Psychosocial Essay free essay sample

The purpose of this essay is to demonstrate knowledge and understanding of both psychological and sociological factors that may impact on the patient/client and also relate to psychological and sociological theories and National Policies. The real name of the client has been changed to protect the patients confidentiality (Nursing and Midwifery Council 2008) NMC. The patient I will be discussing is Mark, a 42 year old man who has worked for a construction company for the past 20 years. Mark is married and has three children ages 3, 4, and 8. Following an incident at home in which Mark fell 15 feet off a roof, he has had persistent chronic lower back pain. Two surgeries over the past 12 months have failed to alleviate his pain. Mark is currently out of work because of this and his wife has had to take on a second job working evening and weekends to make ends meet. Mark has no previous medical history and he classifies himself as being generally healthy. We will write a custom essay sample on Psychosocial Essay or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Prior to his accident, Mark was very active; playing football with his mates on weekends, jogging every morning, going to the pub, holidays with family and having fun with the kids. Presently Mark is unable to stand for long periods of time; this has affected his quality of life as a whole. The reason I have chosen this patient is because he has a condition that I may encounter in my own personal life and I am highly interested to learn about the impact it may have psychologically and sociologically on individuals. Psychological Aspects The psychological factors that Mark may encounter because of his physical condition may include depression, anxiety/anger, sleep disturbances and possibly low self-esteem. According to Abramson et al (1989), depression is caused by internal stable and global attributions for bad events and external unstable and specific attribution for good events. Depression may occur with mark because of the lowered pain tolerance and may decrease his willingness or ability to comply with medical advice. Mark may also be heightened with his perception of pain; he may become reluctant to carry out treatment modules provided to him because of fear of encountering more pain or injury. The combination of immobility and depression can lead Mark to be irritable, nervous or anxious and have an unhealthy desire for isolation; marital conflicts may also develop and escalate. As the depression sets in, Mark may become more angry, easily frustrated, moody, and plagued with feelings of hopelessness. Anxieties may interfere with Marks ability to concentrate; he may find himself worrying about his health and other life stressors such as finances, providing for his family etc. Anxious thoughts such as catastrophizing (e. g. uminating about the negative impact of pain and worrying about whether the pain will get worse), may increase his pain further and encourage disability. After having two unsuccessful operations on his back, Mark may also have doubts about recovering and therefore may also lose hope. As pain often prevents sleep, Mark may also be affected with constant state of tiredness because of sleep deprivation. According to Lamberg (1999), sleep disorders and persistent pain mutually interact, and it is often a clinical challenge to determine if the pain is due to poor sleep quality or whether sleep disturbance is due to night pain. For example, sleep deprivation can trigger a decrease in pain tolerance and pain thresholds (Onen et al 2001). Conversely, chronic pain may lead to non-restorative sleep and sleep fragmentation, as well as unpleasant consequences such as impaired thinking and greater proneness to accidents. Mark may also experience low self-esteem, having feelings of being unworthy or not measuring up to others and feeling incapable of achievements or successes in life. Body image disturbances such as weight gain may also be a contributing factor to Marks psychological well being. Weight gain can be a side effect of many medications, physical changes combined with an inability to exercise or perform physical tasks can have a negative impact on his body image, in extreme cases this may lead to eating disorders, but much more commonly it affects a person’s self-esteem (Burton et al1995). According to Burton et al (1995), self esteem can have negative consequences such as attempted suicide or withdrawal from friends and family. In relation to my client’s condition, I believe the Behaviourist theory most applies to him. Schwartz et al (1982) mentioned that, Behaviourism is a learning theory that only focuses on objectively observable behaviours and discounts any independent activities of the mind. Behaviour theorists define learning as the acquisition of new behaviour based on environment conditions. Experiments by behaviourists identify conditioning as a universal learning process. There are two different types of conditioning, each yield a different behavioural pattern. The first is Classic Conditioning discovered by Pavlov (1903), which occurs when a natural reflex responds to a stimulus. According to Pavlov (1903), we are all biologically â€Å"wired† so that a certain stimulus will produce a specific response. The second is Operant Conditioning by Skinner (1931). This occurs when a response to a stimulus is reinforced. Operant Conditioning is a feedback system in which a reward or reinforcement follows the response from a stimulus, and then the response becomes more probable in the future (Skinner 1931). Behaviourists tried to show that all behaviour could be shaped, altered, weekend or strengthened as a direct of environmental manipulations. Fordyce et al (1968) were the first to apply the behaviour model to pain. It was thought that there was a simple casual connection between pain and its rein-forcers. The respondent acute pain was seen as a reflexive response to antecedent stimulus and the respondent pain may eventually evolve into operant and persisting pain if the environment offers pain contingent reinforcements. According to Gamsa (1994), pain behaviour may also be learned by observing â€Å"pain models† i. e. individuals who exhibit such behaviour or more complex factors such as personal dynamics, emotional state, physical vulnerability and numerous psycho-social variables that have not been addressed. Fordyce et al (1968) proposed that operant pain persisted because of the behaviour of others (family, friends and healthcare providers) during the acute pain stage, which reinforced the pain to return secondary gains, such as permission to avoid chores or obtain otherwise unobtainable attention and care. The relation between the Behaviourist theory and my client is, the stimulus may be the intake of analgesia (pain relief) and associating that with being pain free, feeling more comfortable, being less irritable and having a better concentration level every time he consumes some. This in turn can activate the response (being pain free) from the stimulus (intake of analgesia). However, if the analgesia were to be eliminated, he may associate that with more pain, discomfort and irritability etc. Hubplace (2010) mentioned that the intake of analgesia may have negative impact on individuals as it can become addictive. Mark may be prone to addiction of pain relief because of the chronic pain he is experiencing on his back. Under the Classic Conditioning, Mark’s fear and anxieties about his condition can trigger a natural reflex which may create a response (pain) from a stimulus (fear/anxieties). Marks pain may also increase because of his environmental factors, not being able to do the things he used to do, for example playing with the kids, recreation activities, bathing, socialising etc. Family members, friends and his children may reinforce his pain also by the way they treat him, talk to him, and behave around him. Conditioning of pain is the main relation of the theory to my client; Mark may condition his pain with his behaviour of being in constant pain when in actual fact the presence of pain may actually be absent. Sociological Aspects The Sociological factors that Mark may encounter include loss of identity, daily activities, employment status, intimacy/sexual activity, social isolation, marital/family relations and financial strain. As Mark is currently out of work, he is faced with a financial strain; the family may experience a loss of wages and fuel a financial burden on the couple, causing conflicts and disagreements within the marriage and possibly altering their life style from what it used to be. Prior to Marks onset accident, his identity may have revolved around his job, hobbies and family. His condition could have significant consequences, such as limiting the range of enjoyable activities, for example, going to the pub, holidays, playing with his kids, working and providing for his family. Chapman et al (1993) mentioned that, individuals who were unable to work because of chronic pain found that their conception of themselves as a hard-working provider for their family was severely challenged, which can perpetuate feelings of guilt, depression and social isolation. According to the Organisation for Economic Co Operation and development (OECD 2005), Social isolation is characterized by a lack of contact with other people in normal daily living, in the work place, with friends, and social activities. OECD (2005) define social isolation has being a symptom and cause of social distress. It may follow a difficult event in a person’s life, for example, the loss of a job, the breakdown of a marriage, illness or financial difficulties. Feelings of isolation can occur in Mark making it difficult or him to reintegrate socially, this can affect moral, and the lack of contacts with other people may reduce both social and economic opportunities for him. The chronic pain in his back may be linked with the concept of suffering which includes; threats to ones integrity, ones wholeness, predominance of negative emotions, overwhelming helplessness and decreased ability to cope. This can be partly because resources are depleted by the persistence of the pain and accumulated losses including appearance, way of life and quality of life (Chapman et al 1993). The loss of intimacy is central to a decreased quality of life. Marks family may become irritated by his constant complaining of pain; his wife may be constantly hearing about the type of pain he is having, where the pain is occurring, and how he is attempting to cope with the pain. Some family members and friends may become desensitized to the pain, and consequently ignore his request for attention and support of pain relief. Marks children may also try to avoid him as he may become less loving, tender and nurturing as he used to be, he may even vent his frustrations and anger on his children and may not be able to tolerate noise, discomfort or even the very presence of his children. Chronic back pain constrains the expression of intimacy in many activities, for example, sex (Schlesinger1996). With regards to sex, Mark may have fears of increasing pain, therefore varying the amount of willingness to learn non-painful/less painful intimate behaviours which in turn can affect his sexual desires. For example, something as rewarding as sex is not going to be seen as desirable if it always involved pain or if the pain makes the person unable to function well in their sexual behaviours, for instance, obtaining and maintaining an erection. The Sociological theory that relates to my client is the Role Theory. Role Theory suggests that human behaviour is guided by expectations held by individuals and other people (Biddle 1986). The expectations involve different roles individuals perform or enact in their daily lives; for example a father, friend or son. The Role Theory implies that if individuals have information about the role and expectations for a specific status, for example a doctor, accountant or dentist, a portion of the behaviour of the persons occupying that position can be predicted. For instance, a doctor is expected to diagnose an illness and prescribe medications, this can be predicted from individuals. There are several extensions of the Role Theory; one that relates to my client is the â€Å"impression management† which is a theory and process developed by Goffman (1961). This theory argues that individuals are constantly engaged in controlling how others perceive them. This process refers to the influence of other people’s perceptions by regulating and controlling information in social interaction. If an individual tries to influence the perception of their own image, it is called self-perception (Goffman 1961). He suggested that individuals were like actors if placed on a face to face situation. It implied that individuals were aware of how they were being perceived by their audience. With relation to my client’s physical disability, Mark may be faced with the alteration of his roles, for example, as the provider for his family, a father to his children, a husband to his wife, a friend and colleague to his work mates. Having been off from work for some time, Mark is faced with the loss of earnings therefore losing the role of the provider or head of the family. Under the Impression Management Theory, Mark may be aware of how his family may perceive him due to his unemployment status. The role of a friend may also be absent has he may isolate himself from friends and society as a result of being restricted on doing the things he used to do prior to his accident. The role of a father may also be affected as he may lose all interest in interacting with his children, playing games or bonding with them. The pain that he may be experiencing on his back may take all of his attention, making it hard for him to focus on anything else. The role of a lover and husband may also be affected; his libido may decrease due to the fears and anxieties of acquiring further harm or pain and the closeness he used to have with his wife may also be affected due to her always working and not having enough time together as a family. This may cause conflicts within their marriage and may possibly lead to divorce, causing Mark to lose the role of a husband. National Policies The Department of Health (2006) suggest that information about life style choices that promote good musculoskeletal health should be available to the public from the education, health and community services in a range of languages and formats. The information should be evidence based of consistent equality and should include information on physical activities, diet and nutrition, exercise, self management and the prevention of injuries. It should be available in settings such as the work place, primary nd secondary care services, schools, leisure facilities, pharmacists and centres for further education and specialist musculoskeletal clinics. This policy would help Mark to manage his condition if and when he eventually returns back to work. Having the knowledge of the risk factors and the prevention of further harm to his back may help to minimise his pain and discomfort in the future. To conclude, chronic back pain can have many consequences to an individual’s quality of life, these may include; social activities, mental state and sexual relations. The management of chronic back pain doesn’t only rely on the physical side of it but also the psychological being of the individual. If both the physical and psychological management of pain is achieved, the chances of the individual overcoming their condition/disability are much higher. However, there are no guarantees that the pain will be alleviated completely. This assignment has helped me to gain the understanding of the psycho-social factors that illnesses can influence on individuals. Individuals need to be treated as a whole, for their physical/physiological, social and psychological well being to ensure that the best quality of care and treatment is being implemented. I hope to put this knowledge into practice in the near future as a qualified nurse. When assessing patients with their illnesses and conditions, I hope to recognise the psycho-social implications that may affect their everyday life and give them as much support as I can and if necessary refer them to the relevant people. ,