Jill Robinson

Making decisions and solving problems

A nurse on night duty is checking the patients on the ward when she in interrupted by a call from Mr Matthews who is a patient in a different part of the ward. She decides to respond immediately and goes to find out what he wants. When she resumes her round she finds that the next patient she comes to has no pulse although his body is still warm and his colour appears normal. In spite of attempts by both herself and the resuscitation team, the patient dies. How do you think the nurse might feel about her decision to respond immediately to Mr Matthew’s call? Do you think the nurse would feel differently about her decision if the patient had obviously been dead for more than a few moments?

Child health development

In the previous chapters it has been assumed that the patients in our investigations have been adults; however, much of nursing is concerned with the care of children. The question arises as to whether there are differences in children’s health behaviour according to age. Studies of human development have found many changes in behaviour throughout the lifespan, and these can be divided into two categories: 1. Quantitative changes (differences in amount). Children might not know how you catch a cold because they have never been told about colds. 2. Qualitative changes (differences in essence/nature). Children find it impossible to understand about catching a cold no matter how hard you try to explain.

Learning, memory and social influence

❏ Mary has a phobia about spiders, and cannot enter a room unless someone has checked to make sure there are no spiders. She has been having therapy because of this phobia, and together with her therapist has agreed a programme of gradual desensitisation. She has been introduced first to pictures of spiders and, over time, to the real thing. At each session, the therapist plays some of Mary’s favourite music and guides her through a range of relaxation techniques. Slowly, Mary comes to associate the idea of spiders with pleasant and relaxing sensations. ❏ John and his wife Jean have gone to their doctor to get the results of some tests John has had. The doctor informs them that John has cancer but says that there are a number of things that can be done. He goes on to describe these in some detail. When John and Jean get home all they can remember of the interview is that John has cancer. They know they were told about various treatments but cannot recall what they were.

What lies behind our behaviour

❏ In 1966 Charles Whitman got up, shot his wife and his mother, and then went out and shot a further 14 people. There have been many instances of such bizarre, violent acts, but what lies behind this sort of behaviour? In the case of Charles Whitman it was found that he had a huge tumour in the limbic region of his brain. Could the presence of this tumour have been in any way responsible for his behaviour? Physiological psychologists are concerned with answering these sorts of questions by examining the relationship between an individual’s physiology and his behaviour. ❏ A patient is being admitted to hospital for major surgery. He tells the nurse that he is feeling particularly unwell today and says he has clammy hands, palpitations and is short of breath. The nurse’s early observations show he has raised cystolic blood pressure and raised pulse rate. The patient describes these sensations as symptoms of his illness, but perhaps this is because he is in a hospital setting which he associates with being unwell. Alternatively, he might have described them as signs of anxiety and fear related to his hospital admission and anticipated surgery.

Making judgements about others

❏ Imagine that it is the first day of term of a new course. The course tutor comes into the room and spends a few minutes making some introductory remarks and then leaves. Later that day over a cup of coffee, a friend asks what you thought of your new tutor. You immediately launch into a description of your reactions, maybe even making predictions about whether you are going to like the course or not. In just a few minutes you have formed a clear first impression of your new tutor. But is your impression correct? ❏ A patient discharges herself after major surgery against medical advice, only to be readmitted with serious complications at the site of the operation. The nurse on duty may have judged the patient as uncooperative and ungrateful for the treatment she received and a source of potential trouble during her future stay in hospital. In reality the patient may have been responding to a concern for her children, whom she feels have inadequate care and support in her absence.

Adolescence, adulthood and ageing

❏ Barbara: aged 16, looks anorexic, seems to get on well with her parents, has no boyfriend but two reasonably close friends, exams imminent, took a bottle of paracetemol plus a half bottle of vodka, found by her mother in a pool of vomit. ❏ James: aged 44, works too hard, has problems with his teenage son, knows he should do something about the pains in his chest (will see someone next week), his wife’s father is intolerable at weekends, which is causing problems with his wife, thinks ‘must walk the dog more often’. ❏ Edith: aged 72, used to be very good at her job and good at crosswords too, but her memory has been getting very bad, thinks that she has become a real nuisance to every one because of it, also gets disoriented and will not keep still, is in hospital for a back operation.

The effect of groups on behaviour

❏ Anne Roberts is a schoolteacher who has recently been admitted to hospital. During the drug round she notices that none of the other patients ask any questions about the drugs they are given. Although Anne wishes to know more about the drugs she has been prescribed before she takes them, she finds herself accepting them with a smile and a comment about the weather. In this situation, Anne’s behaviour has been influenced by the actions of other people. If Anne had not seen herself as a member of a group of patients, or if she had been on her own, she might have been more forthcoming in asking about the drugs.

Changing attitudes and behaviour

❏ A female patient has chronic emphysema yet continues to smoke two packets of cigarettes a day. You have told her that she has to give up smoking because her health will deteriorate further if she continues. She says to you that there is nothing wrong with smoking and anyway she enjoys it. Clearly, her attitude to the relationship between smoking and health differs from yours. You realise that you have to change her attitude to smoking, but how? ❏ People keep telling you that you ought to lose weight. You know they have a point since you have put on over twenty kilograms in the last year. You think how it would feel to carry around that weight in a rucksack all the time. The problem is that you really want to lose weight but can’t. Is there anything psychology can do to help?

Pain and stress: a biopsychosocial approach

The title of this chapter indicates that both pain and stress have multidimensional components. This means that one cannot investigate the psychology of pain and stress in isolation from biological and social factors. Pain and stress are neither physiological, psychological nor social, but a combination of all three. Therefore, it is important to examine the ways in which the components of pain and stress interact to produce two of the major topics in nursing practice. Karoly (1985) has said that pain is one of the most pervasive symptoms in medical practice, the most frequently stated cause of disability, and the single most compelling force underlying an individual’s decision to seek or avoid medical care.

The hospital and the community

Hospitals have not always existed. The ancient Roman army was one of the first groups of people to provide ‘hospitals’, in the form of separate barracks for their ill or wounded soldiers. From about AD 542 Christian monasteries took on the role of caring for the sick, in addition to sheltering the poor and needy. During the eighteenth and nineteenth centuries, hospitals became much more specialised and established wards for different categories of illness. These institutions still catered mainly for poor people, who often died of their afflictions, and so most people, if they could afford it, were treated at home by private physicians. With the advances in medical knowledge and treatment at the end of the nineteenth and beginning of the twentieth centuries, the reputation of hospitals improved and they became widely accepted as institutions with a variety of functions such as treating disease and injuries, preventing illness, conducting tests and research, teaching and assisting patients’ rehabilitation. However, while the physical experience of hospital has vastly improved, the psychological experience of the hospital is still found to cause problems for both patients and staff.