Psychological and Sociological Factors Influencing Patient Care

This case study aims to achieve the following learning outcomes:

• to demonstrate a critical and systematic understanding of the psychological and sociological factors which influence patient care,
• to critically explore the aspects of risk assessment and safeguarding to promote safe, effective care,
• to demonstrate detailed and current knowledge of inter-professional working and how it promotes person-centred care.

For confidentiality purpose I would refer to my patient as BA. Patient consent was sought and agreed with my mentor.

Patient BA is a 41yr old man, divorced with two children. He is independent, loves to party with friends. On a night out, patient BA was drunk, got into a fight and got punched in the chest. Unaware of what had happened the previous night, he woke up with pain in the thoracic region. Patient BA thought he had broken some ribs and was in pain and discomfort. After about 3-4weeks BA expected the pain to have been reduced because he had knowledge of broken ribs repairing itself. The pain was not relieved but rather got worse. Patient BA had lost a considerable amount of weight, had reduced appetite, and expressed that ‘I thought I was about to die’, his mum called the emergency services and BA was taken to hospital. On admission patient BA was diagnosed with Community Acquired Pneumonia and Shortness of Breath. Patient BA’s past medical history shows that he is on lifelong Tinzaparin for DVT and is an ex-IVDU.

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According to NICE Guidelines Pneumonia is an infection of the lung tissues, in which the air sacs in the lungs become inflamed, filled with fluid and microorganism and are not able to function properly.  Diagnosis is usually based on symptoms of lower respiratory tract infection and can be confirmed by a chest x-ray. Pneumonia can be classed as either community acquired, or hospital acquired depending on how patient got the infection. The NICE guideline quality statement states that patients brought into hospital with suspected community acquired pneumonia are to have a chest x-ray and have a diagnosis within 4 hours of coming to hospital. The rationale is that timely diagnosis is obtained by carrying out a series of tests which includes a chest x-ray which has been assessed and where pneumonia is presenting, timely treatment with antibiotics is carried out, and ensures patients are not inappropriately given antibiotics treatment NICE. (2016). Pneumonia in Adults.

On admission onto the ward patient BA admitted to feeling imprisoned and feels stuck in hospital. Patient BA is independent, has capacity to make own decisions in general {activities of daily living}.  The activities of daily living according to Roper Logan Tierney model in practice 2008 identifies twelve activities which are regarded to be the core of the model of living which are: maintaining a safe environment, eating and drinking, communicating, eliminating, breathing, mobilising, sleeping, working and playing, controlling of body temperature, personal care and hygiene, expressing sexuality and dying. These activities of daily living work hand in hand. If any is omitted or is lacking it affects the others. Example without breathing you cannot communicate, eat or drink. Difficulty in breathing affects every other system in the body. Breathing is affected by all the ADL (Holland, K et al., 2008).

In caring for patient BA, the nurses carried out a nursing assessment which aimed to find out information about patient’s background (Psychological, physiological, sociological, spiritual) and enabled them to perform a holistic assessment of patient’s individual needs in other to plan patient’s care and set achievable goals with patient BA’s consent. The Acute Medicine Assessment Document was used by the doctors to reach a diagnosis on patient’s presenting conditions.

Holistic assessment is a process of defining a condition using theory and presence. It is done when a nurse considers the whole health of a person rather than focus on one key area. Reference.com. (2019).

Creating a holistic therapeutic relationship involves physical, psychological and social aspects. The social aspect of this look at patient’s perception of self and others. In other to provide a holistic care requires staff to address patient’s physical and social needs as well. Montgomery and Dossey (2008) cited in Goodman, B. & Ley, T. (2012).  supports meeting patients’ need holistically by engaging in therapeutic relationship. Goodman, B. & Ley, T. (2012).

Being in hospital can present specific stresses over and above that which is associated with the illness a patient suffers. It ranges from environmental factors like being in an unfamiliar environment, to lack of privacy and independence and uncertainty about health outcomes. When a patient’s needs are not met it could affect them emotionally. Most people can adjust easily whilst others might find that their emotional and social coping mechanisms are challenged. BMA Science and Education. (2011). Patient BA found that he struggled to cope in the confines imposed on him by his illness, though patient BA could self-discharge from the hospital, he understood that he needed to complete his antibiotics treatment and gain confirmation from the multidisciplinary team that he is fit and healthy to go home. Patient BA did not cope well in the hospital settings as stated that “feels imprisoned”. Patient BA’s support system was somewhat unstable as he misused substances on the ward when stressed and became disoriented thereby prompting the need for safeguarding. There was a concern of overdosing as patient BA was prescribed strong painkillers (Oramorph). The nurses had to risk assess patient BA by asking a series of questions to check his alertness and orientation before administering his strong painkillers to avoid/limit any contra-indications or side effects with any substance which he may have taken/not taken.

The RCN outlines 8 principles of nursing care which shows: that nursing staff take responsibility for the care they have provided to the patient and are responsible for their actions and omissions; Care that meets the legal and professional standards and requirements has been agreed with patient and their family or carers; Staff promote safety of patients, self, colleagues and others; Staff promote person centred care that enables decisions and informed choices about care to be made by patients, service users, their families and carers; Confidentiality in dealing with patient record is maintained, effective communication process is carried out and effectively reporting any concerns to appropriate persons;

The principle also states that staff have up to date skills and knowledge about patient care needs. Working together with own team and other professionals to achieve a high standard of care with the best possible outcome for the patient and service user; Development of self and other staff in a way that promotes a holistic person-centred care. Royal College of Nursing. (2019). principles of nursing practice

Being able to respond to a patient’s care needs is a complex, intricate and subjective process that needs the care giver to understand the patient’s world. By recognising and respecting a patient’s individuality nurses show they are willing to get to know and help the patient. Studies have shown caring to be at the centre of nursing. Heywood Jones, I. (Ed.) (1999). Whilst Saving lives and preventing health deterioration are of much importance, so also is the consideration of the psychological and social needs of patients as part of holistic care delivery. BMA Science and Education. (2011).

The NMC Code of conduct, performance and ethics sets key principles for nurses and midwifes practice and states their professional responsibilities. It is a key tool that is used in safeguarding the health and wellbeing of the wider public (Goldsmith, j. 2011).

The care act 2014 emphasizes the statutory responsibilities for the integration of care between health and local authorities. Adult safeguarding means protecting a person’s right to safety, free from neglect and abuse (NHS England. The Care Act 2014). Patient BA found having misused substances on hospital ground, put himself and other vulnerable patients at risk which led to hospital security team involvement.  Section 42 of the Care Act 2014 states that safeguarding enquiries is required where a person needs care and support, is experiencing, or is at risk of abuse or neglect, and because of their care or support needs, they are unable to protect self from abuse, neglect or risks. Somerset adult safeguarding board. 2018. In this case patient misuse of substances.

The fact that patient BA misused substances does not give healthcare professional grounds to abuse or neglect, the Nurses and other healthcare professionals provided adequate care and support needed, adhering to the NMC Codes and safeguarding of other vulnerable adults from abuse or risk of it.

Interprofessional teamworking creates a diverse field of knowledge, skills and talent all working together to achieve a common goal. Scaria, M.K. (2016). Part of the care provided to patient BA included short term oxygen therapy through a nasal cannula to help with shortness of breath. In an article of a research carried out by Zhang, Y., Fang, C., Dong, B.R., Wu, T., & Feng, J.L. (2012). Oxygen Therapy for Pneumonia in Adult in the Cochrane database of systematic reviews had the objective of determining the effectiveness and safety of oxygen therapy in treating pneumonia in adults over the age of 18 and the authors concluded that non-invasive ventilation could be of more benefit than standard oxygen supplement through a venturi mask for pneumonia. Though oxygen therapy is commonly prescribed to patients with pneumonia, there have been inconsistent results during their research on the effect of the oxygen therapy on pneumonia.

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The Physiotherapists were also involved in patient BA’s care by giving specific advice on what sleeping position to undertake to relieve pain and what sort of exercises would aid in recovery. Physiotherapists are part of the multidisciplinary team and were present in the ward where patient BA was admitted. They consider the body as whole by providing holistic care. Some of the approaches used by physiotherapists includes: education and advice, movement, tailored exercise, physical activity advice and manual therapy. Other therapies such as hydrotherapy and acupuncture can also be carried out by physiotherapists NHS. (2018).

The MDT have all contributed to the overall treatment and wellbeing of patient BA, the doctors have been prompt in the diagnosis of patient BA’s illness and prescribing of medications and oxygen therapy, the nurses have contributed to ensuring medications are administered appropriately (right patient, right drug, right dosage, right time, right route), the physiotherapists have been able to give advice on the best positioning to relieve pain and exercises to aid breathing, the security team have ensured the safety of vulnerable patients and staffs in general. Part of the MDT also includes the housekeepers and kitchen staffs who ensure the hospital environment is kept clean and free from infection, and the kitchen staff ensuring the patients food are ready on time and served in accordance with hospital policy on food hygiene.

From this case study I have been able to critically research pneumonia, its symptoms and how it could be mistaken for the cold or flu infection. I have also learnt that trauma to the chest could cause pneumonia Ho S, Teng Y, Yang S, et al (2017). Pneumonia can be prevented by getting immunisation against the pneumococcus bacteria and having the annual flu vaccine. Stopping smoking also reduces damage to the lining of the airway and reduces infection risks. Patient. (2018).

How the multidisciplinary team contributes to the care delivered to patients and enhances patient’s recovery from their illnesses making their stay in the hospital pleasant.

I have also learnt in detail how care is managed through psychological and sociological approaches and how to ensure future practice includes holistic care which considers the patient as whole and not just focusing only on their illness.

REFERENCES

• BMA Science and Education. (2011). The psychological and social needs of patients. Retrieved from https://www.ahsw.org.uk/userfiles/Other_Resources/Health__Social_Care_Wellbeing/psychologicalsocialneedsofpatients_tcm41-202964_copy.pdf.
• Dougherty, L. & lister, S. (2015). The Royal Marsden Manual of Clinical Nursing Procedures (9th ed.). West Sussex: John Wiley & Sons, ltd.
• Goldsmith, j. (2011). The NMC Code: conduct, performance and ethics. Nursing Times, 107, 37-37. Retrieved from https://www.nursingtimes.net/clinical-archive/the-nmc-code-conduct-performance-and-ethics/5035067.article.
• Goodman, B. & Ley, T. (2012). Psychology and Sociology in Nursing. London: Sage Publications Ltd.
• Heywood Jones, I. (Ed.) (1999). The UKCC Code of Conduct a critical guide. London: Emap Healthcare Ltd.
• Ho S, Teng Y, Yang S, et al Risk of pneumonia in patients with isolated minor rib fractures: a nationwide cohort study BMJ Open 2017;7:e013029. doi: 10.1136/bmjopen-2016-013029 https://bmjopen.bmj.com/content/7/1/e013029.citation-tools
• Holland, k., Jenkins, j., Solomon, j., & Whittam, s. (2008). Applying the Roper Logan Tierney Model in Practice (2nd ed.). Philadelphia: Elsevier’s Health Sciences.
• NICE. (2016). Pneumonia in Adults. Retrieved from https://www.nice.org.uk/guidance/qs110/chapter/Introduction.
• NICE. (2016). pneumonia in adults. Retrieved from https://www.nice.org.uk/guidance/qs110/chapter/quality-statement-3-chest-xray-and-diagnosis-within-4-hours-of-hospital-presentation#quality-statement-3-chest-xray-and-diagnosis-within-4-hours-of-hospital-presentation.
• NHS. (2018). Physiotherapy. Retrieved from https://www.nhs.uk/conditions/physiotherapy/#.
• NHS England. The Care Act 2014. Retrieved from https://www.england.nhs.uk/wp-content/uploads/2017/02/adult-pocket-guide.pdf.
• Patient. (2018). pneumonia in adults. Retrieved from https://patient.info/chest-lungs/chest-infection/pneumonia.
• Reference.com. (2019). What is Holistic Assessment. Retrieved from https://www.reference.com/world-view/holistic-assessment-a82e712842f53e88.
• Royal College of Nursing. (2019). principles of nursing practice. Retrieved from https://www.rcn.org.uk/professional-development/principles-of-nursing-practice.
• Scaria, M.K. (2016). Role of Care Pathway in Interprofessional Teamwork. Nursing Standard, 30 (52), 30,52-42-47. doi: 10.7748/ns.2016.e10402.
• Somerset adult safeguarding board. (2018). what is adult safeguarding. Retrieved from https://ssab.safeguardingsomerset.org.uk/wp-content/uploads/Joint-Safeguarding-Adults-Policy-FINAL-25-January-2018-Somerset-PUBLISHED.pdf.
• Zhang, Y., Fang, C., Dong, B.R., Wu, T., & Feng, J.L. (2012). Oxygen Therapy for Pneumonia in Adult. Retrieved from https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006607.pub4/epdf/full.