Psychology in Nursing Aspects and Characteristics - Case Study Example

Psychology in Nursing – Aspects and Characteristics Psychology and Nursing - A 22-year old woman admitted following a motorcycle accident in which her partner dies and she requires an above knee amputation. 1. Introduction One of the most difficult issues that an employee in the healthcare sector has to deal with is undoubtedly the psychology of patient; however, through the years coping with patients can possibly change mostly because of the continuous development of social and cultural characteristics of societies around the world. It should be noticed here that the needs of patients in psychological support can be differentiated in countries around the world under the influence of local traditions and stereotypes. On the other hand, all patients internationally need to communicate throughout their illness especially when the support from the family or the close social environment (e.g. relatives, friends and so on) is limited or even non-existent. In order to respond to the needs of patients around the world for psychological support, governments in all countries have developed an appropriate legal framework (including provision for psychological support services within healthcare institutes – either of the public or the private sector) internationally. However, apart from the legal provisions regarding the development of psychological support in the healthcare sector, the application of a relevant scheme in practice requires that employees in the above sector are appropriately trained on all the parts of the specific scheme. For this reason, specifically customized training programs have been developed in most organizations operating in the healthcare industry around the world. However, it should be noticed that the application of theory in practice – as in case that will be developed below – can be quite challenging especially if the employees involved do not have the appropriate skills in order to respond to the needs of a relevant project. 2. Psychology in nursing – aspects and characteristics As already noticed above, psychology is a necessary part of services provided in all healthcare organizations around the world. The level of importance of psychological support for each specific patient can be differentiated though in accordance with the characteristics of his/ her case, i.e. the type of the illness from which the particular patient suffers. In healthcare institutions around the world, the psychological support of patients is mostly offered by nurses – who can have been appropriately trained or just involved in a specific case because of his/ her experience on a specific illness. In the literature and the empirical research, the role of nurses to the improvement of the psychological condition of patients has been extensively examined – different assumptions can be made in each case under the influence of a series of factors, like the patient’s psychological profile, the type of illness involved, the local social and cultural ethics and stereotypes and so on. In all cases, the role of nurses has been proved to be significant towards the improvement of the psychological condition of patients in all healthcare departments (i.e. from the patients with chronic illnesses up to those in the emergency unit). It could be noticed though that the theories used for the interpretation of the role of nurses in the improvement of patients’ psychological condition can present many differentiations taking into account the conditions of each specific case but also in accordance with the scientific principles developed through the years (different theoretical approaches could be used in order to explain the relationship between nursing and psychology taken into account the level of theoretical knowledge related with each particular period). Towards this direction, it is noticed by Malinski (2002) that ‘neither the human sciences nor the natural sciences are seen as providing a sufficient base for all nursing knowledge; both qualitative and quantitative approaches are viewed as potentially useful strategies given the nature of the phenomenon to be explored’ (Malinski, 2002, 14). In accordance with the above the role of nurses in the provision of psychological support to patients can be significant but it should be carefully evaluated as of its overall effect on the improvement of the patient’s condition. Of course, it could be supported that psychological support is not directly related with the improvement of a patient’s physical condition (although they are cases where the psychology of a patient strongly influences the improvement of his/ her health condition – or the opposite where the patient’s psychology is extremely negative). In any case, psychological support could not result to the worsening of a patient’s condition – only a positive influence on the patient’s physical condition could be expected. Regarding the above issues, it is stated by Crose et al. (1994, 104) that ‘recent developments in federal legislation, reimbursement policies, and professional politics have promoted wider appeal within professional psychology for consultation services to nursing homes’. In other words, professional psychologists could be actively involved in the daily operational activities of nursing homes as consultants. The above phenomenon – which could be described also as exchange of services and roles within the health sector – could support the development of consultancy services in all healthcare sectors; however appropriate training should be provided to the people participating in the relevant project – even if they are professional psychologists – making sure that the needs of patients in each particular healthcare institute are appropriately evaluated. In order for nurses to be involved in the psychological support of patients in various healthcare departments, it is necessary – as noticed above – to be appropriately prepared and trained even if they work in the particular sector for quite a long; their experience is not disregarded but it is necessary that the needs of each particular patient are taken into consideration while the recent developments in counseling should be also made known to all people involved in such a project. On the other hand, it is not always easy for people working in the healthcare sector to understand a patient’s psychology and especially his/ her response to a particular treatment – even if clinical outcomes from other similar cases lead to specific assumptions regarding the potential behaviour of a patient under particular circumstances (not only medical, i.e. the treatment used but also interpersonal, like his/ her relationship with his/ her family/ friends). Various forms of a patient’s reactions to specific treatment - medical or psychological – have been identified in the empirical research. In this context, we could refer to the study of Al-Omari et al. (2008, 126) who noticed that ‘psychological acculturation is a complex process that has been widely discussed in the literature of anthropology, psychology, and sociology’. Psychological acculturation could be also related with the healthcare sector; long term treatment – especially when made in-house – could lead patients to the development of the above behaviour which could strongly influence (negatively) their effort against a particular illness. Because of the co-existence of many factors that can influence the improvement of a patient’s psychological condition (or its worsening under the terms explained above) it is necessary for nurses that work in the various healthcare departments to be appropriately trained before involved actively in the psychological support of patients. Of course, nurses have to support the patients’ psychology – in each case that they participate actively in a patient’s treatment - but this is just a limited psychological intervention compared to a more extensive one that it can be required to specific cases – like the one described above. In these cases, the nurses working in the relevant departments should be appropriately trained in order to respond to the needs of patients for increased psychological support – an indicative example is presented in the section that follows. 3. Practical implications of interaction between psychology and nursing – analysis of case study When nurses have to deal with patients with severe problems of health – and thus an increased need for psychological support – they should be appropriately prepared in advance (training would be then absolutely necessary); in any case, it would be expected that a high level of stress would be developed by the nurse involved in such an activity in order to respond to the needs of the patient who is severely ill. Various theories and assumptions have been developed in the literature regarding the above issue. In accordance with Makie (2006, 101) ‘workload was identified as the most frequent source of stress for the present sample of nurses; the second most reported stressor was emotional issues related to death and dying’. On the other hand, McVicar (2003) supported that stress can be developed in nurses under the influence of the following factors: ‘workload, leadership/management style, professional conflict and emotional cost of caring; lack of reward and shift-working may also now be displacing some of the other issues in order of ranking’ (McVicar, 2003, 633). The above findings are in accordance with those of Chang et al. (2007) who examined the influence of working environment on a nurse’s psychological condition – referring specifically to the nurses working in an oncology health care department - and found that ‘high patient acuity, heavy workload, and patient deaths can all contribute to work-related stress for pediatric oncology nurses’ (Chang et al., 2007, 340). The development of stress can prohibit nurses from offering the necessary psychological support to patients – especially those that are severely ill. In the case under examination, appropriate mechanisms of behaviour would be identified by nurses that would be involved in the treatment of the young woman – being seriously traumatized in a motorcycle accident. The loss of his partner’s life – which is not probably announced to the young woman in her admittance to the hospital should be announced rather at a later stage of her stay in hospital. Her severe trauma would be the first issue at which the psychological support offered by nurses involved in her treatment. More specifically, the fact that the young woman was diagnosed with severe trauma in her leg which should be treated only by an above knee amputation should be carefully handled by the nurses (in fact by all medical staff) participating in the above case. It would be preferable that those nurses are experienced in similar clinical events and that have been given the appropriate training for offering psychological support to patients that are severely ill. The above assumption is in accordance with the views of Nystrom (2002) who examined the psychological support offered by nurses working in emergency care units focusing on the existence of adequate support to the patients hospitalized because of a severe health problem which is in progress. His research led to the result that ‘the difficulty of these nurses in accomplishing a holistic perspective seemed to be due to overvaluation of measurable tasks, such as medical interventions, and undervaluation of nonmeasurable tasks, such as caring’ (Nystrom, 2002, 403). In other words, nurses in these units are likely to lack the necessary time in order to respond appropriately to all their duties especially to their duty of psychological support of the patients. In the case under examination, the patient involved will have to suffer a severe damage of her health that will result in her inability to move – at least without the necessary support. Moreover, the relevant surgery will be followed by a (possibly long) stay in the emergency unit. Moreover, the outcome of the whole treatment cannot be precisely estimated in advance – additional surgery will be possibly required in case of a failure. All these issues should be the basis for the development of specific behaviour towards the patient (referring to all medical staff but especially the nurses that will participate actively in all parts of the relevant treatment). The communication with the patient’s personal environment (family, friends) could help the nurses to understand better the needs of the specific patient and behave appropriately. Any information on the circumstances and especially the outcome of the accident (loss of life of partner) should be avoided at least until the significant improvement of the condition of health of the patient. 4. Conclusion The issues developed above prove that nurses have a significant role in the improvement of the psychological condition of patients – only when the relevant preparation (e.g. training) has been made. In the literature it is supported that ‘health care organizations encourage self-care, prioritize time to talk, and offer counseling to nursing staff with emotionally difficult working conditions’ (Sandgren et al., 2006, 79). On the other hand, it could be noticed that the role of nurses in the improvement of a patient’s psychology can be more importance in accordance with the conditions of each specific case (as explained above). Baumann et al. (2003) examined the role of nurses in the improvement of psychology of patients suffering by cancer and came to the conclusion that ‘nurses, who are able to offer true presence from a place of hope and fulfilled-emptiness, bear witness to persons in a way that can help them transfigure the experience of living with cancer’ (Baumann et al., 2003, 52). From a similar point of view, it is supported by Hawley et al. (2007) that nurses can offer significant support ‘to critically ill patients in a manner that more fully captures nursing practice as enacted in the critical care setting’ (Hawley et al., 2007, 663). All these views could be also used in order to identify the most appropriate behaviour of nurses towards the patient of the case presented in this paper. It should be noticed however that the effectiveness of the psychological support offered by the nurses of the specific department may not be clearly obvious since the primary stages of the therapy; rather in the long term the positive influence of the psychological support to the patient’s psychology would be easy to be identified. References Al-Omari, H., Pallikkathayil, L. (2008) Psychological Acculturation: A Concept Analysis With Implications for Nursing Practice. Journal of Transcultural Nursing, 19(2): 126-133 Baumann, S., Englert, R. (2003) A Comparison of Three Views of Spirituality in Oncology Nursing. Nursing Science Quarterly, 16(1): 52-59 Chang, A., Kicis, J., Sangha, G. (2007) Effect of the Clinical Support Nurse Role on Work-related stress for Nurses on an Inpatient Pediatric Oncology Unit. Journal of pediatric oncology unit, 24(6): 340-349 Crose, R., Kixmiller, J. (1994) Counseling Psychologists as Nursing Home Consultants. The Counseling Psychologist, 22(1): 104-114 Hawley, P., Jensen, L. (2007) Making a Difference in Critical Care Nursing Practice. Qualitative Health Research, 17(5): 663-674 Makie, V. (2006) Stress and Coping Strategies Amongst registered nurses working in a South African Tertiary Hospital. University of the Western Cape, [Online], available at http://etd.uwc.ac.za/usrfiles/modules/etd/docs/etd_gen8Srv25Nme4_5578_1189147933.pdf Malinski, V. (2002) Nursing Research and the Human Sciences. Nursing Science Quarterly, 15(1): 14-20 McVicar, A. (2003) Workplace stress in nursing: a literature review. Journal of Advanced Nursing, 44(6): 633-642, [Online], available at http://www.journalofadvancednursing.com/docs/0309-2402.2003.02853.x.pdf Nustrom, M. (2002) Inadequate Nursing Care in an Emergency Care Unit in Sweden. Journal of Holistic Nursing, 20(4): 403-417 Sandgren, A., Thulesius, H., Fridlund, B., Petersson, K. (2006) Striving for Emotional Survival in Palliative Cancer Nursing. 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