Psychological and social factors that may impact on the patient/client

1. Write about a patient client from their own discipline for whom they have provided care

2. Demonstrate knowledge and understanding of BOTH psychological and social factors that may impact on the patient/client.

3. Make reference to related psychological AND sociological theory AND national policy within the text using the Harverd system. (Student will NOT be allowed to bring any material into the examination.)

My client's pretended name is Hana. I met her at the hospital. She was admitted because she fall down at nursery home, where she lives, and break her right shoulder. In addition she is diabetic and has hypertension.

Hana is 75 years of age and she was my first experience as a training adult nurse. In the morning when the night nurses hand-over to the morning nurses they were complaining about her. They asserted that she did not sleep all night, she was screaming, shouting and swearing. All the other patients did not sleep too. The nurses also said that she was not able to go to theatre that morning because the nursing home could not provide information about her medicine. Even they do not know if Hana does take tablet for high blood pressure or insulin for diabetes. So the doctor want make sure about her health condition fist before the theatre.

When the nurses started their duty Hana started to scream saying that the pain is killing her. I was concerned about her and I did observe that her blood pressure was very high. The blood glucose was 21-7. The doctor prescribed insulin and high blood pressure tablet (الاسم). Also, the pain nurse prescribed morphine to relief the pain.

As usual the nurses were very busy, Hana was screaming and all the patients were holding their hands to block their ears. As a student nurse I want to test myself if I can communicate with Hana or not. I went to her and after greeting her I asked her “what was the problem”. She said that she had severed pain. When I asked her if she was hungry she said yes. I asked her what she preferred for breakfast, she said that she wanted cornflakes and tea without sugar. After I brought her breakfast she said that she does not want to eat because she can not sit. I called a nurse and we sat her up and I started to feed her at the some time talk to her and asked her if she has a family. I found that she does not have any family, she grown up at the foster home after world war. She used to work at pubs. She had a daughter but she lost her in the accident where they were driving a car to home coming from a party before 20 years and since that time her health started deteriorated. She also said that she is not happy at the nursing home and she believed that everybody hated her and they wish if she would die. She also said that they drop the water under her bed because they wanted to cause her the problem that she was in at the moment.

The nurses decided to put her in a side room alone and that time Hana started to scream and shout because she did not want to be in a room alone.

After I finished my duty and I went home I could not stop thinking about her. I found that Hana is not only suffering from physical illness (broken shoulder) but she is also suffering from psychological and sociological problem. According to psychologists there are many factors that determine our behaviour such as the genes we are born with, physiological brain, nervous system. Cognitive system, thoughts, perception. The social and cultural environments in which we develop over time. Life experiences including those from childhood and personal differences including our IQ personality and mental health.

Psychology is essential for health care professional because it enable the nurses to understand and care after the patient more holistically. Biological psychologists suggested that behaviour is controlled by the central nervous system. Therefore, it is important to study how the brain functions in order to understand behaviour (Growth, 2005). According to this nurses might analysis Hana's brain is not functioning well because she is getting older or she has other mental problem therefore she was acting like a child screaming, shouting and swearing at the nurses.

Additionally, Freud's theory of biological concept is that the human mind and personality are made up of three parts: The Id which is part of the personality that follows only pleasure and direct satisfaction and mental processes in the newborn babies are Id processes only and they do not care about others to meet their need (pleasure principle).

The ego: this part of personality is aware of reality and is in contact with the outside world. The ego also understands that other people have needs with the demands of the id and superego (reality principle).

The superego:

It is the moral part of us and develops due the moral which get from the caregiver and it contains the social conscience and through the experience of guilt and anxiety when we do something wrong and teaches the person acceptable social behaviour. Ego ideal make the person always feels conscience and guilt.

Most of Hana's mid and personality may made up of the Id and that the reason for being demanding and she keeps calling the nurses in the way that made them reply as soon as possible even though they were busy.

Beck (Cognition) believes that negative behaviour, thoughts and feeling are important factors which lead to depression. These negative thinking styles focus on what Beck describe as the cognitive trial (Growth, 2005). In Hana's situation, after her daughter's death her sadness and negative thinking deteriorates her health and she became very depressed.

The Humanistic approach studies personality from inside out. It emphasizes individual experiences and the basics of individual self worth. They believe that the person is unique and life experience and how it is interpreted is the key factor in determining who and what the person would become. Roger believes these states generally result from early childhood experiences with parents and other adult who make their love conditional. Hana grown up at the care home where she used to loved if she is behaving good or being rejected from her career if she behaved abnormally (conditionally). the experience in her childhood and she is linking this to her situation now. she thinks the nurses hate her because of her behaviour but at the same time she is screaming because she was in pain she could not help it.

Freud (psychoanalysis) considered part experience to explain present behaviour such as childhood, abuse and family brake up. Freud mentioned that there are five different sages of development in the early childhood which would affect the person's life as an adult if he/she had bad experienced. Hana's parents died when she was young and she grown up in a care home (Growth, 2005). According to Freud she may had bad experience in her early childhood which is affecting he now.

Jon Bowlby, British psychologists (1975) believes that the infant and young children should stay close and experience a warm and continuous relationship with tier mother and both should find it satisfaction and enjoyment. However, children who did not benefit from their mothers are considered to be suffering from maternal deprivation which contributes to delinquency. Hana may did not have enough attachment with her mother and this is resulting in not to feel shame of abusing the nurse and hit them.

According to social cultural humans are nitrated in a social world and within differing culture diversities. Consequently, this must have an impact on the behaviour of individual. Hana's anxiety can be understood only by going outside the individual and examine the social and cultural world in which she has grown. Hana was screaming at the nurse and swearing at them this it could be because they are from different culture and the culture she was grown up used to discriminate other culture which she learnt that from her social culture.

Hana was violence with nurses that could be she experienced violence in her childhood in where she grown up and this from the point of view of behaviourism. she may have a history of personality disorder and she is experiencing mental health problem which could be genetic factor.

Sociology is relevant to nurses because for the period of time that nurses is caring for patient they have a unique insight into their social world. Understanding why people talk and act in certain way, nurses may be able to adjust their behaviour to enhance the patient's experience.

In Hana's situation because she grown up in care home she did not learn the norms, values and how to socialise with different ethnic minority.

Hana is from lower social class which affects her health. Social stratification is a particular from of social inequality. It is refers to presence of distance social groups which are ranked on above the other in terms of factors such as prestige and wealth. Social stratification affects the morality and mobility of people's life. Some sociologists see the working class as the lowest stratum in capitalist societies and they use term such people underclass.

Hana's did not have such a social life because she has grown up with her family. According to some socialists family is very important.

There is a link between social class and morbidity, mortality and health social support will support the patient emotionally which can make the patient feel safe. because people with many supports such as, marriage relatives, church memberships live longer and tend to succumb less to stress related illness.

There are a number of ways in which health disparities play out based on different systems of stratification. Health disparities resulting from economic stratification are wide-ranging. Poorer women have reduced access to mammograms to detect breast cancer, even when they are better candidates for screening.[1] Wealthier people live longer than poorer people. Wealthier people in the U.S. today live about 4.5 years longer than poorer people (79.2 vs. 74.7, respectively).[2] Additionally, affluent and more educated people are more likely to take advantages of advances in medical science and technology and have seen a more rapid decline in smoking rates, which directly improves health.[2] Disparities in health care between the rich and poor are not inevitable - they are directly correlated with disparities in wealth. The differential and unequal treatment of the rich and poor follows the gap between the rich and the poor: From 1966 to 1980, socioeconomic disparities declined in tandem with a decline in mortality rates, but the disparity has since increased as income stratification has.[2]

Financial access to health care is not the only factor that affects health; poorer people are generally less likely to exercise, resulting in overall poorer health as well.[3] This is probably due to fewer opportunities to exercise and a less well-developed understanding of the importance exercise. Poorer individuals also live in more dangerous neighborhoods and are more likely to eat unhealthy food and engage in risky or unhealthy behavior, all of which contributes to poorer health.[2]

Researchers also find health disparities based on gender stratification. One study found that women are less likely than men to be recommended for knee replacement surgery, even when they have the same symptoms.[4] While it was unclear what role the sex of the recommending physicians played, the authors of this study encourage women to challenge their doctors in order to get care equivalent to men.

Health disparities based on race also exist. Similar to the difference in life expectancy found between the rich and the poor, affluent white women live 14 years longer in the U.S. (81.1 years) than poor black men (66.9 years).[2] There is also evidence that blacks receive less aggressive medical care than whites, similar to what happens with women compared to men.[2] Another contributor to the overall worse health of blacks is the incident of HIV/AIDS - the rate of new AIDS cases is 10 times higher among blacks than whites.[2]

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