Fundamental of Behavioral Sciences

Essay Questions 1

Health is the state of complete social, physical, and mental wellbeing. The social, economic, environmental, and personal factors influence people’s health status collectively grouped as health determinants. Considering the case of Lottie, social determinants significantly contributed to her current health experience and wellbeing. Social determinants of health include lifestyle, genetic, sex, age factors, living condition, community, and social networks (McFarland and MacDonald, 2019, p 3).

The first social determinant factor in Lottie’s current health situation is genetic factors. Recently, Lottie has become disturbed about being very overweight or obese. Her condition could be genetically transferred since her parents are also overweight, and Lottie has been ‘big’ even as a child. Research shows that genetics can contribute to obesity in specific disorders such as Prader-Willi syndrome and Bardet-Biedl syndrome. However, genetic factors alone may not envisage future health. Genetic factors and behavior, including low diet and physical inactivity, may be required for a person to be obese (Young, Hinnant and Leshner, 2016, p 903). Lottie and her family have relied on local takeaway meals and snacks over the years. She is likely not exercising as she spends most of her time watching television and Netflix films when not working. Such behaviors alongside her genetic makeup could have contributed to her being overweight.

Income and social status also contribute to Lottie’s current health condition. Lottie and her family live in concentrated poverty or lower income, which is linked to poor health. The family is struggling to make ends meet after she and her husband lost their jobs. They have also been earning low income due to their jobs’ nature, making it difficult to afford a good meal (Matthews 2015). Lottie worked part-time in a corner shop that closed down, and Robyn worked in a bar before being shut by the owners. Economic pressure is forcing families to reduce the overall cost of food, resulting in a surge in consumption of pre-packaged convenience diets, which are in excess of fat and calories. Besides, Lottie and her husband have been drinking in the bar where they worked before it was shut, and they are forced to do their drinking at home, which is costly. Alcohol drinking is also attached to poor health.

Loss of social networks and support is another health determinant factor leading to Lottie’s poor health. Lottie and the family have lost touch with most of their old friends over the past years while bringing up the children. They also have few relatives living in the area to give them social support. The physical environment is also not favorable for Lottie’s family as it not secure. Their neighborhood is known for having a drug gang problem, making it insecure for Lottie’s children and the family.

The essential information necessary for the practice nurse at the GP surgery to assist Lottie includes her family history, diet patterns, history of drug or alcohol use, and socioeconomic factors such as income or loss of her job, which are determinants for health inequalities. Nurses must be aware of health inequalities, causal factors, and effects. The nurse must also establish and address the root cause of suboptimal health in a population or from an individual perspective to prevent further deterioration (McFarland and MacDonald, 2019, p 3). This is made possible by the nurse obtaining any bit of information that might contribute to the patient’s current health status.

Essay Questions 2

            There is a concern about Gerry’s school attendance, and he is also lonely and reluctant to communicate with either staff or students, a sign of withdrawal. Gerry does not socialize; he is refusing to eat or play with other students. Gerry is also shaggy; he wears baggy clothes and keeps his arms and legs covered at all times, suggesting he is holding his feelings and keeping other people out of his life or depressed every time. Past traumatic events primarily cause withdrawal, inability to socialize, and depression among students (Gilliver, C., 2018).

Gerry has been exposed to adverse childhood experiences (ACEs) throughout his childhood caused by family violence and divorced parents. He could, most of the time, be forced to hide before a physical fight between his parents when the father is drunk. The mother also took a backseat in Gerry’s upbringing, leaving him to struggle on his own. All this stress alongside the parents’ eventual divorce and taking care of the elderly grandmother subjected Gerry to constant stress during his childhood.

According to the American Academy of Pediatrics, some stress in life is everyday and essential for development. However, stress caused by adverse childhood experiences (ACEs) may become toxic, mainly when it is strong, lengthen and recurrent stimulation of the body’s stress reaction systems without an adequate parental or adult relationship (Gilliver, C., 2018, p 47), such as in the case of Gerry. Biological responses to toxic stress caused by ACEs can be extremely destructive and extend to adulthood life. Many of the life-threatening health complications that surface during adulthood, such as heart disease, obesity, drug addictions, and alcoholism, are linked to childhood adversity (American Academy of Pediatrics, 2014, p 2).

Children who encounter ACEs growing up like Gerry are at a higher level of developing behavioral and learning challenges and other risks such as early initiation of sexual activities or pregnancy. The impact can be extended to the next generations if the experience is not corrected. For instance, adults who encountered ACEs while growing up may have problems with parenting capability or maladaptive responses to their children (American Academy of Pediatrics, 2014, p 2), which could be the case with Gerry’s mother taking a backseat, making Gerry struggle with her own life.

Menschner and Maul’s (2016) developed a trauma-informed care model to help in early intervention or prevention of ACEs and assist adults with ACEs to recover. It entails school nurses, primary care nurses, health visitors, and adolescent and child mental care service or pediatric nurses to manage ACEs. The principles of care in safeguarding Gerry as a vulnerable person and providing support to his family are based on trauma-informed care principles. The trauma-informed care intervention model requires that staff recognize and understand ACEs and their impact. For instance, nurses must be able to recognize the symptoms and signs of the trauma in their patients and families. The model also emphasizes the reliability, trustworthiness, and safety of the patient during the care, alongside peer support collaboration, empowerment of gender and historical issues (Gilliver 2018, p 48). The fundamental principles create an environment that respects people’s diverse experiences, hence managing the incidences of re-traumatization (Whitby, 2018). The primary objective of trauma-informed care is to avoid chances of re-traumatization and enhance the patient’s safety.

Essay Questions 3

Amina’s periods of excessive alcohol binge drinking are motivated by peer pressure at work. Peer pressure to consume alcohol may influence excessive alcohol intake, which can have devastating effects on an individual’s health and wellbeing. Study shows that normative perception is significant predictors of alcohol use. Social cognitive models, including the “theory of planned behaviour,” attributes social influence and norm linked constructs as an explanation for behaviour. Norms and social influence play a significant role in explaining excessive alcohol consumption (Cooke, Dahdah, Norman, and French, 2016, p 149). For instance, part of the organization’s culture in Amina’s case advocates for hard work during the week and socializing on weekends. There is an expectation that every worker must join in for a few drinks. Amina considers drinking as a relaxation method after demanding accounting job tasks during the weekday and socializing with colleagues as part of the office culture. Job demands, such as accounting jobs, have also been cited as social factors that push people to drink.

The best way to discuss alcohol use with Amina, to engage with her and promote behavior change is to embrace behavior change interventions that focus on “making every contact count”—asking the patient about her lifestyle and what she might want to change, responding effectively to the issue and developing an action plan for the intended change. NHS staffs are required to use every contact with the patent as an opportunity to promote health and wellbeing, such as advising on less alcohol use and more physical activities (Fuller, 2015, p 23). Brief interventions are one approach recommended by the NHS’s proposed “National Institute for Health and Care Excellence (NICE)” guideline on an individual’s behavior change applicable in Amina’s case. NHS nurses are trained to deliver brief intervention for patients whose behaviors could subject their wellbeing and health to risks. The brief intervention lasts about 30 minutes, characterized by verbal discussion, encouragement, and negotiation about the patient’s health issues (Fuller, 2015, p 24). Brief intervention with Amina may include discussion on her lifestyle, particularly concerning alcohol and what aspect of the behavior the patient feels is possible to change alongside negotiation and encouragement for change.

The negotiation and encouragement aspects may entail discussing the benefits of not consuming excess alcohol and approaches that can help the patient refrain. This can happen in the accident and emergency unit where the nurse is examining Amina for kidney problems caused by excessive drinking and can act as an introduction to further extensive intervention, either an extended brief intervention or high-intensity intervention.

As for Amina’s case, a high-intensity intervention will be most appropriate since her current condition exposes her to a high risk of harm. Amina has even developed acute pancreatitis because of drinking excessive alcohol and may require a regular visit by a behavior change nurse after the discharge to help her manage her condition. As recommended by NICE, high-intensity intervention is offered to patients with severe behavior problems such as critical dependencies on alcohol, as in the case of Amina. The behavior change treatment provider or nurse offering high-intensity intervention must visit the patient regularly. The nurse of care providers must have high-level training in an advanced set of core competencies in cognitive behavioral therapy techniques (Fuller, 2015, p 24) to respond effectively to acute behavioral problems such as alcohol and drug addictions.

Essay Questions 4

Frank’s increased agitation is caused by cognitive impairment due to Alzheimer’s, a progressive cognitive disorder that causes brain cells to degenerate. He has lived along with the condition for many years. Frank’s condition is significantly recent, explaining his agitating behaviors when experiencing unmet needs, in this case, low energy and frequent need to visit the washroom. Since he was moved to nursing home care, Frank has started experiencing the frequent urge to visit the toilet, particularly during the night and evening hours. Frank is also not comfortable with the new environment as he struggles to trace his way in the home care, ending up wandering and pacing up and down the corridors. Unrecognized triggers may also explain Frank’s agitation. Recently, Frank lashed out when approached, refusing care, and help from the female staff, which might indicate gender-related triggers, making the patient uncomfortable. Frank’s agitation might also indicate Delirium and dementia, typical of people in their old age, 75 years plus (Harwood, 2017, p 176). Delirium is a condition resulting from acute illness and can be reversed, while dementia is caused by the brain’s anatomic changes and is irreversible.

The strategies to calm Frank and maintain feelings of comfort and safety during her period in the home care facility include both primary, second, and tertiary interventions. Primary intervention strategies focus on reducing aggressive behavior happening in the first instance. The first focus is on the physical environment, ensuring that the environment increases the patient’s satisfaction through ergonomic designs and layouts that reduce stress and pain and enhances communication (Harwood, 2017, p 53). Frank seems to be struggling to locate the toilet at night, making him soiling his pajamas on some nights. He gets distressed and confused during the night and evening hours, an indication that the environment is not ergonomically designed to favor patients’ safety and satisfaction during those houses and should be looked into by the caregivers.

The secondary intervention approach can also be adopted in Frank’s case, focusing on reducing the imminent risks and potential escalation based on the source of the aggression. Secondary measures operate on the basis that aggression or violent acts from the patients follow the same pattern called the assault cycle, which encompasses “trigger, escalation, crisis, recovery and post-crisis depression” (Harwood, 2017, p 54). A trigger is the event that initiates the aggression (Harwood, 2017, p 176) and should be established to help manage the aggression. The trigger for the case of Frank could a bad attitude developed against female nurses.

In these cases, a replacement should be considered before the situation escalates. It is still possible for the patient to calm themselves or be calmed by others at the trigger phase (Harwood, 2017, p 54); hence early move is necessary. Anger increases at the escalation phase, but the patient can still be calmed through others’ interventions. For instance, providing a male nurse to Frank or making it possible for him to locate essential locations such as the washroom by ensuring adequate lighting or ensuring his privacy may calm him.

It is critical to act decisively before the condition reaches escalation or crisis level. In the event of extreme aggression or violent behavior, a de-escalation strategy applies. The de-escalation approach is to build and maintain a therapeutic relationship with the patients to boost their esteem. The approach includes ensuring the patient’s safety and effective communication phase and follows only after identifying the trigger (Harwood, 2017, p 57). A combination of the approaches mentioned above could help to manage Frank’s current situation.

Bibliography

American Academy of Pediatrics, 2014. Adverse childhood experiences and the lifelong consequences of trauma.

Cooke, R., Dahdah, M., Norman, P. and French, D.P., 2016. How well does the theory of planned behaviour predict alcohol consumption? A systematic review and meta-analysis. Health psychology review, 10(2), pp.148-167.

Fuller, S., 2015. HEALTH-RELATED BEHAVIOUR: PART 2 OF 2: Building brief intervention into your everyday work. Nursing Times, 111(5), pp.23-25.

Gilliver, C., 2018. Trauma-informed care in response to adverse childhood experiences. Nursing Times, 114(7), pp.46-49.

Harwood, R.H., 2017. How to deal with violent and aggressive patients in acute medical settings. Journal of the Royal College of Physicians of Edinburgh, 47(2).

Matthews, D., 2015. Can sociology help to improve nursing practice?. Nursing times, 111(41), pp.18-20.

McFarland, A., and MacDonald, E., 2019. Role of the nurse in identifying and addressing health inequalities. Nursing Standard, 34(4).

Whitby, P., 2018. Role of front-line nurse leadership in improving care. Nursing Standard, 33(8).

Young, R., Hinnant, A., and Leshner, G., 2016. Individual and social determinants of obesity in strategic health messages: Interaction with political ideology. Health Communication, 31(7), pp.903-910.