies. These thoughts have made her be isolated and detached from the society. Life, to her, has transformed to become so unbearable. The emotional turmoil she is battling is unbelievable. From a psychological perspective, RA has plunged Racheal into deep depression especially now that she no longer keeps close touch with the world. She has dumped or snubbed most of the friends she used to have. Hammen and Watkins (2013: 155) argue that patients are more likely to be depressed when they cannot closely relate to people who sooth and assure them all is well. They continue to suffer more silently and this may breed depression. Krippner, Bova and Gray, (2007: 67) maintains that depression thrives in isolated minds. There are many pieces of evidence that have been provided by researchers to show that there is a relationship between RA and depression. Boomershine (2009: 138) highlights that the condition, just like any other chronic illness, is more hazardous when one do not get the psychosocial support. Depression follows immediately especially when a person begins to feel they are battling the disease alone without anyone to back them up. The fear of not being accepted particularly by their spouses or family members is a major source of depression (Bunton 2006: 345). For example, Rachael feels the husband has deserted her because her condition is dreadful. She fears losing the beauty and charisma she used to have in her 30s. Consequently, she is reportedly worried about the future of her children in case she dies now that her husband seems to be ‘committed’ somewhere else. All these anxieties are piling up to depress her. Her condition is, therefore, co-occurring with several other psychological maladies that are consuming her from within. She is emotionally, physically and socially in pain that is making her suffer even more. Rachael is, indeed, a disturbed woman. Health Belief Model Looking back at how her condition begun and her response to it reveal numerous issues. In reference to health belief model the decision Rachael made to seek for medical consultation was influenced by various factors. She recounts having felt some serious pains in her legs that came and went away. Since she perceived herself to be highly susceptible to illnesses, especially, those that were related to the joints, she decided to go for medical check up. This was after a discussion with her husband who insisted she needed to register for a gym session to help her exercise as she spent extremely long hours sitting at work. She was accompanied by her husband who was caringly concerned about what was ailing his wife. They first went to book an appointment with their family doctor who recommended they meet a week after if the problem was not so grave. They went back home and two days later she felt another sharp pain, some fever and could notice a bump on her arm. The husband decided they go to a chemist and buy some drug that could reduce the pains she felt in the joints. This seems to have worked as she felt better and the pain disappeared. She then decided to cancel the appointment she had previously booked with the doctor. She was convinced it was the lack of exercise so she decided to enrol for gym classes where she could work out (Carpenter 2010: 663-664). The behaviour of Rachael in response to the signs and symptoms she was noticing are well encapsulated by the Health Belief Model. The patient’s resolution not to see a physician so she may be evaluated properly was influenced largely by her husband who believed this was a mere lack of exercise. She gave in to the husband’s persuasion and decided to cancel the appointment. According to Kronenfeld (2009: 111), people’s treatment-seeking behaviours depends on several factors such as the level or risk, susceptibility, self-efficacy, likely benefits among other variables. For Racheal, she perceived her condition to be mild and the fact that someone she trusted convinced her even made her to ignore further the idea of seeking medical attention. Later on, she developed more severe symptoms and her condition exacerbated. She, therefore, decided on her own to go to a doctor only to be diagnosed with Rheumatoid Arthritis; something that has not given her peace for quite a long time. Bio-psychosocial Model Racheal’s condition can be viewed from the bio-psychosocial perspective that is a multifaceted approach that evaluates health and illness from the three disciplinary aspects: biological, social and psychological factors and their contributions and implications. This provides a holistic insight into the origin, progress and effect of a particular illness or health concern. The perspective demands that a patient should be analysed from the three perspectives collectively so as to gain a deep understanding into the real issues surrounding their health. Biological perspective The biological perspective is principally concerned about the contributions of biological factors to an individual’s health status. It approaches illnesses from the medical point view. For example, Rachael’s condition is known as Rheumatoid Arthritis which is a chronic disorder that when not managed may lead to serious medical consequences and even death. The biological perspective digs deep into finding the cause of disease and gives medical explanations. For Rachael’s case, her condition is as a result of a mess within the immune system that is attacking her body tissues. This has biological roots as the immune systems are physiologically wired to fight viruses and diseases but may turn ‘wild’ to destroy an individual’s body as seen in Rachael’s case (Simmons 2011: 35). The biological effects this illness has on an individual are devastatingly dreadful as it may lead to death besides the excruciating pain it puts one through. The problem, therefore, has to be managed or controlled using various drugs so as to neutralise the biological impacts (Isaacs and Moreland 2011: 126). Psychological Perspective According to Von Roenn, Paice and Preodor (2006: 77), an illness does not only paralyse the physical being of a person but also goes deep down into an individual mental faculty and creates a profound turmoil that can extensively affect the individual. The interplay of various cognitive processes such as thoughts, judgment, decision-making and problem-solving as well as opinions and rationalisation determines how someone will respond to illness. What they make of their condition will influence how they react to it. For example, someone can only battle cancer or live a healthy positive HIV/AIDS life if they strongly believe they can overcome it. Treatment-seeking behaviours are all aspects of the psychological status of an individual that influence the health outcome of a person. From the start, Racheal was suspicious that she could easily contract some disease because of her behaviour. She even decided to make an appointment with a doctor. However, this changed after her husband persuaded her otherwise. This shows the emotional attachment and trust she had on her husband that she could believe his words even though she was suffering. Consequently, the current psychological state of Racheal is worrying. She is emotionally detached from people. She is also depressed and psychologically distressed owing to the fact that the husband is not as supportive as she expected. These are seriously aggravating her medical condition, and her health is rapidly deteriorating. As Ayers (2007:109) conceptualises it, the first step of healing comes from psychological stability. If a patient is not in a healthy psychological state, it becomes a daunting task to manage or control such incurable diseases. Racheal has not been able to accept that she is ill but can overcome and restore her initial health status if she calms down psychologically. Probably she is currently thinking of death and such thought can intensify her illness further. Consequently, her distress is displaced to her children who look up to their mother for guidance. Ogden (2007: 110) claims that young children in the early ages learn to conquer their worlds from their parents. In cases where the parents are hopeless and frantic, the children will grow up frustrated and doubtful about their abilities and potentialities. Social Perspective This is an outlook of the society’s contribution to illness and health. It seeks evaluate how the environment can contribute to the health of an individual. Larkin (2009: 99) believes that different societies have behaviours and cultural practices that can either lead people to illnesses or assist individuals to live healthily in their environment. For example, a poor lifestyle that involves excessive drinking can be a health hazard. This may lifestyle may be specifically triggered by the circle of wrong friends that surrounds an individual. Even after Racheal has been put under medical management, social aspects such as occupation may impede her recovery process. For example, if she does things she was warned against due to the social pressures then she might not successfully manage her condition (Phellas 2010: 159). Consequently, her illness may be worsened by the fact that she has to meet the social demands of her gender, race, social status, sex, religion among others. For example, she was worried the society might not accept her due to her changed physical looks. These are social issues that affect patients profoundly hence stunting their recovery (Ogden 2007: 115). Sociological Theory: Labelling As a matter of fact, people tend to have problems because of the tag they place on matters that concern them. For example, shouting in public is wrong because some groups of individuals came together and decided such acts are not society friendly. Labelling perspective, as a sociological theory, posits that the label or interpretation that people make concerning issues is what make them be accepted or rejected (Dahms 2011: 130). In the health arena, patients who label their conditions to be embarrassing suffer a lot with the feelings of rejection and unworthiness. The society has different labels that are put on every action, situation or item. This is the cause of stigma, discrimination and prejudice. Those conditions that are labelled as ‘unwanted’ are met with resentment while those that are favourable are embraced. It is exactly what is happening to Racheal. She feels unwanted and rejected because she has labelled her condition as bad. She also feels inadequate since she has noticed some physical changes in her body. She labels her husband’s absence as a sign of rejection (Phellas 2010: 161). Conclusion In conclusion, exploring narratives is an essential practice that enables healthcare providers especially nurses to insightfully gain a comprehensive understanding about a patient and what can be done to help them recover successfully. It is an imperative tool that illuminates the deeper underlying issues that could be encumbering a patient’s healing. As seen, it should, however, be handled with utmost consideration of ethical guidelines. Principles such as confidentiality, privacy and informed consent should highly be adhered to. From the narrative of Racheal, theories and models have made it easy to unfold almost all the issue that triggers her illnesses and their implications. The bio-psychosocial model is a multidisciplinary perspective that has managed to unearth all the issues relating to biological, social and psychological aspects of Rachael’s journey. Diverse sociological theories including labelling theory have also been discussed to understand best the sociological interpretations of the issues surrounding Rachael. Conclusively, Rachael requires a multidisciplinary approach to remedy her health situation. References Ayers, S. (2007) Cambridge handbook of psychology, health and medicine, Cambridge, Cambridge University Press. Berkenkotter, C. (2008) Patient tales, Columbia, S.C., University of South Carolina Press. Boomershine, C. (2009) Effective rheumatoid arthritis treatment requires comprehensive management strategies, Arthritis Research & Therapy, vol. 11, no. 6, p. 138. Bunton, R. (2006) Critical Health Psychology: Julie Hepworth, Journal of Health Psychology, vol. 11, no. 3, pp. 343-345. Carpenter, C. (2010) A Meta-Analysis of the Effectiveness of Health Belief Model Variables in Predicting Behavior, Health Communication, vol. 25, no. 8, pp. 661-669. Chamberlain, V. 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