Introduction TheWorld Health Organisation (WHO) defined health in 1948 as a, “state of completephysical, mental and social wellbeing and not merely the absence of disease orinfirmity.” (WHO, 2018). This definition highlights the fact that it is notmerely the physical ill-health of a service user that should be considered byhealthcare professionals, but also the factors relating to their psychological andsocial wellbeing. Since the 1990’s, the idea of person-centred care hasappeared with increasing regularity in United Kingdom health policy (The HealthFoundation, 2014).
As a result, a transition has emerged from the traditionalmedical model of healthcare, which focussed on the anatomical and physiologicalsymptoms of the service user, to a more person-centred model of healthcare.This more holistic approach considers their entire wellbeing, as individualswithin their own community, who have specific needs and values that areimportant to them. Research has shown that if the broader wellbeing of thepatient is addressed, they are more likely to be treated with the respect,dignity and compassion that they deserve (British Medical Association, 2011).Thisessay summarises some of the underlying psychological and social factors thatmay affect service users attending the radiography department. These importantfactors should be considered by radiography department staff when communicatingwith patients in order to achieve person-centred care. There are an abundanceof factors that could be discussed; examples include gender roles, disabilities,income, social class, wealth, occupation, culture, educational background,media influence, relationships, mental illness, anxiety, anger and alienation. This essay will however focus on socioeconomicfactors and patient stress and anxiety.
Social Factors Theassociation between a person’s health and their social class is one that iswell documented and applies to all aspects of health including mortality rates,life expectancy and likelihood of accessing public health services. In spite of the fact that the NHS is aservice accessible to all, a report on England from the Office for NationalStatistics highlighted major differences in a number of health related issues acrossthe different social classes.Aperson’s social class is usually determined by their educational background,occupation, income and wealth. People inthe United Kingdom in higher social classes tend to have jobs that providesubstantial income, favourable working conditions and a higher status. As aresult, they experience better than average health and wellbeing. In contrast, lower social classes tend tohave more manual, less stimulating, lower status jobs with poor workingconditions.
Therefore being part of alow social class can have a detrimental impact on a person’s physical andemotional wellbeing, compared with people belonging to the higher socialclasses, who tend to have better paid jobs with more favourable workingconditions. The more manual,uncomfortable nature of low income occupations puts members of the lower socialclasses at more risk of occupational hazards. Direct effects on their healthand wellbeing include accidents leading to fractures and soft tissue injuries,musculoskeletal pain from repetitive actions and respiratory problems due topoor air quality in places such as factories and workshops. A study carried out by Charles Court-Brown etal. (2013), investigated the relationship between social deprivation and theincidence of adult fractures. The investigation was performed at The RoyalInfirmary of Edinburgh and concluded that fracture incidence significantlyincreases in the most deprived 10% of the population. The study suggests that people belonging tothe lowest social classes are more prone to falls and accidents and, inparticularly, high-energy proximal tibia fractures.Individualsbelonging to high social classes usually have a greater income and as a resultbecome wealthier.
Consequently, this gives them levels of disposable incomethat members of the lower social classes do not have. Wealthier families tendto have a better quality of life and have more potential to reduce their healthrisks because they have greater opportunity to make positive health decisions. Moredisposable income means that wealthier people can invest in gym memberships andare more likely to exercise for leisure. Although the lower classes tend tohave more manual occupations, this physical activity does not adequately effecttheir cardiorespiratory system for it to be beneficial and, after a hard day’swork, they are unlikely to want to partake in even more physical exercise. Wealthier families also tend to havehealthier diets as they can afford to buy better quality and more nutritiousfoods, whilst poorer families tend to eat more fatty, processed and conveniencefoods. Studies have also linked lower socioeconomic groups with heavier alcoholconsumption and increased tobacco use.
Research into alcohol consumption ofmembers of the adult population of Wales found that participants from the mostsocially deprived areas were most likely to binge drink. Suggested reasons forthis are that people of low social class use alcohol as a coping mechanism todeal with the stresses of everyday life, and also that cheap alcohol is morereadily available in socially deprived areas due to there being a higherdensity of alcohol outlets( ). When onclinical placement in the accident and emergency department of the Royal StokeUniversity Hospital, it was observed that the majority of people who werereferred for ultrasound scans specifically to look for liver problems, werepeople of middle age who had alcohol dependencies. Some were unemployed andothers had no fixed abode. The vast majority were unkempt and some were still underthe influence of alcohol at the time of the scan.
All of them were found tohave varying degrees of fatty liver disease and cirrhosis.Thecumulative effect of poor diet, inadequate physical exercise, excessive alcoholconsumption and tobacco use means that being part of the lower social classesis related to increased risks of obesity, heart disease, myocardial infarction,liver disease, diabetes and increased susceptibility to certain cancers (). Psychological Factors Psychologicalfactors refer to the thoughts and feelings that affect the functioning of thehuman mind. These factors affect a person’s behaviour, attitude and decisions towardstheir healthcare.
Psychological factors subconsciously influence how people dealwith the dynamics of different health issues during their lifetime. Physicalillness and pain can have a profound negative impact on a person’s emotionalwellbeing. Attending hospital inflicts added stress onto a patient due to theunfamiliarity of the clinical environment, particularly the technical equipmentand surroundings of an imaging department. Anxiety is an importantpsychological factor that must be considered by radiography staff in order toget the best possible outcomes for the patient.
Service users undergoingradiographic examinations for diagnostic purposes will have increased feelingsof anxiety due to the uncertainties of the outcome of their illness and fear ofthe unpleasant nature of certain radiographic procedures. A study carried outin 2011 on behalf of the Radiological Society of North America assessed the levelsof distress of women in the waiting room of an imaging department who wereattending for radiological procedures. The results showed that the women thatwere attending for diagnostic breast biopsy, and the women attending forinvasive treatment of malignant liver cancers and uterine fibroid treatment,experienced abnormal levels of perceived stress, depressed mood and negativeimpact of events. Interestingly however, it was only the women attending forbreast biopsies that experienced highly alleviated levels of anxiety. This suggests that the invasiveness of the procedurehas less influence on patient anxiety than the uncertainty of the test results( ). The patients attending fortreatment rather than diagnostics already knew that they had cancer or fibroidsand so the fear of the unknown was not as influential on their emotionalwellbeing. Feelingsof anxiety and stress can stop patients from retaining information and can alsoaffect how they respond to instructions. During was an extremely anxious lady camefor a barium swallow examination.
The high anxiety levels of the lady meantthat she found it difficult to follow basic instructions such as holding thebarium in her mouth and swallowing at the correct time. Even when theradiologist explained to the patient after the examination that there was nothingsignificant to worry about, she continued to question the radiologist as thoughshe could not believe the positive outcome. The patient’s abnormal level ofanxiety was partly a result of the fact that prior to her appointment, she hadconvinced herself that she was going to be diagnosed with a tumour. The temptationof patients to self-diagnose is a prevalent issue in modern healthcare, and canoften increase feelings of depression and anxiety in service users. People arenow less passive in their attitude towards their healthcare and will use onlineresources to try to have greater understanding about healthcare issues. Unfortunately,when this information is not accurate and a healthcare professional has notalso been consulted, it can cause unnecessary worry to an already anxiouspatient and as a result has a profound negative influence on their psychologicalhealth and wellbeing.
Feelingsof intense anxiety or stress can cause physiological changes in the body thatmirror the symptoms of other illnesses. People who are abnormally anxious canexperience increased heart and breathing rates, profuse sweating, tremblingsensations and gastro-intestinal problems. Patients will often have numerous radiographic examinations because ofthese symptoms and will still not get an answer because their symptoms areanxiety related. They may be referred for a chest X-ray or ECG because of an increasedheart rate, or for a virtual colonoscopy because of digestive problems, but theimaging will often not show any physical cause of the symptoms.
Psychologicalfactors such as stress and anxiety must be considered by radiography staff toensure that service users do not feel like their psychological wellbeing isbeing ignored. Radiographers are therefore faced with the challenge of notletting the technicalities of the radiographic examination distract them frombeing attentive to the patient’s emotional health and wellbeing. Discussion and Reflection Ill-healthmakes service users vulnerable and scared. They are forced to trust that thehealthcare professionals they encounter on their patient journey will do thebest for them as individuals and will consider their entire wellbeing, not justtheir anatomical and physiological symptoms.
Thetraditional passive role of the patient is becoming a thing of the past andthey are now encouraged partners in their own care, collaborating withhealthcare professionals in decisions regarding their treatment. The Planetreemodel encompasses this patient-centred approach to healthcare suggesting thatcultural transformation and staff engagement is essential if we are to providea more value-based health service. It is the responsibility of all healthcareworkers to consider the psychological and social factors that may affect serviceusers on an individual basis (Planetree, 2018). When applied to radiographic practice, the Societyof Radiographers Professional Code of Conduct (2013) states that all of theprofessional workforce for diagnostic imaging and radiotherapy must, “Listen toand respect the wishes of patients, seeking to empower them to make decisionsabout their care and treatment.” The code of conduct puts patient-centred careat the heart of radiographic practice which it insists must be based on valuessuch as respect, trustworthiness and empowerment (Society of Radiographers,2013). Radiographers consequently have a responsibility to consider the broaderwellbeing of the patient, including the social and psychological factors thatmay influence their everyday lives.
Correlationbetween socioeconomic status and health shows that health improves incrementallymoving upward through the social classes. Members of lower social classes aremore likely to suffer from chronic illnesses, it could therefore be deducedperhaps that diagnostic radiography departments in particular will see morepatients from the middle to lower social classes.Psychologicalfactors such as stress and anxiety put emotional strain on service usersattending radiographic examination appointments and can create added challengesfor radiographers who already have to contend with consistently stretched resourcesand time constraints. Radiographers mustuse