Nursing practice is often associated with caring for the body (Sheridan & Radmacher 1992) and is underpinned by psychosocial care. The physiological disease is assessed upon patients’ admission into hospitals, Sheldon (1997) and Oliviere et al (1998) added that a holistic approach of care, that is, the psychosocial and spiritual health should be considered in order to inform nursing practice. Furthermore, in this essay the psychological, being the emotions, self-awareness, self-efficacy and cognition; and social model of care will be briefly explored and discussed and its relation to nursing practice. Peplau (1952) suggested that good therapeutic communication is of paramount importance to prevent patients from experiencing stress, consequently, a model of stress and their own coping mechanism will be applied in supporting the patients through their stressful hospital experiences. Definition of key words will be given to facilitate understanding.
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NCHSPCS (2000) defined psychosocial care as “concerned with the psychological and emotional wellbeing of the patients and their families/carers, including issues of self-esteem, insight into an adaption to their illness and its consequences, therapeutic (sic) communication, social functioning and relationships” (NCHSPCS 2000) not excluding their spiritual wellbeing. Sheridan & Radmacher (1992) suggested that biomedical model assesses only patients’ physical ill-health and it may lead them to poorer health outcome. Whereas, improvements of patients overall health is attributed far more to psychological, social and environmental changes than to medical skill ().
Emotion as defined by Walker (2007) is a subjective feeling experienced and perceived by an individual and this affects the way the person behaves. Lazarus (1984a) argued that cognitive activity is a precondition for an individual to experience emotions; thereby no affect is experienced when the mind does not recognise emotions. However, Zajonc (1984) challenged Lazarus views by stating that there is no empirical evidence to prove that cognitive appraisal is a precursor to emotional affect. However, Scherer (2005) agreed with Lazarus (1984a) and also referred to emotion and self-esteem as part of cognition or psyche.
According, to Barry (1992) and Niven (2006) self-esteem is defined as one’s feeling regarding one’s self worth, values, showing of self respect or self-confidence. Self-efficacy refers to a person’s belief, whether he/she can successfully engage in and execute a specific behaviour. Therefore, emotions, self-esteem and self-efficacy are social cognitive process that an individual acquire and it is influenced by attachment relationships (Bowlby1969) constructed by children in early years of development.
Research has shown that communicating and involving families/carers in patient’s care plan not only improve recovery process of patients, it also provides an insight into the family dynamics. It further provides nurses with information about the social background of patients which may assist in framing questions. Furthermore, nurses have knowledge of what the family/carers know about the illness that the patient is experiencing. It is important to seek patients’ consent before information is solicited not forgetting the confidentiality clause.
Furthermore, health and class researchers agreed that there are clear relationship between patterns of mortality and morbidity (illness) and the patients’ social class (DH 1980). There exist health inequalities between social classes; patients from middle class have higher propensity to visit doctors than patients from lower class. Moreover, middle class patients possess better financial and other resources, (example, housing), to support them when discharged from the hospital, whereas patients in the lower class living in poorer, damp and overcrowded conditions are not able to draw on these resources to make positive effect on their healing process. Furthermore, lower class patients might be living in a rough area hence may be reluctant to venture out to participate in their daily activities (Roper et al) and this important for nurses to know so that adequate support are put in place before they are discharged.
The psychological and social factors are one of the two elements in psychosocial care. Additionally, spiritual wellbeing refers to the possession of a belief in some unifying force that gives purpose or meaning to life or to a sense of belonging to a scheme of existence greater than merely personal, is another dimension of psychosocial care (reference). Furthermore, their religion also plays a key role especially when it comes to nutritional requirements and different customs.
The essence of nursing practice as it relates to patients psychosocial care is for nurses to understand patients feeling by perceiving it as if it was of their own. Caring is defined as involving concern, empathy and expertise making things better for others and is based on compassion (Smith 1992 & Niven 2006). It is further based on the application therapeutic communication (Peplau1952) involving many familiar concepts, including maintaining eye contact, attentive listening to patient’s narratives and the use of silence, touch and humour appropriately, using empathy rather than sympathy and above all not to be judgemental. Therefore, warmth, acceptance, genuineness and empathy underpin the nursing ethos and this is the platform to focus away from the illness to that of the patient’s psychology (Baughan & Smith 2008) to create common ground in the midst of engaging or empowering the patients in their care.
Consequently, empowering the patients is giving them information and increasing their understanding, enabling them to cope with and take control of their disease and also to psychologically support them, rapport-building, reassurance, empathy and promoting self-esteem and in the long term to build their self-confidence. One should constantly maintain patients’ privacy and dignity (Faulkner 2000) and it involves getting the patients’ consent whilst preserving their confidentiality. Allen (2009) voiced the opinion of Wright (2004) that bad communication limits the extent that psychosocial care can be effectively given by the nurses to their patients, therefore, leading to stress.
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Stress is an interaction between an event in a person’s life which is perceived as placing considerable demands on his physiological and psychosocial life and it mediates a behavioural change to either alter or manage the stress (Baum 1990 cited in Taylor 2003 pg 153). There are three models of stress, firstly, Holmes & Rahe (1967) referred to stress as a response to a social readjustment scale where life events are rated on a scale from more stressful to less stressful. However, Ogden (2007) suggested that Seyles and Holmes & Rahe models only took into consideration the physiological external stressor and not the psychological factors such as their moods, emotions, thoughts and their behaviours and the environment.
Finally, the transactional model (Lazarus & Folkman 1984) of stress takes into consideration the wide range of factors that may influence the way a person copes with the demands of everyday life. So, instead of saying that a particular event is stressful, it considers that any event is potentially stressful; whether or not it is ultimately stressful for any one individual is likely to be mediated by a range of factors in the person’s own life.
Chronic pain if not properly sedated can cause stress, using the transactional model of stress, it suggests that when the pain occurs John’s reaction to it will depend on his primary appraisal. In this case, John concluded that it does experience sharper pain than he had ever experienced in his life. He is experiencing stress and this is termed secondary appraisal. The resource he has available to cope with this stress is the analgesic drugs and secondly the nurse who always uses encouraging words is sufficient to allow him to cope effectively with the stressor. Sometimes it is not enough and as a result experiences a response that one would refer to as a stress response (Sheridan & Radmacher 1992).
The nurse used therapeutic communication especially whilst bathing him and changing his bed linen to gain additional information. John has only months to live after diagnosed with lung cancer due to heavy smoking. He was his wife carer it was not a priority to see a doctor then and she passed away two years ago (Holmes & Rahe 1967). He has developed low moods, aggressive and low self-esteem which has lead him to abuse alcohol (Baer et al 1987 & Colder 2001) though Conway et al, (1981) suggested that people smoked more than drink when they are highly stress. He has lost his self-confidence and his abilities to focus on negative outcomes (Bandura 1994)
Furthermore, they expect to be given the right information when needed, not in jargons but in bit size in a way understood by the patient.
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