Psychosocial Theory and Social Learning Theory Application for ADHD

Identification of the description of the Problem (15 pts)

This paper will examine the effects of attention deficit hyperactivity disorder also known as ADHD – in early childhood ages 3 to 12. Furthermore, this paper will examine ADHD through the lense of Erickson’s Psychosocial Theory and Bandura’s Social Learning Theory. This paper will further discuss an existing intervention that relates to ADHD.

According to Human Behavior in the Social Environment: Perspectives on Development and the Life Course, Anissa T. Rogers (2016) defines attention deficit hyperactivity disorder (ADHD) as a brain disorder associated with learning disabilities and is marked by an ongoing pattern of inattention, hyperactivity, and impulsivity that interferes with the individual’s functioning and/or development. Children with ADHD may display numerous and various combinations of symptoms that can range from “[being] easily bored, [having] trouble focusing on tasks and activities, [children] [may] demonstrate high level of activity, [they] [may] also show an unwillingness or inability to think before acting, or they may exhibit low levels of impulse control (Rogers, 2016, pp.255)”.

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As reported by the Diagnostic and Statistical Manuel of Mental Disorder (DSM-5)(2013), children with ADHD have poor neuropsychological functioning compared to their typically developing peers. The DSM-5 indicates that symptoms of ADHD are first identified in school-aged children (approximately at ages three and six), and on average is later diagnosed at age seven. Furthermore, there is no clear factor that identifies the specific causes of ADHD; however, there is evidence that genetics is one factor that contributes to ADHD and other factors that scientists consider are premature birth, brain injury and mother smoking, using alcohol, or having extreme stress during pregnancy (American Psychiatric Association, 2013).

In terms of scope and severity, the article Attention-Deficit/Hyperactivity Disorder (ADHD) (2013) from the Center for Disease Control and Prevention (CDC) website, posted aparent report from 2016 and found that 9.4 percent of children from the ages 2 to 17 have ever been diagnosed. The 2016 report also explained that among children between the ages 2 to 17 had ADHD accompanied with a behavior and conduct problem such as anxiety, depression, autism spectrum disorder and Tourette Syndrome (ADHD, 2013). Furthermore, the data also reported that 62 percent of children in the United States between the ages 2 to 17 are taking ADHD medications, 47 percent received behavioral treatment, and 77 percent received a combination of both the medication and behavioral treatment or one treatment alone (ADHD, 2013).

In discussion about the significance of ADHD within specific at-risk ethnic/racial groups and subpopulations, the report 2011 to 2013 data brief of the National Center for Health Statistics (NCHS), Patricia Pastor, Cynthia Reuben, Catherine Duran, and LaJeana Hawkins (2015) reported that children ages four to five, 2.8 percent non-Hispanic white children were diagnosed with ADHD while 3.2 percent were non-Hispanic black children, and 2.2 percent were Hispanic children. Prevalence among the next age group of ages 6 to 11 was much higher than the younger children, while the third age group of 12 to 17 was much greater overall (Paster et al., 2015).

 Another factor that contributes to ADHD according to Pastor et al (2015) indicates that children ages 4 to 17, the prevalence of ever diagnosed with ADHD was higher among children with public insurance compared to children with private insurance. In agreement with Pastor et al., Abigail Russell, Tasmin Ford, and Ginny Russelle (2015) claim that health insurance is related associated with socioeconomic status. In a longitudinal study of 8,132 parents and children, Russell et al. (2015) explore the relationship between socioeconomic disadvantages in childhood and ADHD. As a result, the study concluded that “financial difficulties, housing tenure, maternal age at birth of [the] child, marital status [and] [parental] [involvement]” has a direct and indirect impact on a child’s risk of ADHD (Russell et al., 2015, pp.5). In other words, both home and environmental factors are all associated with the greatest increased odds for ADHD among children.

ADHD often appears to run in the family, but researchers and studies have suggested that the causes of ADHD may be a genetic component that is hereditary among the family. Non-genetics causes such as abnormal brain development, brain injury, and/or environmental factors are also believed to play a role in the disorder (Muenke, 2014). Furthermore, the Mayo Clinic (2018) also suggests that certain environmental factors such as lead poisoning may also increase the risk of developing ADHD; as well as, developmental problems that deal with the central nervous system.  In addition, maternal drug use, alcohol use, smoking during pregnancy and premature birth are other risk factors that may also contribute to ADHD (Mayo Clinic, 2018).

Mayo Clinic (2018) states that ADHD does not cause other psychological or developmental problem, but children with ADHD are more likely than others to experience learning disabilities in which includes problems with understanding and communicating. ADHD may also contribute to anxiety disorders which may cause overwhelming worry and nervousness; depression, which frequently occurs in children with ADHD; disruptive mood dysregulation disorder which is characterized by irritability and problem tolerating frustration; oppositional defiant disorder (ODD), conduct disorder, a behavior that is marked by being antisocial; bipolar disorder and Tourette syndrome (Mayo Clinic, 2018).

Children with ADHD may not only impact their academic performance at school, but it may also impact their social scene as well. Children with ADHD may have trouble making friends, they may have challenges keeping relationships, they may struggle with verbal communication and they may have a lack of self-control over their behavior (Mayo Clinic, 2007). In addition to Mayo Clinic’s findings, the ADHD Institute (2017) found that ADHD can have a significant social impact by disruption education and academics, employment, finances, family life and relationships, and they may experience impulsivity and increased risk-taking behavior that may lead to adults breaking societal rules and norms (ADHD Institute, 2017).

Cultural background is a common variable in receiving appropriate medical attention in today’s society. As maintained by H. Starr (2007), ethnicity and race influence how a patient and/or the family responds to a diagnosis of ADHD and it’s treatments. According to the report, 48 percent of Hispanics and 49 percent of African-American children with ADHD used medication compared to 61 percent of white children (Starr, 2007). Furthermore, it is also stated that there has been a higher degree of acculturation that is associated with an improved ability to recognize symptoms of ADHD (Starr, 2007).  Starr (2007) states that the Hispanic population faced many challenges that may interfere with the diagnosis and treatment of ADHD due to the greater stigma regarding mental disorders and less frequent use of mental health specialist. Another issue in which the Hispanic community may not seek immediate medical attention is due to their folk medicine (curanderismo) and/or the use of a less acculturated approach of self-treatment (Starr, 2007). Due to limited studies on African-Americans with ADHD, there is not efficient research on this article that explains how the African-American culture affects receiving the diagnosis and treatment to ADHD; however, Starr (2007) notes that this community is also in need in education and awareness about ADHD. On the contrary, Carol Siegel, Eugene Laska, Joseph Wanderline, Jennifer Hernandez, and Rachel Levenson (2016) confirms that African-American parents may not respond to their children experiencing ADHD symptoms. This culture may not view hyperactivity as a medical problem in which reduces that parent’s motivation to mention it to their child’s primary care provider (Siegal et al, 2016).

Application of theories (60 pts)

ADHD can affect individuals of all ages and can have an impact on their behavior, learning and social skills development. However, in respect to this paper and topic, I will be focusing in early childhood of ages 3 to 12 using Erikson’s Psychosocial Theory and Bandura’s Social Learning Theory. More specifically, I will be focusing on two of Erikson’s stages which are stage three: initiative versus guilt (ages 3 to 6) and stage four, industry versus inferiority (ages 6 to 12).

 Erik Erikson’s theory of psychosocial development evolves from Freud’s psychodynamic theory, where Erikson focuses on the social dynamics of human behavior. Moreover, Erikson’s theory is based on the epigenetic principle, which states that “people have a biological blueprint that dictates how [the] [individual] grow[s] and [how] [the] [individual] reach[es] maturity” (Rogers, 2016). Furthermore, Erikson also states that each of the eight stages is characterized by “Psychosocial crises” that is based on physiological development. Crises in each stage should be resolved by the ego in order for development to proceed correctly. Resolving each stage is critical because it develops positive qualities that allow the individual for growth and supports the exploration of the self and the environment (Rogers, 2016).

 To briefly mention the eight stages to Erikson’s stages of psychosocial development, stage one is trust versus mistrust (birth to 18 months), stage two: autonomy versus shame and doubt (18 months to three years of age), stage three: initiative versus guilt (three to six), stage four: industry versus inferiority (six to age twelve), stage five: identity versus identity confusion (adolescence), stage six: intimacy versus isolation (young adulthood), stage seven: generativity versus stagnation (adulthood) and stage eight: integrity versus despair (old age) (Rogers, 2016).

 Using knowledge from Erikson’s theory, it provides a useful developmental guide to use on individuals with ADHD to determine which stage their developmental milestones should be at. For example, a child age three a should be in stage three, initiative versus guilt, according to Erikson’s stages of psychosocial development. During the initiative versus guilt stage, children begin to assert their power and control over the world through direct play and other social interaction. Children who take initiative enables them to make plans and set goals without the fear of failure. While mistakes are inevitable in life, children who have developed a sense of initiative will understand that mistakes happen and may need to try again. On the other hand, children who are discouraged will show a lack of confidence upon interests and will not take the initiative to shape their lives (Rogers, 2016). Essentially, children who fail to develop a sense of initiative in this stage may develop the fear to trying new things and exploring new things; and ultimately, interpret the mistake as a sign of personal failure and may be left with the sense that they are doing something wrong or that they are “bad”.

 While children do not successfully master the previous stage of initiative versus guilt, they continue to move through Erikson’s fourth stage, industry versus inferiority. During this stage, school and social interactions play is an important component in this stage and in the child’s life. More specifically, friends and classmates are a vital role in how children progress through the industry versus inferiority stage. Succeeding at play and schoolwork, children are able to develop a sense of competence and pride in their abilities. By feeling competent and capable of, children are able to form a strong concept of themselves. Children who discover that they are not as capable as their peers who are can result in feelings of inadequacy and inferior to their peers (Rogers, 2016).

 In addition to using Erikson’s psychosocial theory, I will also use Albert Bandura’s social learning theory to discuss the disorder in terms of the theory and to explain how ADHD can be used in the design of the intervention. Bandura’s social learning theory posits that people learn from one another, via observation, imitation, and modeling. Moreover, by observing other’s behaviors, one sees the consequences and the rewards for that particular behavior (Rogers, 2016). In other words, people learn by other’s successes and failures. In addition, an important component that Bandura identifies in his theory is self-efficacy in which is defined as, “people’s expectations that they can perform a task successfully” (Rogers, 2016, pp.95). Bandura argues that successful experiences in life are necessary to build self-efficacy, seek new opportunities that lead them to successful outcomes, in which as a result leads to feeling competent (Rogers, 2016).

 Though Bandura’s social learning theory does not directly address ADHD, his theory can be applied to individuals of all ages who have ADHD, by offering a guidance about how these individuals can achieve their self-efficacy and improve their social behaviors.  ADHD is a disorder that interferes with individuals social learning due to their hyperactivity and inattentive in which as a result limits their ability to observe and imitate positive behavior from role models, especially in classroom setting where student with the same or similar behavior problems do not have a positive role model to whom they can imitate “acceptable” behavior (Rogers, 2016). These individuals also have problems with social skills and interactions with others, they experience challenges in the education field such as school and academics. Here, and anywhere else, the individual may experience a low level of self-efficacy, especially when they are told that they cannot control their own behavior (Rogers, 2016).

 So, question is, how can parents, educators, relatives, and many others do to take an extra step to model a positive behavior they want to see in children with ADHD rather than only focusing on correcting the behavior? Well, teaching children basic skills, encouraging independence and self-autonomy can help these children develop self-efficacy. Self-efficacy can encourage children to take control of their behavior by developing healthy coping mechanisms, followed by a treatment plan and improve impulse control.


Design of Intervention

 There are numerous of intervention that children with ADHD can benefit from if they are used properly and accurately. According to Caroline Miller (2018), behavioral interventions do not specifically target the core symptoms of ADHD, but these types of therapies teach children skills that they can use to control their behavior. Children with severe ADHD ultimately benefit from behavioral therapy alongside medication (Miller, 2018). Miller (2018) also points out that the importance of behavioral therapy is to teach children skills that will continue to benefit them as they grow older. Some parent to child interventions that Miller (2018) listed are Parent-Child Therapy (PCIT), Parent Management Training (PMT), and the Positive Parenting Program (Triple P). These interventions involve both the parent and the child working together by training the parent how to appropriately interact with their child, in order to elicit desirable behavior on the part of the child and discourage behavior that causes problems and conflicts. In these interventions, a psychiatrist usually trains parents to use praise, positive reinforcement, rewards, more effectively as well as using consistent consequences when children do not comply with instructions. As a result, this intervention results in better behavior among children, by decreasing tantrums, decreasing parental stress, and increasing parental-child interaction (Miller, 2018). This intervention can relate to Erikson’s fourth stage of industry versus inferiority because children are learning to perform complex tasks with the positive enforcement, children are encouraged by the parents to develop a feeling of competency and belief in their abilities. If this intervention failed, children with ADHD will doubt their abilities and continue to fail other stages of Erikson.

 Behavioral therapy is another intervention that is used among children with ADHD; however, is it most effective in young children when it is delivered by the parents and who are not taken medication before the age of six (CDC, 2018). Similarly, to the parent-child therapy, behavior therapy is used to improve the child’s behavior, self-control and increase self-esteem, in which leads to improving functioning at home, school, and in social relationships (CDC, 2018). This type of therapy is provided by psychologists, social workers, licensed counselors and even paraprofessionals who meet with the family on a regular basis at the family home to teach, monitor, implement, and provide support to the family. In between session, parents practice behavioral skills taught by the paraprofessional to reinforce positive behavior at all times. This intervention is also beneficial because it reinforces positive behavioral by the family’s behavioral model. More specifically, this intervention works with the entire family or those who want to be involved in, reinforcing family members to always be the positive role model in their love one’s life. Having the individual observe his role models at home, benefits from imitating positive behavior; thus, decreasing unwanted behavioral and increasing communication, positive reinforcement, structure and discipline.


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Psychosocial Effects of Cystic Fibrosis on Patients and Their Carers

Consider the literature regarding the psychosocial effects of Cystic fibrosis on patients and their carers. How might these findings promote holistic physiotherapy patient management?

Cystic fibrosis is a life-threatening disease that can affect not only the patients that are suffering from the disease, but it can also affect the people caring for them in many ways such as mentally, socially, emotionally and even spiritually (Quittner et al, 1992). This assignment aims to explore how physiotherapists can promote and help manage patients with cystic fibrosis using a holistic approach. When physiotherapists take this approach, not only the disease is focused upon and treated, but the patient is comprehensively treated i.e. the treatment of the mind, body and soul.

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Cystic fibrosis is a recessive disease considered fatal if not treated properly. The disease manifests itself in several parts of the body, particularly the lungs. Cystic fibrosis can also affect the pancreas, the integumentary system, and the urogenital system (Taber, 2009). The disease can present a variety of signs and symptoms such as but not limited to frequent coughing, an increase in phlegm/sputum production, reduced exercise tolerance, coughing up of blood, frequent lung infections, pancreatitis, male infertility, malabsorption, and clubbed fingers and toes. Patients who suffer from cystic fibrosis may go on to develop diseases such as bronchiectasis, bronchitis, emphysema, atelectasis, and some patients may even develop respiratory failure (Taber, 2009; McPhee, 2010). These symptoms and associated diseases can have a detrimental effect on the patient’s physical health and can also affect the patient mentally and psychosocially (Foster et al., 2001).

The physiotherapists role in providing treatment to cystic fibrosis patients is to improve their breathing, prevent declining and deteriorating pulmonary function, and to aim for the patient to live life as comfortably as possible. Due to the complexity of the disease and the vast amount of daily medications needed, patients normally require an extensive and personalised approach to treatment (Daniels, 2010). According to Hodson, Geddes, and Bush (2007), management of patients with cystic fibrosis should be comprehensive i.e. holistic and address each patients’ individual needs. The purpose of holistic physiotherapy patient management for cystic fibrosis patients is to reduce or prevent any further inflammatory changes in the respiratory system, increase life expectancy, improve or maintain exercise tolerance and provide positive patient outcomes and quality of life.

According to Harrop (2007) and Foster et al (2001), persistent coughing and the accompanying removal of sputum/phlegm from the throat during conversations or social interactions can lead to embarrassment for the patient and may cause negative reactions with friends. Patients with cystic fibrosis are usually taken care of by their close family members who may even take the professional role as carers to support and treat their symptoms. But as the disease is progressive, it can in some severe cases lead to an early death. Therefore, it can be challenging to manage and can become very stressful for the carers due to the complexity and amounts of time spent treating the patient. This can leave the carers physically and mentally exhausted (Goldbeck et al., 2014). Hence, patients with cystic fibrosis and their family members who care for them often seek help in managing the disease by acquiring guidance and knowledge that can help with psychosocial, mental and physical issues. It is for these reasons’ physiotherapists and other members of the multidisciplinary team specially trained to deal with cystic fibrosis are available to provide help and guidance when needed (National Institute for Health and Care Excellence, 2017).

One of the major factors that are disregarded during the treatment of cystic fibrosis are the patient’s psychosocial issues such as family dynamics, career issues, relationships issues, depression, anxiety, social support, and loneliness (Upton 2013). From amongst the members of the multidisciplinary team, physiotherapists are the ones that spend quite a large portion of time with cystic fibrosis patients. So, they are the ones that have the best opportunity to address the patients’ psychosocial issues. This requires the need for promoting holistic physiotherapy patient management so that these issues can be acknowledged and addressed when treating the patient. The above-mentioned issues can affect the progress of the patient’s treatment and overall quality of life (Quittner, Modi and Roux, 2004).

A holistic approach as defined by Hyerman (2005, p. 31) is “caring for the whole person in the context of the person’s values, their family beliefs, their family system, their culture, the socio-ecological situation in the larger community, and considering a range of therapies based on the evidence of their benefits and cost”. Vender (2008) mentions that this approach requires physiotherapists as well as the multidisciplinary team to acknowledge that people suffering from cystic fibrosis can be complex, meaning that their lives can carry a vast amount of complexities that can affect normal day to day activities. Each aspect of their illness has the potential to affect the mental wellbeing of the affected individual. Knowing that patients with cystic fibrosis have a variety of factors that concern them, provides a good reason for physiotherapists as well as carers and other health care workers to promote holistic patient management. As treating the body as a whole (i.e. holistically) and not just focusing on the disease itself will have a better impact on the patient’s wellbeing (Vender, 2008).

According to Paterson (2001), patients that are suffering from cystic fibrosis mentally, socially, or psychologically (i.e. the disease is having a negative impact on the patients’ state of mind) are more engaging in a successful manner with practitioners and therapists who undertake a holistic approach to managing their disease. Therefore, it is significant that physiotherapists take a holistic approach to managing and treating their patients. This is to ensure that the patient’s, social, emotional and physical needs are taken care of (Beck, Rawlins and Williams, 1993). Dossey, Keegan, and Guzzetta (2004) suggest that a holistic approach to patient management encourages positive outcomes between patients and the people looking after them. It also enables the therapist and patient to give full attention to one another and provides the therapist with a deeper understanding of the behaviour of patients’ and meanings that they attribute to their disease.

Holistic treatments may incorporate alternative methods like music therapy particularly using wind instruments. These types of therapies are considered to be beneficial towards treating patients psychologically. Some studies have shown that music therapy can even improve/enhance lung function and reduce stress and anxiety levels of patients with lung diseases (Griggs-Drane, 1999; Wade, 2002).

Physiotherapists treating patients with cystic fibrosis may often sense or feel the need to understand their patients and carers concerns more deeply, especially those with psychosocial issues. So, in order to treat the patients and also to understand the concerns of their carers may require a holistic approach (Wicks, 2007). When using a holistic approach, many questions may need to be addressed such as asking about the patients’ work, hobbies, what they mostly think about, and asking about their feelings. Also acknowledging the concerns of their carers, helping them with any issues and giving them support and advice can lead to better outcomes for patients (Booth 2004).

Doring (1976) mentions that physiotherapists have occasion to enquire into the ability and feeling levels of patients. For example, what kind of things is the patient is able to do now that they are suffering from the disease, what they were able to do normally, how they feel towards their pain, how the disease is affecting them in relation to friends or family, what they perceive the future holds for them and so on. These types of questions may begin to get the patient to open up and feel free to say things to get off their chest. In this way the therapist Is using a holistic approach which benefits both the patient and the physiotherapist as it enables the patient to gain trust in the therapist (Doring, 1976).

Identifying and addressing the impact that emotions, depression, and anxiety can have on patients with cystic fibrosis and their carers can aid in promoting more personalised suitable treatment and management plans. This can ultimately improve the overall wellbeing of the patient (Besier, Quittner and Goldbeck, 2008). Anxiety and depression can have an effect on outcomes in patients, have a poorer adherence to treatment, and affect a patient’s quality of life. Not only does anxiety and depression affect patients, but it can also affect their carers especially the ones close to them especially parents and children (Besier, Quittner and Goldbeck, 2008). Understanding the things that encourage the patient to adhere to treatment while identifying their strengths and weaknesses provides the physiotherapist with key information, so that they may be able to provide an optimum holistic treatment program (Bezner, 2015).

Conner and Norman (2005) stress that a holistic approach to physiotherapy is the key to encouraging and sustaining a good and healthier lifestyle. It involves the patient having a sincere intention to follow treatment plans, have belief and confidence in themselves, showing ability to prosper, creating a perception that there is a social pressure to perform, and having hope and eagerness of an outcome that would be beneficial and satisfactory to them.

The Chartered society of physiotherapy (2012) stipulates the need to care for patients as a whole and not just focus on disease, but focus on patient centred management, i.e. caring for the patient holistically. As Physiotherapists are expected to make clinical choices together and in agreement with patients while having consideration for various suitable treatment options. The importance on holistic practice in their clinical choices is emphasised along with the anticipation that other members of the multi-disciplinary team will implement holistic practice in all aspects of their care too.

Quittner, Modi and Roux, (2004) found that the benefits of managing physiotherapy holistically, enables patients to avoid unnecessary and multiple visits to the hospital which reduces costs and also is less time consuming. They also found that patients who had received some type of training to help with the symptoms of their disease were easily able to continue guided physiotherapy treatments in the comfort of their own homes – again the major benefit being not having to use scarce healthcare resources.

The median survival age for people with cystic fibrosis is anticipated to reach approximately 50 years and adults with cystic fibrosis in the United Kingdom will be more in number than children living with cystic fibrosis (Dodge et al., 2007). But surviving the disease and reaching adulthood begins presenting some of the people affected with the disease with various challenges that are completely new and can be overwhelming to them. For instance, being the main person responsible for their own care instead of their parents or other family members, trying to find suitable employment, sorting out finances, becoming independent from parents, settling down, getting married and thinking about planning a new family life (Bezner, 2015). Special cystic fibrosis clinics with the required specialist health staff, i.e. physiotherapist, doctors and nurses are in place to enable an easier transition between paediatric and adult care. One of the biggest issues and complaints that can arise from therapists in these clinics is that there is not enough time to provide the holistic care needed. This is because the professional environment a lot of the time consists of heavy workloads which can affect therapists and other healthcare workers from providing consistent holistic care (Olive, 2003).

Holistic patient management can increase motivation in physiotherapists and other health workers alike as well as increasing their knowledge. A point to note is that the importance of professional and suitable environment is a prerequisite of holistic care (McEvoy and Duffy, 2008). One of the biggest contributing factors for disregarding holistic patient management is poor compliance and ignoring needs of the patient. Some of which may not seem that important to the therapist but are of concern to the patient (Henderson, 2002).

In conclusion, physiotherapists should be able to recognise and address the effects that are associated with patients suffering from cystic fibrosis. They should also consider the effects on their carers and how these effects can be addressed and managed in a suitable way. As mentioned, one of the best ways that these effects can be managed is through a holistic approach to care and patient management. This essay has defined what holistic care and management is, why it is important, how it should be done and the outcome that can be accomplished by both Physiotherapists and patients when using a holistic approach. (word count: 2073)


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Psychosocial Impact Of Stroke Health And Social Care Essay

The literature review was based on extensive survey of books, journals and international nursing studies. A review of literature relevant to the study was undertaken which helped the investigator to develop insight into the problem and gain information on what has been done in the past. An extensive review of literature was done by the investigator to lay a broad foundation for the study and a conceptual framework framed based on Peplau’s Interpersonal Theory to proceed with the study under the following headings.
For the purpose of logical sequence the chapter was divided into the following sections.
2.1 Part-I : Studies related to psychosocial impact of stroke.
2.1Part-II : Studies related to effectiveness of psychosocial interventions on psychosocial health of stroke clients.
Caso V, et al., (2012) conducted a cohort study among women aged between 54 and 79 without an history of stroke for a period of six years to identify the depressive symptoms using the mental health index score. Findings revealed that during this 6 year follow up, 1033 incidence of stroke were documented. They concluded the study by telling that having a history of depression was associated with an increased risk for total stroke.

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Choi-Kwon S, et al., (2012) conducted a study on prevalence of post stroke depression (PSD) and post stroke emotional incontinence (PSEI) among 508 acute ischemic stroke clients by using Beck’s depression inventory and Kim’s criteria. Findings revealed that PSD and PSEI were present in 13.6% and 9.4% of patients, respectively, at admission and in 17.6% and 11.74, respectively at 3 months after stroke. Low social support (p=0.042) was related to PESI 3 months after stroke.
Campbell Burton et al., (2011) in the meta-analysis study reported that approximately 20% of the stroke clients experienced anxiety and depressive symptoms at some point following stroke incident.
Clau JP, Thopmpson DR., (2011) conducted a quantitative study to assess the perceived self-esteem level among 50 stroke survivors. Findings reported that self-esteem is seen to enhance people’s ability to cope with disease. Low self esteem may inhibit stroke clients participation in rehabilitation and thus result in poor health and social isolation.
Gallagher P (2011) conducted a grounded theory study to examine the emotional process of stroke recovery among 9 stroke survivors. Data was collected from formal unstructured interview and one group interview. The findings revealed that physical and emotional recovery is inseparable, becoming normal was influenced by personal strength, family support, faith and comparing self to peers.
Gurr B, Muelenz C (2011) in a descriptive follow-up study on psychological problems after stroke among 35 stroke survivors reported that early detection and review of post stroke psychological problems may optimize recovery from stroke. The study highlights the importance of mood assessment for all the stroke patients. The researcher suggest that patients with psychological distress must have an access to psychological interventions.
Buijck BI et al., (2010) conducted a longitudinal multicenter study to assess the prevalence of neuropsychiatric symptoms (NPS) among 145 stroke clients using Neuropsychiatric inventory -Nursing home version. The findings revealed that the most common NPS were depression(34%), eating changes (18%), night time disturbances(19%), anxiety(15%) irritability(12%), disinhibition (12%). The findings of the study suggest that NPS should be optimally treated to enhance the outcome of rehabilitation.
Hackett ML, et al., (2009) conducted a cohort study on psychosocial outcomes in stroke among seventy stroke survivors less than 65 years of age. They stated in their study that each year approximately 12,000 Australians of working age survive with stroke. They have the responsibility for generating the income and providing family care. The suggestions of the study were effective rehabilitative medical and social interventions must be provided for them to promote and maintain healthy ageing and mental health condition.
Sharma, et al., (2009) conducted an explorative study to explore the relationship of self esteem level, self esteem stability and admission functional status on discharge depressive symptoms in acute stroke rehabilitation among 120 stroke patients by using state self-esteem scale during inpatient and completed a measure of depressive symptoms at discharge. Functional status was rated using functional independence measure. Results suggested that patients with lower self rated self esteem and poorer functional status indicated higher levels of depressive symptoms.
Carin-levy G, et al., (2008) conducted a descriptive study among 40 stroke survivors, experience of taking part in exercise and relaxation classes were explored which contributed to improved self perceived quality of life, improved psychosocial functioning and improved motivation to take part in recovery process.
Asplaud K et al., (2007) conducted a prospective study to describe the various aspects of psychosocial function after stroke and the development of change over time on 50 stroke survivors. Findings revealed that patients with two years post stroke had more psychiatric problems. The study was concluded by stating that major depression early after stroke, functional impairment and an impaired social network interact to reduce life satisfaction for the long-term survivors.
Edward C. Jacob (2007) in the descriptive study on assessing the quality of life among stroke survivors stated in the study that stroke is been feared because of the short and the long term disability involved. Approximately around 4.4million stroke client are not able to get back to their lives productively. Quality of life scale and Barthel index score was used to collect the data. The findings revealed that in an stroke episode 30% of them require assistance in their activities of the daily living, one third of the survivors suffer from post stroke depression.
Lightbody CE et al., (2007) conducted a cross-sectional study among 28 post stroke clients to identify depression by using Geriatric mental state examination and Montogmery-Asberg depression rating scale. The findings suggested that 25% of the clients were depressed and Montogmery-Asberg depression rating scale is quicker to administer, it may prove more useful to nurses clinically.
Raju RS et al., (2007) conducted a prospective hospital based study in CMC Punjab among 1 month post stroke clients. Data regarding psychosocial problems and quality of life was analyzed by using WHO quality of life BREF scale. The conclusion of the study is that presence of anxiety, depression, and functional dependence were associated with impaired quality of life.
Jun EM, Roh YH., (2012) conducted a quasi experimental study to assess the effect of music movement therapy on physical and psychological outcomes among stroke patients. A convenience sampling method was used to randomize experimental and control group. The intervention music movement therapy was given for 60 minutes three times per week for 8 weeks. Findings revealed that the experimental group had significantly increased mood state in psychological function compared with control group. The study concluded by emphasizing early intervention for stroke clients during their hospitalization.
Morris J, Oliver Kroll., (2012) conducted a descriptive study among stroke clients to assess the importance of psychological and social factors in influencing the uptake and maintenance of physical activity. After a structured review of the empirical literature, the study concludes that self efficacy and social support appear relevant to physical activity behavior after stroke and should be included in theoretically based physical interventions.
Yang NC, Yeh SH., (2012) reported in the case report that patients with stroke related disabilities are at risk of depression and social isolation. While good at dealing with physical illness, nurses are often poor at attending to patients mental and spiritual needs. The author had used a model of spiritual care and in-depth evaluation to identify several underlying psychological issues of stroke clients. These included feelings of hopelessness and loss of control and motivation. The authors established trust through active listening. A multidimentional spiritual care approach was applied to help the patient shift from hopelessness to hopefulness. This enhanced motivation of the patients to participate in rehabilitation.
Cynthiya L. Flick (2011) developed a self-directed learning module to assess the stroke outcome and psychosocial consequences. She discussed on the predictive factors for mortality and functional recovery. The importance was laid on the rehabilitation programs-reintegration and socialization after stroke and management of psychosocial effects of stroke on patients and families.
Green TL, King KM (2011) conducted a descriptive correlational study to examine the relationships between mild stroke functional and psychosocial outcomes among the 38 elderly mild stroke clients. Functional outcome was measured using Modified Rankin scale, patient’s quality of life using stroke impact scale, mood using the Beck depression inventory. Findings revealed that at three months post discharge, patient’s functional status scores had significantly improved with corresponding increase in quality of life scores. The study concluded that the nurses must consider the psychological and social implications of the recovery process of stroke clients following discharge.
Kim DS, et al., (2011) conducted an experimental study to assess the effects of music therapy on mood in stroke patients. Samples selected were 20 post stroke patients divided in to experimental and control group. The experimental group participated in the music therapy program for three weeks. Psychological status was evaluated with the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) before and after music therapy. Findings suggested that BAI and BDI scores showed a greater decrease in the music group than the control group. The study concluded by stating that music therapy has a positive effect on mood in post stroke patients and may be beneficial for mood improvement with stroke.
MacIssac (2011) conducted a mixed method study to explore the supportive care needs after stroke, a need assessment survey was developed and administered to 10 patients with stroke to identify the specific needs of the population and the applicability of the tool was further evaluated through a focus group of nurses working in stroke care. The results suggested that the survey aided the nurses in early identification of the supportive care needs for the patients.
Hua CY et al., (2010) conducted a descriptive study to identify the mediating roles of social support on post stroke depression and quality of life among 102 clients with ischemic stroke. The clients were assessed using social support inventory, Barthel index, quality of life index stroke version and face to face survey interviews. The results suggested that half of the clients suffered depression and social support partially mediated the prediction of post stroke depression by functional ability.
Forsblom A, et al., (2009) conducted a study on therapeutic role of music listening in stroke rehabilitation. Data was collected by two parallel interview schedule of stroke patients (n=20) and professional nurses (n=5) to gain more insight into the therapeutic role of music listening in stroke rehabilitation. Results suggested that music listening can be used to relax, improve mood, and provide both mental and physical activation during the early stages of recovery from stroke.
Salter, Folley N, Teasell., (2009) in a systemic review of literature states that psychological consequences of stroke are important determinants of health related quality of life. As many as one-third of stroke clients will experience post stroke depression, however perceived social support may be protective in terms of both onset and duration of depressed mood. Improvement of available social support could be an important strategy in reducing or preventing psychiatric distress and warding of post stroke depression.
Vickeryi CD, Sepehri., (2009) conducted a quasi-experimental study on self- esteem in an acute stroke rehabilitation sample: a control group comparison. Stroke survivors (n=80) were matched on age and education to a group of neurologically intact community dwelling control participants. Data was collected using visual analogue self esteem scale, Rosenberg self esteem scale, geriatric depression scale. Findings revealed that stroke survivors rated significantly lower mean levels of self esteem on the visual analogue self esteem scale (37 versus41) and the Rosenberg rated higher mean levels of depressive mood on the geriatric depression scale (9versus 6). Significantly higher correlations between self esteem and mood ratings were noted in the stroke group that in control group. The study suggest that lower self esteem ratings do not appear to be a byproduct of depressive mood. Clinicians may facilitate the emotional adjustment of the survivor by considering this facet of psychological impact and intervening to address self esteem.
Lamb M., (2008) in a systemic review of literature revealed that the onset and early period following a stroke is a confusing and terrifying experience. The period of recovery involves considerable psychological and physical work for elderly individuals to reconstruct their lives. For those with a spiritual tradition, connectedness to others and spiritual connection is important during recovery.
Mant J Winner S., (2008) conducted a descriptive study on family support for stroke. Twenty stroke clients family was visited and data was collected regarding functional dependence and used stroke impact scale, care giver burden was assessed. Findings revealed that family support is essential for stroke clients to have a regular follow-up and to alleviate the psycho social problems of stroke clients.
Robinson Smith G., (2008) conducted a study on prayer after stroke-its relationship to quality of life among eight stroke patients who used prayer after stroke as a coping strategy to improve self efficacy and quality of life. A qualitative approach using the interview method was employed to expand on spiritual practices expressed through prayer as a way of coping after stroke. Findings revealed that stroke may encourage patients to re-examine spiritual aspects of life and the challenges associated with stroke can promote spiritual growth and development. potential strategies are suggested to nurses to identify patients spiritual needs.
Vohora, R., Ogi, L., (2008) conducted a pre-experimental study to address the emotional needs of stroke survivors in a stroke rehabilitation ward at Moseley Hall Hospital, U.K. A group intervention was developed for 31patients in stroke ward. The interventions were group discussion where they share their experiences, thoughts and feelings and had group activity. The group met five times over two and a half weeks. Each session was designed to last for around an hour. To analyze the result of the intervention Patients were asked to indicate the degree to which they liked each session, 26 responses were given regarding the perceived most helpful aspects of the group, with only 5 responses were for the least helpful. The study was concluded by reporting that it is crucial to address patients emotional needs following a stroke and attention should be paid to psychological intervention. Patients reported, finding the opportunity to share experiences with others in similar situations as the most helpful aspect of the stroke group.
Bandagi R, Fox PG., (2007) in a descriptive study on coping with stroke: psychological and social dimensions on U.S patients reported that stroke patients experience physical and emotional symptoms which affect their daily functioning. Coping strategies included maintaining a positive attitude and asserting independence as much as possible in acute stroke experience. The findings revealed that Hopefulness was often inspired by interaction with family and spiritual beliefs. The study suggested that Nurses can understand the patient’s perceptions of stroke experience and increase their ability to provide interventions to promote their coping strategies.
Micheal KM, Allen JK., (2007) conducted a quantitative study to identify the relationship of social support on fatigue after stroke among stroke survivors. The severity of fatigue in a sample of 53 community dwelling subjects was assessed by using fatigue severity scale. The findings suggested that 46% of the sample had severe fatigue and patients with elevated fatigue severity score had lower social support (p 

11 Stages of Psychosocial Development


In their book, Development Through Life: A Psychosocial Approach, Barbara Newman and Philip Newman build upon the premises of development stages that were initially laid out by Dr. Sigmund Freud as psychosexual stages and later expanded on by Dr. Erik Erikson as psychosocial development stages (Newman & Newman, 2018). These stages are not directly linked to an age range, though Newman and Newman have assigned ages, rather development and experience attained along the way. Erikson posited that a person would pass through these stages in a logical fashion and that experience prevented revisiting an earlier stage (Newman & Newman, 2018).

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In this paper, I define each stage by age, experience, ego quality, and core pathology. I compliment these defined stages with my personal experience from these stages. I detail my favorite and least favorite stage and explain why I feel this way. I then project my expected expectations of stages I have not yet attained as they may apply to my life and my future. I explain if and how Newman and Newman’s framework applies to my personal and private experiences.

Prenatal Stage

The prenatal stage is defined as conception to birth (Newman & Newman, 2018). This stage covers the fertilization of the egg, the combination of chromosomes and genes from each parent, and the development through three trimesters. This growth period is entirely dependent on the mother for nutrition. Factors like the mother’s age, diet, stress, drug use, and socioeconomic status have a major impact on the fetus’ growth and health. Access to quality health care and family support also affect the mother’s ability to make quality choices concerning the welfare of the child.

Infancy Stage

The infancy stage is categorized as birth-two years old or sometimes referred to as basic trust vs. mistrust (Newman & Newman, 2018). During the time the person will experience the maturation of sensory/perceptual and motor functions (2018). They will develop sensorimotor intelligence: processing, organizing, and using information (2018). They will start using communication, showing attachment, and develop emotionally (Newman & Newman, 2018). I have no first-hand memories of the infancy stage. As I understand it, we moved a few times and my sister was born 15 months after me. This time was spent as a nuclear family. I categorize my experience as hopeful rather than withdrawal.

This stage also sees the infant develop motor skills, reflexes, and causality. Many, not all, infants will learn to crawl and walk during this stage. Infants will explore new things; mainly by putting them in their mouth. Infants will play games like drop the spoon and have a parent pick it up, and then drop it again. Infants are exploring their world to the fullest. The hope is that infants will gain the trust of the parents or caretaker as opposed to mistrust. This determination can have far-reaching implications throughout their development and maturity. Infants will likely babble as they seek to understand and utilize our language.

Toddlerhood Stage

 The toddlerhood stage is categorized as people 2-4 years old or autonomy versus shame/doubt. Toddlers explore the world around them and learn true cause and effect. This is slightly more advanced than dropping the spoon and has the parent retrieve it. The toddler wants to do things for themselves. Toddlers learn to use the toilet instead of soiling themselves. Their walk becomes more developed and may include running, jumping, and hopping (Newman & Newman, 2018).

 The toddler rapidly acquires the use of language. They increase their vocabulary, start forming sentences and begin comprehending grammar (Newman & Newman, 2018). One of the more interesting aspects of this stage is the emergence of fantasy play. When playing with dolls, cars, or blocks they begin to imagine entire worlds their toys are living in. As this fantasy play becomes more advanced it becomes more “…socially interactive, more organized and planned, and play leaders emerge” (Newman & Newman, 2018). Toddlers begin to know what they want or at least think they know what they want. They can become upset when they are unable to communicate their desires to their parents.

 I contacted my father to fill in some gaps for me during this assignment. I don’t have many memories from this stage but I thought I would share one of his stories about me. One evening my mother was finishing the laundry. My family is in the living room; my father in his chair, my mother, sister and I were on the floor. My mother was folding the laundry and placing it in the clothes basket beside her. My sister and I were behind the clothes basket getting into mischief. As mother placed the folded clothes into the basket my sister and I were taking the folded clothes and tossing them behind us. When my mother placed the final piece of clothing into the basket she stood up and nearly fell over. She was not prepared for how light the basket was. After my father bellowed a huge laugh she turned around to see all of the freshly folded laundry strewn around the living room. Father had witnessed the whole event and even tried to alert my mother to the situation. She continued on with her story without skipping a beat or hearing what he was trying to tell her.

Early School Age

 Those who are four to six years old fall into the early school age category and might be described through initiative or guilt (Newman & Newman, 2018). Children in this category are exposed to gender roles, morality, and discipline. They begin developing self-esteem as they begin to reap recognition for their behavior and achievements. Friendship groups form among peers and may be segregated by sex, age, or race. Children at this stage are very inquisitive and want to know how and why the world around them works the way it does. Their innovation and initiative drive their learning and exploration (Newman & Newman, 2018). Children at this stage also feel guilt or remorse. This is the feeling is in response to unacceptable behavior but is different from shame (Newman & Newman, 2018).

 I remember starting school. I was anxious about riding the bus and not knowing anyone in the class. As a four-year-old, I was smaller than everyone but somehow able to start Kindergarten. I went to school on Monday, Wednesday, and every other Friday with Ms. Bow as my teacher. The other half of the class attended Tuesday, Thursday, and every other Friday. My favorite part of Kindergarten was playing with these huge blocks and building these massive forts. I enjoyed playing in the countryside and watching He-Man and the Masters of the Universe on television. I remember riding my Big-Wheel in the yard and skipping rocks on the lake. Even though I switched schools twice during Kindergarten and second grade, I still have friends from each school.

Middle Childhood

 Middle childhood is defined as children ages six to 12 years old and might be described through the task of industry or inferiority (Newman & Newman, 2018). Children in this developmental stage create close friendships, begin seeking peer approval and can struggle with loneliness and rejection (2018). Children begin learning and acquiring skills and the ability to self-evaluate. They take pride in the hard work they put into a task and function based on expectations. They work together, rely on each other, and compete with each other.

 This is my self-described most tumultuous stage of development. Prior to turning 13 years old, I had moved 26 times. The differences in my home life, as compared to other children, were enormous and unsettling. Each time my mother required treatment for mental illness, my sister and I needed to be relocated. Many times we moved in with our maternal grandmother. Other times we moved in with our father or a foster home. I dreaded the end of each school day as I wondered where we would sleep that night. Questions pierced my thoughts during the ride from school to wherever we ended up. Will we have food tonight? Will my mother be herself or will she be someone else? Will we be sleeping in the same room we slept in the night before? I began to wonder if God existed and if he did, did he love me? The constant reorganization of my life left me lost.

Early Adolescence

 Early adolescence is defined as 12-18 years old and can be categorized by identity or role confusion (Newman & Newman, 2018). In this stage, the body is rapidly changing. Puberty has a massive impact on boys and girls that completely change body composition and ready the body for reproduction. This period includes changes to romantic relationships that become more sexual in nature. Peer group tend to have more of a direct influence over the teenager than the parents. People in this group begin forming their own opinions of what is and is not acceptable for themselves and their futures.

 My life in early adolescence continued my trend of moving. The stress of continued chaos began to affect my grades as I was no longer able to concentrate at school. Puberty brought acne and awkwardness to the forefront of my world as my support structure began to crumble. I began to see just how poor we were and how much socioeconomic status affected everyday interactions with classmates. I was an outcast. I was unable to function around people joking with me. I took their casual and innocent comments as attacks against me personally. I was angry and alone. After my mother tried to smother me with a pillow, I finally moved out of my mother’s house at 16 years old and moved into my grandma’s house. I told my mother that if she loved me that she would let me stay with grandma and not say a word about it. I was finally free of the chaos and able to choose my own path from a new found place of stability.

Later Adolescence

 Later adolescence is defined as those 18-24 years old and the defining period ending childhood while transitioning into adulthood. During this period people transition to autonomy and generally leave home in pursuit of their own ideas and goals. This may include college, career, and marriage. Oftentimes people in this category reevaluate their own sexuality simultaneously exploring their freedom from their parents. They will struggle in determining their own identity; trying to answer the question, who am I?

 Upon graduation I found myself trying to define who I was. I proposed to my girlfriend and enlisted in the United States Navy. After boot camp and advanced school, I reported for duty to Naval Air Station Lemoore, CA where I worked as an ejection seat mechanic. I married my bride and we found ourselves expecting our first child soon thereafter. We moved to Tinker AFB, OK in 2002 where my wife gave birth to our oldest daughter. I was 21 years old with three years of military experience, two years of marriage, and we now had a newborn. I found myself woefully undertrained as a husband and father. I was still learning my role as a husband when our daughter was born and I had no idea how to be a good father. I also found myself struggling in my role as a Sailor. Although I struggled a great deal in this developmental stage, I found it easier to tackle with my wife at my side. This was the first time I realized that I had someone with me no matter how hard things became.

Early Adulthood

 Early Adulthood is defined as 24-34 years old. In this stage, adults are likely finished with traditional schooling sans those in graduate programs. Here people have begun charting their life course. They will determine a career, endeavor into marriage, and likely into parenthood. This stage changes the dynamics between adults and their parents; hopefully, changing from one of authority or friendship and counsel. The pull of work and life will help direct social circles and workout routines. If a person is not careful their life can spin out of control.

 In this stage, I started making real strides in my career. I was getting promoted early and often, I graduated from the University of Oklahoma with zero debt, and I attended Navy flight school as a commissioned officer. Inside our household, we were struggling. My wife was suffering from a multitude of medical problems and my ego was inflating due to work successes. Our marriage was on the rocks and my extended family was experiencing trauma and horrors due to mental illness. After my wife battled with endometriosis, that bore the scars or multiple laparoscopies and chemically induced menopause, our son was born five years after our daughter. I finally achieved all of my life’s goals and our marriage was stronger than ever. We recommitted our marriage to God.

Middle Adulthood

 Middle adulthood is defined as 34-60 years old. Adults in this category are mastering skills, managing careers, and balancing life. They are likely raising children and are becoming grandparents, and tackling society’s largest issues. They are oftentimes caring for their own aging parents and witnessing them enter the end of life stage. Many adults will retire and begin traveling while hoping they have saved enough money to take them through their lifetime and any health concerns they might experience.

 As I have recently reached middle adulthood I cannot speak to all the wonders that await me. I can say that this is by far my favorite stage so far. Last year I got to speak on stage in Dallas, TX and doors began opening for me to start my own business teaching personal finance to those in need. I started Warrior’s Wallet and have been able to help 500 families get their finances in order. To date, they have collectively paid off more than $5 million in debt! I can’t think of a better was to share my time and experience. I now serve as vice president of Books by Vets, a non-profit dedicated to helping veterans, first responders and their families tell their stories free of charge. I serve on the board of the S.H.I.N.E. Foundation. SHINE is a community service partnership between the county and the court system that allows nonviolent offenders alternative sentencing to keep their families intact. God willing I will be able to retire from the Navy soon and I will start speaking to school all over the world. I hope to organize my services as a non-profit.

Later adulthood

 Later adulthood is defined as 60-75 years old. During this stage, people begin to accept they are in the later stages of life. Those in this stage will most certainly be affected by a decline in health, fitness, and mental capacity. Advances in technology have helped this developmental stage to stave off the creep of mental decline and isolation. Couples face a greatly increased chance that they will become a widow and must fight off death anxiety, depression, and despair. Those in good health will enjoy the recreation, travel, and leisure retirement should provide. Those who stay in touch with friends and family will have a much higher chance of maintaining cognitive ability and mental decline.

 When I project my life out to this stage, I imagine a world where I am still speaking. I have amassed enough resources, wisdom, and following to continue doing whatever I please. I picture giving away 90% of my income to scholarships aimed at sending people to college and furthering their education. My life will be filled with friends and family to share my joy with. I will give of my wisdom and mentorship freely and enjoy time with my grandchildren and great-grandchildren.


 Elderhood is defined as 75 years old until death. Successful aging consists of avoiding disease, engaging with life, and maintaining high cognitive and physical function (Newman & Newman, 2018). Here, nutrition, fitness, and social interaction are required to maintain a semblance of humanity. People often move into nursing homes or require palliative care. Dementia and Alzheimer’s can strip away any trace of the person we thought we knew.

 My paternal grandparents were married 65 years before my grandmother passed away at 80. Her husband remained in his home but was no longer able to care for himself. After his daughter moved in, he was able to maintain life until 85 when he was no longer able to sustain himself.


 I have described the 11 stages of psychosocial development and told stories relevant to each of these stages. These stages may be defined by age or by the psychosocial crisis experienced in each stage. Once achieved a person is unable to regress back to previously visited stages. Although I have experienced much of what life has to offer, I am still excited about future adventures and growth opportunities.


Newman, B. M., & Newman, P. R. (2018). Development Through Life: A Psychosocial Approach (13th ed.). Boston, MA: Cengage Learning.


Evaluation of the HEEADSSS Adolescent Psychosocial Assessment


In the field of adolescent health, professionals need to master the act of effectual communication in order to understand adolescent development. Word specifics and the way the words are delivered can assist, enlighten, and win over behaviour at crucial and specified periods, assisting adolescents to develop health literacy, self-efficacy, and resilience (Cherry, 2017).

Psychosocial, behavioural and lifestyle problems are the major causes of morbidity and mortality among adolescents. These young adults may not present with, or express concerns directly about sexual health, relationships with significant others or mental health issues. Often, adolescents present with relatively minor issues or physical complaints such as a headache, tiredness, or stomach ache which may mask larger issues involving sexuality, depression, anxiety, eating disorders, drug use, issues with school, bullying concerns, and problems with family, friends or intimate partners. Nurses in community health school settings need to establish good communication and rapport skills and use systems at a school level to help students who frequently present for minor issues. (McMurray & Clendon, 2015)

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Adolescents facing difficulties may not fully understand what is happening to them and may be unable to articulate thoughts and feelings without medical professional help. It is common for adolescents to seek information and even self-diagnose using websites of varying reliability. Few will be aware of the range of services and support available to them via the school health nurse.

The ability to conduct a HEEADSSS adolescent psychosocial assessment is a key competency for nurses working in secondary schools.

HEEADSSS is an acronym, representing the following domains:

H Home

E Education and employment,

E Eating and exercise

A Activities and peer relationships, social media

D Drug use, including prescribed medications, cigarettes, alcohol, and other drugs

S Sexuality and gender

S Suicide and depression (including mood and possible psychiatric symptoms)

S Safety and spirituality

The adolescent stage (12–18 years old) is the period whereby a person develops from childhood to adulthood and the individual’s body and mind go through a number of changes that can be exciting, frightening, and confusing. During this stage, youth often have active social lives and experience pressure to experiment. These needs often result in different psychosocial issues (such as anxiety, depression, eating disorders and even suicide) that affect adolescents and lead to mental health issues that can be avoided with support. It is therefore crucial that at-risk adolescents are evaluated for psychosocial disorders by trained professionals working in the school setting (Levy, 2017).

The HEEADSSS adolescent psychosocial health assessment provides a structure for:

Developing rapport with a young person while systematically gathering information about their world, including family, peers, school, culture, and their inner world.

Developing a picture of the young person’s strengths and protective factors.

Conducting a risk assessment and screening for specific risk issues.

Identifying areas for intervention and prevention.

Guiding health counseling, including commending and building on strengths, exploring options, planning actions, providing information, identifying the need for intervention and referral.

It should be noted that HEEADSSS is a guide and not to be seen in any form as a checklist.

The HEEADSSS format is designed to start with less sensitive areas of a young person’s life and move towards more sensitive areas. For some adolescents, however, the first domain (Home) can be a difficult and highly sensitive area:

There may be conflict or violence in the home environment

Adolescents from Culturally and Linguistically Diverse (CALD) backgrounds may initially feel uncomfortable talking about their parents and other family issues

They may think that they do not have the right to complain or fear of being perceived as complaining about their parents

Some adolescents may be living in out of home care arrangements.

Adolescents are often more willing to engage with these topics if health providers seek their permission to ask sensitive questions. Health professionals can use the third-person approach, which normalizes the process and lessens the impact of sensitive questions. They can progress from neutral to more sensitive topics—for example, if the young person mentions that they have a boyfriend or girlfriend, a further question might be to ask about their sexual activity level. When exploring the area of sexuality, the provider should not assume the young person’s sexual orientation; instead, they should adopt a gender-neutral and non-judgmental approach when asking sensitive questions (Levy, 2017).

Literature Review

Health promotion and positive development approaches involving adolescents take place over time and are subject to multiple contextual and societal factors during that time (Klein et al., 2014). Effective evaluation of such programming depends on a long-term commitment to tracking changes in life experiences and asset development, as opposed to measuring only efficacy outcomes. Some researchers have applied a unified approach, combining both qualitative and quantitative methods and procedures in the evaluation of long term, youth development programs (Montgomery et al., 2008). Holt (2009) suggests that combining varied research approaches can contribute to a better understanding of complex issues, allowing for cross-validation of research findings and compensate for the limitations inherent in each study design.

Evaluation of the Screening Policy

 The HEADSSS assessment has been used successfully around the world in the adolescent health care field. This system has been used to facilitate effective communication and create a respectful and confidential environment where teenagers may feel more comfortable to obtain adequate health care.

Many adolescents do not recognise dangerous behaviour patterns as dangerous because they see their activities not as problems but as solutions. The Registered Nurses challenge is to explore these behaviours and the context in which the adolescent lives to develop realistic solutions with patient buy-in. The physician may be overwhelmed by the number of issues to be covered in the interview. It is obvious that every topic cannot be covered in a single visit, but the goal is to establish an entry point for open communication. Depending on the nature of the risk factors identified and the intervention to be established, the solution could either be to extend the initial visit or arrange a follow-up. Taking on a nonjudgmental approach during the psychosocial interview is crucial, so the adolescent feels they can trust and confide in the Nurse and feel safe and secure in further visits (Cherry,2017).

HEEADSSS may not be suitable for use with all adolescents. Alternative screening tools might be considered for adolescents with an intellectual disability.

Following the assessment process, the healthcare provider and adolescent and, where appropriate, their parents or carers, develop a management plan collaboratively. Actively engaging the young person in identifying what they want to work on and how they want to go about it, empowers them to be an active partner in their own health and wellbeing. It also increases the likelihood that they will follow through with the plan (Levy, 2017).

Involvement of Parents and Caregivers in the Management Plan

For many adolescents, parents are the main providers of physical and emotional support. For some adolescents, a carer such as a member of the extended family, or another trusted adult, will be their main source of support. Generally, management or treatment plans are more successful when parents or carers are involved (McMurray & Clendon, 2015).

From a medico-legal perspective, this also means considering the young person’s capacity for decision-making and informed consent. Providers should be sensitive to the concerns of parents from cultural backgrounds where healthcare may be viewed as a family matter.

Reliability of the HEEADSSS Screening

The HEEADSSS screening is carried out on all aspects of the adolescent’s life to ascertain the factors that are causing the adolescent’s psychosocial issues. When the assessment is done, it can show the adolescent not only the negative influences in their lives but also the positive influences. The screening is a comprehensive tool that yields objective results so that an accurate diagnosis can be made.

Adolescent Psychosocial Health Policy and Assessment

Having discovered the dangers of psychosocial disorders for youth, it is evident that this crucial problem needs to be taken seriously. Policies have been put in place to allow for the smooth running of such programs that help the youth in these kinds of situations. These policies target the primary caregivers that take on the responsibility for the health and wellbeing of these adolescents (Royal Australasian College of Physicians, 2000). Having policies in place allows for direction on how to handle these matters when they arise. It is crucial to create a safe environment for adolescents to come for help should they find themselves in these situations.

There is a need to not just assess the mental health of the youth but also their emotional and behavioural issues. To do so, The Registered Nurse (RN) must obtain the adolescent’s psychosocial history. The HEEADSSS method is used to interview adolescents to obtain their psychosocial history focusing on the adolescent’s home environment, education, employment, eating habits, peer-related activities, drugs and alcohol, sexuality, suicide/depression and safety from injury or violence (Klein, Goldenring & Adelman, 2014). It is common for adolescents to be reluctant to discuss their health issues voluntarily. Using a routine psychosocial assessment is helpful in forming an understanding of context of behaviour and allows for an engagement between the patient and the RN. Using the HEEADSSS method allows the nurse to produce a management plan and the patient may also be more willing to be honest with a physician (The Royal Australasian College of Physicians, 2000). During the interview, the Registered Nurse should ensure the patient feels at ease while concentrating on the patient’s strengths and positive attributes (Klein et al., 2014). However, it is important to note that the HEEADSSS framework will only help to identify the psychosocial issues the adolescent is going through. Management options will squarely depend on the level of concern, the skills of the medical professional, and the available resources (The Royal Australasian College of Physicians, 2000).

Evidently, the issues adolescents are dealing with such as their need to fit in are leading them to engage in risky behaviours. Left unresolved these issues can lead adolescents to develop other mental health issues like depression, self-harm, and suicide (McMurray & Clendon, 2015). The community has a role to play in helping adolescents to fit in and handle their issues safely.

Schools likewise play a vital role in adolescent development. There is a need for balance between the school, home environment, and social networking. (Knight et al., 2002). Many students may find it hard to balance these three because they may not be used to handling all these aspects of life at once. Adolescence is the bridge between childhood and adulthood where a student starts to realise that there is more to life than just going to school and doing what their parents and the teachers expect of them. This realization leads to a level of independence which may be difficult for some adolescents to handle (Cherry, 2017). These new responsibilities coupled with other issues in school such as bullying may lead to serious mental health issues and influence the youth’s self-esteem. Investment needs to be made in counselling in schools and assuring the youth that problems can be worked out and they will eventually get over the issues (Levy, 2017).

Adolescence is the initial stage of adulthood therefore the community should be putting focus on mental health and ensuring this is upheld for the rest of life. Communities must invest in building public health policies, creating a supportive environment for adolescents, strengthening community action, reorienting health services, and developing the adolescent’s personal skills to boost confidence (McMurray & Clendon, 2015).

Other Methods of Adolescent Screening

Drug abuse is high on the list of factors affecting teenage mental health. HEEADSSS is an effective method for screening psychosocial problems affecting youth due to drug and substance abuse. However, in order to determine if there is drug abuse or the extent to which drugs have been abused medical professions can use the CRAFFT screening tool.

The CRAFFT screening tool has been designed to ascertain if an individual has engaged in substance-related risks. It uses a set of questions built upon six keywords: car, relax, alcohol, forget, friends, and trouble. The keywords are incorporated into questions to make it easy for an adolescent to answer the physician’s questions. There are six test questions for the six keywords involved. These questions are appropriate for adolescents by design and it screens for not just alcohol but also other forms of drugs and is most effective when administered under appropriate conditions.

One of the most useful aspects of the CRAFFT test is that the questions can be administered by the Registered Nurse during a general health interview or during a physical examination (Knight, Sherritt, Shrier, Harris & Chang, 2002).

Substance abuse is one of the biggest issues facing adolescents today and it has been noted to be one of the causes of both physical and mental health. Due to this realisation, it is prudent to ensure that adolescents receive medical care in ideal places for this screening and eventually allowing for early intervention (Knight et al., 2002).

The Role of HEEADSSS in Enhancing Adolescent Development

The HEEADSSS test is crucial in helping medical staff and parents of adolescents better understand how they can help the adolescent navigate their way through this vulnerable life stage.

If the adolescent is indulging in dangerous behaviour, it is up to the parents, counsellors, Education and medical staff to find ways to protect the adolescents from themselves. The HEEADSSS method enables the parties involved to explore the behaviours exhibited and understand the context in which the adolescents are operating and allowing them to develop realistic solutions (Klein et al., 2014). The HEEADSSS test further enables the Nurse to produce plans that help guide these adolescents to understand why they are behaving the way they are and coming up with ways to help them navigate out of different situations.

Adolescents who have gone through the screening are able to understand the consequences of their actions and feel empowered to seek support. They better understand that they are not alone facing these problems and most importantly that there are others going through the same. It further helps them to understand that there are people, who are willing to support the throughout (McMurray & Clendon, 2015). This knowledge is crucial in helping the adolescent have more confidence in themselves, which will help them have better judgment and decision-making capacity.

Referral options using an interdisciplinary approach are identified

Community health school nurses serve as a point of contact for the students. The nurse is able to carry out health assessments, provide appropriate treatment where needed as well as provide the first point of contact for students. Interventions and follow up of school children within the school setting is crucial. The student services team in a school work in collaboration to support both the educational and psychosocial wellbeing of students. Depending on assessment information, it may be necessary to provide appropriate referrals outside of the school. The school nurse may refer to the student’s general practitioner, mental health team in the community/in-patient units or other hospital and government services such as child protection and family services when appropriate (Cherry, 2017). The school nurse must work collaboratively to address the student’s health and wellness issues. Integrating knowledge and methods from different disciplines is all part of the interdisciplinary approach.

Recommendations for a Primary healthcare partnership model of practice

The role of Parents, Community and Health Nurses.

Adolescents do not exist in a vacuum, they have various people such as friends, family, and/or educators in their lives who love them and want them to succeed (Cherry, 2017). Parents can, however, end up overwhelmed and may need the support of other knowledgeable Adults. It is therefore crucial for school nurses and educators to play a role in prevention, identification, referral, and treatment of adolescents. The government and the local community have a role to play in supporting the parents and their adolescent children by availing resources to help in such situations like carrying out successful neighbourhood mobilisation. For this kind of mobilisation to be successful it must be carried out through at least four mediums: community organising and development, the collaboration of service delivery, implementing community-based programs, and finally the involvement of families in school governance and instruction (National Research Council, 1993).

Each initiative exists due to simple networking and partnership creation to resource holding. This is because it allows for the provision of services through the partnering of the state and the community. The Partnering of the state and community allows for the provision of services with each initiative existing due to simple networking and resource holding (Knight et al., 2002). Partnering is a method that works very well however it is not as successful when the state agencies are unable to instantly share authority with the community. Such programs are highly beneficial as they help families of adolescents who would otherwise lose out due to lack of resources because their parents are unable to afford the services. These community-based youth programs help the adolescents in their development journey by providing them with a sense of belonging, create crucial relationships, and develop interpersonal skills that allow them to grow (National Research Council,1993).


It is quite clear that adolescence is a crucial stage that does not just affect the youth but also the parents and the community at large. Screening systems such as HEEADSSS empower adolescents to get the help they need to cope with the issues that come with this stage of development. The adoption of the HEEADSSS screening system would go a long way in reducing occurrences of mental health issues because it allows for early detection. This detection system encourages preventative measures to be taken; thus, reducing the chance of serious issues like drug and alcohol addiction, sexually transmitted diseases, teenage pregnancies, and many other psychosocial problems. (McMurray & Clendon, 2015).

It is therefore important for governments to invest in community-based initiatives. By doing so, the youth will be able to open up more frequently about the issues that they are going through. This will in turn help parents and medical staff to note issues early on before they become serious and more complicated. It is crucial for schools to encourage the use of the HEEADSSS assessment tool to effectively help their students. In the end, the use of tools like HEEADSSS will empower the community to support these adolescents’ mental and emotional wellbeing.


Cherry, A. (2017). International Handbook on Adolescent Health and Development. The Public Health Response. Retrieved from

Chown P., Kang M., Sanci L., Newnham V. & Bennett D.L. (2008). Adolescent Health: Enhancing the skills of General Practitioners in caring for young people from culturally diverse backgrounds. NSW Centre for the Advancement of Adolescent Health and Transcultural Mental Health Centre, Sydney.

De Los Reyes, A. & Aldao, A. (2015). Introduction to the Special Issue: Toward Implementing Physiological Measures in Clinical Child and Adolescent Assessments, Journal of Clinical Child & Adolescent Psychology, 44(2), 221-237, DOI: 10.1080/15374416.2014.891227

Gumbiner, J. (2003). Adolescent assessment. Hoboken, N.J.: J. Wiley & Sons.

Klein, D. A., Goldenring, J. M., Adelman, W.P. (2014). HEEADSSS 3.0: The psychosocial interview for adolescents updated for a new century fuelled by media. Retrieved from

Knight, J.R., Sherritt, L., Shrier, L.A., Harris, S. K. & Chang, G. (2002). Validity of the CRAFFT Substance Abuse Screening Test Among Clinic Patients.Jama Pediatrics. Retrieved from

Lenhart A., Ling R., Campbell S. & Purcell K. (2010). Teens and mobile phones. Washington, DC: Pew Internet & American Life Project; Retrieved from http:// Mobile-2010-with-topline.pdf.

Levy, S. (2017). Overview of Psychosocial Problems in Adolescents. Retrieved from

MacKenzie R.G. (2013) Communicating with Adolescents, in A Clinical Handbook in Adolescent Medicine edited by Steinbeck K. and Kohn M. World Scientific Publishing Company: Singapore.

McDougall, T. (2017). Children and Young People’s Mental Health. (Ed.). London: Routledge.

McMurray, A., Clendon, J. (2015). Community Health and Wellness: Public Healthcare and Practice (5th ed.). Australia Services: Churchill Livingstone

National Research Council. (1993). Losing Generations: Adolescents in High -Risk Settings. Washington, DC: The National Academies Press. Retrieved from

Royal Australasian College of Physicians. (2000) Routine Adolescent Psychosocial Health Assessment – Position Statement. Retrieved from


Erik Erikson’s Psychosocial Theory

Erik Erikson’s Psychosocial Theory 

Erik Erikson is a psychosocial theorist who utilized stages to analyze individuals throughout development. Psychosocial theories focus on the “psychological needs of the individual conflicting with the needs of society” (McLeod, 2018, Paragraph 2). His theory can be compared to multiple other psychologists but is applied to the lifespan in different ways. In this paper, we will discuss the general theory, observed applications, and possible future applications.

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Theory Details

Erik Erikson’s psychosocial theory consists of 8 stages that develop upon each other throughout an individual’s life span. These stages begin at birth and end with death. Erikson’s theory is cumulative, each stage building on the previous. Each stage contains a “crisis” that the individual must overcome. Failure to complete one stage can lead to “a more unhealthy personality and sense of self” (McLeod, 2018, Paragraph 4). While the stages can still be completed after failure, it is more difficult than successfully  completing the stages in order.

Erikson’s first stage, occurring during infancy, is Trust vs Mistrust. This stage is dependent on the child developing a relationship with a base of care and love. This tells the child that they are deserving of the care they have received (Arnett, 2016). Another theory similar to stage one is the Attachment Theory by John Bowlby and Mary Ainsworth. This theory reflects on the need for an emotional attachment between a child and its caregiver. Without this attachment, the child will develop a sense of mistrust of the adults around them.

Stage two develops from around 18 months to 3 years of age and is focused on control and independence. This is the stage of Autonomy vs Shame and Doubt. If the children are encouraged to explore and complete tasks on their own, they will develop a greater sense of self and become more confident. Without the encouragement, they will become “overly dependent” and “doubt their abilities” (McLeod, 2018, Paragraph 14). The love and care experienced in stage one will help encourage the child that he/she has a place in the world and can be an independent person. With criticism, they will experience both mistrust and shame.

During early childhood, a child develops the ability to assert their feelings and initiate their own activities. The Initiative vs Guilt stage is crucial to learning the world around them. Questions are common and should be encouraged, rather than enforcing the sense of guilt for “being a nuisance” (McLeod, 2018, Paragraph 26). Healthy balance in this stage is important to develop a purpose of interaction.

Between the ages of five and twelve, the Industry vs Inferiority stage occurs. Individuals will need to establish a peer group that provides approval to boost a child’s self-esteem (McLeod, 2018). The reinforcement from peers will make the individual feel competent and able to achieve goals. Without this, the child will feel that they will not reach their potential and cannot live up to the demands of society.

The fifth stage of Erikson’s theory occurs from 12-18 years of age and focuses on identity based on values and goals. During Identity vs Identity Confusion, “adolescents must develop an awareness of who they are,” and find their place in society (Arnett, 2016, p. 23). The main identities involved are sexual and occupational (McLeod, 2018).

Intimacy vs Isolation is the sixth stage in Erikson’s theory and takes place around the ages of 18-40 years. Exploring relationships to find intimate, loving commitment lead to successful completion of this stage. Avoiding these relationships leads to isolation and loneliness.

The seventh stage is Generativity vs Stagnation. This stage occurs in middle adulthood (40-65) and is focused on making an impact on the world (McLeod, 2018). Making positive efforts that will benefit the collective future of others and encourage being part of the bigger pictures. Focusing on one’s own needs results in a shallow state of disconnect with the world.

The final stage of Erikson’s theory starts at age 65 and ends with death. Erikson’s stage of Ego Integrity vs Despair contemplates the “acceptance of one’s one and only life cycle as something that had to be” and the sense of wholeness when reflecting on life (Erikson, 1950, p. 268). If an individual does not feel productive in life, they will feel guilt and despair. Success will lead to a sense of closure and acceptance of life and death.

Theory Application

 Starting from day one, I have been loved on, encouraged, and cared for. The care and support of my family and others led to the successful completion of trust. The growing continued successfully through a representation of stage two. I am the youngest child of three and always desired to participate in whatever trouble my sisters were getting into. When I was around 18 months, my mom had to remove the baby gate from the stairs and help encourage my independence as I tried to climb the gate in order to chase my sisters. She realized that it was time to stop limiting my explorations and let me grow. This encouragement of independence also helped develop initiative. I loved playing and exploring. Rather than belittling my play, my parents and sisters would often try to join in. They still often set boundaries to encourage a healthy/safe reinforcement.

 The fourth stage occurs during elementary school years. This is hard time for many people but the school system I was placed in greatly advocates peers encouraging one another. Even when I was homeschooled for a year, the peers I had left in the school system stayed in contact and welcomed me back the next year with open arms. I was also encouraged by my educators to take pride in my work and not slack off.

 At the current point in my life, I feel that I have just completed Erikson’s fifth stage of finding my identity. I have found a new sense of independence being out of the house and am focused on completing my degree and continuing forward with my life. I have found the friends and significant other I would like to keep around. I am working on the completion of intimacy. It is hard to fully grasp this concept but once experiencing that relationship with someone, it is clear. If I wasn’t focused on completing my degree, I would probably already be married and starting the rest of my life with the man I love.

Future Career

 Although being a hermit does not sound too bad, I plan to work in the medical field. I will constantly be encountering people at all stages of life. I am sure I will experience the babies who have been neglected and need to be loved and experience trust. I will experience the children who are afraid to go out on their own. I will experience the kids who are trying to “find themselves” and somehow injure themselves. I will experience the depressed and lonely who feel that they are useless because they don’t have a mate. I will (and have already) experience the end of life contemplations. The reflections of the good and bad in life, of the successes and failures. I will get to comfort and walk through the confusing stages of life with all patients and families. This is my dream and Erikson’s theory helps explain the emotions of all my future endeavors.


Erikson outlines a “realistic perspective of personality development” (McLeod, 2018, Paragraph 63). Rather than focusing on a specific characteristic or stage of life, Erikson takes the perspective of an everchanging and developing disposition helping to validate individuals in all stages of growth. The application of Erikson’s eight stages is not limiting in age nor careers or goals in life.


Arnett, J. J. (2016). Child development: A cultural approach, 2nd Edition. Boston: Pearson.

Erikson, E.H. (1950). Childhood and society. New York: Norton.

McLeod, S. A, (2018, May 03). Erik Erikson’s stages of psychosocial development. Simply Psychology.


Psychosocial Effects Of Aging Health And Social Care Essay

Geriatrics is a branch of medicine dealing with the aged and the problems of the aging. The field gerontology includes of illness prevention and management, health maintenance, and promotions of quality of life for the aged. Research on a wide variety topic raging from family aspects of aging economic resources, and the delivery of long-term care states that gender, race, ethnicity, and social class consistently influenced the quality of the experience of aging. The experience of aging results from interaction of physical, mental, social and cultural factors. Aging varies across cultures. Culturally, aging as well as the treatment of the elderly, is often determined by the values of an ethnic group. Culture also may determine the way the older person views the process of aging as well as the manner in a more heterogeneous elderly population than any generation that proceed it can be expected. Health care professionals will need to know not only diseases and disorders common to a specific age group but those common to a particular ethnic group as well. An appreciations of backgrounds can help the health care professional provide a personal approach when dealing with and meeting the needs of elderly patients. Aging is a board concept that includes physical changes in people’s bodies over adult life, psychological changes in their minds and mental capacities, social psychological changes in what they think and believe, and social changes in how they are viewed, what they expected of them. Aging is constantly evolving concept. Notions are a biologic age is more critical than chronologic age when determining health status of the elderly is valid. Aging is an individual and extremely variable process. The functional capacity of major body organs varies with advancing age. As one grows older, environmental and lifestyle factors affect the age-related functional changes in the body organ. The majority of the elderly seen in the health care setting have been diagnosed with at least one chronic condition. Individuals who in the 1970s would not be able to survives a debilitating illness, such as cancer or a catastrophic health events like a heart attack, can now live for more extended periods of time, sometimes with a variety of concurrent debilitating conditions. Although age is the most consistent and strongest predictor of risk for cancer and

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for death from cancer, Management of the elderly cancer patient becomes complex because other chronic conditions, such as osteoarthritis, diabetes, chronic obstructive pulmonary disease (COPD), and heart disease, must also be considered in their care. The attitude of health care providers towards older adults affect their health care. Unfortunately, research indicates that health care professionals are significantly more negative in their attitudes towards older patients than younger ones. This attitude must change if the health care provider is to have a positive interaction with the elderly patient. These attitude appear to be related to the pervasive stereotyping of the elderly, which serves to justify avoiding care and contact with them, as well as being reminders of our own mortality. Ageism is a term used to describe the stereotyping of and discrimination against elderly persons and is considered to be similar to that of the racism and sexism. It emphasized that frequently the elderly are perceived to be repulsive and that a distaste for the aging process itself exists. Ageism suggests that he majority of elderly are senile, miserable most of the time, and dependent rather than independent individuals.
The media have also influenced on going stereotypical notions about the elderly. Health care providers must learn to appreciate the positive aspects of aging so that they can assists the elderly in having a positive experience with their imaging procedure.
The human body undergoes a multiplicity of physiologic change second by second. Little considerations is given regarding these changes unless they are brought on by sudden physical, psychological, or cognitive events. Radiographers must remember that each elderly person they encounter is a unique individual with distinct characteristics. These individual have experienced a life filled with memories and accomplishment.
Young or old, the definition of quality of life is an individual and personal one. Research has shown that health status is an excellent predictor of happiness. Greater social contact, health satisfaction, low vulnerable personality traits, fewer stressful life events have been linked to successful aging. Self-efficacy can be defined as the level of control one has over one’s future. Many elderly people feel they have no control over medical emergencies and fixed incomes. Many have fewer choices about their personal living arrangements. These environmental factors can lead to depression and decreased self-efficacy. An increase in illness will usually parallel a decrease in self-efficacy.
The elderly may experience changing roles from life of independence. The family role of an adult caring for children and grandchildren may evolved into the children caring for their caring aging parents. It is also a time of loss. Losses may include the death of a spouse and friends, as well as loss of income due to retirement. The loss of health may be the reason for the health care visit. The overall loss control may lead to isolation and depression in the elderly. Death and dying is also an imminent fact of life.
The aging process alone does not likely alter the essential core of human being. Physical illness is not aging, and age-related changes in the body are often modest in magnitude. As one ages, the tendencies to prefer slower-paced activities, take longer to learn new tasks, become more forgetful, and lose portions of sensory processing skills increase slowly but perceptibly. Health care professionals need to be reminded that aging and disease are not synonymous. The more closely a function is tied to physical capabilities, the more likely it is to decline with age, whereas the closer a function depends on experience, the more likely it will increase with age.
Joint stiffness, weight gain, fatigue and loss of bone mass can be slowed through proper nutritional interventions and low-impact exercise. The importance of exercise cannot be overstated . Exercise has been shown increase aerobic capacity and mental speed. Exercise programs designed for the elderly should emphasized increased strength, flexibility, and endurance. One of the best predictors of good health in later years is the number and extent of healthy lifestyles that were established in earlier life.
The elderly person may shown decreases in attention skills during complex tasks. Balance , coordination, strength and reaction time all decrease with age. Falls associated with balance problems are common in the elderly population, resulting in a need to concentrate on walking. Not overwhelming them with instructions is helpful. Their hesitation to follow instructions may be fear instilled from a previous fall. Sight, hearing, taste and smell are all sensory modalities that decline with age. Older people have more difficulty with bright lights and tuning out background noise. Many elderly people become adept at lip reading to compensate for loss of hearing. For radiographers to assume that all elderly patients are hard of hearing is not usual; they are not talking in a normal tone, while making volume adjustments only if necessary, is a good rule of thumb. Speaking slowly, directly, and distinctly when giving instructions allows older adults an opportunity to sort through directions and improves their ability to follow them with better accuracy.
Cognitive impairment in the elderly can be caused by disease, aging, and disuse. Dementia is defined as progressive cognitive impairment that eventually interferes with daily functioning. It includes cognitive, psychologic, and functional deficits including memory impairment. With normal aging comes a slowing down and a gradual wearing out of bodily systems bit it does not include dementia . Yet the prevalence of dementia increases with age. Persistent disturbances in cognitive functioning, including memory and intellectual ability, accompany dementia. Fears of cognitive loss, especially Alzheimer’s disease, are widespread among older people. Alzheimer’s disease is the most common form of dementia. Therefore health care professionals are more likely to encounter people with this type. The majority of elderly people work at maintaining and keeping their mental functions by staying active through mental games and exercises and keeping engaged in regular conversation. When caring for patients with any degree of dementia, verbal conversation should be inclusive and respectful. One should never discuss the patients as through they are not in the room or are not active participants in the procedure.
One of the first questions asked of any patient entering a health care facilities for emergency service “Do you know where you are and what day it is?” The health care providers need to know just how alert the patient is. Although memory does decline with age, this is experienced mostly with short-term memory tasks. Long-term memory or subconscious memory tasks show little change over time and with increasing age. There can be a variety of reasons for confusion or disorientation. Medication, psychiatric disturbance, or retirement can confuse the patient. For some older people, retirement means creating a new set routines and adjusting to them. The majority of elders like structure in their lives and have familiar routines for approaching each day.
Health and well- being depend largely on the degree to which organ systems can successfully work together to maintain internal stability, With age, there is apparently a gradual impairment of these homeostatic mechanisms. Elderly people experience nonuniform, gradual, ongoing organ function failure in all systems. Many of the body organs gradually lose strength with advancing age. These changes place the elderly at risk for disease or dysfunction, especially in the presence of stress. At some point the likelihood of illness, disease and death increases. Various physical diseases and disorder affect both mental and physical health of people of all ages. They are more profound among elderly people because diseases and disorders among older people are more likely to be chronic in nature. Although aging is inevitable, the aging experience is highly individual and is affected by heredity, lifestyle choices physical health, and attitude. A great portion of usual aging risks can be modified with positive shifts in life style. In elderly, the aging of the organs systems is one of the process where they need to understands and there are as list below:
Integumentary systems disorders
Nervous systems disorders
Sensory systems disorders
Musculoskeletal systems disorders
Cardiovascular systems disorders
Gastrointestinal system disorder
Immune system decline
Respiratory system disorder
Hematologic system disorders
Genitourinary systems disorders
Endocrine systems disorders.
The role of the radiographer is no different than that of all other health professionals. The whole person must be treated, not just the manifested symptoms of an illness or injury. Medical imaging and therapeutic procedures reflect the impact of ongoing systemic aging in documentable and visual forms. Adapting procedures to accommodate disabilities and disease of geriatric patients is a critical responsibility and a challenge based almost exclusively on the radiographer’s knowledge, abilities, and skill. An understanding of the physiology and pathology of aging, in addition to an awareness of the economic the social, psychologic, cognitive, and economic aspects of aging, are required to meet the needs of the elderly population. Conditions typically associated with elderly patient invariably require adaptations or modifications of routine imaging procedures. The radiographer must be able to differentiate between age related changes and disease processes. Production of diagnostic images requiring professional decision making to compensate for physiologic changes, while maintaining the compliance, safety, and comfort of the patient, is foundation of the contract between the elderly patient and the radiographer.
The preceding discussions and understanding of the physical, cognitive, and psychosocial effects of aging can help radiographers adapt to the positioning challenges of the geriatric patient. In come cases routine examinations need to be modified to accommodate the limitation, safety, and comfort of the patient. Communicating clear instructions with the patient is important. The following discussion addresses positioning suggestion for various structures. The common radiography examinations for geriatrics are:
Upper extremity
Lower extremity
The position of choice for the chest radiograph is the upright position; however, the elderly patient may not be able to stand without assistance for this examination. The traditional posteroanterior (PA) position is to have the “backs of hands on hips.” This may be difficult for someone with impaired balance and flexibility. The radiographer can allow the patient to warp his or her arms around the chest stands as a means of support and security. The patient may not be able to maintain his or her arms over the head for lateral projection of the chest. Provide extra security and stability while moving the arms up and forwards.
When the patient cannot stands, The examination may be done seated in a wheelchair, but some issues will affected the radiographic quality. First, the radiologist need to be aware that the radiograph is an anteroposterior (AP) instead of a PA projection, which may make comparison difficult. Hyperkyphosis can result in the lung apices being obscured, and the abdomen may obscure the lung bases. In sitting position, respiration may be compromised, and the patient should be instructed on the importance of a deep inspiration.
Positioning of the image receptor for kyphotic patient should be higher than normal because the shoulder and apices are in a higher position. Radiographic landmarks may change with age, and the centering may need to be lower, if the patient is extremely kyphotic. When positioning the patient for the sitting lateral chest projection, the radiographer should place a large sponge behind the patient to lean him or her forward.
Sitting Chest PA Chest Standing
Radiographic spine examinations may be painful for the patient suffering from osteoporosis who is lying on the x-ray table. Positioning aids such as radiolucent sponge, sandbags, and a mattress may be used as long as the quality, of the image is not compromised. Performing upright radiographic examination may be also appropriate if a patient can safely tolerate this position. The combination of cervical lordosis and thoracic kyphosis can make positioning and visualization of the cervical and thoracic spine difficult. Lateral cervical projections can be done with the patient standings, sitting, or lying supine. The AP projection in the sitting position may not visualized the upper cervical vertebrae because the chin may obscure this anatomy. In the supine position the head may not reach the table and result in magnification. The AP and open-mouth projection are difficult to do in wheelchair.
The thoracic and lumbar spines are sites for compression fractures. The use of positioning blocks may be necessary to help the patient remain in position. For the lateral projection, a lead blocker or shield behind the spine should be used to absorb as much scatter radiation as possible.
Lateral Spine
Osteoarthritis, osteoporosis, and injuries as the result of falls contribute to hip pathologies. A common fracture in the elderly is the femoral neck. An AP projection of the pelvis should be done to examine the hip. If indication is trauma, the radiographer should not attempt to rotate the limbs. The second view taken should be a cross-table lateral of the affected hip. If hip pain is the indication, assist the patient to internal rotation of the legs with the use of sandbags if necessary.
Immobilization device are place to the patient foot.
Positioning the geriatric patient for projections of the upper extremities can present its own challenges. Often the upper extremities have limited flexibility and mobility. A cerebrovascular accident or stroke may cause contractures of the affected limb. Contracted limbs cannot be forced into position, and cross-table views may need to be done. The inability of the patient to move his or her limb should not be interpreted as a lack of cooperation. Supination is often a problem in patients with contractures, fractures, and paralysis. The routine AP and lateral projections can be supported with the use of sponges, sandbags, and blocks to raise and support the extremity being imaged. The shoulder is also a site decreased mobility, dislocation, and fractures. The therapist should assess how much movement the patient can do before attempting to move the arm. The use of finger sponges may also help with the contractures of the fingers.
Hand Projection Lateral Wrist
The lower extremities may have limited flexibility and mobility. The ability to dorsiflex the ankle may be reduced as a result of neurologic disorders. Imaging on the x-ray table may need to be modified when a patient cannot turn on his or her side. Flexion of the knee may be impaired and required a cross-table lateral projection. If tangential projection of the patella, such as the Settegast method, is necessary and the patient can turn on his or her side, place the image receptor superior to the knee and direct to central ray perpendicular through the patellofemoral joint. Projections of the feet and ankles may be obtained with the patient sitting in the wheelchair. The use of positioning sponges and sandbags support and maintain the position of the body part being imaged.
AP Ankle Projection Lateral Ankle Projection
Patient care must be apply to geriatric patient because they all are all fragile where their bone can easily broke or they can be easily fainted during the examination. For communications, take time to educate the patient and his or her family, speak lower and closer, and treat the patient with dignity and respect. Transportation and lifting patient are also be need because geriatrics patient is not stronger than normal person. If possible, give the patient time to rest between projection and procedures. Avoid adhesive tape because elderly skin is thin and fragile. Provide warm blankets in cold examination rooms, use table pads and hands rails and always access the patient’s medical history before contrast media is administered.
Take time with the patient Immobilization Device
The imaging professional will continue to see a change in health care delivery system with the dramatic shift in the population of persons older than age 65. This shift in the general population is resulting in an ongoing increase in the number of medical imaging procedures preformed on elderly patients. Demographic and social effects aging determine the way in which the elderly adapt to and view the process of aging. An individual’s family size and perceptions of aging, economic resources, gender , race, ethnicity, social class, and the availability and delivery of health care will affect the quality of the aging experience. Biologic age will be much more critical than chronologic aging when determining the health status of the elderly. Healthier lifestyles and advancement in medical treatment will create a generation of successfully aging adults, which in turn should decrease the negative stereotyping of the elderly person. Attitudes of all health care professionals, whether positive or negative, will affect the care provided to be growing elderly population. Education about the mental and physiologic alterations associated with aging, along with the cultural, economic and social influences accompanying aging, enables the radiographer to adapt imaging and therapeutic procedures to the elderly patient’s disabilities resulting from age-related changes.
The human body undergoes a multiplicity of physiologic changes and failure in all systems. The aging experience is affected by heredity, lifestyle choices, physical health, and attitude, making it highly individualized. No individual’s aging process is predictable and is never exactly the same as that of any other individual. Radiologic technologists must use their knowledge, abilities, and skills to adjust imaging procedures to accommodate for disabilities and disease encountered with geriatric patients. Safety and comfort of the patient is essential in maintaining compliance throughout imaging procedures. Implementation of skills such as good communication, listening, sensitivity, and empathy, all lead to patient compliance. Knowledge of age-related changes and disease process will enhance the radiographer’s ability to provide diagnostic information and treatment when providing care that meets the needs of the increasing elderly patient population.

Psychosocial Implications of Substance Use and Addiction


This research paper will address Substance Use and Addiction, and the psychosocial implications associated with it.  This paper will also address the prevalence, incidence, symptoms, signs, investigations, and ethical considerations of substance use and addiction.



Substance addiction can be defined as a behavior that creates physical and psychological pleasure; however, the cost to the individual visibly outweighs the benefits. Substances, such as psychoactive drugs, that affect the brains pleasure zones will often result in dependence; these substances include anything from alcohol and nicotine, to a variety of legal and illegal drugs (Fleury et al., 2014; Babor, 2011).

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There is a numerous amount of psychological information on substance use and abuse, however, there is not one individualized theory focused on addiction.  Addiction is defined as a condition of being habitually or compulsively occupied with, or involved in something (Pinel, 2014). Substance addiction is often described as an unmanageable, compulsive act that is carried out even when it threatens the individual’s health and wellbeing; the individual often negates to see the potential harmful social consequences that follow the addictive behavior (Matusow & Rosenblum, 2014). The word addict carries with it a negative stigma that is born from the perception of society. Addicts are often perceived as uncaring, unreliable and unstable individuals; this perception does not necessarily apply to all addicts. Some individuals can function and manage their lives in such a way that no one is aware of their substance dependence; these individuals are referred to as functioning addicts (Smith, et al., 2014).

Theoretical Underpinnings

The Disease Model of Addiction

Psychological research has resulted in a theoretical model of addiction as a disease. The addiction model has neutralized the negative connotations associated with substance addiction and helps to encourage substance users to partake in addiction treatments and self-help meetings (Smith, et al., 2014). Consequently, the disease model has a limited view on the various treatment methods; it does not take into consideration the reality of the everyday life that substance users face. Moreover, the disease model neglects to address the social issues that arise from substance use and addiction (Fleury et al., 2014 and Smith, et al., 2014). When deciding on a treatment plan individualized for the substance user it is important that all treatment and intervention methods are thoroughly examined. Another psychological theory on substance use is the psychodynamic model. The psychodynamic model implies that addictive behavior is brought on due to the relationship between external events and the unconscious psychological processes of which the user stays oblivious (Klostermann & O’Farrell, 2013). The psychodynamic model has been successful in shedding light onto the importance of early childhood development and parental influences as possible origins of addictive behavior (Klostermann & O’Farrell, 2013).

The Behavioral Model of Addiction

Unlike the previously discussed theories on substance use, behavioral models of addiction base themselves upon the theory that the continued use of a substance will create elation, which in turn will intensify the need for the substance use to continue (Babor, 2011;Fleury et al., 2014;Goodwin & Sias, 2014). The need to ease withdrawal symptoms can be explained by reinforcing contingencies, however, the substance user will experience negative reinforcement due to taking the dose to help ease the pain (Fleury et al., 2014). Although the feeling of elation explains the continued use of the substance, it does not explain why some individuals are able to stop while other individuals become addicted. The social learning theory delves into this issue by explaining how social and psychological factors influence the emotional quandaries individuals find themselves in when they are using the substance (Fleury et al., 2014). Psychologists argue that the social learning theory explains human behavior by analyzing the continuous collective interaction between behavioral, cognitive and environmental factors; this theory looks at how an individual’s self-control and decision processes are affected (Babor, 2011; Fleury et al., 2014; Goodwin & Sias, 2014).

The Social Model of Addiction

The social learning theory focuses on an individual’s personal experiences from families, friends and other individuals. How individuals learn and perceive substance use, whether positive or negative, will affect the learning process and this in turn affects their behavior (Babor, 2011). Cognitive behavioral treatment, a popular addiction treatment bred from both the social learning theory and other behaviorist theories, helps substance user’s deal with wanting to make new life changes, managing their cravings, thoughts and develop new problem solving skills (Babor, 2011;Fleury et al., 2014;Goodwin & Sias, 2014).

The social model also takes into account the comorbid psychopathologies associated with addiction. These psychopathologies include depression, major depressive disorder, generalized anxiety disorder, panic disorder, trauma, oppositional defiant disorder, and conduct disorder, (Goldston, et al., 2009). These comorbid psychopathologies are categorized into internalizing and externalizing, with the former being more strongly connected to addiction (Verona & Javdani, 2011).

Numerous studies indicate that depression and hopelessness are directly linked to adolescent substance use; depression was present in 90% of the cases in which there was comorbidity (Goldston, et al., 2009). Substance use acts emerge as a result of a vulnerable personality (psychopathology, increased traumatization, high harm avoidance, etc.) and additional stressors, as well as the presence and interaction between internalizing and externalizing factors. Stressors can precipitate an individual’s emotional distress, which may be alleviated by their social support, family connectedness, and coping behaviors. Comorbid psychopathologies, as well as substance use, weakens these effective coping behaviors and increase exposure to stressors, ultimately increasing the risk of substance use (Ruchkin, et al., 2003).

Substance Use and Abuse

Illegal substance use and underage alcohol consumption is a prevalent issue within society today. Early experimentation with drugs and alcohol have an influencing role on how individuals view substance use in the future; individual that have a positive experience will be more susceptible to use again. Individuals who are social, or recreational, substance user also have the potential to become addicts due to their psychological state and what substance they are using. Individuals who are deemed “social users” can control what substances they take and the amount they use, however, social users still share the risk of having their substance use interfere with their home and work lives. When the individual begins to lose control of their consumption and how much they are consuming, they begin to become less of a social user and more of an addict. Once the individual cross the line from social user to addict, their primary focus is on how and when they can use again. Addiction is no different whether you are addicted to a substance, alcohol, or food (Pinel, 2014).

All drugs affect the brain chemical balance, no matter what the substance, this is known as the brains reward system. When analyzing the brain of a non-addict it is different from that of an addict. When an individual uses a substance there is a surge of dopamine and other pleasure messengers, however, these quickly desensitize due to the adaptivity of the brain; this adaptation results in withdrawal symptoms.  Short-term substance use does not affect the brains chemical makeup contrary to long-term substance use (Pinel, 2014). If an individual continues to abuse substances permanent neurological changes begin to affect the chemical makeup of the brain; these changes in the brain affect behavior and/or the ability to make rational decisions (Pinel, 2014). These chemical changes in the brain results in the individual’s persistent substance usage in hopes to achieve the “high.” Individuals may become addicted primarily to help deal with withdrawal symptoms (physically dependency), stress issues or simply to avoid everyday reality (psychological dependency) (Pinel, 2014).

Research suggests that addiction runs in families; however, it may not be merely a function of the parent-child relationship or imitation, but rather an inherited trait. In 1998, Statham and colleagues conducted a twin study in which the heritability quotient was 55%. Serotonin metabolism and receptivity is the focus in the attempts to pinpoint the mechanism through which genes affect behavior (Wenar & Kerig, 2006). Others argue that an individual’s biological genes make up may have a role to play regarding a person’s addiction. If this is the case, then if an individual’s parents were alcoholics or drug addicts then they would be at a greater risk of following the same path resulting in the individual becoming an addict them self. This could possibly prove that in a minority of cases addiction could be genetic. The individual will not necessarily be born a drug addict or alcoholic, but is however, more at risk of becoming involved in substance use later in their life.

Additionally, research suggests that genetics plays a role in an individual’s susceptibility to addiction (Fleury, et al., 2014).Once a substance user decides to cross over the line of being in control of their thoughts and actions to achieve the “high” they become addicts; they have no self-control and the chemical effect on the brain has made the “high” unachievable. The individual’s lack of ability to control their substance use is now looked at as the disease of addiction. It is, however, achievable for the brain to recover from long-term substance use. For this to be achieved it involves long term abstinence from the use of chemical changing substances (Matusow & Rosenblum, 2013).


If there is to be progress in the disease from the abuse of drugs and alcohol, continuing to educate society about the possible dangers using can have not only to themselves, but also to their family and friends. By continuing to do this we will have a better chance of witnessing a decline in the abuse of drug and alcohol substances and by large an improvement in everyday living. Abstinence as previously mentioned is the only viable treatment program regarding the disease model of addiction. However, there are suggestions that in the process of recovery relapses are all too common (Matusow & Rosenblum, 2013).

Ethical Considerations

To help fully appreciate addiction there must be a more integrated approach which will take the different processes into consideration. Smith, et al. (2014) states that there are five stages that individuals will go through when experiencing behavioral changes. The first stage is when the individual is ignorant or unaware that they have a problem and have no wish to change. Stage two looks at the individual and how they begin to consider changing their behavior but have not yet made any attempts to do so. Stage three focuses on the acceptance that there may be a problem and begins to make changes. The fourth stage is when the individual begins to put their plans into action to help change their behavior. The final stage is when the changes made are maintained and the individual is dedicated in making lifestyle changes to allow this to be maintained (Smith, et al., 2014). A successful addiction treatment should encompass both the biological factors as well as the behavioral and social factors that influence individuals. Although there is no concrete theory and treatment on substance use and addiction, much improvement has been made in understanding this complex disease.


Babor, T. F. (2011). Substance, not semantics, is the issue: comments on the proposed addiction criteria for DSM-V. Addiction, 106(5), 870-872.

Fleury, M. f., Grenier, G., Bamvita, J., Perreault, M., & Carón, J. (2014). Predictors of Alcohol and Drug Dependence. Canadian Journal Of Psychiatry, 59(4), 203-212.

Goodwin, J. g., & Sias, S. M. (2014). Severe Substance Use Disorder Viewed as a Chronic Condition and Disability. Journal Of Rehabilitation, 80(4), 42-49.

Klostermann, K., & O’Farrell, T. J. (2013). Treating Substance Abuse: Partner and Family Approaches. Social Work In Public Health, 28(3/4), 234-247.

Matusow, H., & Rosenblum, A. (2013). The Most Critical Unresolved Issue Associated With: Psychoanalytic Theories of Addiction: Can the Talking Cure Tell Us Anything About Substance Use and Misuse?. Substance Use & Misuse, 48(3), 239-247.

Pinel, J. (2014). Biopsychology Plus NEW MyPsychLab with eText-Access Card Package (9th ed). Upper Saddle River, NJ: Pearson

Smith, J. L., Mattick, R. P., Jamadar, S. D., & Iredale, J. M. (2014). Deficits in behavioral inhibition in substance abuse and addiction: A meta-analysis. Drug And Alcohol Dependence, 1451-33.


Psychosocial Concepts in Radiography

“Promising too much can be as cruel as caring too little” (Kelley, 2005, p. 69). The aim of this assignment is to describe and discuss the psychosocial aspects of patient/client care as applied to radiography, and the skills required the deal with a range of issues in work environment and explore medico legal aspects of radiographer’s scope of practice while relating to the given scenario.

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Oxford English Dictionary(2013) defines psychosocial as “relating to the interrelation of social factors and individual thought and behaviour” and medico legal “refers to that which is related to medicine and the law. It refers to that which pertains to the legal aspects involved in the practice of medicine. It covers the prerogatives and responsibilities that a medical professional is bound by as well as the rights of the patient” (AJ, 2013).
Upon arriving to the department it is paramount the radiographer justifies the x-ray request form on clinical grounds, and must adhere to the minimum requirements set by IR(ME)R which requires 3 forms of ID, the request form to be signed, information to identify the patient and clinical information to justify exposure. (DoH, 2000). once patient has been located, the radiographer is greeted by angry relatives who are complaining their mother had nothing to drink for 24 hours and has soiled herself, with this in consideration it is vital the radiographer introduces themselves and confirms the patients details for example, patients name, DOB and Address and hospital number if checking wristband as patient has limited ability to communicate. Infection control will be required as the patient has defecated herself, a quick check for infections such as clostridium difficile; if infections are present it should be present on the x-ray request or patient notes.
The first impression a patient forms from the way practitioner portray themselves by greeting the patient and explaining the procedure in the first few minutes. If a negative impression is formed during this encounter, it will be difficult to erase and the subsequent practitioner and patient interaction will be affected (Ramlaul and Vosper, 2013). When dealing with the patient/relatives the radiographer must be assertive, confident compassionate, and empathetic to the patient’s situation (Scriven and Orme, 2001), and must use clinical reasoning which refers to thinking and processes associated with the clinical practice of health care providers (Higgs, Jones, Loftus and Christensen, 2008)
Reassure the family that you have just arrived and here to resolve the matter, explain there could be a valid reason regarding the water, but you will look into it. Give reasons why there might be a shortage of nurses due to “fast interaction period of emergency departments which may be similar times to medical imaging” (Ramlaul and Vosper, 2013, p.13). This might be why the radiographer was not able to locate the nurses. Communication between healthcare professionals and patients is paramount to improve quality of care for patients, and eliminate any possibility for mistakes (O’Daniel and Rosenstein 2008). This scenario has clearly demonstrated the lack of Inter-professional communication and collaboration and how detrimental it is to patient care.
The psychosocial aspects of any individual can be affected by a small initial stimulus which can start a chain of events that have enormous outcomes; this is known as the butterfly effect (Burton, 2013). Little do we realise a smile can be enough to put someone at ease, and that can be the difference between a positive experience and a negative one. We have to understand the social/environmental aspect of an individual also plays a huge role in the way they think, talk, and behave (Niven, 2000).
The radiographer must take into consideration the psychological state of the patient, which may help understand the different feelings the patient might be experiencing such as, anxiety, shame, angry, distressed, shocked, and unwell. It is important the radiographer focus on their thoughts and feelings to better treat them.
Compassionate care must be 1st priority for all health professionals; this constitutes the six C’s, Care, compassion, competence, communication, courage, commitment. This guide helps health professionals to make sure their care meets the standards patients rightly expect and deserve (Cummings and Bennett, 2012). This should apply to all health professionals. With regards to Francis report UK The Mid Staffordshire NHS Foundation Trust Public Inquiry, (2010) which was carried out from January 2005 to March 2009 for the hundreds of appalling failings of compassionate care were left in excrement in soiled bed clothes for lengthy periods and many other failings. Referring back to the scenario it is seen the patient is in a similar situation and as a witness; the radiographer must report this, failure to do so is against the law.
Radiographers should uphold National Health Service constitution and values which are based on comprehensive service available to all race, gender, disability, age, sexual orientation, religion or belief and adhere the core value of NHS, respect and dignity, commitment to quality of care, compassion, communication, improving lives, and working together for patients (DoH, 2013).
Communication comes in many forms, verbal, non-verbal (sign language, facial expression and other forms of body language) it can be difficult at times to assess patients, this may be due to may barriers such as gender, age, language and disability, each barrier differ from patient to patient, with regards to the scenario the frail old lady is in a venerable state and unable to communicate regardless the radiographer must communicate with her as she may understand other means of communication which may include simple muscle movements such as blinking or squeezing a hand. Due to the lack of time usually available to radiographers, the task of identifying and treating symptoms may become the only goal for the practitioner, who then denies the patient the opportunity to explain their illness (Edelmann, 2000).
Radiographers must provide holistic care for the patient, while assessing patients and their clinical requirements to determine appropriate radiographic technique, and to perform a wide range of radiographic examinations on patients to produce high quality images while observing and maintaining contact with patients during their waiting, examination and post-examination stay in the hospital, And complying with Data Protection Act, IRMER, IRR, ALARP, Health and Safety at work, and many more (Agcas, 2012). Radiographers must keep within their scope of practice based on competency, education, extent of experience and knowledge while practising in a safe and competent manner (SoR, 2008).
And adhere to legislations set for radiographers, scope of practice, local rules, policies and procedures and HCPC standards of proficiency, is responsible and accountable for the patient undergoing x-ray (and other imaging modalities).
What is scope of practice for a radiographer? HCPC (2012) defines the scope of practice is the area/areas in which the radiographer has knowledge, skills and experience to practice lawfully, safely and effectively in a way that meets the HCPC standards and does not pose a danger to the public or to yourself. However if a practitioner wanted to move outside their scope of practice can do so providing they are capable of working lawfully, safely and effectively.
Relating back to the scenario it may need to be considered whether taking a portable abdominal x-ray is in the local rules, policies, and procedures, must weigh the risks/benefit, consider their personal experience and is it enough to carry out the x-ray in a safe, effective and lawful manor. As health professionals one must understand their own capacity and limitations and act accordingly.
Taking consent from the patient can be verbal, written or implied. Every adult has the right to determine what is done to their body (UIC, 2004). Taking an x-ray without obtaining valid consent can be detrimental which leaves the practitioner open to lawsuits and questions their fitness to practice. As we know the patient is not able to communicate, hence the radiographer might adopt different means on consent for example implied. Patient might be asked to blink twice if it’s okay to go ahead and blink once if not vice versa. Pertaining to moving and handling patient the radiographer should make use of the mandatory manual handling training provided by the trust/university. The radiographer must not in under any circumstance cannot pat-slide by themselves and must have a minimum of 3 trained personals.
This scenario is a classic example of negligence, where no nurses are present to attend to the patient, torts law comes into play in this scenario, where unintentional negligence of the patient where the duty of care is at breech. If the radiographer carried out the x-ray after the patient had been cleaned by the radiographer and/or nurse, the radiographer must inform patient about the x-ray being taken and once consented markers must be used in the primary beams instead of post processing to avoid confusions, and most importantly, the x-ray can be used in court if required, furthermore upon taking the x-ray a holders form need to be filled in if holder was required and must wear lead coats. A risk assessment must be carried out to determine if it is possible to carry out the x-ray and apply ALARA (as low as reasonably achievable) as mobile x-rays tend to used higher exposures this is achieved by many ways such as increasing the FDD.
This scenario can most certainly make everyone feel agitated, stressed, scared and terrified, and nervous. However as professionals one must show confidence in the face of adversity and demonstrate good communication skills and follow the HCPC standards of conduct, the scope of practice, upholding the NHS constitution along with compassionate care guide, will ultimately enable the health practitioner to be more confident and well equipped in practice.
In conclusion one can argue it requires inter-professional team effort to give the best experience to any patient, which is be true, but it requires the efforts of each individual put together collectively to formulate productivity and efficiency for the best interests of the patients.
Reference List
Agcas. (2012). Role of a diagnostic radiographer. Prospects. Retrieved December, 13, 2013, from description.htm.
Burton, J. (2013). Radiography and the butterfly effect. SoR. Retrieved December, 16, 2013, from
Cummings, J & Bennett, V. (2012). Compassion in practice. Retrieved December, 22, 2013, from
Department of health. (2000). Ionising Radiations Medical Exposure Regulations: Good Practice. Retrieved November, 25, 2013, from /system /uploads/attachment_data/file/227075/IRMER_regulations_2000.pdf.
Department of Health. (2013). The NHS Constitution: TheNHS belongs to us all. Retrieved December, 10, 2013, from /Rightsandpledges/NHSConstitution/Pages/Overview.aspx.
Donald R. Kelley. (2005). Divided Power: The Presidency, Congress, and the Formation of American Foreign Policy, Intraparty factionalism on key foreign policy issues. (p.69). University of Arkansas Press
Edelmann, R. J., (2000). Psychosocial Aspects of the Health Care Process. Harlow Prentice Hall
Higgs, J. Jones, M. Loftus, S. & Christensen, N. (2008). Clinical Reasoning: in the Health Professions. (3rded.). London: Elsevier
Jeevs, A. (2013). What is medico legal? AskJeeves. Retrieved December, 20, 2013, from
Niven, N. (2000). Health psychology: For health care professionals. (3rded.). Edinburgh: Livingstone.
O’Daniel, M. & Rosenstein, A. H. (2008). Patient Safety and Quality: Professional Communication and Team Collaboration. PubMed, 8(43), 33.
Ramlaul, A. & Vosper, M. (2013). Patient centred care in medical imaging and radiotherapy: In medical imaging and radiotherapy.London: Churchill-Livingstone.
Scriven, A. & Orme, J. (2001). Health Promotion, professional perspectives. (2nded.). London: Macmillan.
The Health Professions Council. (2012). Standards of proficiency, your scope of practice. London: HCPC.
The Society of Radiographers. (2013). Code of Conduct and Ethics. London: SoR.
University of Illinois at Chicago College of medicine UIC. (2004), Informed consent, Retrieved November, 30, 2013, from
United Kingdom. The Mid Staffordshire NHS Foundation Trust Public Inquiry. (2010). Independent Inquiry into care provided by Mid Staffordshire NHS Foundation Trust. London: TSO. (Chairman R. Francis).

Application of Erikson’s Psychosocial Development Theory in Patient Care Plan

 In clinical we use Erik Erikson’s theory of psychosocial development to assist in developing a comprehensive and holistic plan of care for the patients we see. Erik Erikson’s various stages are simple to understand and easily applied to all age groups. A prime example is in the number of teenagers we see during clinical. The stage identity versus role confusion relates to them perfectly as it is obvious they are struggling to find where they fit in with family, peers and society. Those that have adequate support and encouragement become independent and develop a strong sense of who they are while those teenagers that do not will become insecure and confused about their future. We see many teenage girls come in dressed as males, who actually identify as male, that have yet to find happiness. They are the ones that lack a sense of identity and are unable to develop genuine relationships with their peers. This inability to form relationships will cause further complications in the next stage intimacy versus isolation.

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 As part of the class requirements, we are to present a project. I have chosen to research the effect of probiotics on mental illness. As the field of psychiatry is beginning to learn more each day about the gut-brain axis use of probiotics to improve mental disorders is being closely examined. For instance, a study by Raygan, Ostadmohammadi, and Asemi (2018) demonstrated that the addition of probiotics and selenium to the diets of subjects with diabetes and coronary heart disease improved indicators of metabolic profiles and mental health when compared to placebos. The idea of being able to use natural supplementations to improve mental disorders, especially for those resistant to taking psychiatric medications, is fascinating to me and while I do not believe that we will be able to replace psychiatric medications I do think this subject has opportunities for advancement.

Throughout the master’s program, it is emphasized that nurse practitioners have the ability to save the consumer money. It is well-known that there is a physician shortage in many rural areas and this is especially true for the field of mental health. In clinical we have patients that drive 1-2 hours to see us as they do not have access to a mental health provider closer to them. Unfortunately, those that do not have access to transportation will not receive the care they need to stay well leading to illness and the high costs related to this.

 Nowhere is family involvement more important than in mental health. We meet with children and parents to discuss our plan of care to learn whether it is working. We have family meetings with adults and their families as well. The goal is for them to gain an understanding of the illness their loved one is suffering from and how to help them manage it. If those with mental illness do not have an adequate support system they will often fail in maintaining actions that keep them well..

 Providing culturally competent care is a difficult but essential goal as a nurse practitioner. My clinical site this semester has not offered much diversity but we do round at the local hospital and will often see people of different cultures there. The inability to communicate with these patients is frustrating and I often wonder if they understand their plan of care. Clinicians must be aware that incorporating someone’s cultural beliefs in their treatment plan increases the likelihood of success.

 Another important aspect of patient care is following legal and ethical principles. Psychiatric nurse practitioners have to be very careful with the information they get from clients as there are many laws that have been enacted to protect the privacy of people suffering from mental disorders. The psychiatric nurse practitioner may take away a person’s freedom to a certain extent in special situations, therefore, when they choose to involuntarily admit someone they are legally and ethically obligated to do all they can to protect that patient’s rights.

 Establishing a therapeutic relationship is one of the most important components of therapy. Building trust may be difficult as many clients are suspicious and distrustful of those they perceive “in power.” At times the client may refuse to work on building a relationship with the therapist as they are not ready for help. We often see patients that have been involuntarily admitted who feel anger and betrayal. We have to remember clients that have been involuntary admitted are able to develop positive relationships during an obviously upsetting time when they experience feelings of connectedness, are given treatment information, feel as though they are viewed as a person and not a diagnosis and feel a sense of partnership with their therapy team. For those unable to develop a trusting relationship there is no perception of benefit from therapy (Wyder, Bland, Blythe, Matarasso, & Crompton, 2015).

 Throughout my time in school, I have worked on developing an ethical framework that would guide me in my practice. I have a foundation but I believe that this will be a work in progress and will change somewhat when I actually enter into practice and begin seeing patients every day. My goal is to treat all patients with mental illness that I see with respect and compassion which seems to be something that is often sorely lacking for them.


Raygan, F., Ostadmohammadi, V., & Asemi, Z. (2018). The effects of probiotic and selenium co-supplementation on mental health parameters and metabolic profiles in type 2 diabetic patients with coronary heart disease: A randomized, double-blind, placebo-controlled trial. Clinical Nutrition.

Wyder, M., Bland, R., Blythe, A., Matarasso, B., & Crompton, D. (2015). Therapeutic relationships and involuntary treatment orders: Service users’ interactions with health-care professionals on the ward. International Journal of Mental Health Nursing, 24(2), 181-189.