The best definition of psychosocial care is found in the National Council for Hospice and Specialist (2000) which describe it as “concerned with the psychological and emotional wellbeing of the patients and their families/carers, including issues of self-esteem, insight into an adaption to their illness and its consequences, communication, social functioning and relationships”. Psychosocial care theory differs from theory of biomedical care in that the former uses the holistic approach (Sheldon, 1997 and Oliviere et al, 1998) or the diseases, psychology, social and spiritual health of patients whereas the latter care only for patients’ physical ill-health. Furthermore, the biomedical model predicts poorer health outcome, psychological distress and poorer daily function, more days spent in bed, and more health professionals visit and surgeries (Sheridan & Radmacher, 1992). Keywords used will be defined to facilitate understanding.
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The theory of psychosocial care has the following components; firstly, psychology deals with the way the patients use their conscious and subconscious (Freud) is dealt with their emotions, which is their feeling fine tuned throughout their lifespan development, to be aware of their different moods. Then their self-esteem, the patients perceived their self-worth, value themselves, self-respect and self confidence (Barry, 1992 & Niven, 2006), should be respected, hence, make them more confident and themselves. Scherer (2005) referred to emotion and self-esteem as behaviour forming strategies and
Emotions are intensified feelings or complex patterns of feelings that one experience when the patients found themselves in a strange environment, giving their intimate information to people they just met moments ago. Nursing professional should respect patients as a person by so doing will make them feel more confident in themselves or raising their self-esteem. Therefore, self-esteem is ones feelings regarding the patients self-worth, values oneself, shows self respect or self confidence Scherer (Barry, 1992 & Niven, 2006). (2005) referred to emotion and self-esteem as part of cognition or psyche. The cognitive approach is to let the patient talk about his feelings as most that we do is controlled by our unconscious mind, we have to listen carefully to what the patient is saying (Freud). Moreover, we should ensure that information being given by the nurses is understood by the person (Smith et al, 2003). We should praise the patient if he has done something good.
The patients’ social environment is important for their care as the nursing professionals must understand the supporting mechanism they have and those that needs to be put into place. In doing so one has to understand their need for equality and sensitivity that are required to care for patients from different ethnic and cultural background. The family being a component of the social jigsaw and it is important to involve them as long as the patients have given their consent. One has to be aware of confidentiality when talking about the patients’ information even to family. Research has shown that the involvement of families/carers greatly improve the psychological aspect of the patients’ rehabilitation (to put references). Social class again research has shown that patients coming from social class 3 access medical help faster than those living in social class 1. Therefore, this will affect their healing process if they are staying in an overcrowded and damp or living alone and have no family support. If they are staying in a rough area of the Borough therefore they are afraid to go out. Their culture is important as it is their core values and beliefs they have within their society. Environment is important to know if they are staying near a busy and noisy road. Their religion is important especially when it comes to food. The psychological and social aspects of the patients are one of the two elements in psychosocial care. Spiritual health refers to the possession of a belief in some unifying force that gives purpose or meaning to life or to a sense of belonging to a scheme of existence greater than merely personal, is another dimension of psychosocial care.
The nursing practice is based on warmth, acceptance, genuineness and empathy and by moving our focus away from the illness to that of the patients (Baughan & Smith, 2008), not forgetting to maintain privacy and dignity whilst talking to the patients (Faulkner, 2000) by getting the patients consent and their confidential preserved. Talking, caring, listening and supporting patients are qualities that nursing needs in forming good relationships with patients. Nurses should provide care that is focused on patients and tailored to their individual needs. Words like trusts, empathy, listening and compassion spring to mind. Nursing uses therapeutic comforting touching with confidence, not denying patients’ information, discussing the problem in a clear and understanding manner, being honest and have empathy not sympathy are useful tools to enhance the nursing practice. Subsequently, through therapeutic communication (Peplau, 1952) it built trust and confidence between the nursing professionals and the patients. Moreover, without the proper use of therapeutic communication, which is achieved through touch, silence and humour (where appropriate), listening to their narratives, not being judgemental, being considerate, respect their confidentiality and dignity as a person are important skills. The patients are able to reveal intimate details of their psychological and social health which inform the nursing professionals of better ways to support the patients towards the road to long lasting recovery. Therefore, Allen voiced the opinion of Wright (2004) “too posh to wash” that bad communication limits the extent that psychosocial care can be effectively given to patients.
This will be achieved by using therapeutic communication (Peplau, 1952) through explaining clearly what is being done, touching, silence and humour and listening carefully to what the patients are saying without interaction and being judgmental. Furthermore, they expect to be given the right information when needed, not in jargons but in an understandable language. This is the platform from which one can use to get the correct information from the patients.
Caring can be defined as involving concern, empathy and expertise making things better for others and is based on compassion (Smith, 1992; Eriksson, 1994 cited by Barry, 1994; Niven, 2006);). In view of the caring nature of the nursing professionals the patients are willing to (offered) information that they will not do so to other people (including their families/carers)…into their confidence therefore could have intimate knowledge than other medical professionals may not be able to tease out. This is possible by listening attentively to what the patients are saying without interruptions, to emphatise () with the
In return the patients expect that they are given the right information at the right time in a way that they understood. Their self esteem is ones feeling regarding their self worth, values oneself, show self respect or self confidence (Barry, 1992 & Niven, 2006). It can be improved through group support, forming realistic expectations, maintaining physical health, examining problem and seeking help e.g. limit smoking and alcohol.
Empowerment ranged from giving patients information and helping them to understand, cope with and take control of their disease to psychological support them, rapport-building, reassurance, empathy and promoting self-esteem.
The points raised so far is giving the reader a theoretical view of the way psychosocial aspect of care is relevant to nursing practice
Stress and coping are concepts that will be used as reference to bring theory into practice observed whilst on the ward. Stress is defined as an interaction between an event in a person’s life which is perceived as placing considerable demands on him and their response to coping with it. Therefore, the transactional model (Lazarus & Folkman, 1984) of stress and coping is appropriate to further expand the stress being felt by the patient. A transactional model of stress is when a patient is confronted with, does that event present any threat to him at the time, and if not then he does not perceive the event as stressful. However, if it does whether he experiences stress will depend on his secondary appraisal and if he has the necessary resources, such as personal, social, financial support and/or hardiness; is sufficient to allow him to cope effectively with the stressor. Moreover, he may not perceive himself to have sufficient resources available to deal with the problem and as result he will experience a response that one would refer to as a stress response.
It will also relate the concept to nursing practice
Self-efficacy according to Bandura () is when the patients believe that they can successfully connect with and execute a specific behaviour
X, a 65years old Caucasian male, married with two children, was admitted to hospital suffering with excruating abdominal pain. He has been diagnosed a week ago with lung cancer due to his heavy smoking, 15 cigarettes a day, increased to more than 20 after the death of his wife. His children said that he X constantly said that he wants to go and meet his wife wherever she might be. He is not eating properly and recently has been drinking heavily. He has low self-esteem and sometimes cries. Whilst helping him to shower daily the nurse was able get more information, he does not want to go a hospice or a care home like his children are saying. He wants to stay and die in his family home. Moreover, apart from his children he does not have any relatives staying close by. He is afraid of dying
Therefore, he is not caring for himself and not eating properly. was admitted to the ward after he was diagnosed with advanced lung cancer. Psychosocial care states that the patients’ psychological and social factors are taken into consideration when assessing them. The ward is busy though Wright (2004) stated that nurses are too busy to talk to their patient, it is not the case here each patient is treated as an individual and they are listened to without being judgemental. Moreover, the opinions of the patients’ families/carers are listened to and information is shared with them after getting the consent of the patients due to confidentiality legislation. Mr. X
Lists of References
Allen D. (2009) Nurses are only effective as their communication skills. Nursing Standard. 23 (28) 28-29.
Baer P.E., Garmezy L.B.; McLaughlin R.J., Pokorny A.D. and Wernick M.J. (1987). Stress, Coping, Family Conflict, and Adolescent Alcohol Use. Journal of Behavioural Medicine 10, 5, Pages 449 -466.
Bandura A. (1978). Reflections on Self-Efficacy. Advances in Behavioural Research and Therapy 1, Pages 237-269.
Bandura A. & Locke E.A. (2003). Negative Self-efficacy and Goal Effects Revisited. Journal of Applied Psychology. 88, 1, Pages 87-99.
Barry P.D. (1996). Psychosocial Nursing: Care of Physically Ill Patients & their families. (3rd Edition) Philadelphia: Lippincott-Raven publishers.
Colder C.R. (2001). Life Stress, Physiological and Subjective Indexes of Negative Emotionality, and Coping Reasons for Drinking: Is there Evidence for a Self-Medication Model of Alchol Use? Psychology of Addictive Behaviours. 15, 3, Pages 237-245.
Faulkner A. (2000), Effective Interaction with Patients. London: Churchill Livingstone.
National Council for Hospice and Specialist (2000). What do we mean by ‘psychosocial’? London; March 2000 Briefing No. 4.
Niven N. (2006). The Psychology of Nursing Care (2nd Edition) London: Palgrave MacMillan.
Oliviere D., Hargreaves R., Monroe B. (1998) Good Practices in Palliative Care: A psychosocial perspective. Aldershot: Ashgate Publishing Ltd.
Scherer K.R. (2005). What are emotions? And how can they be measured. Social Science Information. 44 (4) 695-729.
Sheldon F. (1997) Psychosocial Palliative Care: Good Practice in the care of the dying and bereaved. Cheltenham: Stanley Thornes (Publishing) Ltd.
Sheridan C.L. & Radmacher S.A. (1992) Health Psychology: Challenging the Biomedical Model. Chichester: Wiley
Smith A. (2009) Exploring the legitimacy of intuition as a form of nursing knowledge. Nursing Standard. 23 (40) 35-40.
Smith P. (1992). The Emotional Labour of Nursing. Basingstoke: The MacMillan Press Ltd.
Summers L.C. (2002) Mutual Timing: An essential Component of Provider/Patient Communication. Journal of American Academy of Nurse Practitioner. 14(1) 19-25.
Wilson V. (2004). Supporting Family carers in the community setting. Nursing Standard. 18, 29, Pages 47-53.
Smith said that intuition is a valuable source of knowledge though it could be difficult to put into words as there is little empirical evidence…
Self-esteem refers to one’s sense of self-respect or self-confidence. It is how much one likes oneself and values one’s own personal worth as an individual.
Self-esteem can be improved in several ways: Support groups; Completing required tasks; Forming realistic expectations, Taking/Making time for you ; Maintaining physical health; Examining problems and seeking help
External influences are those factors that we do not control, such as who raised us.
The family influences include family upbringing.
Healthy, nurturing families produce more well-adjusted adults.
Dysfunctional families may produce confused adults who have a harder time adapting to life.
Influences of the greater environment include safety, access to health services and programs, and socioeconomic status.
Internal factors include hereditary traits, hormonal functioning, physical health status, physical fitness, and other selected elements of mental and emotional health
(Definition) It can be improved through support group, forming realistic expectations, maintaining physical health, examining problem and seeking help limit smoking and alcohol.
He was assessed by the nurse after he gave his consent whereby information about his past and present illness, demographic and his activity of daily living was recorded on the assessment form. The nurse recorded the reading of his vital signs such as pulse, respiratory, temperature, O2 and heart, taking the vital signs at all time Mr. X dignity was not abused. Patients records are confidential information and can only be access by the nursing and medical professionals working with the specific patients.
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Respondents found it very hard to cope with watching their partner’s suffering, and not knowing how to deal with it. In this situation the nurse’s role should include giving information and educating patients and partners, as well as offering support. Information should be accessible throughout the course of the illness, and needs to cover physical and emotional issues (Northouse and Peters-Golden, 1993).
Self-efficacy :Learned helplessness is a response to continued failure where people give up and fail to take action to help themselves.
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