In the discussion part explain the behavioral and psychological responses identified
in the patient/family to their illness in relation to the literature presented in your
introduction and literature review section. Use evidence to support the key issues you’ve
identified in your literature review. To do this effectively, you’ll need to critically analyse
and evaluate your Literature.
? Also, consider external (e.g., social and physical environmental) factors NOT just the
internal causes such as the illness, biology, or personality etc
? In this section, also discuss how the nursing/paramedic care management issues
contributed to the patient/family’s behavioural and psychological responses and how they
affect the patient’s outcome. Link it with case study.
Behavioral and psychosocial responses
As mentioned by Abdel-Kader, Unruh, & Weisbord, 2009, patients diagnosed with
chronic kidney disease (CKD) have difficulty in falling asleep. One of the main causes of
disturbed sleeping pattern is restless leg syndrome (RLS). RLS occurs when the patient legs are
at rest, and is associated with itchy, painful and irritating feeling. This experience is exacerbated
by alcohol, tobacco and caffeine. In addition, it has been hypothesized that inadequate dialysis
clearance can lead to poor sleeping pattern. This is because build up of waste in blood causes the
patient to feel uncomfortable and ill due to toxins build up in the patient’s body. Emotional
health such as anxiety, sadness and worry can keep the patient up at night, thereby altering her
sleeping pattern (Iliescu, Yeates, & Holland, 2004).
Depression and anxiety is also another common psychosocial response in patients
diagnosed with CKD. According to Boer and colleagues 2007, depression is associated with
multiple outcomes such as rates of hospitalizations, poor treatment compliance and impaired
health related quality of life. In this Mr Jacobs case, the most likely cause of depression is that he
Behavioral and psychosocial responses
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has a lot of information to process about his health, leading to strong emotions about changes in
his life that could bring up despair. For instance, some restrictions such as fluid intake, control of
diet and discomforts associated with insertion of arteriovenous fistula, central venous catheters
and the sound of the dialysis machines are other sources of depression in patients diagnosed with
CKD. These complex daily functioning and fear of future influence patient’s level of anxiety.
This is because they cause unfavorable self image causing negative emotions such as anger,
disappointment, dissatisfaction and despondency.
Jenifer and Veronica 2013, report that socio economic status also affects the
psychological and behavioral responses to CKD. The study indicates that patient’s income,
occupation, wealth and education influences their responses, with people from low economic and
education background experiencing the most negative responses. Smoking and alcohol use also
increases risk for CKD progression through oxidative stress, tubular atrophy, endothelial
dysfunction; which in turn increases risks for depression. When these environmental factors
exceed the adaptive capacity of the patient’s psychological and physiological responses, they
develop a condition known as stress. This is associated with tissue damage and progression of
the deases.
Nursing care management and its influence on patient’s outcomes
According to Siedel and colleagues 2014, classical social relationships affect the patient’s
well being. Evidence based research indicates that patients that have sparse social support have
high risk of dying. The exact mechanism of dense social support as a protective mechanism in
patients diagnosed with CKD is unknown, but it is hypothesized that such support protects the
patients against the environmental threats to their health. Mr. Jacob condition is deteriorating
Behavioral and psychosocial responses
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because he is not receiving the adequate social support. He has the difficult of going to social
functions and the feelings are overwhelming. Janice feels overwhelmed with taking care of
taking care of Mr. Jacobs because she performs all her household chores and Mr. Jacobs is
uncooperative.
Włoszczak-Szubzda ,Jarosz, & Goniewicz, 2013 argue that elementary duty of nurses is
to give assistance and CARE- which is an acronym referring to “Comfort, Acceptance,
Responsiveness and Empathy.” The psychological comfort of the patient is determined by the
nurse’s skills in undertaking sensitive health issues. Poor nursing care plans results into greater
patient’s discomfort and risk of getting depressed. The concept of acceptance refers to respecting
of patient’s feelings as well as their attitudes. For instance, the nurse accepted Mr. Jacobs’s
decision of refusing to take sedatives. To ensure positive behavioral and physiological responses,
the nurse must be cultural competent.
Responsiveness refers to Nurse’s perceptions on the patient’s verbal and non-verbal
communication, listening and observing the patient, paying attention to the patient’s gestures,
hesitation, and the body sign language. For instance, the nurse in the dayshift observed that the
patient was irritable and anxious. However, no interventions are made to manage the patient
anxiety, which is probably the reason why Mr. Jacobs could not sleep. The last aspect is
empathy, which is basically the nurse’s capability to experience the psychological states of the
patient, and the skills of understanding their thinking and disease perception. This aspect is
important especially when designing patient education on effective coping strategies
(Włoszczak-Szubzda ,Jarosz, & Goniewicz, 2013).
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References
Abdel-Kader, K., Unruh, M.L., &Weisbord, S. D. (2009).Symptom burden, depression, and
quality of life in chronic and end-stage kidney disease. Clin J Am Soc Nephrol.
4(6):1057-64.
Boer, K. R., Mahler, C. W., Unlu, C., Lamme, B., Vroom, M. B., Sprangers, M. A., …
Boermeester, M. A. (2007). Long-term prevalence of post-traumatic stress disorder
symptoms in patients after secondary peritonitis. Critical Care, 11(1), R30.
Iliescu, E. A., Yeates, K.E., & Holland, D.C. (2004). Quality of sleep in patients with chronic
kidney disease. Nephrol Dial Transplant. 2004 Jan;19(1):95-9.
Jennifer F., and Veronica J. T, (2013).“The Psychosocial Experience of Patients with End-Stage
Renal Disease and Its Impact on Quality of Life: Findings from a Needs Assessment to
Shape a Service,” ISRN Nephrology, vol. 2013, Article ID 308986, 8 pages, 2013.
Seidel UK, Gronewold J, Volsek M, Todica O, Kribben A, et al. (2014) Physical, Cognitive and
Emotional Factors Contributing to Quality of Life, Functional Health and Participation in
Community Dwelling in Chronic Kidney Disease. PLOS ONE 9(3): e91176.
Włoszczak-Szubzda A, Jarosz MJ, Goniewicz M. (2013). Professional communication
competences of paramedics – practical and educational perspectives. Ann Agric Environ
Med. 20(2): 366–372.