Case Study: Biomedical And Biopsychosocial Models In The Provision Of Care And Treatment

Case Study

This essay will demonstrate an understanding of the biopsychosocial influences of health and well-being of a patient who had been cared for during first placement. The author will describe biomedical and biopsychosocial. The essay will focus on a case study of a patient with a history of Cardiovascular Obstructive Pulmonary Disease (COPD) who was admitted at a local hospital due to shortness of breath. It will further describe the impact of biopsychosocial factors affecting the anatomy and physiology of the patient biologically, psychologically and socially. The author will also outline the significant of health promotion. Conclusion will summarise the findings that would have been established in this essay.

The biomedical model refers to all diseases and infections that has only physical nature. The model only focused on the type of illness and treatment from a biological perspective (Harrison (2009). Engel (1977) saw that biochemical model did not incorporate other factors, therefore, biopsychosocial model was introduced to understand the psychological and social factors. Biopsychosocial model investigates factors that influence health and well-being (Ungvarsky, 2019). World Health Organisation WHO (1948) defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity,” (WHO, 2018a, p.100).

It is important to respect the patient’s spiritual, social, emotional, physical needs; sharing or disclosing of information during assessments and treatment (Cox, 2011). In line with Nursing and Midwifery council, sharing of patient’s identity and information is a breach of confidentiality. Therefore, patient’s information and names will be anonymous throughout this essay (NMC, 2018). Instead, pseudonym will be used for the patient. Patient will be referred to as Mary throughout.

Mary is a 50-year-old working mum who was diagnosed with COPD early 2018. She worked as a teacher at a local school. She lived with her husband, two adult children and grandchildren. Mary and husband were both heavy smokers since high school. On admission, Mary displayed shortness of breath. Samples of blood, urine and sputum were obtained. All normal but sputum showed bluish yellow/green colour. Miravitlles et al (2010) points out that when sputum changes colour in COPD patient, it is a sign for bacterial infection. Skin and fingernails had discolour showing lack of oxygen in the blood. Stark et al (2019) defines COPD as a “progressive, irreversible disease of the lungs that causes airflow obstruction and a progressive decline in lung function”. The most biological influences of COPD are emphysema and chronic bronchitis.

Emphysema is the disease of the lung that often occurs in smokers which destroys the alveoli, the sacs in the lungs. Mary’s alveoli were damaged by smoking and when alveoli get damaged, air sacs within the lung’s airways become stiffer and shrinks forcing the carbon dioxide out of the body. Consequently, the bronchial will be affected and there will be less oxygen circulation in the bloodstream making it difficult to push the trapped air from the sacs causing chronic bronchitis (Slezak, 2019). Whenever Mary coughs, she produced mucus flame, and this shows chronic bronchitis that occurs in the bronchial tubes because of limited airflow. When the air sacs in the lungs become damaged, they affect the exchange of oxygen and carbon dioxide in the body causing complications such as wheezing, shortness of breath or coughing (Ross and William, 2014).

Observations were obtained showing 86% of oxygen saturates, low for a COPD patient with wider expiratory wheezing and hyperresonant (Sarkar et al, 2019). However, 2 litres of oxygen supplement were prescribed, regained normal sats of 88-92%, pulse was within range between 12-20 beats per minute. Hourly observations recommended as people with COPD are likely at risk of hypercapnia when on oxygen supplement. Salbutamol inhaler was prescribed 100 micrograms 2 puffs when required 4 times a day and sodium chloride 0.9%for nebulizer 5ml four times a day. This was used to reduce her breathlessness and wheezing. Mary was in pain and distress and was prone infectious diseases since she was in hospital.

However, analgesics were prescribed; paracetamol 500mg three times a day for pain relief due to continuously coughing; anticoagulant 200 (rivaroxaban) 20mg once a day for blood thinning since she was always in bed. Due to diet change, patient experienced constipation because of use of painkillers (Woodward, 2012). Senna 7,5mg tablets was prescribed and was given 15mg every other day to improve bowel movement. Fortisip compact protein liquid 1 container three times a day was prescribed as nutrient supplement. Her blood pressure was always high ranging from systolic160/110 diastolic. She was on her regular Calcium channel blockers; Amlodipine and Furosemide 40mg once a day to reduce high blood pressure. There are no interactions between Amlodipine and Furosemide that prohibit taking both. Lastly, antibiotics Co-amoxiclav 1.2g injection to help fight micro-organism that are frequently found in COPD patients. When the anatomy is weak, the body is physically exposed to infection hence prone to pathogens that causes illness (Matkovic and Miravitlles, (2013).

All these medications Mary was taking had some psychological side effects that impacted on Mary’s biological life. Mary feared death and was always panicking. COPD has become the six cause of death claiming 4.9% of death in developing countries (Govender, 2011) resulting in three million cases of death recorded each year (Salvi et al, 2012). Mary was worried because as a teacher she knew there is no known treatment for COPD apart from self-management. Because of this, Mary displayed some challenging behaviours that were showing some psychological aspects such as agitation, stress, depressed, anger, panic and fear. These factors brought a huge impact on her mental well-being.

Psychology is the study of mind and emotions. Freud theory seeks to study the mind therefore, noticed that some patients shows physical symptoms, and some shows emotional behaviour (Sarafino and Smith, 2014). Mary believed the use of oxygen was her only source of breathing. It is essential to give reassurance to patients with COPD as they always think they are dying. As healthcare professionals, it is vital to approach patients with holistic care, compassionate and to deliver care at patient’s best interest. Patients should be encouraged to talk about their emotions to caregivers, healthcare professionals, family and friends to improve their well-being. Biologically, stress and depression can inhibit natural healing (NICE, 2011).

Women with COPD had higher levels of anxiety and depression compared with men (Busch et al, 2014). Due to shortness of breath, Mary’s sleep was deprived. Sleep is fundamental to health. When one loses sleep, it leads to other chronic illnesses such as diabetes which increases with age (Grossman et al, 2017). When women experience psychological difficulties, they fear bringing burden to their families, caregivers, spouses or and even anyone surrounding them. The more they fear the more they feel neglected. There is always a stigma attached to COPD patients as this is their way of communicating their unmet psychological needs. This why it is always recommended for healthcare staff to treat individually with respect and dignity (NMC, 2018). Bad practice of care may cause more impact on patients’ health. Healthcare providers should display a gentle care and show reassurance to help relieve their anxiety. When the mind has been affected by an illness, the emotions affect the social life living the patient feeling helpless and lonely.

Sociology is the study of human social life. Sociologists theories seeks to understand social interaction and social needs of a patient (Denny and Earle, 2010). Mary’s social life had been affected by biological and psychological factors. She avoided visits from family members and exhibited challenging behaviour towards staff. She would no longer go out for a cigarette even when she had cravings. She felt lonely and worried about her husband copying alone. Husband had reduced his visits since he had been receiving insults. Mary had lost communication skills, social skills and self- esteem as breathing was restricted, all these biopsychosocial factors impacted her biological, psychological and social life.

Researchers discovered that women are more affected by situations, such as their age, financial, relationships and this can contribute to their life-cycle forces (Kail and Cavanaugh, 2017). The negative attitude towards the illness will incur slow recovery. Women struggle with the demand of social life when ill, as a result, they fail to balance between the demands of social factors hence lacks ability to adapt and cope. These factors impact life expectancy due to poor attitude towards health. If patient approach life with a positive mind they will have a longer lifespan (Kail and Cavanaugh, 2017). It is imperative for healthcare staff to promote health and encourage patients to live a healthier life no matter how bad their conditions might be. This will help reduce mortality rate. More than 3 million people died of COPD in 2012 and majority of the deaths occurred in developing countries (WHO, 2017). It is predicated that by 2030, COPD will be the third leading cause of death worldwide. With this high rate of mortality, it is high time patients should be taught to promote health.

WHO (2018b) defines health promotion as the process of empowering people to have knowledge on how to live a healthy lifestyle. This is done by improving the health status of an individual and the public. It involves encouraging, supporting and educating people on how to live a health life (Evans et al, 2014). Health promotion focuses on addressing biological, physical and social factors and ways of preventing disease onset (WHO, 2018a). Becker’s (1974) health belief model focuses beyond individual’s beliefs and behaviour towards their diseases and illnesses. The model seeks to understand the ideas of prevention programmes such as health screening or health promoting (Evans et al, 2014). It is fundamental to educate and encourage patients to include one of a day such as vegetables or fruits to improve their health. Health promoters such as healthcare staff, the local community, National Health Services (NHS), should set targets to influence families and individuals on the core principles of health aiming to reduce biopsychosocial factors. Government ought to introduce polices and codes of practice that aims to prevent disease onset for example, introducing smoking secession or a no smoking in public policy.

This can only be done by educating people, encourage people to join support groups and counselling sessions for people living with COPD so they can talk about their emotions. Hearing other people who are through same struggles can be comforting and encouraging. If Mary had received education or counselling on how to manage her COPD, she would not have been stressed, instead she would have learnt how to cope and manage it. This is to raise awareness to patients if other health conditions may arise. Not every case of shortness of breath is COPD. Mary’s condition was at an advanced stage that she was finding it difficult to cope, therefore, she received all care from the multi-disciplinary professionals such as from dieticians, physiotherapist, occupational therapist and speech and language therapist (NMC, 2018). Dietician gave Mary advice on how to boost her fluid intake and to have a good balanced diet to improve her nutrition for the benefit of the physical body. The physiotherapist and occupational therapist were also involved in giving Mary information on how to do exercises regularly so that she can keep up with her breathing and to manage her stress when she is surrounded by other people. Caregivers, families, peers and healthcare professionals play a vital role in providing exceptional care.

In conclusion, biomedical and biopsychosocial models played a vital role in the provision of care and treatment for Mary. The models recognise that there is a link on a patient’s behaviour that can impact their biological, psychological and sociological health and well-being. Biopsychosocial helps healthcare professionals to understand the cycles that affects the health and well-being of patient or staff; and it also helps healthcare staff to approach patients with a holistic care and understanding of the biological, psychological and sociological influences that can affect a patient’s health and well-being. The outline of health promotion was to educate patients with positive knowledge on how to prevent and improve their health and well-being. In the same way, it is a mandate for healthcare professionals to deliver exceptional care to the patients they are assigned to. (2032 words).