Multiple Sclerosis Case Study

All names and places are changed to maintain confidentiality due to the NMC Code 2015. Student nurse Jack on placement in East Farm Hospital. He was working with Sam, a health care assistant that day as his mentor wanted Jack to learn more about caring for the patients. This case study will be about one particular patient Jessica is a woman in her fifty’s with multiple sclerosis who is in the hospital for rehab.

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The student nurse was on shift when he heard shouting for help from a side room. The health care assistant Sam turned round to the student and said; “she is off again that is all she does every day.” The student said; “shall we go and check to see if she is ok?” However, Sam said; “no point, but you can check if you want.” The student nurse went to check on the patient, he went into the room and asked if everything was ok and introduced himself as Jack. The patient replied my name is Jessica.

Jessica needed help as she had had an accident and her pad was wet. Jessica had got all upset and was calling for help. Jack noticed that her blankets were at the bottom of the bed and she was exposed. Jack managed to calm Jessica down and said to her; “shall we get you changed?” Jack called on Sam to help as it takes two people to move or change Jessica.

As Jack and Sam were changing Jessica, Sam was saying; “is she being a pain again?” Jack replied no; “Jessica is wet and needs our help.” Sam and Jack started to change Jessica when Sam began telling Jack that he cannot wait till it is over today as he is going out tonight with friends”. Jack was not interested in this, and instead, he asked Jessica “what are your hobbies, what do you like?” but Sam answered for her saying she likes music but can’t sing when she sings it’s like a cat.” So Jack asked Jessica again what she likes as he did not like what Sam said. Jessica replied that she likes to read and going to church and enjoys singing.

Jack and Sam finished changing Jessica then Jack handed the call bell to her. However, Sam said “No! Don’t give her that or she will be calling every five minutes”. Sam left, but Jack stayed to chat with Jessica. Jessica told Jack she was not always like this; she said used to run her own business and to manage her staff. She told Jack she did not like being in the hospital and wants to go home, but she cannot till the adult social care team say that she could go home. They have told Jessica she would be better off in a home instead. However, Jessica does not want to go into a home; she wants a return to her home and her family. Jessica feels that she has lost all power to do or say anything about her life. Jack reassures her says he will talk to the Sister then he said it is nice to talk to you and handed the call bell to Jessica.

The two theoretical perspectives that will be discussed and looked at. In this essay are power and stigma. The essay will explore how power in nursing is used to control and also how it affects people when they are disempowered due to ill health and having to rely on others. Then the essay will discuss and look at stigma and the way it is used and how a person or groups of people become stereotyped.

Stigma is taken from the Greek for a mark branded on a slave or criminal (White, 1998). Goffman’s (1963) critical work on stigmatization that causes rejection by others has, over the years, stimulated a great variety of educational discussions on the consequences of this to staff and patients (Link and Phelan, 2001). According to Goffman (1963), the mark of shame may be a physical or mental mark of disgrace that causes a person to stand out from the community of individuals. Goffman identified three types of stigmatization including, ‘abominations of the body, the tribal mark of shame, and marks of different character’ (Goffman, 1963, pg 14). Abominations of the body are when the ‘physical deformities this can take the form of any physical impairment. Then blemishes of individual character these can take the form of dishonesty, unemployment, and addiction. There is the tribal stigma of race, nation, and religion (Goffman, 1963, p. 10).

People who have these physical and psychological marks often this reduced the form of a human being treated like an animal. Which as a result leads to their position within the community of people being ruined by the upsetting effects of the stigma that causes rejection by others (Goffman, 1963). The health care assistant Sam turned round to the student and said; “she is off again that is all she does every day.” This is a negative attitude to be treating Jessica unfairly. The views that are based on unfair, pre-decided bad opinions, within the wrong information, causes’ unfair and wrong views with Jessica and sets judgment can be due to bad opinions. That could affect her in an emotional manner (Stier and Hinshaw, 2007) Corrigan and Wassel (2008) state that discriminative behavior can be seen as a direct result of unfair, pre-decided wrong opinions. It involves a particular group being treated in a different way so that group can access opportunities available to them and have their rights being restricted (Stier and Hinshaw, 2007).

The severity and impact of the incapacity of multiple sclerosis vary between patients counting on the stage of the illness and their personal experience, values, and beliefs. The impact of a chronic ill health will affect several lives, together with members of their family and friends close them. The diagnoses of multiple sclerosis will trigger entirely different responses, as some individuals could also be in denial and stay to be angry for quite some time, whereby others deal with such diagnoses thoroughly and check out and accommodate their lifestyle to the requirements in effectively managing their ill health. Furthermore, ill health beliefs more confirm the impact a chronic condition has on the individuals’ psychological and social well-being, and successively, their quality of life. Health care professionals, the NHS, and support teams will effectively aid in rising patients and carers learning and understanding of the way to manage the ill health; that is crucial because it can offer the patients with some freedom and self-control over the condition and personal satisfaction in life (Green, 2009).

Numerous challenges are experienced by people living with multiple sclerosis and their carers, and one issue that contributes to their problems is being stigmatized and tagged by non-labelled people. This astigmatism will doubtless result in social isolation and may become frustration and depression inside the patient. Therefore, so as to boost the standard of a lifetime of patients and carers, it’s crucial that stigma is reduced. It may be achieved by introducing interventions expanding learning and attention to the truth and actualities of living with an endless condition like multiple sclerosis, Increasing the notice of affected patients of existing support teams may additional aid patients in managing and dealing with their ill health and further improve any impact socially (Green, 2009).

Power is described by the psychoanalyst May (1974) exists as a potentiality in every human being. This occurs in ontological phases on a continuum, from ‘power to be,’ to ‘self-affirmation,’ ‘self-assertion,’ ‘aggression’ and ‘violence’ in humans. The two aspects of aggression and violence are the negative end of the continuum of power, used to obtain dominion on individuals. However, aggression can also be subtle as the contrary case model will highlight. Nurses need to understand the elusive concept of power and how it permeates any human interaction in society and hence in nursing since nursing is in part social activity. This should result not only in more efficient patient care but by giving power to patients through knowledge transfer the patients can participate in self-care. Awareness by the nurse of expert power would also be beneficial for student nurses learning clinical and interpersonal skills in the clinical areas (McMahon1990).

The nursing literature cites Foucault, a prolific writer about power (Gilbert 1995). Foucault is about definitions and associations with power, range from sexuality or procreation to murder or prison. While admittedly such a range is comprehensive, power in relationships, as classified by May (1974) is perhaps more analogous to power in a nursing context. These were exploitative ‘restrictive power,’ manipulative ‘power over another,’ competitive ‘power against another,’ nutrient ‘power of the other,’ and integrative ‘power with the other.’ Coupled with the ontological the nature of being phased in real life these could both equally apply to nursing or society. This is an example of Jessica not being able to go home as the adult social team wanting her to go into a nursing home in which Jessica has denied and wants to go home but at this present time she has to stay in hospital and wait for the care be put in place at home and the adult social care team say she can go.

The authors in nursing literature similarly differentiate power as ‘power over as opposed to the power to’ (Hokanson Hawks, 1991). ‘Nursing interaction and collegiality power’ (McMahon 1990), ‘repressive or productive power’ (Gilbert 1995), ‘gentle or harsh force in power’ (Tappen 1995) and ‘overt and subtle power’ (Hewison 1995).

Talcott Parson’s (1951) definition, cited by Haralombos & Holborn (1993) of the variable sum of power, added to the ontological power dimension in relationships as identified by May (1974), can arguably be applied to nursing. Power is potential in every human being, and whether this potential is released or not, depends on in large part on how the person holding of power wields it. This is aptly defined in the quote; “Power is the ability to cause or prevent change. It has two dimensions. One is power as potent or latent power.

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The other dimension is a power as actuality.” May 1974:99 Actual power is the basis for goal setting and goal achievement in patient care. The potentiality of power is best understood when it comes to nurses giving power to the patient or junior nurses using the nutritive and integrative aspects of power As Thompson et al. (1995) stated nurses wield power which, if ‘relinquished’ could be shared with the patients and the relatives or juniors.

Power relinquishment means it is diffused among the people the nurse interacts with and thus empowers them to decide on how to manage their conditions and their lives better. Arguably, goal setting is applicable for any society, whether for economic growth (Haralombos & Holborn, 1993) or patient recuperation (King 1981). This is best described when Jack was told not to give the call bell to Jessica as she would be calling every five minutes this is Sam taking the power from Jessica and causing more of an issue, but when Jack gives Jessica the call bell at the end he would have given her the power not to feel alone and is able to call for help without getting into trouble. But as is stated Talcott Parson’s (1951) definition, cited by Haralombos & Holborn (1993) of the variable sum of power, added to the ontological power dimension in relationships as identified by May (1974), can arguably be applied to nursing. As Jessica has said to Jack that she was not always like this and that she used to run her own business and mange staff and now she is in hospital Jessica feels powerless and feels that she has no say in the outcome of her care and treatment and by making sure she had some power , Jack was able to have a chat with her and listen to what she was saying and by giving her the time and freedom to join others in the dining area gave Jessica the power to talk and ask for help when needed and not to worry what others think or say.

Power is potential in every human being, and whether this potential is released or not, depends on in large part on how the person holding of power wields it. This is aptly defined in the quote; “Power is the ability to cause or prevent change. It has two dimensions. One is power as potent or latent power. The other dimension is a power as actuality.” May 1974:99 Actual power is the basis for goal setting and goal achievement in patient care. The potentiality of power is best understood when it comes to nurses giving power to the patient or junior nurses using the nutritive and integrative aspects of power this is where Jack gave power to Jessica

As Thompson et al. (1995) stated nurses wield power which, if ‘relinquished’ could be shared with the patients and the relatives or juniors. Power relinquishment means it is diffused among the people the nurse interacts with and thus empowers them to decide on how to manage their conditions and their lives better. Arguably, goal setting is applicable for any society, whether for economic growth (Haralombos & Holborn, 1993) or patient recuperation (King 1981). This is maybe best exemplified by the employment of three entirely different case studies, wherever power modifies and permeates the link or interaction between humans (Devito 1994).

Power can be envisaged and practiced or mail-practiced, be it in direct patient care and education as well as at managerial level. May’s (1974) assertion that power is available in human beings in varying amounts, accompanied by the six types of power, should be readily understandable for any nurse with a modicum of nursing experience. Any nurse should be capable of using her knowledge, power productively for the benefit of the patient, for the same patient to be competent to live with a medical condition independently. Moreover, power permeates not only from nurse to patient, but also from nurse to nurse Processing ReWrite Suggestions Done

(Unique Article). Therefore, nurses have to be compelled to remember of the firm result of power, and the way dispersive power helps within the management of patient care in the slightest degree levels as of May (1974) described power is essential for any society, nursing society is no exception and to decree otherwise is pointless. “The denial of power in society is an example of pseudo-innocence.”

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