Four Aspects of the Social Context of Care - Essay Example

?Social Health Care 532827) Introduction Universal health care is a critical issue that is plaguing countries worldwide. A country that is not ableto care for its sick and destitute would be a moral let down to its people even though there is an overall economic growth. The report covers the health indicators of individual’s right from their childhood. The social interactions during the course of their childhood also affect the health of people as they mature. Poverty, use of drugs and unemployment are some of the key factors that determine the health of individuals. Health is also affected by the kind of living and working conditions he enjoys and whether the people he is interacting with are having a positive influence on his life. (Wilkinson Richard and Marmont Michael, 2003) There was a previous school of thought which prescribed that the doctors along with the nurses should not get too involved in the social aspect of the patient. One tends to lose their level of reasoning and rationality of thought on such interactions. Making the correct diagnosis along with administering the drug by the nurses were the requirements of a doctor and a nurse. However the present school of thought introduces a social aspect into the medium whereby doctors and nurses are advised to have a more pleasant interaction with the patients. Even if the patient can afford the treatment the greatest barricade for ordinary people gaining access to proper healthcare includes class, gender, ethnicity and disability. Stigma Stigma relates to a psychological problem that is experienced by patients having Aids, epilepsy and other mental illness. This is characterised by a feeling of depression and low well being. (Brakel Wim, 2005) The literary concept of stigma is defined as the social rejection of an individual or a group due to a negative judgement made by the society at large due to a health problem that the individual or group is facing. Stigma is associated with the following actions 1. Discrimination- This entails preferential treatment given to some people over others due to a particular health issue a patient might posses. (Wilkinson Richard and Marmont Michael, 2003) Source: Brakel Wim, 2005, measuring social stigma 2. Participant Restriction- This involves the problems a patient might experience when intermingling with society in general. Participation is restricted from certain activities which can have a negative impact on his psychological well being. (Brakel Wim, 2005) 3. Stereotype- This occurs when the society at large perceives people suffering from a particular illness as all having the same personality traits and behaving in a certain manner. This can give rise to cliches with society not appreciating the individuality of the person. Stigma affects the mental condition of the patient adding to the illness or disability he is already experiencing. People tend to develop an inferiority complex. Stigma and discrimination is harmful in areas related to medical access to these patients. For AIDS patients the primal fear is total isolation since the general feeling among public is that it is contagious and can spread via contact. ( Brakel Wim, 2005) This fear causes them to hide their disease resulting in severe lowering of self esteem. Concealing the disease can also increase the risk of them aggravating it even further at the same time affecting the individuals around them. Indicators have been developed to assess the stigma that is associated with each disease like Aids and leprosy. The AIDS Attitude Scale developed in 1992 has been used for stigma assessment among health care professionals. (Brakel Wim, 2005) This has now been updated to include the attitude of the general public as well. One instrument called the Explanatory Model Interview Catalogue (EMIC) has been developed to measure stigma for different health conditions by creating a data base of the attitude of society at large. The answers to the queries are graded on a scale of 0-3. The answer ‘0’ refers to no, ‘1’ is uncertain, ‘2’ is possibly of conditionally and ‘3’ is yes. (Brakel Wim, 2005) The primary areas where the attitudes were measured include hiding the disease, avoiding physical or emotional contact with people, general response of society; whether of pity or fear. This also included degree of shame the patient experienced and how much respect people held him in society. It also assessed whether he was being mocked at and the prospects of marriage for that individual. Compared to other illness or disabilities, a patient suffering from AIDS has to suffer a different form of social abuse. This is because people contracting this disease are perceived to be high on drugs, having homosexual behaviour and generally engaging in sex with multiple partners. (Barbra Doziers Blog, 2010) Relationships between health care professionals and patients It has been said that the relationship between health care professionals and patients are often paternalistic. The old cultural authority which was exerted by these doctors over patients is slowly and surely giving way to a more practical approach where the patients are coerced by whatever means possible to stick to the medicine regimen that is prescribed by the doctor. Past studies have indicated that patients stick to the practices that have been recommended for a certain period of time. However if the problem or the illness persists they lose hope and discontinue the medical regimen.( Lutfey Karen, 2005) However new studies have shown that it is not just the patients that are to blame since a part of the problem are also due to the attitudes that were exerted by these health care professionals. Times are however changing and the medical health care sector is getting corporatized. The attitude of the health care professionals has also undergone dramatic changes. Their persuasive skills have come to the fore and different innovative methods for different sections and classes of people are being used to ensure that they stick to the medical pointers. (Lutfey Karen, 2005) Previously it was found out that in most cases the medical regimen was dropped midway because people found it difficult to access doctors and confront their problems with the doctors more confidently. The side effects caused due the medicines also proved to be a dampener. There were some people who were plain stubborn and dropped out midway. Another category of patients included those who found the doctors instructions difficult to follow and remain confused regarding the medication to be taken. (Lutfey Karen, 2005) The present school of thought tries to be more engaging with the patient and tries to develop a positive rapport with the patient at the outset. The different methods of treatment are discussed and information solicited from the patient regarding the method they are most comfortable with. The doctors of the present generation consider the patient to be the same footing and makes sure that the patient fully understands the nature of the disease, the medicines and treatment that is being proposed and the benefits of the same. The risks involved in such an exercise are also fully explained in detail. This is as opposed to the previous method where patients were kept in the dark about their illness and doctors were discouraged from holding conversations with the patient regarding their fears and anxieties. Researches carried out on diabetic patients have found out the best way to go about the business of chartering the patients on a safe lifestyle would be to educate them regarding the nature of illness and the problems that can arise on leading a certain kind of lifestyle. (Lutfey Karen, 2005) This basic education stands them in good stead in understanding the nature of the disease as opposed to injecting insulin without any knowledge as to what really is taking place in his body. There will also be times in diabetic patients when they experiences high and low sugar levels thus leading to several discomforts. If these could be explained earlier the stress of dealing with these problems is greatly reduced. Sociological Imagination It has been argued that the new nursing techniques should engage in a more holistic approach so that a sociological model is evolved. Along with the importance of cleanliness and hygiene this model adopted a more humane approach to nursing needs. Importance was given to effective communication. This sort of communication emphasized that the nurses should empathize with these patients and hears out their problems to solve them. (Mulholland Jon, 1996) They should become their confidant so that the nurses in turn can have some kind of influence over these patients. Sociological imagination offers new devices that can be used to solve old nursing problems. Nursing has three critical sociological perspectives to choose from. ‘Pragmatic Utility’ is the best option the nurse can select to handle a current sociological situation. ‘Philosophical Compatibility’ is the judgement that is made by the nurse from their set of philosophical principles that is to be used when dealing with a definite sociological problem. The last criterion is the ‘Ideological Sympathy’. (Mulholland Jon, 1996) This refers to the nurses taking a more sympathetic approach to the problem and treating it as their own. There are however some who are highly critical of this ‘Sociological Imagination’ Theory. They argue that nursing actions cannot be quantified into realms of social counselling and they are ill equipped to handle philosophical problems. Nursing entails a series of procedures that are to be followed and does involve taking complex decisions. Other risks involved in getting nurses getting more involved with patients is that they might inadvertently blurt out some medical problem or diagnosis without getting it ratified from the doctor. If this turns out to be false it turns out embarrassing for both the nurse and the doctor. The other problem could be that there would be only a select category of nurses that would be always getting hands down experience encouraging them to maybe spell out opinions not verified by the doctor. (Mulholland Jon, 1996) In spite of these pitfalls it is recommended that sociology should be part of the course curriculum among nurses. This is so because it has been noted that for patients that developed a healthy social interaction with the nurses, the speed of recovery and response to medicines were far greater than nurses who just diligently performed their duties and engaged in minimal interaction. Class and Health care issues It has been found out there exists a serious class divide when it comes to access of health care among people representing different social classes. The social class indicators referred to indicate money, education and status of the person in society. The Black Report that was published in 1980 found out that although the health witnessed a marginal improvement there was a long way to go as far as resolving health care accessibility’s for people of the lesser classes. (Maguire Kath, 2002) Infant mortality rates among these categories of people seemed to be the worst hit. Some of the class inequalities that lead to poor health care issues 1. Artefact- This includes the access to a good house, education and lot of money. This automatically increases the social stature of the individual in society and he is given first preference to health care issues relegating those with more important requirements to the background. (Wilkinson Richard and Marmont Michael, 2003) 2. Cultural explanations- It has been laid out that the people of the lower middle class due to their inherent lack of knowledge tend to have more of oily food, smoke and drink and also do not involve in much exercises. (Veenstra Gerry, 2005) This leads to further deterioration of health. Some countries even have people having certain types of food which might not necessarily be the most edible but goes a long way in satisfying hunger for a long period of time. This leads to major health complications. 3. Social Selection- Most patients that are schizophrenic tend to go down to the bottom of the social inequality ladder. (Veenstra Gerry, 2005) Medical treatment for these people is therefore likely to suffer. There are some diseases like leprosy that if affected to a person of lower class; finds treatment very difficult. These diseases therefore create very difficult situations for the people low on the social class. 4. Material Explanation- The root cause of these people achieving low healthcare index and also being affected by negative health is because these people are subject to abject poverty with their living conditions abysmal. When budget runs into rough weather the first casualty faced is that the patient is more than concerned about meeting daily expenses rather than getting proper treatment. (Farell Clare et al, 2008) Some of the health problems that might arise as a manifestation of poverty include poor living conditions and inefficient clearing of waste material since the living area available is small. This creates a high risk situation for children. 5. Social capital- People in the higher strata of society maintains a close system of contacts and influences at higher places and channels of power. By their close interactions with society at large which is made possible by the educational brilliance or their money power people tend to listen to their problems.( Veenstra Gerry, 2005) It is often the case that a child with a chronic illness would more often than not get a chance to be examined by a world renowned doctor and get the illness verified. If lucky the illness might even be treated. It is hard even to imagine that a person of lower standing who has necessarily arranged the money would still find it difficult to gain access to a good doctor simply because of his lack of influence and personal contacts. Conclusion The report in general discusses the stigma that is associated with people suffering from epilepsy and aids. People suffering from such type of diseases are falsely made stereotypes which are therefore perceived to be their nature in the public. Some are made fun off while for others with HIV a notion is circulated that the reason for their disease was promiscuous or on drugs. However they fail to understand that people can contract HIV from a host of other areas. The paternalistic methods of interaction between health care professionals are making way into a more interactive way where patients are persuaded to follow medical regimens. This has lead to more success rates and also prevented patients from leaving midway into the program. Sociological Imagination as another feature that is being added into the nurses curriculum whereby they are encouraged to have ideological sympathy for patients. Lastly it has been observed that people from lower classes of society are discriminated in areas of health care access. This is not true just for people across different classes but also true for people with disabilities and different ethnicities. This report seeks to address the impediments to good healthcare that is faced by different classes of people experiencing different forms of illness and the improvements which health care professionals can engage in to mitigate the same. Reference List 1. Wilkinson Richard and Marmont Michael, 2003, The Solid facts, Social Determinants of Health, World Health Organization. 2. Brakel Wim, 2005, Measuring health related stigma, Royal Tropical Institute 3. Maguire Kath, 2002, The Black Report and Inequalities in Health, Sociologies of Health & Illness, available at http://www.medgraphics.cam.ac, [accessed on 5th May 2011] 4. Veenstra Gerry, 2005, Social space, social class and Bourdieu: Health inequalities in British Columbia, Canada, Health and Place 5. Lutfey Karen, 2005, On practices of ‘good doctoring’: reconsidering the relationship between provider roles and patient adherence, Sociology of Health & Illness Vol 27 No4 6. Mulholland Jon, 1996, Assimilating sociology: critical reflections on the ‘Sociology in nursing’ debate, Journal of Advanced Nursing 7. Farell Clare et al, 2008, An all-Ireland approach to social determinants, Tackling Health Inequalities. 8. Barbra Doziers Blog, 2010, Effects of Stigmatization on People who are HIV positive in relation to physical disability, available at http://barbradozier.worldpress.com, [accessed on 5th May 2011] Read More