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PSYCHOSOCIAL ASPECTS OF CARE The emotional response of the patient during illness is of extreme importance. The mind-body-spirit connection is well established; it is known, for example, that when a physiological response occurs, there is a corresponding psychological response. Also, there are physiological conditions that have a psychological component, for example, the emotional instability associated with steroid therapy or Cushing’s syndrome or the irritability of hypoglycemia. Rapid growth in the field of psychoneuroimmunology is regularly providing new information about these issues. With expanding technology in healthcare, ethical issues are hotly debated. Although the stress of illness is well recognized, the effect on the individual is unpredictable. It is not necessarily the event that creates problems, but rather the patient’s perception of and response to the event, which may result in unmet psychological needs that drain energy resources needed for healing. The caregivers’, patients’, and significant others’ (SOs) values, sensitivity to different cultures, and language barriers (including difficulties that people have in talking about their bodies) affect the care a patient expects and receives. CARE SETTING Any setting in which nursing contact occurs/care is provided. RELATED CONCERNS This is an aspect of all care and plans of care. Assessment Factors to Be Considered INDIVIDUAL Age and gender Religious affiliation: church attendance, importance of religion in patient’s life, belief in life after death Level of knowledge/education; how the individual accesses and incorporates information, e.g., auditory, visual, kinesthetic Patient’s dominant language/literacy? Knowledge and use of other languages? Style of speech? Patterns of communication with SOs, with healthcare givers? Perception of body and its functions: In health, illness, this illness? How does patient define and perceive illness? How is patient experiencing illness versus what illness actually is? Emotional response to current treatment/hospitalization Past experience with illness, hospitalization, and healthcare systems Emotional reactions in feeling (sensory) terms: e.g., states, “I feel scared.” Behavior when anxious, afraid, impatient, withdrawn, or angry SIGNIFICANT OTHERS Marital status; SOs, nuclear family, extended family. Recurring or patterned relationships Family development cycle: Just married, children (young, adolescent, leaving/returning home), retired? What are the interaction processes within the family? Patient’s role in family tasks and functions How are SOs affected by the illness and prognosis? Lifestyle differences that need to be considered: Dietary, spiritual, sexual preference, other community (e.g., religious order, commune, retirement center)
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SOCIOECONOMIC Employment; finances Environmental factors: Home, work, and recreation; out of usual environment (on vacation, visiting) Social class; value system Social acceptability of disease/condition (e.g., sexually transmitted diseases [STDs], HIV, obesity, substance abuse) CULTURAL
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