Using the case study details provided. Apply the theory, terms and concepts encountered to analyse and discuss the behaviours Bill (refer to text book & other references). An essay format is required including an abstract.
Text Book: Health & Human Behaviour by Ken Jones & Debra Creedy (refer to attachment for for common terms & phrases. APA reference style)
Details of Case Study / Essay: 2,000 word approx
Using the case study details provided. Apply the theory, terms and concepts encountered throughout the subject to analyse and discuss the behaviours Bill (refer to the text book & other readings). An essay format is required including an abstract, introduction, discussion, conclusion and a reference list.
Bill who is 65 years of age lives with chronic hypertension. Bill lives in a small coastal town and describes himself as ?semi-retired?. He works part-time at the local golf course as a groundsman. Bill is married however, the marriage has experienced extreme difficulties over the past 5 years following his diagnosis. His wife Betty describes him as ?a crabby old man? who is constantly complaining about ?everything?. Bill has two grown children and 5 grandchildren who all live in distant states.
He loves to go fishing in his spare time and is a keen gardener however, is finding it increasingly difficult to perform heavy manual labour due to his age and declining health. Bill is also extremely overweight and avoids going to see his GP as much as possible. He likes to eat take away food and makes many poor life style choices such as drinking too much red wine and not exercising enough. Betty is now threatening to leave Bill and is seeking counselling in relation to the unhappy state of this marriage and the consequent stress and anxiety it is causing her. Bill is in denial that there is a problem with the marriage and has started spending a large amount of time at the local Hotel playing the ?pokies?. Consequently, the family?s financial status is not solid as money seems to keep disappearing at a rapid rate. Recently, they have not had enough money to pay the rates and are rapidly slipping behind in home loan repayments. Bill has also recently been experiencing problems with his vision, but refuses to seek help to rectify this choosing to buy cheap five dollar spectacles from the local chemist.
Bill is worried that if his health declines further his wife will put him in a nursing home. ?That will be the end of me to go into one of those dog box homes? he told his next-door neighbour. Bill also frequently indicates ?it?s my life and no one is going to tell me what to do- those young quack doctors think they know it all and just want to pump me with pills?. At the doctors office last week, Bill stated to the registered nurse that since he had been taking the blood pressure pills he was feeling a little better and had been able to work in the garden more on the weekend and did not need to take a ?breather? so often at work, He requested a repeat prescription from the doctor. In relation to his weight he also indicated that he?d heard about Dr Slims new weight loss program that was advertised on the TV and wanted to know if ?those shakes really work??. He then admitted he was only trying to loose weight due to his wife?s nagging. ?if she could learn to cook better I?d eat at home more? he said.
***Note: Below are supporting summaries for the essay (some theories/concepts have been highlighted in yellow)
Summary 1 ? ?The Big Picture what is Health?
Term: Self-Efficacy: the perception on the part of the individual that they can influence and control their own out comes
Everybody perceives sickness and health in different ways.? Try out the forum under discussion topics week 1 and post your own personal definition of health. Health perceptions could change based on current life circumstances.? It is interesting to try and identify when someone actually considers themselves sick or ill – was it when they first noticed symptoms – was it when they were diagnosed by someone (who may or may not have been their doctor).?
The second area of importance is the difference between the two models of health:
(i) medical and
Although obviously the ideal model of health is the biopsychosocial model, which looks at a person in an holistic way. If I was acutely ill, I would like to ensure that initially the health care team is looking at me thought the eyes of a medical model.?
The last important area is understanding the differences between the measures of health and illness; morbidity, incidence, mortality and prevalence.? You will come across these terms over and over again, it is important to sort out the differences now.
When you meet a client on your clinical placement or person from within your own social networks or the person you have chosen for your case study ?.think about why they consider themselves ill or not.
If they don’t consider themselves ill ? why not??
You could ask them – what was it that alerted you to the fact that you could be sick??
How do they usually know they are sick?? Do they wait for a doctor’s diagnosis??
Is there a difference in the way different environments view health? Look at the clinical area that you are placed in or have encountered – what model of health does it largely follow? What model of health does your client usually adhere to?? A good way of understanding your theory is to ask the same questions of yourself.? Then ask yourself why?? Are you a person that rarely visits a doctor?? Why is that?? Is it because
Summary 2 – Reactions to Illness
The first part of this week’s readings is ‘Responses to illness’.
We can study this by looking at Ethel (from the role play) as an example.
The first response is ‘physical’. This includes symptoms of the illness and for Ethel it is her rectal and vaginal bleeding. Her emotional response is ‘anxiety’. She does worry about it.
Her cognitive responses include thinking about what would happen if the illness was severe – to Cyril, the bowls club and her family.
Her behavioural responses include information seeking – talking to her neighbour.
Illness behaviour is the process of moving from being a well person to being an ill patient. Your text explains it as moving through a number of decisions. Again we can simplify it by looking at Ethel.
First of all she asks ‘Are my symptoms normal?’ This is the means of Ethel validating that she is not ill. She answers yes – most women have some type of changes down below.
The next question is ‘What choices are available for dealing with the symptoms?’ For Ethel the symptoms have not gone away so she has asked Cyril and her neighbour. Cyril has downplayed her concerns ‘It’s all in your head’ and Mavis has stated that she can’t be sick because her sister had bowel cancer and was skinny whereas Ethel has ‘some weight’.
The next decision to be made is to whether to seek help from a professional.
(i) The first decider is perceived interference of symptoms with vocational, physical or social activities or personal relationships. Ethel doesn’t seem to perceive that her symptoms interfere in the above ways.
(ii) The next possible impetus to encourage a person to seek help is a personal – crisis – again not applicable to Ethel.
(iii) The last – pressure from others to seek help – also is not an impetus for Ethel as Cyril and Mavis reinforce to her that she doesn’t need help. However, the trigger – ‘the symptom has gone on long enough or past a self-imposed deadline’ seem to be being an impetus for Ethel to think that she may need to seek help and allowed her to be easily influenced by myself to do so.
What can the professionals provide? Ethel felt that the doctor was too young and too male for her to be able to comfortably explain her symptoms. So this was a problem for her. You will see later that when the nurse was able to organise for her to see a female – she was much happier.
Use these concepts when you talk to your case study – to reflect on how they initially decided to seek help.
There is little evidence from Ethel that she took a sick role. However, what is important to remember that it a set of rights and obligations. Or another way of putting it – if the person obliges -they are then able to have the rights. As the textbook suggests – there is a number of moral implications with this. For example if a person hasn’t ‘obliged’ with the known ways of preventing illness such as health eating, not smoking etc. and become ill – has this person the right to receive the same care as someone who has taken care of themselves and become ill? This is something to consider later when you look at rationalisation of health resources.
The next section is on abnormal illness behaviour. I guess one way of looking at abnormal illness behaviour is when a person continues in the sick role when they don’t need to.
Factors affecting reactions to illness. We can use Ethel again to draw on to understand this section.
(i) The illness. The nature of the illness obviously affects a person’s reaction. As Ethel perceives that her diabetes and other symptoms are not severe and in fact normal – her reaction is only minimal.
(ii) The situation. Ethel has important social networks – her bowls club and neighbour and of course Cyril all are important to her and allow her to minimise her reaction to her illness. Lastly, Ethel, as an individual was taught be her mother to ‘just get on with it’. You can really understand why she has such a minimal reaction.
(iii) The biological factors are easy to understand. Personality – I am sure that we all have our own views on this – do you think someone with a particular personality is more prone to illness? Research is not conclusive at all.
Have a careful look at this section. We all have strategies to cope with extremes in our life including illness. They are often call defence mechanisms. Ask yourself what do you do in such situations. Avoidance is a common one – Ethel shows some signs of that. However, they do help us to manage for a while but if overshot – are not practical.
This is an interesting section. The most important thing to learn from this is that perception is often different for everyone.
Understanding reactions to chronic conditions
This chapter is an important one in understanding your case study as this person is likely to have a chronic illness. Look at the relationship between chronic conditions and disability. Does Ethel have a disability – she doesn’t seem to? Her ability to engage in her normal activities does not seem to be impeded. Ask yourself – what disability does your case study have? and what is their reaction to this?
Cognitive responses – The three type of responses are a useful way of understanding why someone responds the way that they do. Obviously if they see their chronic illness in terms of helplessness – they are likely to be quite pessimistic about their capabilities. Whereas the last type of response, perceived benefit, is the one that is easiest to work with. The person has turned a negative situation into a positive one and saw that it has benefits for them.
There are a number of things to remember with this chapter. Chronic disease is an issue in our society. As our society has more older people there will be increased number of people with chronic illnesses. Chronic illness often involve a level of disability. People react and adapt differently to chronic illness. Understanding this reaction and adaptation is very important for a health professional.
Summary 3 – Social influences and inequalities
This chapter begins with a reference to the Inverse Care Law ? the availability of good medical care tends to vary inversely with the need of the population served. This is a very interesting observation and important to remember when you enter the world as a health professional. This law points to the external variables that influence the medical care available to individuals and this chapter highlights some of the important ones.
Culture is an important determinant in the way that we view health and illness. There is no need to elaborate as I know that you have probably already studied this concept. However, it is important to reiterate the concept of ethnocentrism which is the belief that one?s own culture is the natural or best culture. It is a natural belief ? it is difficult not to believe that your own belief system is not the best or natural one when this is what you have always known. It is very difficult to ?put yourself in the shoes? of another culture. However, it is important to recognise and acknowledge that we will all probably have this tendency and when dealing with someone from another culture or issues with another culture to remember that this belief is likely to interfere with your objectivity and every not and then to take a step backwards to consider how much this is influencing your thinking.
Culture ethnicity and race
Race is not relative to health, only in how it affects health behaviour or how it affects the treatment of the individual by others in society.
Ethnicity is the way that people define themselves in terms of their cultural roots. Ethnicity, and in particular being part of a minority group, is often thought of in relation to disadvantage ? discrimination, less access to resources and stereotyping. However, it can also have advantages ? extra or special access to housing, educational benefits, job opportunities etc. Although ethnicity may be related to health outcomes, this, like race has more to do with health behaviours than actual ethnicity.
Culture and health beliefs
Your text gives an explanation from Kleineman about this. Kleineman proposed that all cultures provide their members with an explanatory model for illness. This explanatory model includes the cause, prognosis and treatment. This makes sense if you compare the explanations about illness from China with what we are used to in Australia.
Our Western explanation model is based on a scientific one ? causes of illness are seen to be related to infections, injuries and body system problems. The prognosis then is able to be very specific (the illness is likely to last x number of days as that is usually how long it takes for our body to fight off the infection). Also the treatment is then to kill the microbe that is infecting, relieve the effects of the injury or fix up the body part that is not working correctly.
Compare this Western scientific explanation to a Chinese model which is based on a philosophy. It may be very difficult for someone who grew up with a Western model to accept a philosophical one as it doesn?t seem to have measures ? there is not a specific thing to fix up or mend.
The family as a transmitter of culture (p. 145)
As the title suggests ? it is the family that convey or transmits cultural knowledge. A large part of this is language. But importantly, the family also provides our understanding of health and illness. This is likely to be culturally appropriate, but may differ from family to family. We all have our own little stories about how our family transmitted this ? how sick did someone have to be before visiting a doctor ? what happened when someone was sick ? was there lots of caring statements ? or was it a more ? so you?re sick ? get over it!!?. What type of remedies were given out ? Vicks vapour rub ? eucalyptus on the pillow ? goanna oil ? paw paw ointment ? I am sure you can name your family?s favourite.
Medicine as a culture (p.147)
This section argues that a group of health care providers form a subculture within a broader culture. As culturally different health care practices become more prevalent within out multi cultural society, the dominant medical culture may become challenged. Scientific evaluation, or evidence based medicine, has become the accepted standard of care in western society. This means that all clinical practice should be based on evidence from scientific trials that were randomised and ideally blind. This means that the research population group isn?t specifically chosen, but randomly chosen from the population. Blind means that the participant wasn?t aware whether they were receiving the research treatment or not.
Inequalities in health(p.148)
It has been observed across a number of countries that the higher one?s income, the better one?s health. It has been suggested that this is related to a number of factors:
? Behaviour ? more people from lower income levels smoke, eat less healthy diets, work in higher risk and drive older cars.
? Physical and social living conditions are worse the lower the income. These include housing: old/damp buildings, poor sanitation, living in high population density and higher pollution. This is because housing with these conditions is more affordable. Health activities then become more difficult to achieve because of these impediments. The geographical areas where such housing exists usually offer poorer quality educational, occupational and recreational choices ? all contributing to less healthy behaviours.
? Social selection ? this sounds a bit like Darwin?s theory ? but the fittest, tallest and strongest individuals are likely to do better in life ? are likely to be more healthy and also have access to better health resources. These people usually have a better education and are likely to marry someone like themselves. This is in comparison to those who have come from a disadvantaged group ? who are likely to live in less sociably desirable situations, have less access to resources etc and are likely to partner with someone in similar situations.
? One disadvantage is likely to lead to another disadvantage. Although health is meant to be equally accessible to all in Australia ? all of the above factors point to the difficulty in achieving this.
Social organisation of health (p. 150)
It is fairly obvious that the organisation of health services will differ from country to country based that country?s needs, health issues and financial resources. Those countries that have publicly funded health care usually provide more equitable health care.
Rationing of health (p. 151)
This is an interesting concept and quite a ?thorny issue?. There is no doubt that this occurs. The text gives the example of organ transplants as only being available for the more healthy individuals. A few years ago the Australian Medical Association suggested that patients who smoked should be placed low on waiting lists. This, of course, did not happen. The text also gave an example of rationing with the refusal to list Viagra on the PBS. This is not because there is not enough of the drug, or because the people who require it do not practice appropriate health practices, it is because if it was listed it would cost Australia too much money.
Managing inequalities in health (p. 152)
? Social polices to build up physical assets e.g. hospitals and schools
? Social policies to build up social assets e.g. education and social security
? Social policies to address the unequal distribution of wealth and employment (Medicare is an example of this ? those who earn less do not have to pay Medicare)
? Improvement of living and working conditions for the disadvantaged
? Modifying behavioural risk factors through health education, behaviour change programs and by removing barriers to change,
? The use of a publicly funded health system
What all of these have in common is they build the social capital of our society. What this means fundamentally is that people get on better together socially ? society trusts their government and the community has a sense of trust and belief in the various groups in its community. The spin-off of this is that (in simple terms) people are more willing to help others ? or as the text states ? people are more willing to act for the mutual benefit of society instead of just for themselves or their social group.
Access to health (p. 152)
This is variable and may be determined by:
? Financial factors ? those who have more money will be able to more and better health care and better living conditions generally.
? Cultural factors ? not being able to speak the dominant language may lead to less access to health services ? cultural norms may also play a part here (see the text?s example of female access being controlled by male family members).
? Geographical ? this is an obvious example here in Australia. Even, here in Rockhampton, we do not have the same access to specialist health care services than those who live in Brisbane. Those in more isolated areas also have less access to those resources that help promote health such as shops, education etc.
? Travel ? travel costs and this lowers the access to health for those in isolated geographical areas.
? Time ? time travelling and time away from work decreases the willingness to access health care services.
? The problems health professionals face working in isolated areas is highlighted in your text and an important concern to take into account.
Gender and health (p. 154)
The interesting issue here is, as the text states, at any age of life women are more likely to be sick and men are more likely to die. This is because of the following:
? Early in life genetic and biological problems are more prevalent in males.
? In childhood, males are more prone to accidents than females related to differences in behaviour.
? Later, males are more likely to undertake risky behaviours e.g. work in riskier environments, play dangerous sports, or generally have less healthy lifestyle such as diet, alcohol use and tobacco.
? Women tend to manage their health better and are more likely to seek medical help when ill.
? Pregnancy, childbirth and mothering expose women to more interactions with health professionals
? Most new drugs are tested on men ? this creates inequality the other way.
Summary – Introduction to Older Adulthood
? In this module we have explored a number of developmental theories and concepts including the concepts of age and ageing.
? There have been some challenges presented for student?s as to how they will critically evaluate the difference between events that occur as part of the ageing process and events that occur as part of the illness or disease process.
? The concept of normalising has also been considered in conjunction with terms of incidence and prevalence of a number of health condition-specifically chronic health conditions.
? Apart from the physical developmental aspects, consideration has been given to the psychological, social and spiritual factors that influence the state of the lifespan.
? Related to ageing and the impact on the human system we have considered:
o wear and tear theory
o free radical theory
o errors in copying theory and
o obsolescence theory
? A key change to the individual?s environment that occurs at this stage of the lifespan is the change to their network or social cohort and this has been attributed to by emergence and changes in health conditions which limits minimises or otherwise reduces the individual capacity to socialise and interact as well is the reciprocal impact that impact “others” ability to interact with older adults. This also includes inequities and inequality (factors of a socio demographic nature).
? Another key change the state of the lifespan is the reduction in the social cohort due to death.
? There is an increased focus on one’s own mortality at this stage of the lifespan.
? We have encountered a number of models that deal with the grief process. It should be remembered that grief is not only area associated with death; grief can extend to situations such as the loss of good health.
? Consideration was also given to legislation that relates to the stage of the lifespan specifically elder abuse and the mandatory reporting obligation that are linked to registered nurses.
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