Introduction The World Health Organisation (WHO) defined healthin 1948 as a, “state of complete physical, mental and social wellbeing and notmerely the absence of disease or infirmity.” (WHO, 2018). This definitionhighlights the fact that it is not merely the physical ill-health of a serviceuser that should be considered by healthcare professionals, but also thefactors relating to their psychological and social wellbeing. Since the 1990’s,the idea of person-centred care has appeared with increasing regularity in UnitedKingdom health policy (The Health Foundation, 2014).
As a result, a transitionhas emerged from the traditional medical model of healthcare, which focussed onthe anatomical and physiological symptoms of the service user, to a more person-centredmodel of healthcare. This more holistic approach considers their entirewellbeing, as individuals within their own community, who have specific needsand values that are important to them. Research has shown that if the broaderwellbeing of the patient is addressed, they are more likely to be treated withthe respect, dignity and compassion that they deserve (British MedicalAssociation, 2011).This essay summarises some of the underlyingpsychological and social factors that may affect service users attending theradiography department. These important factors should be considered by radiographydepartment staff when communicating with patients in order to achieveperson-centred care.
There are numerous factors that could be discussed; examplesinclude gender roles, disabilities, income, social class, wealth, occupation, culture,educational background, media influence, relationships, mental illness, anxiety,anger and alienation (Collins, 2013). This essay will however focus on socioeconomicfactors and patient stress and anxiety. SocialFactors The association between a person’s health and theirsocial class is one that is well documented and applies to all aspects ofhealth including mortality rates, life expectancy and likelihood of accessing publichealth services. In spite of the factthat the NHS is a service accessible to all, a report on England from theOffice for National Statistics highlighted major differences in a number ofhealth related issues across the different social classes (Knott, 2015).
A person’s social class is usually determined bytheir educational background, occupation, income and wealth. People in the United Kingdom in higher socialclasses tend to have jobs that provide substantial income, favourable workingconditions and a higher status. As a result, they experience better thanaverage health and wellbeing (Collins, 2013). In contrast, lower social classes tend to have more manual, lessstimulating jobs that tend to have poor working conditions and a lower status. Therefore being part of a low social class canhave a detrimental impact on a person’s physical and emotional wellbeing,compared with people belonging to the higher social classes, who tend to havebetter paid jobs with more favourable working conditions.
The more manual, uncomfortable nature of lowincome occupations puts members of the lower social classes at more risk ofoccupational hazards. Direct effects on their health and wellbeing includeaccidents leading to fractures and soft tissue injuries, musculoskeletal painfrom repetitive actions and respiratory problems due to poor air quality inplaces such as factories and workshops (Knott, 2015). A study carried out by Court-Brown et al.(2013), investigated the relationship between social deprivation and theincidence of adult fractures. The investigation was performed at The RoyalInfirmary of Edinburgh and concluded that fracture incidence significantlyincreases in the most deprived 10% of the population. The study suggests that people belonging tothe lowest social classes are more prone to falls and accidents and, inparticularly, high-energy proximal tibia fractures.Individuals belonging to high social classesusually have a greater income and as a result become wealthier.
Consequently,this gives them levels of disposable income that members of the lower socialclasses do not have. Wealthier families tend to have a better quality of lifeand have more potential to reduce their health risks because they have greateropportunity to make positive health decisions. More disposable income meansthat wealthier people can invest in gym memberships and are more likely toexercise for leisure.
Although the lower classes tend to have more manualoccupations, this physical activity does not adequately effect theircardiorespiratory system for it to be beneficial and, after a hard day’s work,they are unlikely to want to partake in even more physical exercise (Knott,2015). Wealthier families are morelikely to have healthier diets as they can afford to buy better quality andmore nutritious foods, whilst poorer families tend to eat more fatty, processedand convenience foods. Studies have also linked lower socioeconomic groupswith heavier alcohol consumption and increased tobacco use. Research intoalcohol consumption of members of the adult population of Wales found thatparticipants from the most socially deprived areas were most likely to bingedrink. Suggested reasons for this are that people of low social class usealcohol as a coping mechanism to deal with the stresses of everyday life, andalso that cheap alcohol is more readily available in socially deprived areasdue to there being a higher density of alcohol outlets (Fone, et al., 2013). Whilst on clinical placement in a hospitalemergency department, it was observed that the majority of people who werereferred for ultrasound scans specifically to look for liver problems, werepeople of middle age who had alcohol dependencies.
Some were unemployed andothers had no fixed abode. The vast majority were unkempt and some were still underthe influence of alcohol at the time of the scan. All of them were found tohave varying degrees of fatty liver disease and cirrhosis.The cumulative effect of poor diet, inadequatephysical exercise, excessive alcohol consumption and tobacco use means thatbeing part of the lower social classes is related to increased risks ofobesity, heart disease, myocardial infarction, liver disease, diabetes andincreased susceptibility to certain cancers (BMA, 2011). PsychologicalFactors Psychological factors refer to the thoughts andfeelings that affect the functioning of the human mind (Reference, 2018).
Thesefactors affect a person’s behaviour, attitude and decisions towards theirhealthcare. Psychological factors subconsciously influence how people deal withthe dynamics of different health issues during their lifetime. Physical illness and pain can have a profoundnegative impact on a person’s emotional wellbeing. Attending hospital inflictsadded stress onto a patient due to the unfamiliarity of the clinicalenvironment, particularly the technical equipment and surroundings of an imagingdepartment.
Anxiety is an important psychological factor that must beconsidered by radiography staff in order to get the best possible outcomes forthe patient (Ehrlich and Coakes, 2016). Service users undergoing radiographicexaminations for diagnostic purposes will have increased feelings of anxiety dueto the uncertainties of the outcome of their illness and fear of the unpleasantnature of certain radiographic procedures. A study carried out in 2011 onbehalf of the Radiological Society of North America assessed the levels ofdistress of women sitting in the waiting room of an imaging department. All wereattending for radiological procedures. The results showed that the women thatwere attending for diagnostic breast biopsy, and the women attending forinvasive treatment of malignant liver cancers and uterine fibroid treatment,experienced abnormal levels of perceived stress, depressed mood and negativeimpact of events. Interestingly however, it was only the women attending forbreast biopsies that experienced highly alleviated levels of anxiety. This suggests that the invasiveness of theprocedure has less influence on patient anxiety than the uncertainty of the testresults (Flory and Lang, 2011). The patients attending for treatment ratherthan diagnostics already knew that they had cancer or fibroids and so the fearof the unknown was not as influential on their emotional wellbeing.
Feelings of anxiety and stress can stop patients fromretaining information and can also affect how they respond to instructions.During was an extremely anxious lady came for a barium swallow examination. Thehigh anxiety levels of the lady meant that she found it difficult to followbasic instructions such as holding the barium in her mouth and swallowing atthe correct time. Even after the examination when the radiologist explained tothe patient that there was nothing significant to worry about, the lady couldnot believe the positive outcome. The patient’s abnormal level of anxiety was partlya result of the fact that prior to her appointment, she had convinced herselfthat she was going to be diagnosed with a tumour. Cancer diagnosis is sofrequent in modern society that service users often fear the worst andattribute symptoms of ill health with having a malignant tumour. The temptationof patients to self-diagnose is also prevalent issue in modern healthcare, andcan often increase feelings of depression and anxiety in service users. Peopleare now less passive in their attitude towards their healthcare and will useonline resources to try to have greater understanding about healthcare issues(Collins, 2013).
Unfortunately, whenthis information is not accurate and a healthcare professional has not alsobeen consulted, it can cause unnecessary worry to an already anxious patientand as a result has a profound negative influence on their psychological healthand wellbeing. Feelings of intense anxiety or stress can causephysiological changes in the body that mirror the symptoms of other illnesses.People who are abnormally anxious can experience increased heart and breathingrates, profuse sweating, trembling sensations and gastro-intestinal problems(Healthline, 2018). Patients will oftenhave numerous radiographic examinations because of these symptoms and willstill not get an answer because their symptoms are anxiety related. They may bereferred for a chest X-ray or electrocardiogram (ECG) because of an increasedheart rate, or for a virtual colonoscopy (CTC) because of bowel problems, butthe imaging will often not show any physical cause of the symptoms.Psychological factors such as stress and anxietymust be considered by radiography staff to ensure that service users do notfeel like their psychological wellbeing is being ignored.
Radiographers aretherefore faced with the challenge of not letting the technicalities of theradiographic examination distract them from being attentive to the patient’smental health and wellbeing. Discussionand Reflection Ill-health makes service users vulnerable andscared. They are forced to trust that the healthcare professionals theyencounter on their patient journey will do the best for them as individuals andwill consider their entire wellbeing, not just their anatomical andphysiological symptoms (The Health Foundation, 2014).The traditional passive role of the patient isbecoming a thing of the past and they are now encouraged partners in their owncare, collaborating with healthcare professionals in decisions regarding theirtreatment. The Planetree model encompasses this patient-centred approach tohealthcare suggesting that cultural transformation and staff engagement isessential if we are to provide a more value-based health service. It is theresponsibility of all healthcare workers to consider the psychological andsocial factors that may affect service users on an individual basis (Planetree,2018). The Society of Radiographers Professional Code of Conduct (2013) statesthat all of the professional workforce for diagnostic imaging and radiotherapymust, “Listen to and respect the wishes of patients, seeking to empower them tomake decisions about their care and treatment.” The code of conduct putspatient-centred care at the heart of radiographic practice which it insistsmust be based on values such as respect, trustworthiness and empowerment(Society of Radiographers, 2013).
Radiographers consequently have aresponsibility to consider the broader wellbeing of the patient, including thesocial and psychological factors that may influence their everyday lives. Correlation between socioeconomic status and healthshows that health improves incrementally moving upward through the socialclasses (Matthews, 2015). Members of lower social classes are morelikely to suffer from chronic illnesses, it could therefore be deduced perhapsthat diagnostic radiography departments in particular will see more patientsfrom the middle to lower social classes.Psychological factors such as stress and anxietyput emotional strain on service users attending radiographic examinationappointments, and can create added challenges for radiographers who alreadyhave to contend with consistently stretched resources and time constraints.
Radiographersmust use effective communication to help to reassure anxious patients and tomake them feel as though they are being respected and taken seriously. If theradiographer has the emotional intelligence and skill to do this successfully,patients will be more likely to cooperate and retain information (Ehrlich andCoakes, 2016). This is particularly important where the examination requires alarge degree of patient participation as they will be more able to followinstructions, making it less likely that the examination will need to berepeated or rearranged. A qualitative study carried out in a Swedish hospitalin 2010 aimed to describe patients’ expectations before, and experiences during,a head-first magnetic resonance imaging scan (Carlsson, S. and Carlsson, E.
,2013). It concluded that, althoughpatients had received written information regarding the scanning procedure,communication with the radiographer was described as being crucial in order forthe patient to manage their feelings of anxiety and loss of self-control. This shows the significance of patient-radiographerinteraction and how the technicalities of the examination must not detract fromaddressing the emotional needs of the patient. The brevity of the encounter between patient andradiographer means that psychological and social factors affecting the patienthave to be rapidly deduced. They have very little time to make the patient feelas though they are being attentive to their emotional wellbeing, whilstcarrying out a diagnostic examination and keeping a busy departmentmoving. Radiographers must thereforepossess impeccable skills of communication and be able to adapt theircommunication style to meet the needs of individual service users. Conclusion The health and wellbeing of service usersundergoing radiographic examinations is shaped by both psychological and socialfactors.
These important influences must be considered by healthcareprofessionals in order to deliver patient-centred care and to allow the patientto feel like they are receiving the compassion and respect that they deserve. Radiographershave an obligation to provide compassionate care that promotes the bestinterests of each individual patient. Effective communication is essential inachieving the best patient experiences as all elements of verbal and non-verbalcommunication has the potential to either increase or decrease feelings ofdistress and fragility in the service user.The increasingly complex psychological and socialneeds of a diverse and aging population means that radiographers cannot just beexperts in the technicalities of diagnostic imaging, they have to also beexperts in patient care, support and empathy.