The hypothetical case study comprised of the
32-year-old woman with the imaginary name Frank. The patient was referred with
a 2-week history of symptoms such as swelled legs, eyes, and the body as well.
She had a history of poor diet patterns and chronic constipation without recent
illnesses, fever or hematuria. The initial diagnosis revealed mild bilateral
ascites, pedal edema, low hemoglobin 79 g/L, with low ferritin or iron and
marked microcytosis and hypochromia (Popko, Górska, & Kuźma-Mroczkowska,
2017).
The reduced serum protein and hypoalbuminemia
evaluated with triglycerides (454 mg/dL). The final diagnosis was given to her
as a Nephrotic Syndrome (NS) with anemia, iron deficiency and poor diet based
on laboratory and clinical findings. The patient was treated with iron, oral
and intravenous methylprednisolone supplements. For the management of
thromboembolism, Antiplatelet therapy with dipyridamole was instituted and
furosemide & albumin used to treat the elevated worsened edema and blood
pressure. The treatment and management plan was given to her for a particular
time of 18 months when she was discharged to follow up monthly session. Renal
biopsy was done as it is an essential aspect for the diagnosis of Nephrotic
Syndrom and helps to design the management and treatment plans for patients
(Souvannamethy, 2017).
The diagnosis of Nephrotics Syndrome in the early
adolescent has had a dramatic emotional, behavioral psychological and physical
effect on Frank. The social, occupational and personal functioning deteriorate
due to the ‘'being sick'' thought (Peng, Li, Hu, Yang & Yang, 2015). Frank
encountered with stressful automatic negative thoughts, as she would die soon
(Nourbakhsh, & Mak, 2017).
The obsession of thought enhanced the apprehension
about the recovery and treatment positive sign made her isolated from the
family and society. Furthermore, he developed the symptoms of persecution as
people do not have any concern regarding my health and life and it makes no
difference to them if I would die (Bierzynska, & Saleem, 2017). Healthcare
practitioner gave her psychological and moral support, and then she showed a
little interest in self-care and managing his dialysis treatment.
The literature recommends that numerous factors
impact the Quality of Life among patients, such as psychological, physical,
behavioral and emotional well-being (Souvannamethy, 2017). Patient personal
experience, beliefs expectations, and outcomes play a significant role in
developing the positive and negative attitude towards health care system and
individual self-esteem and self-concept (Schijvens et al., 2017). The unplanned
hospitalization, medication, oral drug intake, formal assessment, changed
dietary plan psychologically and emotionally affect the patient. As a result, they
manifest behavioral and psychological dysfunctioning.
The renal biopsy was a prolonged process that causes
fear, a frustration of the patient towards the treatment process. Although the
results of the renal biopsy were positive, and the patient recovered to some
extent, but the more session was required for the complete recovery. The frank
was prescribed by the Registered Nurse to visit the hospital regular with the
strict dietary plan.
Frank reported that while taking antiplatelet therapy
with dipyridamole and oral supplements to reduce the symptoms of nephrotic
syndrome, she felt herself death near to her. The fear of death was affecting
his self-esteem and self-concept and the self-worth as well. The literature
also suggests that the patient with Nephrotic Syndrom found to have depressive
symptoms and elevated mood. Some studies grounded in the results that the
patients with Nephrotic syndrome manifest anxiety after the exposure with the
management procedure.
According to Beanlands, et al. (2017) the quality of
life of Nephrotic Syndrome patients has investigated dramatically low regarding
physical, behavioral and psychological functioning. Frank also reported the
itching, loss of hearing, clay color stool, and jaundice after taking
furosemide dosage for the management of edema. Furthermore, she accounted for
suspicious attitude towards her recovery. The psychosocial apprehension towards
treatment method and the positive outcome made the patient reluctant toward
health care system. The collaborative work between the patient and healthcare
practitioner may bring positive result and alter the attitude towards illness.
Frank developed the negative attitude towards the
treatment modalities of Nephrotic Syndrome and due to the side effects of
medication and unfamiliarity with advance treatment method. As a result, he
showed reluctant and non-adherent behavior for treatment and skipped the
regular consultation for Nephrotic treatment. Nakata et al. (2017) elaborated
that through education and healthy relationship between healthcare
practitioners and patient, the adaptive functioning of the client may enhance.
The patient will and support is an integral part management plan for gaining
positive outcome from treatment. For the better health recovery, the patient
needs to learn the necessary skill of self-care and coping strategies against
stressors.
According to Korpershoek, van der Bijl, &
Hafsteinsdottir, (2011) Self-care is the fundamental strategy to independently
adapt with day to day stressors, improve the self-efficacy and healthy
behaviors, reduce the patient's vulnerability to developing the psychological
symptoms and apprehensions. Self-care comprised of multiple tasks of daily
living including the personal hygiene, mobility, sitting and moving, making up,
wearing clothes, eating, and bathing (Vining Radomsky, & Trombly Latham,
2008). Research shows that despite the proper treatment plan and self-care
precautions of the patient, the caregiver's inadequate skills and lack of
knowledge may worsen the condition of the patient (Gholamzadeh et al., 2015).
Therefore, the Nephrotic Syndrom patients report
inability to manage their daily life independently when discharge and lacking
caregiver support to regain former. Thus, educational interventions may empower
Nephrotic patient capable of self-care and coping. Psychologists can also
change the negative attitude of the patient towards condition and train them
how to overcome the negative consequences of illness (Wang et al., 2017)
The self-help care that is imperative to look after
by the patient after discharge is comprised of physical activity, diet control,
optimistic mood and timely consultation with a doctor. Majority of the patient
with Nephrotic Syndrome report such experience, the proteinuria, and hematuria
increased after excessive physical activity, and prefer bed rest (Nakata et
al., 2017). They need to educate that long-term bed rest is not suitable for
patients with Nephrotic Syndrome. The excessive physical activity for an
extended period may cause decline the recovery, but the moderate level of
physical activity is positive for Nephrotic patients. The frank was also
suggested to maintain the average level of physical activity by the
Psychologist and Counsellor.
The appropriate diet pattern is also the fundamental
aspect for the recovery of a patient. The diet pattern for Nephrotic Syndrome
patients should be low fat, low salt, low protein, and high fiber diet
oriented. The food directly affects the treatment of the Nephrotic syndrome.
Therefore precautions in a diet are mandatory for fast recovery (Hjorten,
Anwar, & Reidy, 2016). Frank was given prescribed dietary plan to follow
the basic instructions.
The long-term treatment of Nephrotic Syndrome causes
the irritability, pessimism, despair, and elevated mood and emotions, which
directly damage the psychological physical and behavioral health of patients
adversely, affect the disease. The patient encouraged developing an optimistic
attitude, and expectation from recovery may enhance the likeness to recover
fast. The frank was also suggested to be optimistic for her better health. As
the patient of Nephrotic syndrome develop low body resistance and immunity and
become more vulnerable to infections. Therefore, the patients need to consult
their doctors frequently and avoid the outdoor activity in winter to escape
from the oral cavity and perineal skin. The frank was advised to follow the
session after discharge for better health.
Furthermore, due to the unfeasibility of Frank biopsy
from a hospital, he was taught the self-needle to his fistula. He was educated
to insert the long needle into the renal cortex; the buttonhole technique
proved beneficial for him. As Frank was right handed he felt that he could
manage this task independently.
The Psychologists honor the individuality or
uniqueness of the patient, respecting their culture, choice, specific needs and
social context (Iijima, Sako, & Nozu, 2017). This document demonstrates the
vision for patient-centered Nephrotic Syndrom services that include education
programmes to encourage people with long-term Nephrotic Syndrom patient. The
psychologist evaluates the competency and compliance of the patient towards
management plan and self-care practices after instructional delivery.
Although the Frank showed the adherence and
compliance to the treatment process and self-care process, he is still under
the nurse's care. Hopefully, she will get the full recovery if he continued his
self-help care with the collaboration of the Nurses.
The code of ethics enforces some responsibility to
Psychologists that the information delivery about the assessment, management
diagnosis should be précised and authentic. The easy to understand terminology
can bring positive consequences ad mistakes, difficult vocabulary or inaccurate
information could come into question. In that respect, the psychologist should
ensure that the given information is accurate or comprehensible to the patient
(Papakrivopoulou et al., 2016).
The patient suitability refers to the capability of a
patient to competently regulate all the given instruction and accurately follow
the self-care for the maintenance of good health (Lee et al., 2016). As the frank was assessed to be pessimistic,
depressive and apprehensive in the initial stages, therefore it was uncertain
to analyses if he would follow the self-care instructions or not. Furthermore,
the self-esteem and self-concept were also found to be negative; the nurses
tried to develop the optimistic attitude towards recovery. The frank indicated
his motivation for a healthy life, that was a pinpoint towards positive
consequences.
Frank pursues the instruction after discharge, which
legitimates us to progress to the next step, which was to provide a suitable
learning environment and support. She was introduced to the group therapies,
individual therapies, and awareness related workshops to adopt decisive and
optimistic lifestyles. Frank expressed the positive behavioral, emotional,
psychological and social attitudes.
The
self-care or self-management involves various challenges, including timely
identification of symptoms and follow up of a comprehensive management program.
Literature confirms that those patients enjoy more quality of life in term of
health who can take care of their self. The self-management emphasizes the
empowerment and active engagement of patients before, during and after
treatment with the healthcare professionals (Galdas et al., 2015).
Ogunbayo, Schafheutle, Cutts, & Noyce (2015)
supported the benefits of patient self-management by stating that the
self-management the mental and psychological well-being of the patient and
promote the healthy behaviors such as eating healthily, exercising regular
visit to the medical rehabilitation center. De Silver, (2015) indicated that
self-management develop a sense of responsibility among patient and enhances
the positive self-concept and self-esteem that promote a positive approach to
deal with stressors.
The self-care or self-management of the patients
provides numerous benefits to psychologist enlists the abundant advantages of
patients self-care, such as if patients can identify and manage their symptoms
that may help in saving the time of nursing to pay specific care to each
patient. It would be also beneficial for the economic growth of health care
system; there would be no need to hire maximum psychologists and health care
staff (Gulati, Sinha, Jordan, &
Hari, et al. 2010). The education about self-care, dialyzes, diet plan,
psychological management enables a patient to cope with the symptoms in the
initial stages. It is also beneficial for the health of the community as each
member of the society should be aware of necessary precautions of the diseases
and help each other in the time of emergency (Pereira., Wade, Brito-Melo,
Guimarães, 2014). The education of the patient about the illness does not
merely help him in a recovery process.
Dorthea Orem (Simmons, 2009), believed, that people
have a natural tendency for self-care and that psychologist should polish that
tendency of the patients. The patient can learn the Self-care skills after
getting credible and knowledgeable to provide this teaching service (Hudson and
Macdonals, 2010). The preferences of the patient need, and desires by the
psychologist can develop a healthy relationship between patient and
psychologist. As a result, the patient develops the positive outlook towards
treatment modalities.
The prolong sickness and non-adherence to treatment
may alter into a compliant behavior with the optimistic approach. According to
Hjorten, Anwar, & Reidy, (2016) the empathic, neutral and kind attitude
regardless of gender, racial, lingual, and ethnic classification rule out the
oppressions and anxieties of the patients towards health care system. Also, the
easy to understand medical terminology also helps the patient overcome their
fears towards diseases.
The education and proper information about the
disease and treatment reduce a feeling of vulnerability and depression makes
the patient courageous to deal with the illness realistically and positively
(Hjorten, Anwar, & Reidy, 2016). The
health educators work in diverse settings including formal, informal lectures,
group work, select, and implementation of appropriate strategies for different
educational goals. The literature showed that people have the rigid attitude
toward renal biopsy and the self-care management of psychological symptom
associated with the illness (Ravani, Ponticelli, Siciliano, et al., 2013). The fundamental reason for patient's non-adherence
and apprehension about the biopsy was related to fear of inserting the needle
or cut in the skin oriented. Tibbles et al. (2009) have proposed in their study
that clinicians must consider the latest models of self-care to deliver
patient-centered service and promote hemodialysis.
Frank was given a self-care management plan, and he
effectively follows up the education program instruction and knowledge. The
complete compliance to medical treatment enables to Frank to access his
buttonhole fistula, and perform dialysis treatment by inserting a long needle
into the renal cortex. The frank has undergone the depression and anxiety due
to the prolong disease duration and relapses in disease with the medication and
follow up session. The psychologist and the educational program helped him to
cope with stressor and building tolerance level for recovery.
His attitude towards disease and treatment has
altered dramatically, he is showing compliant, and adherent to all instruction
related to following up session. The positive outlook towards treatment and
self-management improved his social, occupational and personal functioning.
Although the self-management is very common in
contemporary health care system, the actual implementation of the educational
program by keeping in mind all the code of ethics and code of conduct is
significant for the improvement of the patients. The patient-center approach is
very much useful that only prefers the patient, wants, need, desire while
implementing treatment modalities, and overcome all the related apprehension
(Zhang, Wang, Liu, Zhong, Yao, & Xiao, 2017). The all above target may
achieve only with the help of psychologists, their knowledge, experience, and
ethical responsibility may evoke the significant positive change in the
attitude of the patient. As mentioned by De Silver, (2011) the positive outlook
of a patient towards illness develop the optimistic approach towards recovery
and the patient productive take part in the management process.