Social Care Analysis of Lisa - Case Study Example

Case Study on Lisa a) Suggest why this person is experiencing stress. This case study is based on Lisa from the given scenario. There are many sources of stress in her life, and it is plausible that these are affecting her emotional and psychological well-being. Stress may be defined as "a reaction, both physical and psychological, to circumstances that are perceived to be both negative and threatening to the individual" (Russell 2005, p. 126). Given this definition, it is likely that Lisa is experiencing the effects of stress in either a psychological or physical form, since there are several aspects of her conditions which may be identified as negative. Outlined below are the potential causes of Lisa's stress: Her financial situation, given the fact that she is receiving no support from her ex-husband; Her emotional vulnerability because of the lack of psychological support from a partner in taking care of the finances and looking after the children; Her concern about her son's possibly having fallen into the wrong company, and her inability to do anything more for him because she already has her hands full in trying to make a living for herself and for her two children, since her mother and the rest of the extended family are having problems of their own, and are unable to offer any support to Lisa either in terms of material assistance or in terms of emotional support; Her anxiety about her daughter Daisy, who is not exhibiting positive signs of regular development. Since she is withdrawn, socially isolated and seems to be behind the rest of her class in terms of communication skills, it is possible that she may be suffering from autism or a learning or communication disability. b) Identify potential effects on the person's health. According to Russell (2005), stress effects an individual in two significant ways-physiological, and psychological. The causes of stress are known as stressors (Russell 2005, p. 126). Stressors can affect an individual in either or both of the following ways: Physiologically by affecting body functioning such as altering pulse rate, blood pressure, and the immune system or by changing hormone levels Psychologically through sensitivity changes in cognitive functioning and emotions such as fear and anger (Russell 2005, p. 126) Given these potential effects of stress, we may evaluate Lisa's health levels in terms of some primary responses to her stressful situation. These stressors may cause the following effects on Lisa's psychological wellness and emotional health: She may feel tired or even fatigued during the course of the day, given everything she has to do, and may consequently fall behind in her schedules or in her ability to keep up with her routine; Her stress levels may also impact her own work as a healthcare provider, which could have repercussions in a larger sense because she would not be able to cater to the requirements of the patients she is to care for, and she may unknowingly cause harm to one or more of them through misdiagnosis or faulty medication; She may also be prone to rising blood pressure or even diabetes, which has been known to be triggered by stress factors. As Russell (2005) observes, "stressors may be categorized as either internal (individual) or external (environmental)" (p. 127). Consequently, Lisa is being assaulted by the effects of stress at a personal as well as sociological level. Her problems are personal (her children's problems, her loneliness, etc) as well as sociological (poverty). In terms of her external problems, stress may be seen as "something than happens to an individual rather than within them" (Russell 2005, p. 127). Lisa should go for regular health checks herself. Being a nurse, she should recognise the signs of stress in her own life, and monitor her blood pressure and blood glucose levels through periodic checks. c) With reference to appropriate psychological theory, discuss possible explanations of their behaviour. Lisa's case merits a focus on human diversity especially considering the disparateness of her professional activities and her personal life, and her probable isolation from others around her. If her stress factors are not controlled or adequately addressed, she may turn to withdrawal from social activities and personal care, since she may be suffering from social and emotional alienation from herself as well as from others. Evidence suggests that her motivations must be understood in terms of this isolation, and also in terms of her status as a victim of socioeconomic alienation. Lisa's case may be analyzed according to Erikson's theories of life stages. The most important points to bear in mind when diagnosing or analyzing a case according to the system of life stages are the following: The importance of seeing all behavior in a social context. This is summed up by the bio-psycho-social model. Erikson's introduction of ethical perspectives into psychology. The life stages exemplify this push/pull nature of life with its inherent dichotomies. When one accepts the existence of these conflicts, one can start trying to resolve issues in non-violent ways. (Brenman-Gibson and Mickles, 2006) Firstly, it must be examined if Lisa is able to form social bonds of friendship with others, either family members or people from work. If it is found that there is in her an inability to share or talk about her feelings and her anxieties with others, this may be an anti-social stance. Any diagnosis of Lisa's behaviour must begin with establishing if she has expressed the recognition that she must accept the presence of conflicts in her life. The following questions may serve to guide a diagnosis of her behaviour: Is she able to communicate freely with those she is close to about the conflicts that are bothering her Is she in denial about the conflicts in her life Is she taking adequate measures to ensure her wellness, or is she unable to come to grips with her problems Has she had a medical check-up in the last six months If not, when was the last time she had one Has she consulted a psychologist or counselor about the emotional issues she is facing Has she consulted a child psychologist or behavioural therapist about Daisy's withdrawal Is she following early intervention procedures to ensure that Daisy is examined and diagnosed, should she be suffering from a serious disability such as autism Has she made an effort to contact her son's school to discuss his possible problems with his teacher or school counselor Is she able to interact socially with men Does she date Does she engage in any relaxing activities like going out to movies or restaurants Since "transformation is possible only where man learns to be nonviolent towards himself as well as towards others" (Brenman-Gibson and Mickles, 2006), Lisa's ability to deal with her stress will largely be determined by her resolve to take care of herself. Lisa is at what Erikson described as the sixth stage in a human being's life, adulthood. The primary development that an individual undergoes during this stage is Learning Intimacy Versus Isolation, and the "successful... adult... can experience true intimacy - the sort of intimacy that makes possible good marriage or a genuine and enduring friendship." ("Erikson's Eight Stages," 1998) In Lisa's case, the trauma of her marriage collapsing and her inability to maintain a socio-economic standard of living has meant that she is unable to carry out the objective of this phase of her life, and she may therefore be prone towards being unable to build intimate personal relationships with other people. As Clifton and Davis observe, "the danger at this stage is isolation which can lead to severe character problems" (Clifton and Davis 1995). If Lisa already seems to be suffering from isolation, this may be reflected in her inability to communicate her thoughts to other people around her. d) With reference to the case study, discuss how the changing family structures may make it more difficult for the modern family to care for its members. Discuss in relation to community care. All of us cope with the world in different ways. As Harder points out, "Erikson's basic philosophy might be said to rest on two major themes: (1) the world gets bigger as we go along and (2) failure is cumulative" (Harder 2002). In other words, the world is already a very stressful place, and Lisa's stress may be seen as a case of being unable to cope with her conditions adequately because of changing family structures, and the family's inability to come together as a functional unit to deal with the problems it is facing in a holistic sense. The primary recognition that this family needs to come to is that they cannot solve their problems and cope with their stress if they are unable to share their responsibilities. For example, Joan's depression over her husband's death may be exacerbated because she is becomingly socially withdrawn, especially from her church activities; not out of choice, but because she is increasingly unable to move around much. This could be addressed by having Jack accompany her to church once a week. It would give Joan a forum in which to express her grief, and it would also lead Jack away from some of the influence of his older friends. Even if he is not religious, merely spending time with Joan would help him break out of his isolated circumstances. The model of the family life cycle in community care may be applied to Lisa and her relatives. Essentially, the family life cycle refers to the stages that an individual goes through from birth to old age as part of a family. Systemic intervention in psychotherapy with reference to the family cycle dwells on traumatic events such as death or loss. Systemic intervention has the objective of helping people "to develop coping skills" by recognizing the sources of disruption in their lives. (Patterson, et al, 1998, p. 1) Psychotherapy places emphasis on the fact that the needs and perceptions of each family member change during the course of time, and especially after life-changing events (Carter and McGoldrick, 2005), such as the death of Joan's husband, or Lisa's divorce. By learning skills that can help them cope with traumatic events, families can cope with such disruption and revise their sense of well-being through understanding and acceptance of loss. Lisa's family may be identified as dysfunctional in Minuchin's terms, since he suggests that a family that is dysfunctional is one that cannot adapt to stress and make the appropriate transitions: the [family] has many problems of relating to one another, bringing up children, dealing with in-laws, and coping with the outside world [] they are constantly struggling with these problems and negotiating the compromises that make a life in common possible. (Minuchin, 1974, p. 6) To provide adequate care for all the members of the family, especially those who are too young (Daisy) or too old (Joan) to look after themselves and are dependent on others for their care, the family needs to develop a holistic approach to caring for each other. Sitzman suggests that 'mindfulness' of the other person and his/her needs can provide a much deeper understanding of the caregiver's role than if the individual is to be given care based on clinical or theoretical principles. She writes: "if one is to work from a caring healing paradigm, one must live it out in daily life" (Sitzman, 2002). In other words, it is important for the members of the family to understand that whatever is offered to every member in terms of care must be viable on an everyday, empirical basis. e) Use the case study to illustrate the gendered nature of health work. Gender politics inform and direct many social processes and transactions, and the healthcare industry seems no exception. Walker, et al (2004) have observed that gender awareness constitutes a significant aspect of how people construct their sense of self. Gender is especially influential in the stereotypes that are represented particularly by the media in popular culture, which convince people that they should conform to popular notions of masculinity and femininity: "people have a concept of their ideal body (part of their ideal sense of self). This is likely to be gender- and age-specific. It is also likely to be influenced by cultural norms which define appropriate size, shape and contours" (Walker, et al, 2004, p. 48). Consequently, social aspects or people's selves, such as their appearance and their roles and responsibilities, are often impacted by gender issues. In Lisa's family, we see a clear illustration of how women have been forced to take on roles that are traditionally occupied by men. Ken is the only significant adult male in the family, and even he is rendered helpless because of his health problems, and is unable to provide for his family. Most of the women in this family, therefore, are shouldering the responsibilities of caregiving as well as meeting financial ends. We see, therefore, that the dissolutions of gendered roles in this family has led to the women having to play the roles that they need to, as well as work doubly hard to perform the roles of the absent men in their lives. This illustrates that the socioeconomic contexts in which they work and live are no longer distinctly compartmentalized in terms of masculine roles and feminine roles. Thereby, the nature of healthcare given to such families must also accordingly look beyond gender discrimination. However, as Walker, et al (2004) observe, this is often not the case. The healthcare industry is also rife with instances of sexism and gender discrimination, like many other aspects of the world today. In their discussion of the prejudice and attribution theory, the authors exemplify how discrimination on the basis of race and gender has resulted in stereotyping, and it is clear that "negative stereotypes lead to prejudice" (p. 191). This in turn leads to what is referred to as "victim-blaming": "the poor are blamed for their poverty and the sick for their illness" (Walker, et al, 2004, p. 192). For example, as the authors observe, a man who comes in to a nursing home with respiratory problems and who is a smoker may be treated with a bias by healthcare providers who believe that his illness is his own fault, since "his doctor has repeatedly told him about the consequence of not giving up" smoking (p. 192). However, a woman who comes in with a similar problem may be discriminated against to an even greater degree, since popular culture assigns women the role of nurturers and care-givers, and does not give them the right to be as irresponsible about their health as men. A man may be socially 'forgiven' for having smoking-related health problems, but a woman is often seen as defying her role as caregiver if she has a similar problem. Such problems are identified by Walker, et al as being "fundamental attribution errors" (p. 192) because they describe the manner in which people respond to others by making judgements about them. The authors identify this error as "one of the (if not the) most important concepts in psychology, because it represents such a common mistake which can have far-reaching consequences" (p. 192). The gender stigma is one that the healthcare industry in particular cannot afford to indulge in, because it deals with the process of caring for people's health. f) Discuss the impact of health inequality with reference to class and gender. Many writers on psychological concerns and sociological reality have observed that the provision of healthcare is often biased in favour of those who belong to the higher economic classes. As Russell (2005) has pointed out, healthcare professionals are often prejudiced against those who are less privileged than others when it comes to the implementation of healthcare services: Further evidence suggests that patients from lower socioeconomic groups may be disadvantaged with regard to health care. Pendleton and Bochner (1980) observed that patients from higher socioeconomic groups were automatically given more explanation during consultations with doctors and Waitzkin found that they were offered clearer explanations, reiterating ideas in non-technical terms. (Russell 2005, p. 32) According to Russell's study, therefore, documented evidence has shown that doctors provide more attention during consultation to patients who are economically wealthy. Based on this case study, one could surmise that Joan, therefore, may not be able to afford healthcare; even if she does opt for professional care-as she will indubitably be forced to as her age progresses-she may not be well-treated because of her socioeconomic liabilities. As Schulz and Mullings (2006) have pointed out, "theoretical and empirical efforts to understand and address disparities in health have emerged in multiple arenas and among scholars and practitioners working in public health" (p. 3). Despite such investigation, it remains to be seen if there can be practical measures or improvements which can be implemented in empirical settings to make a difference. The authors theorize that this may be because the primary challenge in this field is that the structural models in which professionals and their patients function are often determined by misguided paradigms: "the cultural or lifestyle explanatory paradigms, sometimes barely concealing notions of culture of poverty and deviance, can be [...] problematic" (p. 4). The sociological construction of class, therefore, impacts the social transactions among people at disparate levels. An example of the gendered approach to providing healthcare may also be identified in the question as to why there is a paucity of male nurses in most countries, which can be tied in to gender stereotypes that pigeonhole male nurses as inferior to other professions that patriarchal institutions hold as superior. The traditional notion of the nurse is informed by the dominating image of Florence Nightingale, the stereotype of the female nurse, who spreads feminine warmth and comfort as she cares for the sick and injured. Such gender discriminations "structure [...] healthcare at various levels" (Schulz and Mullings, 2006, p. 13). Gender is undoubtedly part of a "web of relationships that constitute social location and cultural identities" (p. 13), an overall network of discrimination that negatively influences the manner in which healthcare is provided through channels that are coloured by prejudices in terms of class, gender, and race. Ethnographic distinctions also imply that people of colour are discriminated against when they go for medical treatment. Such prejudices and rampant discrimination suggests that people who are healthcare providers express, at a fundamental level, the "inability to incorporate the diversity of those affected" (Schulz and Mullings, 2006, pp. 13-14) by illness and other health-related conditions. This is a result of "oppressive social relations" (Schulz and Mullins, 2006, p. 14) that are created by distinctions that do not respect differences in terms of colour, gender, and economic classes. This is a difficult battle because it deals with deep-rooted prejudices at a socioeconomic level, but it must be fought if the healthcare industry is to provide people from all walks of life with the acre and respect that each individual, regardless of gender, age or economic background, deserves to get. Bibliography Brenman-Gibson, M. and Mickles, R. 1996. Erik Erikson: A life's work. Available at http://www.davidsonfilms.com/erikerik.htm Carter, B., & McGoldrick, M. (1999). The expanded family life cycle: Individual, family, and social perspectives (3rd ed.). Needham Heights, MA: Allyn & Bacon. Erikson's development stages. Springhouse Corporation. 1990. Available at http://honolulu.hawaii.edu/intranet/committees/FacDevCom/guidebk/teachtip/erikson.htm Harder, A. F. 2002, "The Developmental Stages of Erik Erikson." Available at http://www.learningplaceonline.com/stages/organize/Erikson.htm Minuchin, S. (1974). Families and family therapy. Cambridge: Harvard University Press. Patterson, J., Williams, L., Grauf-Grounds, C., & Chamow, L. (1998). Essential skills in family therapy: From the first interview to termination. New York: Guilford Press. Russell, J. Introduction to Psychology for Health Carers: Foundations in Nursing & Health Care. Cheltenham: Nelson Thornes, 2005. Schulz, A. J. and Mullings, L. (2006). Gender, Race, Class and Health: Intersectional Approaches. San Francisco: John Wiley & Sons. Sitzman, K. L. 2002. Interbeing and mindfulness: a bridge to understanding Jean Watson's theory of human caring. Nursing Education Perspectives, 5/1/2002 Walker, J., Payne, S., Smith, P. and Jarrett, N. (2004). Psychology for Nurses and the Caring Professions (Second Edition). Maidenhead: Open University Press. Read More