Meeting the psychosocial

needsPresented by:

Mr. Anslin., M.Sc(N)HOD Mental health nursing

Sacon

Knowledge an culture diversity is vital at all levels of nursing practice. Ethnocentric approaches to nursing practice are ineffective in meeting health and nursing needs of diverse cultural group of clients.

Psychosocial needs

Knowledge about culture and their impact on interaction with health care is essential for nurses, whether they are practicing in a clinical setting education, research and administration.

Cont…

Knowledge and skills related to cultural diversity can strengthen health care delivery systems concept of illness, wellness and treatment modalities evolve from a cultural perspective.

Cont…

Cultural diversity in nursing practice derives its conceptual base from nursing, other cross cultural health discipline and the social science such as anthropology, sociology and psychology.

Concept of cultural diversity

“Cultural diversity” refers to the difference between people based on a shared ideology and valued set of beliefs, norms, customs and meanings evidenced in a way of life.

Definition

Define:Stress is the “Non- specific response of the body to any kind of demand made up on it”.

- Selye (1956)

Stress is the arousal of mind and body in response to demands made upon them.

- Schafer (2000)

Stress and adaptation

Stress is a condition in which the human system response to change in its normal balanced state. Stress result from a change in the environment that is perceived as a challenge a threat or a danger.

- Pender, Murdaugh & Parsons (2006)

Cont…

Major life changesStress can also be self generated WorkRelationship difficultiesBeing too busyFinancial problemChildren and family

Common external causes of stress

Inability to accept uncertaintyPessimism Negative self talkUnrealistic expectationLack of assertivenessPerfectionism

Internal causes of stress

Cognitive

symptom

memory concentration Judgment

Signs and symptom of stress overload

Physical symptom

Diarrhea Chest pain

Nausea & Dizziness

Cont…

Emotional symptom

moodinessAgitation

& Irritability

Loneliness

Cont…

Behavioral

symptom

Eating more/ less

Using alcohol/ cigarette

Sleeping too much

Cont…

Coping:Coping is the ability of

person to adjust with situation. Adaptive coping mechanisms are those that promote health while helping the person successfully reduces stress.

Stress adaptation

It is a natural or learned way of responding to a changing environment or specific problem or situation. There are two type of coping strategies:.

1. Problem focused coping2. Emotional focused coping

A coping strategy

Problem focus coping improve a situation by making changes or taking some action.

Emotional focused coping thoughts and actions that relieve emotional distress. It does not improve situation but the person often feels better.

Which is divided in to two:

Coping

Long term coping

Change life style pattern such as

eating health diet, exercise regularly, problem solving & decision making

Short term coping

Using alcohol beverages or

drug, day dreaming.

a) Nursing history: Nurse should assess for client perceived stressors, manifestations of stress and past & present coping strategies.

b) Physical examination: Indicators of stress (Nail biting,

nervousness, weight change) Stress related health problem

(Hypertension, Dyspnea).

Nursing assessments of a clients stress and coping patterns include

Diagnosis:

Anxiety

Family coping

Fear

Impaired adjustme

nt

Planning

Resolve or

Decrease Anxiety

Increase ability to manage

Planning

Improve role

performance

Teach health activities of daily living Eg: Exercise, Rest & sleep, Nutrition

Encourage use of support system Encourage use of management technique Massage and progressive relaxation. Anticipatory guidance (psychologically

preparing herself for an unfamiliar painful event)

Guided imagery and Bio feed back Therapeutic touch (Music, Humor, Laugh)

Implementation

Nurse collect data in accordance to outcome criteria established.

Evaluation activities.

Evaluation

It is one’s mental image of one-self A positive self concept is essential to

a person’s mental and physical health Individuals with a positive self

concept are better able to develop and maintain interpersonal relationships and resist psychological and physical illness.

Self concept

Individual who have a poor self-concept may express feelings of worthlessness, self-dislike or even self-hatred

They may feel and sad or hopeless and may state they lack energy to perform task.

Cont…

Self concept is a complex idea that influence the following:-

How one thinks, talks & acts

Choice one make

Ability to take action to change things

How one see and treats another person

Ability to give and receive love

1) Self knowledge – once ability, nature, limitation, insight.

2) Self expectation – Realistic/ unrealistic

3) Social self – how a person is perceived by others/ society.

4) Social evaluation – the appraisal of oneself in relationship to others.

Dimension of self concept

Components of self concept

Components of self concept

Personal identity

Body image

Role performance

Self esteem

Personal identity is conscious sense of individuality and uniqueness that is continually evolving throughout life.

People often view their identity in term of nature, sex, age, race, ethnic origin or culture, occupation or roles, talents and other situation characteristics (eg: marital status and education).

1. Personal identity

The image of physical self in how a person perceive the size,

appearance and function of the body and its part. Body image is the sum of person’s

conscious and unconscious attitude about his or her body.

This does not necessarily have to reflect reality (Thin – fat).

2. Body image

Throughout life people undergo numerous role changes. A role is a set of expectations about how the person occupying once position behaves.

3. Role performance

It is one’s judgment of one’s own worth, that is how that persons standards and performance compare to others and to one’s ideal self.

4. Self esteem

When thinking about the six topics sometimes we make judgments about how much we approve or disapprove of ourselves. Those judgments will affect how we behave and how much we think we can secured.

Judgments

If there is a mismatch between how you see yourself (eg: your self image) and what you’d like to be (eg: your ideal self) then this is likely to affect how much you value yourself. therefore there is an intimate relationship between self image, ego- ideal and self esteem.

Ideal self:(what you’d like to be)

A person ideal self may not be consistent with what actually happens in life and experience of the person. Hence a difference may exist between a person’s ideal self and actual experience. This is called incongruence.

Cont…

Incongruent Congruent

Self image

Ideal self

Self image

Ideal self

The self image is different to the ideal self. There is only a little overlap. Here self actualization will be difficult.

The self image is similar to the ideal self. There is a more overlap. This person can self- actualize.

Self awareness (Infancy)

Self recoganitation (18 months)

Self definition (3 years)

Self concept (6 – 7 yrs)

Stages in the development of the self

To promote a positive self- concept include helping a client to identify areas of strength for ex: writing, painting, music, sports.

The following nursing technique may enhance self esteem…

1. Encourage client to express their feelings2. Provide accurate information3. Avoid criticism 4. Explore clients positive qualities

and strength.

Nursing intervention

Many disease, accidents, illness and their treatments create sexual dysfunctions and role changes. Rehabilitation nurses are in an excellent position to address these issues with their client. To accomplish this, nurses need to overcome barriers, such as cultural and professional stereotyping, and lack of education.

Sexuality

Nurses must also develop an awareness of belief, attitudes and values related to sexuality, and awareness of how these beliefs, attitudes and values affect their practice.

Rehabilitation nurses have an important role in assuring that experiencing a disability, having a chronic illness or aging does not need to translate into permanent sexual loss or eliminate the ability to give and receive affection.

Cont…

Spirituality generally involves a belief in a relationship with some high power, creative force, drive being or infinite source of energy.

Ex: person may believe in god.

Spirituality

Spirituality is unique to each individual Your “spirit” usually refers to the

deepest part of you, the part that lets you make meaning of your world.

Your spirit provides you with the revealing sense of who you are, where you are here of what your purpose for living is.

It is that inter most part of you that allows you to gain strength and hope.

Spiritual health

The basis of spirituality is discovering a sense of meaning fullness in your life and coming to know that you have purpose to fulfill.

Spiritual wellness

Spiritual distress refer to a challenge to the spiritual well being or to the belief system that provides strength, hope and meaning to life.

Spiritual distress

Treatment related factors

Factors causing spiritual distress in person are:-

Situation

factors

Physical problem

Ex: Pain, experiencing loss of body parts or function, terminal illness.

Blood transfusion, surgery, abortion, amputation of a body.

Death, illness

No one really knows for sure how spirituality is related to health. However it seems the body, mind and spirit are connected.

Some research shows that things such as positive beliefs, comfort and strength gained from religion, meditation and prayer can contribute to healing and a sense of well being.

Improving your spiritual health may help you feel better, prevent some health problem & help you cope with illness, stress/ death.

Spirituality in relation to health

For many people, religion and spirituality are a significant part of who they are, many patient turn to religion & faith as they try to find meaning in their illness and cope with their altered life situation.

Religious faith and spiritual coping has been observed in patient with some disease.

Spiritual needs of patient

If these needs are not addressed, internal struggles may result in existential crisis leading to dejection and perception of being abandoned.

(ex: god does not care for me) The components of a spirituality

based indicator would include a vision of a peaceful and united future: The selected principles.

Cont…

Principles Unity in diversity

Equity and justice

Equality of the sexes

Trustworthiness and moral leadership

Independent investigation of truth

The loss of a loved one is life’s most stressful event and can cause a major emotional crisis. After the death of someone you love, you experience bereavement, which literally means “to be deprived by death”.

When a death take place, you may experienced a wide range of emotion.

When a death is expected, then there is no real order to the giving process.

Coping with loss

Some emotion you may experienced include:

Denial

Shock

Despair Anger

Guilt

Disbelief

ConfusionSadnes

sEmotion

s

It is not easy to cope after a loved one die, you will mourn and grieve.

Mourning is a natural process you go through to accept a major loss.

Mourning may include religious traditional honoring the death or gathering with friends and family to share your loss.

Mourning a loved one

Mourning is personal and may lost months or years.

Profound emotional reaction may occur. (Ex: anxiety, chronic fatigue, depression and thoughts of suicide).

Cont…

It is very important to allow yourself to express these feelings. Many people report physical symptom that accompany grief. (stomach pain, loss of appetite, intestinal upset, sleep disturbance and loss of energy. Mourning can seriously discussed by your relationship with the person who died.

Dealing with a major loss

Child death arouses an overwhelming sense of injustice – unfulfilled dreams and senseless suffering. Parents may feel responsible for the child’s death. Parents may also feel that they have lost a vital part of their own identity.

A child’s death

A spouse death is very traumatic. The death may cause a potential financial crisis if the spouse was the family’s main income source.

A spouse’s death

Elderly people death may be especially vulnerable when they lose a spouse because it means losing a life time of shared experiences. At this time, feeling of loneliness may be compound by the death of close friends.

Elderly people

Define: Grief is a reaction to a major loss. It is most often an unhappy and painful emotion.

Painful psychological and physiological response to loss.

Grief

Causes, Incidents, Risk factors

Death of loved one

Illness

Chronic condition affect quality of

life

Diverse

Symptoms/ Process Denial, Disability, Numbness

Anger, Blaming others

Bargaining

Depressed mood, sadness & crying

Acceptance

1. Seek out caring people (find relatives and friends who understand).

2. Express your feelings (tell others).3. Take care of your health (meet physician).4. Accept that life is for the living .5. Postpone major life change (moving,

remarrying, changing job).6. Be patient 7. Seek outside help when necessary.

Way to cope effectively with your pain

Helping others

grieves

Share the sorrow

Don’t offer false

comfort

Offer practical

help

Be patient

Encourage

professional help when

necessary

Examples of therapeutic health care modalities are:

Creative therapeutic environment

Life style modificationRecreational &

divisional therapy

Life style modification

Meditation

Imagery

Therapeutic

touch

1. Music therapy2. Activities according to the hobbies3. Play activities4. Reading5. Painting6. Yoga7. Exercise8. Group activities/ occupational therapy9. Other activities (watching tv, etc).

Recreational & diversion therapy

Thank you