True Loneliness - Essay Example

Loneliness "True loneliness is so painful that the patient has to hide it, disguise it, defend himself against it. His defenses are what the nurse must deal with as she helps him to learn how to live productively with people" (Peplau, 1955). This is important in the realm of health care, especially when the human aspect is involved in the context of nursing staff. The approach towards management of loneliness is of utmost importance, as this is one of those psychological conditions wherein the treatment circumstances greatly impact the final course of healing. This topic hence entails immense significance and needs to be understood in the context of real-time problems that exist within the treatment mechanism. Concepts of loneliness "Separation distress without an object"(Weiss) "The absence of an adequate positive relationship to persons, places or things" (Brage and Meredith). "An enduring condition of emotional distress that arises when a person feels estranged from, misunderstood or rejected by others and/or lacks appropriate social partners for desired activities, particularly activities that provide a sense of social integration and opportunities for emotional intimacy (Rook). "The affect that is activated when there is an uncontrollable discrepancy between desired and actual levels of intimacy and social interaction, with the desired levels higher than the actual (Suedfeld). Nurses should review their existing service provision for loneliness risk assessment and prevention - including the use of -relieving devices (beds, mattresses and overlays) for the prevention of loneliness in primary and secondary care - as they develop their Local Delivery Plans. The review should consider the resources required to implement the recommendations, the people and processes involved, and the timeline over which full implementation is envisaged. It is in the interests of patients that the implementation timeline is as rapid as possible. The research goes upfront with the hypothesis that the nursing care system can play a vital role in treatment of patients with loneliness. This can largely be speculated due to the fact that it is both an internal and an external condition. Though the internal condition can be taken care of by medicines, the external one largely depends upon the physical environment that is available over there. This is important as this acts as a vector for the study, and gives it the needed direction on order to answer the research question. Loneliness was once viewed as an inevitable consequence of being infirm and bed-ridden. As it has been recognized that this is not the case, loneliness have come to be seen much more as an indicator of the quality of care provided, and are consequently high on the political and health agenda. This article provides an overview of the key aspects of loneliness risk assessment and prevention drawn from a variety of national policy documents (Stephen-Haynes, 2004). Especially in the case of the hospitalization of the patient, the nurse has ample opportunity to monitor the behavioral changes in a person with loneliness. Exchanging notes with the nurse and being in picture with the background of the client would be a great help. The nurse would then have the opportunity to build a rapport, and then gradually build a relationship form where the person in question can rise to a level of conformity. Clear evidence is beginning to emerge that existing interventions for loneliness may be of value in alleviating the burden of mental disorders across all regions of the world (Crawford, 2004). Nurses, by means of appropriate intervention, can help a person make changes in those stimuli that are causing the condition in the first place. Centuries ago, while the science of medical care was in its technical evolution stage, the prime area of reference was only the administration of health care. However, in today's world, where the scientific world has come of age in its standing vis--vis disease care and prevention, subsidiary issues have emerged that are considered to be of prime importance in the domain of health care. The changes in society and life all around the world have brought about considerable changes in the lifestyles of humanity. Similarly, the profession of health care has seen its development through the ages, and many additional factors like communication skills' concerns need to be understood better. The UCLA Loneliness Scale was developed to evaluate subjective feelings of loneliness or social isolation. Items for the original version of the scale were transformed from statements used by individuals believed to be lonely in order to describe feelings of loneliness (Russell, Peplau, & Ferguson, 1978). The questions were deliberately phrased in a pessimistic or "lonely" direction, with individuals indicating how often they felt the way described on a four point scale that ranged from "never' to "often." This was however revised and a new version consisting of 10 items in a positive or non-lonely direction were created (Russell, Peplau, & Cutrona, 1980). Now the more popular version 3 of the UCLA Loneliness Scale is widely referenced (Russell, 1996).In the latest version of the scale, the wording of the items and the response format has been simplified to facilitate administration of the measure to less educated populations and also the elderly. Fine believes that at the end of all of the psychological, legal, and ethical argument, it is most important to remember that no matter how certain any of us may be of our analysis, decisions near the end of life should never be easy. We must remind ourselves that true wisdom comes with the acknowledgment of uncertainty and admitting that we cannot know all there is to know (2005). So, for a researcher to have worked in this discipline and to admit that there is a very thin line to cross, one can surely make conclusions about the complexity of the scenario. The effectiveness of treatment often depends on the willpower that the person is able to generate, which is always increased due to environmental factors. While discussing treatment options for lonely patients, it is indicated that associated positive predictors for linkage to primary care included mental health care visits (Grisword, et al, 2005). It is always important to pair the psychological treatment with appropriate psychological ones. Mere medicines without positive behavioral reinforcement are likely to further mellow down the social functioning of the patient. Disease management appears to improve the detection and care of patients with loneliness (Badamgarav, 2003). A nursing professional, if adequately becomes a part of the care giving team for a patient, can provide limitless benefits to the process of healing. A psychiatrist may be interacting with the patient weekly, but a nurse is likely to meet the patient several times in a day. The reinforcement that can be provided by this health care professional is in many ways greater than the family of the person. Similarly, the same can have an opposite and dangerous effect on treatment if the nurse does not conform to the emotional frequency of the patient. The patient may retaliate, and would consider the health care party to be adversaries. This in turn would mean that the patient has started to develop negative feelings towards the care providers, which will adversely affect the healing process. This shall make the entire process extremely cumbersome, and actually create a negative impression of nurses. Attitudes towards hospitals and nurses depend largely on the patient's previous experiences and expectations. If, for instance, a patient expects that a particular treatment should result in an instant cure, a step by step treatment process will need to be explained very clearly. Nurse attitudes to patients also affect interactions within the hospital system. Having minimal or no idea about the background, perception and ideas of the patient can have drastically negative effects upon the course of treatment. This can generate serious ambiguities in both parties, and can jeopardize the cause of patient care/ curing is not only about dispensing of medicines - health care involves personalized attention to a human being, a feat that can only be possible if his demands are clearly understood. Different cultures and religions accord for varying opinions upon treatment methodologies. Certain provision in vogue in medical practices may not be allowed for certain ethnic groups. This can generate feeling of irritability, and in extreme cases, hatred for the practitioner. Resultantly, it would hamper the cause of support and care. Loneliness is a state of gloom or sorrow that has developed to a stage where it has started troubling the life of an individual. A layman can generally term a person as being 'lonely' without fully considering the clinical provisions associated with the condition. In effect, there are dozens of symptoms that are associated with loneliness, and a nursing professional must be wary of these in order to be able to provide the best possible health care facilities to the patient. For this purpose, it is important to understand the symptoms and treatment options available to the nurses, so that they can contribute more proactively towards the cause of patient care. Though it is the job of a professional such as a psychiatrist and/or clinical psychologist to appropriately diagnose loneliness, yet there are certain definitive symptoms that a nursing health care professional can also ascertain, and assist in the recovery of the individual. A number of traits and habits can provide prominent indicators that would help in the adequate mental state assessment of the patient. The environmental factors such as a traumatic loss or death cannot be overruled as being the causes for triggering loneliness. There are individual areas where the patient would show distinctive patterns of behavior that need to be identified so that appropriate care can be provided. Seven important ones are elaborated hereunder: Appearance - A person who is in a lonely state is less likely to be dressed in a flashy and up-to-date manner. A sense of gloom would force the person to not only dress in an unfashionable manner, but also shabbily. A sense of lack of care would be obvious, and a deliberate effort of not wanting to promote gleaming attire would standout. Behavior - Even in things that were part of his profession or hobbies, he would be taking lesser or no interest. A lonely person is likely to find some sleep early in the night, but if he wakes up, it is very difficult for him to get back to it. If a person gets up and stays up, that is a sure sign of unrest and loneliness. Also, with food, it can go both ways. There is a greater probability for a loss in appetite; however there would also be episodes for binging and showing a craving for certain edibles. Conversation - A lonely person would not be active in conversations and shall like to stay away from all sorts of arguments. A lack of interest in general would be evident in his talks and he would like to evade any questions that are likely to explore his past. Affect - In the context of affect, he would prove to be highly vulnerable, and prone to reacting negatively to situations that afford him to be sorrowful. A sense of self-pity would be very prominent, and extreme cases can also find themselves in the domain of extreme hopelessness. Perception - Their perception about the world around them would be pessimistic as a whole. The negative side of things would be visible to them at most times, and even the happiest of moments to them would give a feeling of dejection. To any elating instant, they would respond by assuming that 'it has to finish', so there is no point in being happy. Cognition - Through their cognitive processes, their glum conception of the environment would be evident. Their thoughts, and problem-solving ability would be restricted due to their lack of imagination, and the will to seek a solution, hence, their normal functioning would be impaired because they would not be seeking a positive end to their actions. It would be extremely difficult to maintain focus and concentration on tasks. Insight - Their insight about their own self, and impressions of their self-esteem would be understandably very sorrowful. Most issues shall seem like burdens, and no effort would appear fruitful. A consistent low morale, and a feeling of self-subjugation at the hands of fate would be the norm, whereby no effort would be put in to change the way things are going leaving no room for improvement. Nurses, by means of appropriate intervention, can help a person make changes in those stimuli that are causing the condition in the first place. Following are five important measures tat can be taken, that would help the nurse in establishing a better therapeutic mechanism for the patient n the psychological domain: Rapport Building - firstly, a health care provider has to have a good and trusting relationship with the patient. If this is not there, then the patient would not yield to their advice, and would hence be devoid of the much needed will power that is essential to the treatment of any disease. Positive Reinforcement - Every human being likes encouragement. At what ever stage of the disease the patient might find himself, the nurse must find an opportunity to give in some encouragement by adding positive remarks to her normal chores. The nurse being in frequent contact with the patient can and should do this very regularly, so that the confidence building of the person takes place. Listen - This is probably the most important tool that can be employees against a lonely patient. Any person who is gloomy or sad, will be bombarded by verbal advises from all quarters; but nobody really knows what he is feeling in the first place. If and when the nurse finds time to listen out the inside of the patient, this would be a great relief, and would act as active catharsis for the patient. Pairing or Grouping - This is a very tactful and useful strategy. Synonymous to group therapy, this involves introducing the patient to a fellow patient, that would allow them to share their experiences and feeling with each other. This would help them appreciate that there are others who have a similar problem and there would a will to fight. Also, members within a group can pull others along when they are not in the 'mood' or when they refuse to take medicine. Avoidance of Conflict - This by far is one of the most important and difficult things to adopt; a nurse in his/her own right is mostly stressed out with work, and it becomes very difficult to maintain a positive frame of mind (and a smiling face) at all times. Lonely patients on the other hand will continue to do things that make the pother person irritable. It is here that the nurse needs to keep control over the nerves, and to avoid any conflict with the patient. Loneliness is a difficult and complex problem, frequently resulting in poor patient outcomes and significantly increased cost of care. The vast body of work related to loneliness has focused on risk assessment and prevention. A number of issues are identified that relate to funding, diet, attitudes, consistency of care, and low levels of staff interest in loneliness management. This work provides baseline data from which current management practices can be reviewed, revised, and empirically evaluated (Wellard, 2001). These individuals should receive additional interventions to reduce the risk of loneliness. Potential interventions include more systematic and frequent follow-up, frequent review of loneliness prevention and management strategies, and provision of needed personal assistance and relevant equipment (Garber et al, 2000). A large proportion of home care patients present with loneliness, and many more patients are at risk. Home care nurses have an opportunity to manipulate favorably certain environmental factors that can prevent loneliness from forming and to develop effective treatment plans for loneliness once it occurs (Macklebust, 1999). As the population ages and becomes frailer, loneliness prevalence and incidence within specific care settings are being evaluated through outcomes review. The need for effective support systems is often overlooked in the community. Thorough patient assessment is required for the countering of loneliness (Cowan, 1996). The prevention and management of loneliness often creates challenging situations requiring specialized knowledge and expert, consistent nursing care. Loneliness can have a devastating impact on health and care provision, ranging from patient discomfort and increased healthcare costs to a potential reflection on the quality of care. Nursing staff, nurses, ancillary health professionals, and the community at large have to play a major role in the successful dealing of the patients with this disease. This is largely attributable to the fact that this disease has both internal and external determinants; though the internal ones shall be dealt with by medications, the external ones are heavily dependent upon how well are the environment stimuli controlled within the health care system. It was also found that the ever changing variables within a system can greatly induce the results found in a research. Therefore, it is imperative, both for the cause of this research and for the sake of research in general, that a standardized research system should be adopted. The role of a nurse is crucial, as proper and timely intervention can greatly help the affected person to revert back to normalcy if positive stimuli are provided. These are to be primarily provided by the clinician, but the role of the nursing health care professional cannot be undermined in this regard. Being in direct and regular contact with the patient, a nurse can help administer and invoke reinforcers that other parties may only advise. Having the facility of frequent surveillance and adequate training, they can play a fundamental role in care giving for the lonely. Lonely patients lack self-confidence and appropriate sense of self-esteem, and with small daily tasks, the nurse can very conveniently build up the morale in the patients. There are numerous forms of psychological therapeutic techniques that a nurse may like to be familiarized with; however, the crux of everything lies in the positive association of the patient with reality - providing him a reason to be! Tanyi (2002) explains this in context of case studies. "Constructed model case Bina is a middle-aged female admitted to the hospital for complications from four miscarriages. She is despondent, and refuses to eat or take medications. She expresses a strong belief in God, which gives meaning to her life, but she is angry and thinks God is punishing her. Bina tells Evelyn, the nurse, that she is afraid her husband might divorce her because of his desire for a child. Bina also believes motherhood is a supreme value that will give meaning and purpose to her life, and is a significant reason for her being; this value is threatened. Evelyn listens attentively while holding Bina's hand. She asks Bina if she would like to see a psychologist, and she accepts. Bina expresses happiness for connecting with Evelyn. Six weeks after her discharge from the hospital, Bina sends Evelyn a letter explaining that counseling helped her establish a new value and belief about motherhood. She plans to adopt a baby within the next 2years. Her reconnection with God, her value, and belief have renewed her sense of faith, purpose, and meaning in life. She expresses a heightened sense of beauty, joy in life. This new sense of being has given Bina the strength to overcome her fears and sadness. This is a model case as it exhibits all of the attributes of countering loneliness as highlighted in the literature. It demonstrates believing and having faith in a higher power, significant relationships, and personal values and beliefs. It further underscores how a belief system and connection with others can promote inner strength and peace. In the process, Bina experiences spiritual transformation, which enables her to transcend her difficulties. This model case therefore contains all the elements identified as critical attributes of countering loneliness. Constructed borderline case Mary comes to the clinic with complaints of general malaise, loss of appetite, and insomnia. Her laboratory tests, history, and physical examinations are normal. Susan, the admitting nurse suspects emotional problems. Mary expresses sadness about her failed marriage, increased loneliness, no strength to move on, and no support from anyone. She questions the value she once had for marriage, and does not believe anyone can help her. Mary's love for her husband, respect, and value for her marriage gave meaning to her life, but since the divorce life has been meaningless. She expresses her uncertainty about God's existence and no longer finds meaning in her work as a social worker. Susan listens attentively and empathizes with Mary; the two women express their sense of connection. Mary states that she feels blessed to have met Susan whose compassion has given her strength. One month later, Mary presents at the clinic with the same complaints, and is admitted to the hospital because she is suicidal. This is a borderline case as it exhibits some of the critical attributes of countering loneliness, but not all. Mary, who feels disconnected from everyone and herself before meeting Susan, experiences a connection with Susan. The connection gives Mary immediate short-term strength but does not add meaning to her life. Mary's shattered belief in marriage is still unresolved, and she has no other belief system to sustain her. Her hatred for life continues and she still finds no meaning in her work. Mary remains hopeless and faithless. Thus, she returns to the clinic with the same complaints, plus suicidal ideation. Antecedents and consequences Antecedents are events that must be present before the occurrence of a concept, and consequences are incidents that emerge as a result of a concept. Antecedents to countering loneliness as delineated from the literature include life and spirit. In this paper life is described as the period of time from conception, birth, to death. Pivotal life events such as illnesses may provide the impetus for loneliness. Spirit is an inherent aspect of human beings, and it is the core of human existence. The consequences of countering loneliness as delineated from the literature are: a sense of hope and peace, love and joy, meaning and purpose in life, self-transcendence, and a sense of spiritual, psychological, physical health and well-being. Other consequences may include guilt and inner conflict about one's values and beliefs." 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