The Impact of Psychological and Sociological Factors
On the
Rehabilitation of Patients and their Families with a Medical Condition
PSYCHOLOGICAL FACTOR
Maintaining a well balance psychological thinking after a severe illness poses major challenges to individuals’ adaptive capabilities. has described stress in a deficit model in which demands made upon an individual exceed the resources available at any given time. Stress can include physical, psychological or environmental factors that can cause distress. Patients are faced with multiple stressful experiences that tend to fluctuate over the course of time. After recovering initially in the physical sense, other challenges begin to surface. These include uncertainties about the ability to return to the previous occupation and handle interpersonal relationships. A severe illness can cause major disruptions to valued and essential activities. The sense of physical frailty and fatigue can also lower the perception of personal control to return to their previous lifestyle and functioning level.
An individual recovering from a medical condition commonly experiences anxiety and depression. To achieve maximum benefits from rehabilitation, psychological counseling must be included ( 1993). Psychological adjustment problems experienced by individuals in rehabilitation affect the resumption of employment, psychosocial adaptation, and sexual functioning. ( 1991). The second purpose of psychological counseling involves providing behavioral change through identification of stressors that affect the individual ( 1994) and management of risk factors through dietary, smoking, and physical activity change (, 1993; , 1994). Psychological counseling can facilitate change in all of the above risk factors. Perceived control over recovery from disease and its possible reoccurrence is important to individual adjustment (, 1994). Following rehabilitation individuals are aware that some disease are chronic and life threatening. Individual is advised to attend to the known risk factors of diet, weight, smoking, stress, and physical activity. Even when these behavioral changes are managed, diseases may reoccur. The uncertainty of when and if it will reoccur presents a threatening situation and places great demands on the individual’s emotional functioning (, 1990). Individuals experiencing emotional distress (depression or fatigue) also experience increased length of recovery time (, 1993). Greater success of rehabilitation depends upon an increased awareness of psychological aspects. (, 1994). also indicates the need for individuals to reduce levels of anxiety and depression while increasing their ability to handle stress and anger. An individual’s fears of sexual dysfunction, dependency upon others to perform physical tasks, lack of money, and sudden death are often neglected by rehabilitation and medical professionals. Many individuals recovering from illness receive little or no information about sexual activity from their attending physicians. (, 1989) Fears and lack of information experienced by individuals postoperatively can be addressed through psychological counseling. A lack of attention to the psychological aspects can affect employment opportunities (, 1981). A multidisciplinary approach to rehabilitation which includes psychological counseling will improve an individual’s quality of life and increase the probability of persons returning to work. (, 1994). Lack of psychological counseling can explain a large percentage of the individuals who do not resume work following medication (, 1982). Early in the recovery process, psychological counseling can clarify which fears of individuals recovering from rehabilitation are realistic and which are irrational ( 1994). The earlier the counseling begins in the recovery process, the more likely the individual will return to work (, 1989). .
SOCIAL FACTOR
An important resource for individuals recovering from medication is the social network of family, friends, neighbors, and coworkers ( 1986). Higher levels of social support significantly helped the individual to have a better emotional status. (, 1993). Family support of the patient’s participation in a rehabilitation program increased levels of psychosocial recovery (, 1991). The patient’s family experiences are significant change. Seen as an interconnected system, a change in one family member causes the family system to adjust in some way. Issues of role strain, marital quality, and financial concerns place added physical and psychological stress upon the spouse ( 1991). The support of family members is indispensable if care is to be provided in a manner that improves meaningful life for patients (, 1999). The supportive behavior of family members who visit a patient daily and provide bedside care depends on how they perceive the patient’s illness experience through the stage.
A reversal of roles within the family member following recovery from the illness with the patient’s spouse (usually the wife) taking on the majority of household duties. (1988). Coping with disease was found easier for those couples that had a satisfactory relationship prior to the onset of illness ( 1986). also found families with a happy and fulfilling marriage experienced less adverse changes in the family situation following coronary bypass surgery. Finances cause major concern for spouses, with many feeling a high level of financial strain or economic inadequacy, especially when the principle wage earner undergoes medication (, 1988). Spouses experienced more stress than the patient undergoing medication (1991). Following discharge from the hospital inclusion of significant others rehabilitation program could facilitate recovery for the patient and provide needed guidance and information. Significant others, should be informed by rehabilitation counselors regarding psychological factors, and advised to report any long-term depression or other adjustment concerns noted above to the physician. Some members of the social network may act in an overly protective manner which may hinder rehabilitation efforts (1980). Social network members should be informed of needs individuals recovering from medication have for accomplishing tasks, making decisions, and assuming control of their own lives ( 1994). Significant others may need guidance from the rehabilitation counselor regarding not placing individuals recovering from medication in a role of helplessness by providing everything they need, allowing the patient to accomplish tasks on their own. Significant others may require guidance or more information from the rehabilitation counselor regarding medical factors which include noting and informing the physician of any behaviors or activities which are contrary to the physician’s recommendations (non-compliance with; diet, exercise, quitting smoking, or medications). Thus, the psychological distress caused by illness is not only limited to the debilitating impact of the physical symptoms. Patients have a long way to go to cope with the intrusion of the illness causing disruption to various aspects of their daily functioning. Furthermore, public fears of the illness and social prejudice can cause difficulties in these patients in getting the help when it is most needed.
How did the Psychological and Sociological Factors Affect the Nursing Care of the Patient?
Due to the rapid socioeconomic changes, the family as an institution is undergoing major change. As the family changes, its ability to continue to meet traditional roles and responsibilities so too does changes. The changing family structure is reducing the ability of the family to provide home care for its family members. The provision of care outside the family in long-term care is emerging as an important part. To meet the needs of the changing society, the legislation on Nursing Law was strengthened. Nursing care institutions provide rehabilitation as well as physical care.
Outcomes in nursing and health care system are greatly influenced by factors such as biopsychosocial functioning and patient satisfaction. Base on the reports and researches conducted in eight selected nursing homes in Taiwan. The researchers operationalized the concepts of biopsychosocial function and patient satisfaction with care as outcomes and considered the impact of individual patient and organizational factors on those care outcomes. The following key hypotheses were generated and tested:
Current patient care, however, requires more than medical technology to achieve positive outcomes. The role of the nurses becomes increasingly important especially in institutions where the predominance of care managed and delivered by nursing staff.
The psychological behavior of the patient towards nursing care determines the success or the failure of rehabilitation. Psychological factors such as anxiety and depression hinders the efficacy of the rehabilitation. Patients with depression experience greater difficulties in problem solving and have reduced adherence to medical therapy, more functional impairments, and substantial increases in health care utilization. Anxiety-prone individuals gave lower ratings to the quality of information received during hospitalization compared with those patients with lower anxiety. Depression and anxiety might also become a communication barrier between the patient and the medical providers like the nurses. As a result, psychological factor may prolong the recovery of the patient. Moreover, it might also cause the early death of the patient. Medical providers will find it hard to apply the appropriate and necessary treatment for the patient. On the other hand, social factors like family, friends, neighbors, and coworkers helped the individual to have a better emotional status. The support of family members is indispensable if care is to be provided in a manner that improves meaningful life for patients ( 1999). The supportive behavior of family members who visit a patient daily and provide bedside care depends on how they perceive the patient’s illness experience through the stage.
How has this informed my Approach to Care Delivery?
By studying how psychological and social factors affect care delivery. I was given a deeper understanding on the importance of psychological and social factors in delivering health and medical services for different patients. As a nurse, it is necessary for me to know first the conditions and circumstances of the patients. In knowing their conditions I can properly adapt appropriate behavior in dealing to patients with such conditions. In that, way I can develop a good communication to the patient and eventually a good nurse and patient relationship.
If this will happened, I can easily convince the patient to take his or her medication. It will also help me in determining the proper health care for the patient. Aside from that as a nurse, handling patient with depression and anxiety needs special care and attention. Part of my task is also to inform the patient’s family the real situation of the patient. As a nurse, it is not only the medical care that I should give but also emotional support for the patient. In delivering medical support, I must also provide emotional comfort. The patient must feel that I care for them, I love them and I really wanted them to recover from their illness.
I must also keep up to date with the different changes in approach in health care delivery.
How the Nurse Should Support the Patient or their Family in Bereavement
Many people dying in hospitals or nursing homes have unmet needs for pain relief, physician communication, emotional support, and being treated with respect. ( 2004). According to the author, the majority of deaths in industrialized countries occur in health care institutions. The authors write that family perceptions of quality of care differed by the last place of care for the patient. “Nearly one-fourth of all respondents reported that the patient did not receive any or enough help with pain (24.2 percent) or dyspnea [difficulty breathing] (22.4 percent). Family members of persons whose last place of care was a nursing home or home with home health nursing services had a higher rate of reported unmet needs for pain compared with those persons with home hospice services. Overall, half of family members reported that the patient did not receive enough emotional support.” “Families reported more concerns with whether the patient was always treated with respect when the last place of care was a nursing home, hospital, or home with home health services, compared with persons who died at home with hospice services.” The authors note that family members of patients receiving hospice services were more satisfied with overall quality of care: 70.7 percent rate care as “excellent” compared with less than 50 percent for the other settings of care. “Key findings of our study are that bereaved family members reported high rates of unmet needs for symptom management, concerns with physician communication about medical decision making, a lack of emotional support for themselves, and a belief that their dying family member was not always treated with respect,” the authors state. “A higher rate of concerns with the quality of end-of-life care was reported for persons whose last place of care was a nursing home or hospital.” “Bereaved family members voiced significant concerns with the quality of end-of-life care, regardless of whether care was provided in a nursing home or hospital. Only bereaved family members whose loved one received home hospice services reported higher satisfaction and fewer unmet needs.
For medical providers to be able to support these family members, the extent to which family members are aware of the patient’s condition and the circumstances of his or her care must be known. A number of studies have been published related to how bereaved family members should be treated at hospices and hospitals ( 1995; 1999). Based on information gained in interviews with two bereaved families and from published research findings (, 1997; 1997).
In my experience the most essential and important thing that nurses should do to support the families in bereavement is to tell the truth. Research findings indicate that truth telling is an essential part of medical care (, 1997). Aside from that the family in bereavement must felt satisfied with the medical services the nurse have provided with the patient. Nurses should act as mediators between doctors and patients and their families. The doctor as well as the nurses must provide the adequate information on the medical treatment given to the patient and the prognosis at the times of admission, following the exacerbation of the disease and informing when or whether the patient was dying.
The lack of information given by doctors and nurses as patients progress through the stage of the patient’s illness indicates the need for continuous updating of information. Therefore, the receipt of adequate information appears to be a determining factor in families’ perceptions of the efficacy of medical care. According to some families in bereavement “they could have adequate talks with patients when given sufficient information about the possible period of survival indicates that family members’ awareness of the prognosis is a determining factor for smooth communication between patients and families.
REFERENCES
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