Suchman’s stages of illness model
• The human being is a social being.
• Social factors play an important role in health. • Social conditions not only increase the likelihood of illness and disability, but they also improve the chances of disease prevention and health maintenance.
• A healthy lifestyle and the avoidance of high-risk behavior increase an individual’s chances of living a longer and healthier life.
• Recognizing that an individual’s health is more than just biological phenomena has highlighted the importance of the behavioral dimension of health.
Mr. As, a 73-year-old Muslim male patient admitted to the —-ward of —-hospital with prostate cancer. Data on psychosocial aspects of his life and illness were gathered until September 9, 2013rt. However, he was later discovered to be reluctant to speak…because he was frequently expressing his financial difficulties, which could not be helped by anyone connected to him.
Prostate cancer is the fifth most common type of cancer in men, and its prevalence increases with age. It affects one out of every ten men who live to the age of 70. Early clinical features are similar to those of bph, and the gland may appear normal on digital examination. Psa levels may be elevated (>4 ng/ml). As the tumor spreads, it may cause bladder neck obstruction, obstruct the ureters, and eventually lead to renal impairment. Rectal examination in late disease reveals a large, hard, and irregular prostate. Rectal ultrasound can detect cancer spread and should be used to guide needle or aspiration biopsy. Prostatic biopsy is important in providing prognostic information because poorly differentiated tumors have a poor prognosis.
The staging of therapy is important. Early disease is treated with local radiotherapy, while advanced disease is treated with orchidectomy and oestrogen-based hormone therapy. All men over the age of 50 should be screened with a rectal examination, transrectal ultrasound, and psa measurement.
• Name: Mr. As • Age: 73 • Gender: Male
• Place : —-/ —— • Hospital No. : ——— Marital Status: married
• Admission date: 1-4-08
• Education: There has been no formal education.
Culture and way of life
Religion: islam, muslim, believes in ‘durgas’ and has visited them.
Food habits: vegetarian four times a day, non-vegetarian once a day
• Lower socioeconomic status • Occupation • Fisherman for 12 years • Beedi worker for 10 years • Went to gulf and worked there for 4 years • Cook for 35 years • His son is in gulf country, but earns only rs.5000/month • His residence is approximately 80 kilometers from —-, • To and fro journey costs rs.50/person
• Head of the family, earning member, and father • These roles are affected by the illness “everything is disrupted at home”
Social support network • Patient has a poor social support network • There is no one to financially support him for treatment of his illness • His daughter visited him twice in the hospital, and no one else visited him or inquired about his illness after he arrived in the hospital
Patient complaints (at the first meeting) • Genital pain (during catheterization) • Urine tube must be removed
He has no taste for anything he eats.
There is no money to pay the hospital bill.
Nighttime sleep deprivation
Identification of patient requirements
Collection, observation, and participation in caring activities
Analysis and interpretation
• “I have pain in the genital region” • “I have a problem of passing urine without control, which is why the tube is inserted” • “I want to get this urine tube removed” • “Who will pay my hospital bill of Rs.50,000?” I need writing help with my dissertation – cheap thesis writing services
Basic physical requirements
• he is advised not to take a bath until the end of radiotherapy to avoid skin excoriation at the site • he maintains adequate cleanliness • he visits the toilet with the assistance of his wife • he is catheterized for the last 2 months • he claims to be a practicing Muslim • he is taking bath means it interferes with his religious practices • he is advised not to take bath because he may wet the irradiation area
Needs related to lifestyle • he is a non-vegetarian • but he is not receiving any non-veg food in the hospital • his lifestyle needs are being hampered in this hospital environment
Habitual requirements • he does not drink tea or coffee • he does not smoke or consume alcohol • as he has any regular habits of drinking tea or coffee or drinking alcohol
Individuals’ understanding and experience with illness
The patient’s understanding of the current illness
The patient describes his illness:
• “I’ve had pain and a urine block for the last six months”
• “I have a serious illness” • “I’ve had diabetes for a year”
• “I had surgery for a urinary block and pain four months ago in —–” What does the patient want to know about the illness?
“Will this disease be cured?”
“I came here because doctors in —— told me that my illness could only be cured in this hospital.”
• The patient understands his illness because it is serious.
• The patient had an orchidectomy and turp 4 months ago and was later referred to a tertiary care hospital for further management.
• The patient wishes to know if his illness will be cured.
• He claims he has no money to spend on her, but his expenses are covered by his daughter and one brother.
What was his previous experience with illness?
Previous illness history
• “Previously, I went to many local folk doctors, but they only made all these illnesses”
• “I’ve had sugar sickness for the past year”
• “The doctor in Kundapura advised me to check my sugar levels, so I know I have a sugar problem.”
• “Aside from this, I’ve never had a major illness in my life.”
• no major illness in his knowledge, whether or not the patient has accepted his illness
• “I haven’t had any habits, such as drinking, smoking, or even drinking coffee, since I was a child.” “I’m not sure why I got this illness.”
• patient consulted many folk doctors for minor illnesses and was never satisfied with them. • he had minor urinary frequency problems for about 4 years and consulted some folk people for some remedies but was never satisfied.
• The patient has accepted the illness as something he did not deserve, and he blames it on fate.
Knowledge of formal and alternative therapies • He is well-versed in both formal and folk medicines.
• “I went to them, but there were no benefits”
He had tried alternative medicines and discovered that they had no effect on his illness.
Current and future course of action knowledge
What is the treatment plan, and is the individual aware of it?
• the patient claims that his x-ray treatment will last one month; • “nobody tells me what my illness is”; and • “I take medications on a regular basis.”
• patient has only partial knowledge of his illness and treatment planss• he is illiterate, but nobody has explained him about his treatment plans
Coping with the illness and its outcome (patient and family) • “what will we do?”
• “we have to suffer everything”s• he looks depressed and tries to avoid visitors
• I don’t have money pay here, I don’t know what to do”
• patient is not showing adaptive responsess• he has depressive cognitionss• he has financial problems
Analyse the individuals and family’s views ons• health teams• doctorss• nurses • “doctor people come and asks how you are? (he explains sarcastically), nothing else”
• “they do not want to know about my pain”s• “sometimes, nurses come asks about me”
“doctor has told something to my daughter”
He is not satisfied with the psychological attention given to him by nurse or doctorshis wife too has the same opinionsdoctor has explained about the illness to his daughter about the diagnosis and prognosis
Distinguish between the meanings of the patient, doctor, nurse
Patient: “they are not asking me anything”
doctor: “he will not understand anything, it is explained to his daughter”snurse: “doctor has explained everything to him, we cannot tell anything to the patient”
Patient wants to know about his illness, and course of treatment, but doctor is preoccupied with the patient’s educational status.
Nursing staff is bothered whether they may convey wrong message to the patient.
There is a communication gap exists among these people.
Observe the patient, doctor and nurse interaction
What patient says has reason.
• doctor has advised him rt for 1 month, so he feels there is nothing more to talk to the patient than enquiring any problems
• nurse is largely functionally oriented and interact with patient only in such occasions
The mutual interaction among the treating team and patient is missing in this situation
Suchman’s stages of illness model
Mr. As has been suffering form prostate cancer for the last 1 year. But his symptoms started about 4 years back. For about 3 years he tried folk remedies based on the advice of other people. He approached medical advice when his symptoms aggravated. He is currently undergoing radiotherapy for prostate cancer and medications for diabetes and other symptoms. This case study helps to understand the psychosocial aspects of illness development and application illness behaviour model in nursing practice.