Social support plays a vital role in every individual’s life. Through comforting relationships and interactions, people are able to express their feelings and share their experiences. These relationships are essential for purposeful and meaningful life. People with mental disorders often experience difficulty in maintaining and initiating relationships with family members, friends, society and even with health care providers. ` For human beings, families are the most obvious of social systems (relationships)` (Charles & Laurel., 2013). Their limited social network keeps them secluded from their environment. In contrast, a good and non threating social networks help pateints in coping with their problems. An intact social network is a precursor for the executive of social support. Person with serious mental illness not only need to overcome the symptoms of disorder but societal and family misconceptions as well. (Batastini, Bolanos & Morgan, 2014)
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I encountered a client in AKUH Psychatric ward for last 2 months with the disgnosis of schizophrenia. Presenting complains were aggresiveness, low mood, low motivation and depression. On exploring patient’s histroy and by observing I came to know that patient is living within his boundries and remains isolated where he doesn’t interact with other patients, nor they interact with him, doesnot participate in any activities and no body came to visit him no relatives no family members . When he was at his house his neighbours used to make fun of him and even family members were misbehaving and giving him no respect. From furthur interviewing and considering above scenerio, I identified that the patient is suffering from social isolation because of lack of social support.
To analyze the varying aspects of this issue, which is of great concern to mental health nurses because they have to deal with such patients who encountered many problems because of low social support and by increasing social support their mental health can be promotes and they can cope with many problems.
Social support is the key to reduce social isolation by promoting interaction within society. It helps in adaptive process of adjustments and helps in sharing of feelings (Schuler, Zaider & Kissane, 2012) People with mental illness often feel lonely, scared and avoided by society. Such people consider themselves as inferior and worthless. `Social relationships both quantity and quality affect mental health, health behavior, physical health, and mortality risk` (Umberson & montez, 2010). Social support promotes mental health by enhancing patient’s self esteem, confidence and empowerment. It aids in the course of illness from acute phase to recovery phase. It fosters prompt recovery and compliance to medical treatment. (Finfgeld-Connett, 2005).
In Pakistani context, our society is bound by social ties in which people share their feelings with loved ones which indeed promotes mental wellbeing and provides person with sense of security, love and affection. Considering literature `mental health problems in Pakistan, a developing
country, have in the last few decades reached an appalling level linked to both the current violence in Pakistani society and disruption in social structure ` (Khalily, 2011). In Pakistani society mentally ill are perceived as abnormal, be mocked by people and often misbehaved by younger’s. As discussed in my scenario, the family members misbehaved with him. The families are ashamed to have mentally challenged family members and they are sent to mental health care institutions giving staff the entire responsibility (Todor, 2013, pg 210). Sufferers of mental illness are often seen as most disadvantaged group whose rights are violated by the members of their own society. A study conducted in Pakistan (Lahore) where medical students and doctors were surveyed to assess their attitude towards mental illness. It came out that half of the health care professionals poses negative attitude towards mental disorders such as schizophrenia, depression and substance abuse regarding their dangerousness, unpredictability and fear of communicating with patients. (Naeem, Ayub, Javed, Irfan, Haral & Kingdon, 2006).
Researchers have proposed several theories which describe the causes of isolation and low social support of mentally ill by society. One of them is labeling theory by Scheff in 1984. This theory proposed that public rejection is due to label such as “mentally ill” which leads to provoke negative emotions such as fear and exclusion that person labeled with mentally ill should be alarm and, therefore, be set aside from communities. (Abdullah and Brown, 2011, pp 935-948).
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While reviewing literature I came across several strategies to reduce social isolation in patients at an individual, group and institutional level . All these strategies are meant to encourage positive sense of self, increased confidence and self esteem. On individual level therapeutic use of self, enhancing spirituality and rebuilding family networks are considered valuable tools for patients. The professional relationship shared between a patient and nurse can decrease patient’s isolation and feelings of loneliness through therapeutic communication and active listening. (Abate, 2011). Client should also be given love and affection from family by rebuilding existing family relationships, promoting family meetings and help patients recall pleasant experiences. This will aid in increasing family bounding and augmenting sense of hope and comfort. In group level, various interventions can be done to increase patient’s coping. Referral to support groups should be incorporated in care plans. ’ The primary goal of support group is to increase member’s coping ability in face of stress, to strengthen the central core of individuals` (Perese & Wolf, 2005). This will help cliet to express their feelings and desires with person going through same situation. It will increase their interpersonal relationships and coping skills and enhance feeling of togetherness and decrease uniqueness. Family education should be done to make them equal part of treatment. Mass media can be involved to convey our messages to population. Institutions should arrange semi structured sessions for the health care providers so as to increase their knowledge and make them competent enough to teach patient an their family members.
During my clinical rotation, I identified and addressed the issue of social isolation at an individual and group level through nursing care process. The planning phase starts with assessment and purpose to promote social interaction. Firstly, I used therapeutic communication as a measure to build rapport with patient and gave him room for expressing and ventilation feelings through active listening. Secondly, I identified teaching needs of patients and delivered ongoing teaching on relaxation technique to make him feel comfortable since physical helath also plays a vital role in maintenance of functional health pattern I involved patient in different leisure activities such as playing indoor games and drawing to increase self esteem.
While evaluating my patient I noticed that he started to participate in small activities with other patients . More over, becoming more sociable, interactive and willing to participate in different activities.
This was the first time I dealt with mental illness patient with decreased social support. Initially I was resistant and scared in caring for these patients. However my perception changed when I came across different strategies to deal with such patients. I tried to remain non judgmental, sensitive and empathetic towards them and applied theoretical knowledge to clinical settings.
In conclusion, decreased social support is the most challenging yet interesting domain which has many solutions. We should inculcate multidimensional approach to address this issue. Health care professionals should take a step forward to confront biased social attitudes In order to increase social support. Nurses should recognize the unmet needs of patients and pay them attentions that are often ignored by society. Increased efforts are needed to incorporate the practice of social support in mental health settings.
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