During my mental health clinical rotation i came across a 35 years old male patient admitted with complain of hallucinations delusions, obsession, aggression, and self talkative behavior. During history patient reveals that his parents get separate when he was seven years old and he was single child shifted with his mother at that time. His history also reveals that he belongs to a poor family living in a small house with poor hygienic conditions. Beside that he has some financial and employment problems. I also noticed my patient’s hygiene was very poor. At every visit, i found him untidy or we can say grimy.
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Self-care is not a new idea. Since the beginning of humankind, people have taken action to ensure personal safety and have developed strategies to deal with illness and other health challenges. The term self-care refers to any self-initiated or self-directed action of engaging in activities of daily living and other activities to preserve bio-psycho-social well-being. Orem indicated that self-care is the practice of activities which people initiate and perform on their own behalf in maintaining life, health and well-being, (Tomey and Alligood 2002).Traditionally self-care defined as activities associated with health promotion. It represents behaviors that individuals undertake to promote or maintain their physical, psychological, and social wellness. Lack of self-care might impair our decision-making and coping skills. Primitive women assisted one another in childbirth and shared the acquired knowledge with the next generation. Implementing self-care strategies to address day-to-day concerns about health is normal and usual. Individuals select self-care behaviors in order to maintain an acceptable level of health or well-being, to prevent illness or injury and to promote health. These self-care behaviors contribute to one’s ability to perform a variety of tasks, ranging from ensuring survival to attaining self-actualization. Families accept responsibilities for facilitating the self-care of their members and take on self-care activities for other members who owing to maturation, illness or other life events, are unable to complete the necessary task themselves. Community leaders and our institutions support resources that enable individuals and families to carry out self-care tasks important to them. Clients at the individual, family and community levels have different self-care needs and expectations.
If we see the significance of the self-care in Pakistani context, it is important for us to maintain and create meaning and purpose in life. Because we must believe that, our taking care is not tangential, but essential for good physical and psychological health, happiness and well-being. The components of self care are, physical self care (walking, working out, eating nutrient rich foods, managing allergies and physical health issues), mental self care (reading and learning new things and being socializing), spiritual self care (prayer, actively practicing their faith), and emotional self care (healthy activities that help people feel good e.g., taking warm baths, listening to music). If we do not take care of our health physically, health complications may worsen to affect our emotional state as well. In Pakistan, improper self-care activities are due to low level of education, unemployment and financial difficulties, which may also lead to mental illnesses. Gilani, I.A, at al. (2005) says in their article, “Factors positively associated with these disorders were female sex, middle age, low level of education, financial difficulty, being a housewife and relationship problems-suggesting that social factors play an important part in the etiology of anxiety and depression in Pakistan”. In addition, in anxiety and depression again we counter self-care deficit. But unfortunately majority of we Pakistani still do not have soap and proper water supply as well as balanced diet to meet their daily life activities which in turn leads to frustration and emotional disturbances. Nazir, Cheema, Zafar,Batool (2009), indicated “A major proportion of the respondents believed that unemployment affects the socio-economic status of the family, leads to poor mental health and increases the magnitude of corruption, drug addiction, crimes and suicide in a society”.
In analysis of the concept I will share a literature indicates poor self-care as a sign of mental illness. Kienlen (2007) stated that, “Signs of mental illness are arranged into six categories: thinking, feeling, and socializing, functioning, problems at home and poor self-care”. Therefore, we can say improper self-care can lead to mental illness or can be a sign of mental illness as well as self-care may be impaired in mental illness. As my patient was fewer concerned in his grooming or caring self may be due to his mental illness. However, we can improve self-care activities in mentally ill patients. They can start caring themselves as in my patient’s scenario i improved my client’s hygiene i motivated him to take bath, change his dress and comb his hair and he was able to do so. By doing so we can improve patients self esteem and self-confidence. Chang (2009) says, “Elders in nursing homes performing self-care independently not only increase their self-esteem, self-confidence, and happiness, it also enhances their physical health. Further, it helps them to return home earlier”. Strategies for self-care involves the need to develop a vision for one’s life and then develop a plan that allows one to live out that vision involves ‘caring for the whole’ – body, mind, and spirit. It involves assessment of self care need, it’s implication and evaluation of proper care given to self or other. The idea of maintaining a well-balanced self-care plan should be appealing. Break it down into parts can help to separate specific areas that may need more attention and simplify the process of choosing activities to improve those areas also helps to make sure that self-care plan is well balanced and healthy. These strategies are personal hygiene, physical exercise, and social support, relaxation techniques as listening music or imagination and positive thinking. These strategies cover all aspects of wellbeing i.e., physical, psychological, and social wellness. Hansson, Hilleras, Forsell (2005), stated in their article “physical exercise was the most commonly reported strategy followed by social support. Reports of using certain self-care strategies (i.e., physical exercise, social support, relaxation and physical health) were associated with a better wellbeing”. Holt and Treloar (2007) also stated that “Participants described a range of self-care practices for mental health including: self-medication, seeking social support, physical exercise, counseling-derived techniques, keeping busy and other less common strategies. These findings show that drug treatment clients undertake similar self-care practices to the general population”. In caring of self and others, we can seek help from others, from peer and family. Institutions can also play a role in teaching of self-care, e.g.; we can use child-to-child approach for basic hygiene or personal care in children. Parents, families and health care professionals can teach, help and support patients. Here i will integrate the Orem’s model of care it is a population-based model to enhance the person’s ability for self-care and this extends to the care of dependent person. The Model has six components:
Self-management support: First, we need to assess the person’s requirements for self-care and the person’s capacity to perform self-care. If patient can understand and able to perform activities we should just empower and organize patients to manage their health and health care. Put emphasis on the patient’s vital role in managing their health. As in my clinical rotation, I emphasized my patient to participate in his health care by taking bath and participating in other activities with other patients.
Delivery system design: We can classify roles and allocate tasks among team members to reassure the delivery of useful, well-organized clinical care and self-management support. As in Karwan-e- Hyatt different persons according to their abilities were allocated different tasks. Patients also allocated roles to enhance their confidence and to empower them to manage self and others.
Decision support: In this step, we should endorse clinical care that is reliable with scientific evidence and patient preferences. We should always involve patient in decision-making, give choices rather then put our decision. During my clinical I always give choices to my client I ask him what he want to do first e.g., to take bath or to talk with me. Share evidence-based strategy and information with patients to promote their participation in self-care is necessary.
Clinical information system: We should make sure that all caregiver are doing his or her duties well. Manage patient and population data to assist competent and useful care. Provide timely reminders for providers and patients as i used to ask my patient did he take bath or not and give him reminder in polite way.
Health care organization: Make a culture, institution that support protected, high value care. Provide incentives based on quality of care.
Community: Make sure to activate community resources to meet requirements of patients. Support patients to contribute in effective community programs. Awareness programs for community about mental illnesses can help in reduction of stigma and increase participation of community. Family should be involved in mentally ill patient’s care and psychotherapy as an fundamental part.
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During my clinical rotation, i assessed my patient’s self-care needs by general observation, therapeutic communication to him, case history and communication to health care providers of institution and discussion with clinical faculty. I found my patient was less anxious for his care; he was antisocial, having lack of interest in participating in group or individual activities. Furthermore, he always refused to talk me. After this assessment i make a plan to enable patient to give the opportunity to do as much as he was able to do for himself, to enable the patient to practice activities that he would need to perform for himself after discharge, even as in the hospital environment. Then i implement my plan as i motivate the patient to take bath and change his dress and he was able to do so. Moreover, in my clinical rotation two times, i was able to conduct group activity with the help of my clinical group and institution. I motivate my patient to participate in-group activities once in musical chair activity and second time he participated in activity of coloring. If i evaluate of my strategies i was able to get positive response from my patient. My patient improved his personal hygiene and was looking neat. In addition, he was happy to do group activities. He reduced hesitation to talk me. He gives positive comments regarding group activity.
In my thinking, self-care is personal health maintenance. It is any activity of an individual, family or community, with the intention of improving or restoring health, or treating or preventing disease. Self-care includes all health decisions people (as individuals) make for themselves and their families to get and stay physically and mentally fit. Self-care is exercising to maintain physical fitness and good mental health. It is also eating well, self-medicating, practicing good hygiene and avoiding health hazards such as smoking to prevent ill health. Self-care is also taking care of minor ailments, long-term conditions, or one’s own health after discharge from secondary and tertiary health care. Individuals do self-care, and experts and professionals support self-care to enable individuals to do enhanced self-care. Barrier to self-care can be physical or mental illness, substance abuse participation in violent or abusive relationships, too tired or lack of energy.
Experience from paper writing is that during it i learn different concept of self-care. Before it in my opinion, self-care was just personal hygiene and well balanced diet but during this paper writing, i come to know that self-care also includes physical exercise, social support, relaxation and physical health.
In summation, i would like to say that self-initiated or self-directed action of engaging in activities of daily living and other activities to preserve physical, psychological spiritual and social well being called self care. Adequate self-care can prevent us from physical as well as psychological illnesses. Self-care depends on our physical and mental condition. Self-care sometimes also depends on our cultural, beliefs, support system, and finance. As self-care, activities improve our physical and psychological well-being, decline in self-care ability can result in our decreased physical and psychological well-being. Clients can be supported in various ways and by different service providers to enable to do enhanced self-care. Aalthough client participation is necessary in self-help initiatives, readiness to accept change also contributes to one’s commitment to participate.
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