The Biopsychosocial Model Health And Social Care Essay

The Biopsychosocial Model Health And Social Care Essay In the preceding paragraphs many theoretical models were put forward, but it is now desirable to introduce a holistic model of causation, one that is more naturalistic than the simple linear reductionist models (Borrell-Carrià ³ et al., 2004). A comprehensive literature search showed that the most common and widely accepted holistic framework for treatment and rehabilitation is the biopsychosocial model. The popularity of this model can be seen by the frequency of its occurrence in online sources. A preliminary assessment of the biopsychosocial model was conducted using the Medline database, using the term biopsychosocial in the topics field. It is well recognised that use of the term biopsychosocial does not necessarily indicate an adoption of the biopsychosocial model, but at a minimum, it does reflect a recognition of the perspective (Suls Rothman, 2004). Figure 1.5: Frequency of citation of the term biopsychosocial using the Medline database. 4.1 The Biopsychosocial Model One of the famous landmarks articles, published almost thirty years ago by Engle (1977), questioned the biomedical interventions used in both psychiatry and medicine, and warned of a crisis in the biomedical paradigm (Alonso, 2004). Engle (1977) argued that a true medical approach should consider: (1) the patient; (2) the healthcare system; (3) the social context of the patients life; and (4) the psychological context (Mrdjenovich et al., 2004; Pereira Smith, 2005). The main proposition of the biopsychosocial model is that treatment interventions should be an interlinked system covering multiple dimensions (i.e. diagnostic and causative variables), taking into account biological, social, psychological and macro (e.g. socioeconomic status, cultural, ethnic) issues (Figure 1.6) (Burton et al., 2008). Any defect in one part of the system will affect another part of the system (Keefe et al., 2002). For instance, deterioration of a patient condition (biological effect) can negatively aff ect patients` emotional states increasing stress and anxiety level (psychological effect) affecting his/ her ability to work or perform his/her daily routine activities (social effect), which will then, subsequently, increase pain and/or disability levels (Keefe et al., 2002). Figure 1.6: A pictorial illustration of the biopsychosocial model. Adapted from Finlay (2009). The biopsychosocial model accentuate the importance of interacting and understanding the patient as a unique individual taking onto consideration their belief system in a moderate way that neither concentrate on the biomedical aspects or psychosocial aspects but rather illustrate their relationship together (Jones et al., 2002). In comparison between the biopsychosocial model and the earlier discussed models, it can be seen that the biopsychosocial model posits a much complex, multidimensional and broader approach of clinical care (Hadjistavropoulos Craig, 2004). Engles new paradigm has often been seen as a radical departure for medicine (Salmon Hall, 2003, p.1972). However, Lambert et al. (1997) stated that although the biopsychosocial model is a new approach, it is still conservative. This assessment was based on several perspectives proposed by the model. First, by underlying the need for good clinical decisions to respond to the eccentricities of each individual patient, it re-affirms the patients role, self identity and professional independence (Armstrong, 2002; Salmon Hall, 2003). Secondly, the model extends the responsibility of medical care to go beyond biological complications and encompass non-medical treatments as well (Baer, 1989). Physicians are required to connect with their patients in a relationship that involves not only the patients complaints and symptoms, but also their personalities and psychosocial lives (Salmon Hall, 2003). Conversely, patients are expected to be prepared to respond to the physicians and bring about the required changes in their lives to prevent and/or manage their illness (Salmon Hall, 2003). However, one of the issues that has been discussed in the literature is whether the concepts of the doctor-patient relationship and patient-centredness can affect and threaten the doctors authority. However, if the requirements for patient-centredness and a doctor-patient relationship are applied in a moderate and professional way, they do not threaten either the doctors authority or their responsibility, especially since physicians maintain their authority by virtue of their specialist knowledge and their responsibility for an accurate diagnosis and appropriate treatment (Salmon Hall, 2003). Taking on the considerations mentioned in this section lead to a perceived need for a study to determine the current methods followed in managing lower limb injuries (either in elective or emergency cases) and whether the biopsychosocial model is a better approach of treatment. 4.1.1 To what extent have the medical establishment and different research fields adopted the biopsychosocial model? The biopsychosocial model has been widely adopted and promoted in different domains, including medical schools, major medical organisations, social work departments, public health, counselling, and some fields of psychology (Kaplan Coogan, 2005). For example, the WHOs International Classification of Functioning, Disability and Health (ICF), which is a global framework of disability and rehabilitation, is based on the biopsychosocial model (WHO, 2001). Dowrick et al. (1996) conducted a study to explore whether the biopsychosocial model is based on rhetoric or reality. A semi-structured postal questionnaire was sent to 494 principal general practitioners. The questionnaire sought the practitioners views about what they believed to be relevant and appropriate to a practitioners skills and knowledge in general medical practice, and investigated whether these views are consistent with the biopsychosocial model. Only 41% (207) of the sample responded to the questionnaire, which is considered to be a low response rate (Church et al., 2001). The results showed that general practitioners embrace the view that physicians should incorporate a biopsychological model, rather than a biopsychosocial model, in their general medical practice. However, the results cannot be generalised because the study was conducted exclusively on members of a specific organisation. Therefore, the results can only be only applied to the specific population describ ed in the study. Similarly, Alonso (2004) also investigated the extent to which the biopsychosocial concept has been adopted by medical researchers. Using the Medline database, Alonso examined published articles in the period 1978-1982 (period a) and the period 1996-2000 (period b). Period a was selected because it covers the first five years since Engels conceptualised his new model, and the second period (period b) was determined by the date of Alonsos study (covering the five years before the study). The findings of the previous study showed that the conceptualisation of health in medical research, as characterised in articles written within the past two decades, has not changed. In other words, physicians are still reluctant to incorporate the biopsychosocial model, and often focus solely on traditional methods of treatment. Other studies (Dowrick et al., 1996; Cohen et al., 2000; Alonso, 2004; Kaplan Coogan, 2005) also concur with the findings of Alonsos original study, and conclude that the bi opsychosocial model has not been fully integrated into actual medical practice. Conversely, in an evaluation of published articles between the years 1977-1987 and 1988-1998, Hwu et al. (2001) found a considerable spread of medical research articles that did include social and psychological aspects in their definitions of health and medical care. In addition, a literature search also shows that several behavioural, medical and psychological phenomena have adopted the biopsychosocial concept (Kaplan Coogan, 2005), in areas such as schizophrenia (Kotsiubinskii, 2002; Schwartz, 2000), chronic fatigue (Johnson, 1998), antisocial behaviour (Dodge Petit, 2003), gastrointestinal illness (Drossman,1998), spinal cord injury (Mathew et al., 2001), and pain management (Truchon, 2001; Covic et al., 2003). Clearly, there are conflicting findings in the existing literature regarding the extent to which the biopsychosocial model has been integrated into the medical domain, indicating a need for future research. 4.1.2 Application of the biopsychosocial model in rehabilitation Several authors have argued that there is a considerable gap between the introduction of a new or revised model and the application of the proposed model in clinical practice (Linton, 1998; Muncey, 2000; Jones et al., 2002). The challenging factors surrounding changes in clinical practice have been reviewed by Muncey (2000), two of which are associated with physicians decision-making skills and knowledge. In addition, physicians reluctance, in some cases, to integrate new models into their clinical practice should also be taken into consideration (Silagy, 1998; Jones et al., 2002). Furthermore, because the current medical literature is often introduced at a basic scientific level, it is complicated for non-researchers to understand and transfer new models and theories to clinical settings (Jones et al., 2002). Jones et al. (2002) stated that in order to achieve successful application of a new pattern of behaviour and practice thinking, two elements are required. These are reflective, critical clinical reasoning (i.e. the decision-making process), and a suitable organization of knowledge in which the new model can be implemented. The significance of the biopsychosocial model is based on its capability to show the multitude of interactions between its elements (Jones et al., 2002). in addition, every individual element can then be further explored. However, this means that physicians need to further develop their clinical practice skills in terms of patient assessment and management, either physically or in terms of other factors that contribute to their patient`s illness (Jones et al., 2002). One of the elements that should be considered in the application of the biopsychosocial model is diagnostic reasoning, which mainly depends on the application of the scientific paradigm (or the empirico-analytical model) for decision-making and validation. This form of reasoning attempts to identify and test hypotheses relating to the nature of psychological and physical impairments and their functional disabilities (Jones et al., 2002). Narrative reasoning is another form of reasoning which is used to understand the patients own experience with their pain and illness (Mattingly, 1994; Jones et al., 2002). However, although this sounds like a simple method, in fact it is far more challenging than simply listening to patients own stories (Jones et al., 2002). Finally, it is essential to highlight the fact that the biopsychosocial approach is not only concerned with curing pathological defects, but also with helping people to regain their normal life activities (Burton et al., 2008). In addition, it is acknowledged that there may be a certain amount of reluctance regarding the adoption of the biopsychosocial model because of the hurdles in the way of its clinical application (Burton et al., 2008). Changing the way in which injuries are managed in clinical settings will require further investigation, since little attention has been paid towards identifying the current methods that are used to manage lower limb injuries (either in emergency or elective settings) and whether the biopsychosocial model is a better approach in managing such injuries. From the findings and the studies presented in this literature review, it can be concluded and hypothesised that enough clinical evidence exists to show that the biopsychosocial model is a better approach to managing lower limb injuries. On the other hand, the literature does not answer the basic question to whether the surgery is elective or emergency make a difference to the patient experience after injury, which necessitate the need for further investigate. 5.0 Conclusion Little attention has been given to the patients experience after lower limb surgery for example, comparing and contrasting the experiences of patients who have had elective or emergency surgeries, exploring physical, social and psychological aspects, and looking at whether methods of treatment and follow-ups are applied differently between elective and emergency surgeries. In addition, although various studies had focused on how the physical, social and psychological factors interlink together, no previous study has investigated the outcome of the application of the biopsychosocial model in managing patients after lower limb surgery as a result of injury, compared to those who were treated using other treatment approaches. Therefore, to address these issues, this study aims to explore and report the patients experience of clinical care of lower limb injury after surgery, comparing and contrasting the experiences of patients who have had elective or emergency surgeries, and investigating whether the biopsychosocial model is a better treatment approach for the management of lower limb injuries than other approaches. Thus, the current study is based on the following research questions: 6.0 Research question Primary research question: What are the differences between patients experiences and clinical approaches after elective lower limb surgery as a result of injury, compared with patients experiences after emergency lower limb surgery as a result of injury? Secondary research question: If a difference exists among patients experiences and clinical approaches between elective and emergency lower limb surgeries as a result of injury, how does this difference related to the current care pathway including the biopsychosocial model? 6.1 Aims and objectives The aim of this study is to develop a better understanding of patients experiences after a lower limb injury that is severe enough to necessitate surgery, and to compare medical services (after lower limb surgery) provided in emergency settings vs. elective settings. In addition, the study aims to investigate the efficiency of current methods of treatment and compare them with treatment methods derived from a biopsychosocial approach. Understanding the experience of lower limb injury from the patients perspective is essential for providing guidelines for appropriate and efficient medical services, and in the prevention of future complications for the patient. In addition, such an understanding will form a reference for future research studies. The objectives of this study are to explore and report: The difference in patients experiences of medical services for lower limb surgery provided in emergency settings and elective settings. Whether the current biomedical approach to managing lower limb injuries is efficient enough from the patients perspective. The importance of psychosocial factors for a patient with lower limb injury. The importance of implementing treatment methods derived from a biopsychosocial model approach. 6.2 Statement of null hypotheses The research is based on three null hypotheses: The primary null hypothesis states that there will be no difference in patients experiences in emergency and elective surgery settings for patients with lower limb injuries. The secondary null hypothesis states that there will be no difference between elective and emergency lower limb surgeries as a result of injury, and hence it does not relate to the current care pathway including the biopsychosocial model.

Politics and Money Essay -- What is Politics?

The late Alabama governor George Wallace once said, "There's not a dime's worth of difference between Republicans and Democrats." Both Republicans and Democrats agree on taking our money. Where they differ is what to spend it on. A Democrat agrees to take our earnings and give them to cities and poor people. A Republican agrees to take our earnings and give them to farmers and failing businesses. Republicans have dominated both houses of Congress since 1994, a year when federal spending was $1.5 trillion. Less than a decade later federal spending in 2002 was over $2.1 trillion, a 37 percent increase. Some politicians might argue that the war on terrorism has been responsible for the massive spending increase. That's nonsense! According to a recent report titled Most New Spending Since 2001 Unrelated to the War on Terrorism by Brian Riedl, a research fellow at the Heritage Foundation, over half of all new spending since 2001 has been unrelated to defense and the 9/11 attacks. Just from 2001 through 2003, federal spending increased $296 billion, of which: $100 billion (34%) went to national defense; $32 billion (11%) went to 9/11 costs, such as homeland security, International aid, and rebuilding damage done by the 9/11 attacks. About · $164 billion (55%) went to spending completely unrelated to either defense or terrorist attacks. Most of the spending represents government t aking the earnings of one American and giving it to another American. Such acts are little more than legalized theft. How did legalized theft become so acceptable for it is not part of our history? Let's look at some of that history. In 1794, James Madison, the acknowledged father of our Constitution, wrote disapprovingly of a $15,000 appropriation for Fren... ...e; it's the American people. Politicians are elected to office on the promise that they will deliver to one group of Americans the earnings that belong to another group of Americans or they will confer a special privilege on one group of Americans that will be denied another. A politician who disavows this practice will not be elected or if elected run out of office and the reason is simple. If a politician doesn't use his office to deliver another American's earnings to his constituency, it doesn't mean that his constituency will pay lower federal taxes. It only means another state's citizens will enjoy the loot. Thus, when legalized theft becomes routine it pays for everyone to participate. Those not participating will end up as losers. While becoming a recipient of stolen property is optimal for the individual, it spells devastation for the nation as a whole.

Psychology and Social Situations Essay

Providing incentive for individuals to establish a carpool system or take the bus instead will motivate them to resort to these resolutions although it has been unsuccessful. The government and other organizations that campaign against overdependence on private vehicles which contribute to heavy traffic should not expect that simply asking the people to share rides and take buses in order to lessen the number of vehicles on the road will work. People should be given incentives in adhering to the requests of concerned organizations, such as free fare or transportation allowances for the people. Organizations and establishments concentrated on a specific location should grant employees with free rides on shuttles that will take them to and from work everyday. This allows individuals to understand that sharing rides and taking the buses will save them the fare and lessen inconveniences caused by heavy traffic. 2. From this particular situation, we may deduce the disparity of knowledge and competencies displayed by children. Individual differences also cause differences on the rate of performance within the classroom, such that there are those that excel and those who fail depending on the cognitive faculties. Assignments are provided by teachers not only to reinforce learning and introduce the succeeding lesson, but also to give children the chance to catch up and experience success through home-based activities that allow them to learn at their own pace. Children who are identified to be the lowest-achieving in class think about their chance of pulling up their grades by spending more time on their assignments and excelling through them. This is the same reason why excellent performers do not spend more time on their homework, because they already have experienced success within the classroom setting. 3. Providing rewards is a good way of motivating children and reinforcing learning. There are various forms of rewards that teachers will be able to use including tangible rewards. Although concrete objects are considered as rewards, they should be given in moderation. Teachers should look for other forms of rewards such as praises and commendations, exemptions from school work or activities, and other types of non-tangible rewards. The danger of utilizing concrete objects as rewards is that children will not be able to learn the value of maintaining desirable learning behavior in class. Every action that they take will depend on the presence of a tangible reward at all times. In this case, desirable learning behaviors are not reinforced and sustained throughout the learning process, and children will only choose to perform well and exhibit good behavior when they see that there will be tangible rewards made available for them after doing so. To address this situation, academic institutions should consider setting standards and guidelines on how teachers should provide rewards, stressing the need to lessen the use of concrete objects but rather utilizing non-tangible rewards that create emphasis on inherent changes and display on desirable learning behavior and excellent learning performances. B. Psychological Disorders 1. The classification of abnormal behavior stems from the need to appropriately determine the medical and professional methods and strategies that will be implemented in order to address problems associated with the variety of abnormal behavior. The classification system of abnormal behavior, particularly the DSM-IV established by the American Psychiatric Association or APA, is utilized in order to provide a clear illustration or image of the kind or type of behavior exhibited by an individual. The DSM-IV utilizes five axes that are utilized to categorize behavior, solidifying them into a profile that provides information on the dimensions of particular behaviors. Utilizing classification systems, such as DSM-IV, although convenient also has flaws or disadvantages, intensifying the difficulty of assessing and classifying behavior. For instance, since the DSM-IV utilizes five axes in categorizing behavior, it becomes a limited means of understanding the dynamics of behavior. Classifying behavior into five categories does not really border on reliability and validity since behavior will not always meet all the criteria of each category. 2. When one is diagnosed with psychological or mental disorders, this means that there is something nonstandard and uncharacteristic about an individual’s way of thinking and behavior. Having a disorder mean that an individual’s life, particularly his functioning, is influenced by its effects building problems and difficulties along the way. The diagnosis will point to possible causes, whether the disorder is caused by biological factors, environmental factors, and such, which affects one’s ability to work efficiently, socialize with other people or become integrated into society under normal circumstances, etc. After being diagnosed with a psychological or mental disorder, it will also mean that an individual will need to seek professional help in order to determine the root of the problem and disorder and identify possible solutions in order to resolve them. 3. Perhaps it is better to be wrongly diagnosed as having a mental disorder even if one actually does not than the other way around because in the process, the individual will still be able to disprove the diagnosis while medical professionals will have enough time to discover the wrongfulness of their diagnosis. One will not lose anything by being misdiagnosed as psychologically or mentally incapacitated, perhaps just time and effort in proving the misdiagnosis of medical professionals. On the other hand, if one is wrongly diagnosed as not having a mental disorder, he will miss the chance of being provided with professional help and assistance as to how he will be able to conquer the problems brought about by his psychological or mental disorder. After being diagnosed without mental disorders even if in fact, one is psychologically or mentally changed, it will not be treated properly fuelling the possibility of one’s illness or disorder getting worse, while at the same time, intensifying the effects that it might bring towards one life. Missing out on the chance of being treated will neglect â€Å"damage control† allowing the illness or disorder to intensify possibly leading to a state wherein medical professionals will not be able to provide and recommend treatment appropriately.

Comparisons of the Natural World - 1345 Words

Illiwa Baldwin CH 202.1305 Jeff Auer March 5 2012 Comparisons of the Natural World Up until the 17th Century, an understanding of the natural world and how it operates was very limited and the general consensus was that there was God, and all things were created by him in a hierarchical order that sustained the balance of man. Although these Gods varied between ethnicities and religions, the general idea of a creator is consistent. However, with the extent of experiences and experimentation of Galileo, Bacon and Newton, the world was able to explore a new realm of reality in scientific discovery and analysis. Although the works of Galileo, Bacon and Newton can be compared with each other in regard to the idea of experimentation and†¦show more content†¦Francis Bacon is better known for his theories that man will better understand nature if he uses the mind as a tool rather than rely entirely on scientific discovery. It is Bacon that attempts to connect the science and understanding of the physical world with society. Baconà ¢â‚¬â„¢s Novum Organum lists a series of aphorisms by which man should abide by in order to attain a better understanding of the natural world. These aphorisms are a guide to accepting science as the entire truth of the natural world. His writings are peculiar because he lays down these guidelines and within them there seems to be a constant message that instructs doubt in scientific experimentation, where Bacon himself is a scientist that utilizes the use of experimentation and scientific method. Moreover, he outlines the four classes of â€Å"idols† that effect the thought and minds of man, â€Å"I have assigned names, calling the first class Idols of the Tribe; the second, Idols of the cave; the third, Idols of the Marketplace; the fourth, Idols of the Theatre† (TOM 29). 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