Psychosocial Factors that Impact on the Way a Radiographer - Essay Example

KNOWLEDGE OF PSYCHOSOCIAL FACTORS CAN IMPACT ON THE WAY A RADIOGRAPHER DEALS WITH AGGRESSION IN PATIENTS/ CARERS WITHIN A RADIOLOGY DEPARTMENT Introduction: Working in a job that deals with the public essentially exposes any employee to the risk of being assaulted. Potential risk of assault is always present in the case of health care workers. The hospital environment which is open to the public, and certain areas which are permanently unsupervised, increase the risk of violence to healthcare workers. The likelihood of being confronted by violent behaviour by psychiatric patients has been seen to be high, and several reports of such encounters have been reported. (Healy, et al 2002 p.85). Other cases of aggression are from patients suffering from chronic physical and psychosomatic problems, and from patients/ carers troubled severely by anxiety and fear. Some other factors that contribute towards aggressive behaviour on the part of patients or their carers are: paucity of sufficient staff to attend to patients immediately. The inconveniences of long waiting periods adversely affect some patients. This is of particular concern in the Accident and Emergency department, where efficient and immediate attention by healthcare workers may be vital. Unacceptably long waiting times, while suffering from pain or discomfort is a major problem for patients. Radiographers are one of the first health care workers of the hospital that the patient will come in contact with, and can vent their anger upon. (p.89). Besides delayed treatment, post-operative confusion is another cause for patients’ violence. At night, when fewer staff members are available, an employee may be at higher risk of assault. Also, alcohol or drug abuse among patients or their carers can cause instances of aggressive behaviour against the staff member. It is also seen that younger and less experienced employees are more prone to encountering violent behaviour.. Lack of effective training in dealing with physical or mental abuse may result in the same employees being targetted many times. Healy et al 2002 (pp 85-86) reiterate that training in the management of abusive behaviour can reduce the number of such occurrences. Radiographers, and the potential risk of confronting aggression: As stated by Healy et al 2002 p85, violence to staff working in non-Irish hospitals is well-reported for doctors, nurses and ambulance workers. As quoted (p.85) from the The College of Radiographers, Journal: Elsevier Science Ltd, 2002, a recent study by the Society of Radiographers demonstrated that radiographers are similarly at risk. The study was aimed at examining the threat to radiographers in Irish hospitals, since there was a paucity of Irish data on this issue. High response rates were observed from all the five hospitals studied. Psychological violence was seen to be the most common type. Violent incidents were most likely to be experienced when the radiographer was working alone, with the recently qualified radiographers most vulnerable. Perpetrators of violence were most likely to be male, and patients were responsible for 85% of incidents. The data provided by this study demonstrate that violence is an important issue for Irish radiographers. Hence, intra-departmental protocols and national strategies should be implemented to minimize risk. The results should have relevance to other hospital personnel, and further research on this issue amongst all hospital groups is seen to be essential. Research On Violence Towards Radiographers: The Society of Radiographers, London, undertook a survey in 1996, as denoted on p.86.(Healy et al 2002). This study revealed that women made up, on an average, 87% of staff in the workplace. The majority of violent incidents occurred against women, with 80% of the incidents involving verbal abuse. Most of the abusers (77%) were patients, followed by members of the public, particularly patients’ relatives. Most incidents happened when radiographers were on emergency duty (44%), working single-handed (39%) or carrying out duties in general X-ray departments (38%). (Healy et al 2002 p.86). Among the types of psychological violence, verbal abuse was found to be of highest incidence, followed by combinations of verbal abuse and threats, and verbal abuse and rude gestures. The least occurring were rude gestures, or threats, and combination of verbal abuse, rude gestures and threats. The physical violence fell into two categories: attempted assault whose frequency was 80%, and actual assault which was 20%. The need is very high for each diagnostic imaging department to have clear protocols and policies regarding mandatory presence of a person to accompany the patient, and safe environment for a radiographer working alone. Importance of knowledge of psychosocial factors, to help the radiologist in dealing with aggression: The aim of the following study was to educate health care professionals on the importance of understanding perceived stress by carers of children with severe abnormalities, e.g. spina bifida, and the ways to reduce psychosocial morbidity in the patients. Zipitis and Paschalides 2003 pp.101-110, report their research on “Caring for a child with spina bifida: understanding the child and the carer.” Sharing adequate information with the patient and his/ her carer was important for allaying their fears. Psychological suffering by carers and perceived stress should be reduced by specific intervention tools, which will ultimately have beneficial effects on affected children. If the radiographer encounters aggression from the carer or the patient, he should deal firmly, but with awareness and empathy towards their mental state. Such a technique would reduce the psychosocial morbidity in the patient and his carer. Zipitis and Paschalides 2003 p.110 reiterate this fact, and add that “further studies are required to pinpoint target areas and evaluate specific interventional tools, in order to reduce perceived stress, and thus psychosocial suffering by carers.” Examples of where different psychosocial factors/ health beliefs can vary the normal communication/ working patterns with an aggressive patient: In their articles,“What is Competence?” Williams and Berry 1999 p 225 described the role of the radiographer as “caring for the needs of the patients while producing high quality radiographs.” From focusing on disease and diagnosis to a more holistic model which also considers the psychological and social dimensions of health, there has been a shift in recent times. Besides interpersonal competencies and communication skills, the radiographer requires sound knowledge of psychosocial factors which may be affecting the patient. Psychosocial factors are: being sensitive to issues of development, culture, race, ethnicity, primary language, health, literacy, disabilities, gender, sexual orientation, social class, environment, etc, that influence the patient’s symptoms and behaviour. Health beliefs are: distress about being diagnosed with a potentially terminal disease like cancer, or dismay at being sick, fear of the unknown/ future, helplessness and lack of coping abilities in the face of being a victim of a serious disease, hope for complete recovery, etc. Example 1: Back-up Personnel: In seriously aggressive cases, the radiographer would ask the hospital authorities to assign some additional staff to help him in dealing with the patient. The back-up personnel can be ready to help in case the radiographer needs them. Sufficient air-space would be provided to avoid a feeling of claustrophobia for the patient. Potentially dangerous objects should be removed from the environment, and the radiographer should remove any articles of clothing like ties or scarves, which may be used against him1. The presence of a panic button, for requesting help would be an important addition to the radiology department. Patients from higher social classes or from any privileged groups may receive this communication or working pattern from the radiographer. The normal working pattern would be categorised by being there, giving help, and giving information. These positive styles of communication are a central tenet of patient satisfaction, understanding, memory and ultimately adherence to medical advice. This is reiterated by Booth, Manning 2006 pp276-282, as they say that the radiographer performs the role of the “nurturing parent” as seen in the system of transactional analysis. Example 2: Listening With Understanding: The psychosocial distress of radio-oncology patients admitted in hospital, and their need for psychotherapeutic intervention has been studied by Fritzche et al 2004 pp.183-189. More than half the number of patients were diagnosed with adjustment-related behavioural disorders. Also, they experienced increased anxiety and depression. These factors can manifest as violent behavior and aggression towards the radiographer. Most of these patients would be from a racially advantaged group, from communities whose native language was not English, disabled or aged. With understanding of the underlying psychosocial issues, the radiologist should help the patient overcome his depression., by questioning him on all the issues that troubled him. Allowing the patient to vent his feelings, would calm him down, and he would be in a frame of mind to listen to the radiographer trying to put him at ease. The health care worker would need to create more time in his schedule to deal effectively with such cases, who needed a listening ear to the health beliefs and fears that overwhelmed them. Example 3: Setting Limits: Women undergoing brachytherapy treatment for gynaecologic cancer experience discomfort and distress, and feel anger about their condition, and fear of the unknown. (Leon, C. et al 2004 pS74). The anger and fear can manifest as rude, abusive behaviour, or even violence shown towards the radiographer. Here the radiographer would set limits, that aggressive behaviour would not be permitted. His tone of voice and manner would convey that he meant business. Thus the radiographer would ensure that the patient first calmed down, . Among psychosocial interventions for reducing treatment-related stress-effects, relaxation and imagery would be most useful. Patients from lower income groups, or patients who were not able to control their anxiety and behaved in a violent manner, would be among those whose aggressive behaviour would not be permitted. Example 4: Affect Management: Cancer patients or their care-givers sometimes become aggressive, due to sustained health difficulties, lowered quality of life, and worries about the future. Here, affect management practised by the radiographer, would prove beneficial. Affect management involves acknowledging the patient’s worries and affects. Validating the affect when necessary, and encouraging them is part of the radiographer’s job. In the case of a multidisciplinary team working on the same patient, at various times, the use of a checklist was found useful. (Rubbens, et al 1996 pS230). Patients who were seriously ill, women, the elderly, or those from minority comunities who felt isolated or helpless would receive this mode of communication pattern from the radiographer. Example 5: Physical Restraint: Normally a radiographer would not apply physical restriction to the patient while taking x-rays, conducting radiation or magnetic resonance imaging. In cases where the patient is mentally disturbed or violent, when he is unable to keep still due to restless behaviour, or in the case of children who refuse to submit to the procedure due to fear, the radiographer may have to restrain the patient physically, and proceed with the test. In pertinent cases, administration of psychotropic drugs may be required to calm the patient.2 To assist in treating the patients, collateral information about them may be obtained from families, identification of risk factors and potential triggers. Normally, those low on the scale of health, race or class, may receive this form of communication pattern, How Does Psychology Help? Having people-skills, understanding the psychology of the patients and empathizing with their situation serve the radiographer well, in executing his work even under difficult circumstances. Knowledge of psychosocial factors, and also ability to deal with violent patients or their carers stand him in good stead. Dealing with patients from other cultures, who may not be able to communicate in English, and interacting successfully with other health care workers in the hospital setting are equally vital. REFERENCES Booth, L.A; Manning, D.J. (2006). “Observations of Radiographer Communication: An Exploratory Study Using Transactional Analysis”, Radiography, Vol 12, Issue 4, pp.276-282. Fritzche, Kurt; Liptai, Cilla; Henke, Michael. (2004). “Psychosocial Distress and Need for Psychotherapeutic Treatment in Cancer Patients Undergoing Radiotherapy”. Vol.72 Issue 2, pp.183-189. Healy, J; Brennan, P.C; Costelloe, J.P. (2002), “Violence at work: a major radiographic issue”, Radiography, Issue 8, pp.85-90. Leon C. et al, (2004), “Anxiety and Depression in Gynaecologic Cancer Patients Before, During and After Brachytherapy, A Randomized Study.” Radiotherapy and Oncology Vol 71, Supplement 2, S74. Rubbens, L; Verstraete J; Van de Velde, G. (1996). “Communication Flow During the Irradiation Process”. Radiotherapy and Oncology Vol 40, Supplement 1, p.S230. Williams, P.L.; Berry, J.E. (1999), “What is competence? A new model for diagnostic radiographers.” Radiography, Vol 5, Issue 4, pp.221-235. Zipitis, Christos S; Paschalides, Constantinos. (2003), “Caring for a child with spina bifida: understanding the child and carer”, Journal of Child Health Care: Sage Publications Vol 7 Issue 2, pp.101-112. Read More