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Assessment Psychosocial Vital Signs and Care Planning

Irene Major is a 51 year old woman. She has given birth to two children, a boy at age 25 and a girl at age 28. Irene breast-fed the two children for one year each and has had no family history of breast cancer. She has witnessed incidences of palpable lumps growing on her breast, but since they disappeared, she never considered them to be serious. Irene has been having regular periods since she was 13, but recently, her periods have been irregular. Her last period was six months ago. She is taking ibuprofen for the treatment for arthritis, one to three tablets a day, between four to six hours. The tablets are taken orally. Irene’s medical history has not been characterized by many problems. She has also not taken hormone replacement therapies during her life. In the same manner, she has had no allergies. Using the following table, this paper points out three psychosocial needs facing Irene (under the three categories of psychosocial vital signs: coping, anxiety and perception). It also identifies the best intervention methods to solve them. These interventions are further assessed to determine their criteria for evaluation.

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Psychosocial Vital Signs Findings/potential issues Interventions Criteria for evaluation
Perception

Spade (2008) explains that, “Perception affects the meaning of situations and the way a person adjusts to circumstances” (p. 144). From the case study, we see that, Irene seems to be experiencing difficulty trying to adjust to her health status because of the way she perceives her health and its impact on her body. This difficulty prevents her from dealing with her predicament the right way. Here, the main issue affecting Irene’s ability to adjust to her new health status is body image issues.
Irene shows signs of having body image issues, especially regarding the breast surgery she is supposed to undertake to remove a lump in her breast. When the doctor told her that she would go through the breast surgery procedure, there were several thoughts going through her head. Most of these thoughts pointed out the fact that, she was worried about her body image. For instance, she pondered on how she would look, after the surgery. This shows a strong concern about her level of body image perception because she shows attributes of self devaluation, manifesting in the fear for the worse (Gorman and Sultan 2008).
Also, from her inner thoughts, she evaluates her self-worth, based on what her husband thinks of her (body) if she undertakes the breast surgery. In this regard, she feels her husband will look at her in a negative way, after having the surgery (Pawlick-Kienlen 2007, p. 1). Here, she probably thinks she will not worth the same attention she did before having the surgery. These thoughts go through her mind despite the confidence exhibited by her husband when booking the surgery.

Body Image To improve Irene’s body image, she should be enrolled in a support group. Here, she should be encouraged to understand that; body image is not made up of only one thing (Pawlick-Kienlen 2007, p. 1). Here, she should also be made to understand that her value as a woman is not just determined by her physical self. There is more to it. Since she is afraid that her husband may find her unattractive if she goes through with the breast surgery, she should be shown that her husband’s perception of her womanhood is not just determined by her physical features only. There are probably other factors that make her attractive to her husband. Such factors may include her personality, her kindness, her honesty and the likes (Cherry 2011, p. 2). These factors are often significant in her overall self valuation. If she focused more on these attributes and thought less about her physical features, she will feel better about herself. These attributes are best explained through a support group intervention. Irene’s interaction with her husband.

Responses from support group members

Irene’s psychosocial health

Community involvement

Personal enhancement

Motivation to undertake the breast surgery

Level of self determination

Coping

Spade (2008) explains that, “Coping is the ability to adapt, change, or live with a situation” (p. 144). Irene’s problem with coping emanates from her thoughts about what affects her health. The case study identifies that Irene experiences difficulty trying to confront her health concerns because she hesitates to see the doctor and book an appointment for screening. This hesitation shows that Irene is in denial about the health risks she faces. Therefore, Irene constantly shows signs of denial which prevent her from taking responsibility for her personal health. Even though she drives through a billboard explaining that, there is a chance for women aged 50-69 to have a free mammogram check up, she never signs up for the health check. This behavior shows a strong sense of denial (Pawlick-Kienlen 2007, p. 1). In fact, Irene acknowledges that she was pushed by her husband to take the mammogram. Irene’s denial is evident from the fact that, she delayed her mammogram test, even though she repetitively told herself that she would voluntarily go for the test. The intention to go for the test was therefore present, but she could not get to book an appointment. People who do not have denial do not need the support (or push) from other people to undertake certain activities (Pawlick-Kienlen 2007, p. 1). Irene therefore lacks in this regard.

Denial Encouraging an open-plan environment is a crucial intervention strategy to help Irene overcome her strong sense of denial (Dawkins 2011, p. 1). An open-plan environment would work towards this objective by ensuring there is a vibrant atmosphere, filled with activities that encourage better coping skills. This environment would discourage denial because there would be a support structure to help Irene better cope with her age. A support structure is essential in this setup because like-minded ideas need to be exchanged to motivate Irene to cope better with her advanced age and the health risks that surround her. In the context of Irene’s case, she should be encouraged to join a self-initiative group because it provides her with the right type of open-plan environment that supports a culture of adaptation (to health problems) (Pawlick-Kienlen 2007, p. 1). Irene’s respect of needs and space for others

Frequency of visits to the health centre

Knowledge of illness

Level of psychological adaptation to the illness

Anxiety
Spade (2008) explains that, “Anxiety, predominately a felt experience, is commonly
viewed on a continuum at mild, moderate, severe, and panic levels. Anxiety affects all dimensions of human response” (p. 145)”. Irene’s sense of anxiety emanates from her fear of the future. This concern affects her normal perception about personal health. However, the same concern affects her perception about future health. Regardless, from this understanding, we can see that Irene’s main anxiety issue is the fear of the future, especially with regard to her health status. The fear of the future is a major psychosocial need experienced by Irene because she becomes increasingly wary of the health risks posed by her old age. She also constantly complains to her husband about the various health risks she ought to be concerned about because of her advanced age. She also makes reference to the bowel cancer kit she bought, and the increased concern about her reproductive health. Moreover, she grumbles to her husband about the increased health risks posed by their old age. In the same context, she even makes reference to her husband’s concern about prostate cancer. These fears show a strong fear of the future because Irene feels really insecure about her age (Widener 2011, p. 1). At old age, she feels more predisposed to health risks, especially because she is turning 52. In fact, this concern was the main reason she decided to go for the mammogram test. Her fear of the future is even exposed by her husband, when he tells her that she needs to go for the mammogram test so that she can ‘get over her fears’ (Widener 2011, p. 1).
Fear of the Future There are very few interventions that can be carried out to enable Irene get over her fear for the future. However, most of the practical interventions revolve around getting the right kind of information about her health (Widener 2011, p. 1). Obtaining the right information about Irene’s health should be done in the context of a one-on-one session with a peer counsellor. This intervention strategy enables Irene to embrace her age and accept that ageing is part of life (and not necessarily a bad thing). If she gets expert advice from a qualified counsellor, she would be told how to ‘live right’. This would involve activities such as eating healthy, exercising, avoiding stress and such like factors. If she attended several counselling sessions, she would feel more secure about the future, by acknowledging that she is reducing the likelihood of suffering health risks as a result of poor lifestyle choices (Widener 2011, p. 1). Frequency of interaction between the peer counsellor and Irene

Irene’s ‘loving’ attention

Emotional behaviours (such as laughing, crying and smiling)

Patient out-reach

Frequency of consultations

Irene’s self-esteem

Counselling relationship

This study notes that, Irene experiences body image issues, is in denial and is uncertain about the future. To solve these concerns, this paper proposes several intervention strategies to curb Irene’s issues. To solve her body image issues, Irene should be enrolled in a support group. Here, she will be made aware that there is more to body image than physical features only. To solve Irene’s problem of denial, Irene should be introduced to an open-plan environment which has the necessary structures to help her get over this issue. Finally, to solve Irene’s uncertainty about the future, she should be encouraged to attend a peer counselling session (Widener 2011, p. 1). These strategies will help her get over her issues.

References

Baumeister, F 1996, ‘Relation of threatened egotism to violence and aggression: The dark side of self-esteem’, Psychological Review, vol.103, pp.5–33, Web.

Cherry, K 2011, ‘Hierarchy of Needs’, Web.

Dawkins, J 2011, ‘How to Foster Self Initiative in the Workplace’, Web.

Gorman, L & Sultan, F 2008, Psychosocial Nursing For General Patient Care, F A Davis Company, Philadelphia.

Pawlick-Kienlen, L 2007, ‘3 Steps to More Self-Confidence for Women’, Web.

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Spade, C 2008, ‘Psychosocial Vital Signs’, Nurse Educator, vol.33, no.4, pp. 181-186.

Widener, C 2011, ‘Getting Over Fear and On with Your Life’, Web.

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