George L. Engel has developed the bio-psychosocial model of health and illness. Wellbeing is considered not to be the condition of only absence of a disease or infirmity; it is the state of living a complete healthy lifestyle. Bio-psychosocial model consists of 3 elements that are bio-physiology, psycho- related to thoughts, emotions, behaviour and other coping methods and social- socio-economic condition, environmental condition and others.
For the complete wellbeing of a person, all the factors related to physiological, psychological and social conditions are required to be well-managed and content. Panov (2017) obtained results which indicates that considering the whole scenario in which the patient is living with a disease or disorder can be beneficial to the create a intervention plan for the client. Undertaking this concern, a collaborative physiological, psychological and social intervention is required to be developed by the health service providers to achieve complete wellbeing. For instance in the case of Rachel, some physiological (loss of appetite), psychological (lack of sleep), and social factors (harming the relationship with neighbours) have been identified. In order to achieve complete wellbeing of Rachel, the mentioned factors are to be addressed for intervention.
In the process of assessment, information about all the important health related factors that are associated with the lack of wellbeing within a person are required to be collected for effective diagnosis and developing treatment plan. Each of the factors of bio-psychosocial model is dynamic in nature that collaboratively impact upon the experience of the patients (Sotomayor & Gallagher, 2019). A client may present his or her complaints to a healthcare provider that might include psychological, social and physical issues. For instance, a stress related behaviour such as refusal to daily meal can be identified by the health assessor however; this behaviour might be a response to any social factor such as experience of bullying and physiological factor that is loss of appetite due to metabolic problems as a physiological response to the bully incident (Hunger et al., 2020). Therefore, each of the factors mentioned were associated with each other and were affecting the wellbeing of a patient together, where addressing only psychological issues might not help in appropriate diagnosis and treatment planning. This is the reason based on which bio-psychosocial factors are required to be considered into the assessment process.
In the current case study Rachael is demonstrating some responses considering which some symptoms related to mood disturbance, deterioration of social relationships and physiological issues such as sleep disturbance and issues with appetite have been identified. Applying the bio-psychosocial model it could be identified that the mother of the patient had a diagnosis of manic depressive disorder and died when Rachael was only 16 years old. The issues mentioned here, such as mood disturbance of the client may be attributed to be predisposed by the physiological condition (genetic condition) of her mother (Fleury et al., 2016).
The genetic impression may have transferred to the client which made Rachael physically vulnerable to the outside incidents. As a response to the social factors such as trauma due to death of her mother and breaking up with her boyfriend, may have triggered the genetic condition to induce coping responses such as partying, listening to music in louder volume, changing clothing multiple times and day and others. Additionally, here are some social factors that are also impacting on the wellbeing of Rachael. These factors include warning from the landlord as a response to the complaints of the neighbours. These might have increased stress of the patient due to which she is demonstrating poor behaviour to her acquaintances and others.
Alnæs et al. (2018) mentioned that most of mental disorders are highly heritable where association of heritability with manifestation of depressive and manic behaviour was 80%. Here, genetic polymorphism can be considered as a factor for inheriting the genetic impression from Rachael’s mother. Genetic polymorphism changes DNA composition making individuals unique from each other. A combination of specific polymorphism can be attributed to the mental condition or disturbances in mood of Rachael. Additionally, the environmental factor such as breaking up with her boyfriend has also played an important role in triggering the responses demonstrated by Rachael. Hackett and Steptoe (2017) demonstrated that the particular factors or events that creates stress within an individual act collaboratively with the predisposing factors (which is genetic predisposition of manic depressive disorders in the current case) and induces responses. Additionally, deterioration of relationship with the neighbours is an indicator of lack of social support. It is a perpetuating or maintaining factor acting as a social factor for persistence of the behaviours mentioned.
Along with the medication and therapeutic support nursing interventions are paramount of patient wellbeing. In the current case, one of the important interventions that are required to be taken under consideration by the current practicing nurse is maintaining a low level of environmental stimuli such as maintain proper ventilation, avoiding bight illumination and eliminating loud noises. Loud noise, bright light and suffocation might increase stress of the patient due to which this intervention is required to be taken under consideration (Sotomayor & Gallagher, 2019). The nursing intervention will also include ensuring safety of the client and others. The nurse will require imposing some external controls (such as restriction for using alcohol or other unhealthy substances) without disrespecting the client’s privacy and preference. Along with that, proper diet assistance is required to be provided to the client. This will required collaborative intervention with the interference of a dietician in the current case scenario.
As per the protocol of International Council of Nurses, nurses are required to conduct extensive research on the factors that might contribute to the illness and required to practice management based on evidences (Mesukko et al., 2020). In the current case, the nurse is also required to develop high level of knowledge regarding the contributing factors to the illness of the client. As the client unable to sleep properly, the nurse is required to create an environment appropriate for sleeping and which does not increase the stress level or invokes traumatic responses. Another intervention planning is to impose some controls upon the client. It is due to the fact that stress responses of the client may lead to risky behavioural demonstration which might harm the client and others (Slemon et al., 2017). This is the reason due to which external controls are required to be put, though the process can never interfere into the privacy of the client. Additionally, the lack of proper diet may be acting as a factor for increasing stress of the client. Therefore, the nurse is required to collaborate with the dietician and a proper diet plan can be developed and followed by including the client into the decision making.
The key ethical principles in nursing include respecting the client’s individuality. The nurse is required to respect the individual perceptions, thoughts, choices and others. The client and the nurse may experience conflict of ideas during the time of nursing intervention (Gerace et al., 2018). For instance, Rachael refuses to take medication prescribed and it can impact her health in long run. The ideal intervention in this regard would have to be aligned with taking an empathetic approach where her mindset and the situational circumstances would be prioritised along with medication assistance.
The nurse intervening on the case of Rachael is required to protect the right of the client here. The treatment plan, schedule and other associated factors might interrupt the daily routine followed by the client. Panov (2017) obtained results which indicate that the nurse is required to take consent from the client before applying any intervention. The client is required to be educated about why the treatment plan is required to be followed and how it will be easier to maintain the prescribed actions. Therefore, Rachael will be included into the decision making process for creating her diet plan, medication use and attending therapeutic sessions. Apart from that the provisions and guidelines enforced by Health Practitioner Regulation National Act (2009) are also required to be followed for protecting the right of Rachael (ACT Government, 2020).
The nurse will also maintain the confidentiality of the information shared by the client. For instance, revealing of the deteriorating social relationships, breaking up with boyfriend and other related information might make the client feel embarrassed and depressed. This will delay the recovery of the patient. The nurse given the responsibility of assisting Rachael may be influenced by the ethical and legal requirements (Sotomayor & Gallagher, 2019). The nurse will be strictly guided by the ethical clinical practice standards where the actions will be restricted to the permitted assistance guidelines. The nurse will be required to strictly adhere to the medication program prescribed by the physician. In case of Rachael it will be difficult to follow strict guidelines. This might create ethical dilemmas with the nurse leading to high professional stress. Rachael may need help when the nurse in not in duty; after her shift starts the nurse will require communicating with the nurse taking care of Rachael while she was not around to ensure no discrepancy arrived in the intervention requirements and actions taken.
ACT Government (2020). https://www.legislation.act.gov.au/a/db_39269/
Alnæs, D., Kaufmann, T., Doan, N. T., Córdova-Palomera, A., Wang, Y., Bettella, F., ... & Westlye, L. T. (2018). Association of heritable cognitive ability and psychopathology with white matter properties in children and adolescents. JAMA psychiatry, 75(3), 287-295. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5885956/
Fleury, M. J., Grenier, G., Bamvita, J. M., Perreault, M., & Caron, J. (2016). Variables associated with perceived unmet need for mental health care in a Canadian epidemiologic catchment area. Psychiatric Services, 67(1), 78-85. https://ps.psychiatryonline.org/doi/pdf/10.1176/appi.ps.201400363
Gerace, A., Oster, C., O'kane, D., Hayman, C. L., & Muir‐Cochrane, E. (2018). Empathic processes during nurse–consumer conflict situations in psychiatric inpatient units: A qualitative study. International Journal of Mental Health Nursing, 27(1), 92-105. https://onlinelibrary.wiley.com/doi/pdf/10.1111/inm.12298
Hackett, R. A., & Steptoe, A. (2017). Type 2 diabetes mellitus and psychological stress—a modifiable risk factor. Nature Reviews Endocrinology, 13(9), 547. https://discovery.ucl.ac.uk/id/eprint/1562662/1/Hackett_ype%202%20diabetes%20mellitus%20and%20psychological%20stress.pdf
Hunger, J. M., Smith, J. P., & Tomiyama, A. J. (2020). An Evidence‐Based Rationale for Adopting Weight‐Inclusive Health Policy. Social Issues and Policy Review, 14(1), 73-107. https://spssi.onlinelibrary.wiley.com/doi/pdf/10.1111/sipr.12062
Mesukko, J., Turale, S., Jintrawet, U., & Niyomkar, S. (2020). Palliative Care Guidelines for Physicians and Nurses Caring for Children and Their Families in the Pediatric Intensive Care Units: A Participatory Action Research Study. Pacific Rim International Journal of Nursing Research, 24(2), 202-218. https://he02.tci-thaijo.org/index.php/PRIJNR/article/download/188181/163907
Panov, V. (2017, June). From Environmental Psychology to Subject-Environment Interactions. In 2nd International Conference on Contemporary Education, Social Sciences and Humanities (ICCESSH 2017). Atlantis Press. https://download.atlantis-press.com/article/25878796.pdf
Slemon, A., Jenkins, E., & Bungay, V. (2017). Safety in psychiatric inpatient care: The impact of risk management culture on mental health nursing practice. Nursing Inquiry, 24(4), e12199. https://onlinelibrary.wiley.com/doi/pdf/10.1111/nin.12199
Sotomayor, C. R., & Gallagher, C. M. (2019, March). The Team Based Biopsychosocial Model: Having a Clinical Ethicist as a Facilitator and a Bridge Between Teams. In HEC Forum (Vol. 31, No. 1, pp. 75-83). Springer Netherlands. https://www.researchgate.net/profile/Colleen_Gallagher/publication/326814713_The_Team_Based_Biopsychosocial_Model_Having_a_Clinical_Ethicist_as_a_Facilitator_and_a_Bridge_Between_Teams/links/5be99d6c4585150b2bb22b72/The-Team-Based-Biopsychosocial-Model-Having-a-Clinical-Ethicist-as-a-Facilitator-and-a-Bridge-Between-Teams.pdf
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