▲ Psychological needs of patients
It must be recognized that patients are social people with different psychology, and these different psychological states will directly affect the nursing effect. So what we are discussing here is the psychological needs of patients.
Patient role: Patient role, also known as patient identity, is a social role. Social role is a behavior pattern stipulated by society to show social status. All behaviors in society are related to their specific roles; On the contrary, his role can expect his behavior to adapt to his role. When a person is diagnosed with a certain disease, he has the status of a patient and changes his psychology and behavior. Parsons, a sociologist, observed the interaction between patients and people around them from a sociological perspective, and divided it into four categories, which were called patient role elements. The first element: exemption from social roles on weekdays. When a person plays the role of a patient, he can be exempted from the responsibility of playing a social role on weekdays. How many original social roles can be exempted depends on the nature and severity of the disease. The second element: the obligation to receive assistance. Sick people can't realize their wishes just because they have the will to recover. They must rely on the help of people around them to realize their wishes. The third element: the responsibility to restore health. Disease is a state in which some needs are not met, which will cause discomfort and even death of patients. Therefore, patients need to be expected to have a desire for survival and hope for the future. These responsibilities include giving up dependent roles and being able to handle their daily life problems independently. The fourth element: the responsibility to seek medical assistance. It can be inferred that the greater the difference between the patient's original role characteristics and the patient's role, the easier it is to adapt; On the contrary, the closer the patient's original role is to the characteristics of the patient's role, such as passivity, willingness to accept others' help, trust others, etc., the easier it is to accept the patient's role.
Birth, old age, illness and death are natural laws. A person's life may be accompanied by the role of the patient for a while, and may even be accompanied by the role of the patient for a lifetime. This is a frightening and disgusting role, but for some reason, sometimes I have to accept or be happy to play this role. When individuals change from other social roles to patient roles, and in the process of accepting patient roles, there will be some inadaptability due to various factors, which will affect the transformation from disease process to health.
The process of patients accepting diseases:
Lederer (1965) thinks that the process of disease is a complicated psychological formation process. She put forward three independent but overlapping periods of accepting the disease:
⑴. From health to illness: When an individual realizes that he is sick, there are several things to do: ① to give up the original social responsibility, ② to accept the help, diagnosis and treatment of others, ③ to cooperate with others to restore health, and ④ to seek appropriate help. Patients who adapt well at this stage can be diagnosed, endure the discomfort and restrictions caused by treatment, and see a doctor regularly. On the contrary, maladjusted patients may deny the disease, deny the symptoms, use inconspicuous symptoms to avoid responsibility, or manipulate others.
⑵. Accepting the illness period: This period starts from the fact that the patient accepts the illness and plays the role of the patient. The patient's behavior becomes self-centered and his interest in other things around him decreases. Because he needs to rely on others and hates this kind of dependence at the same time, his emotions are contradictory and he will pay special attention to some changes in his body. Inadaptive behaviors include giving up hope of recovery, refusing to accept assistance, questioning treatment, avoiding talking about their own problems and feelings, and being unable to cooperate.
⑶. Recovery period: This period is when individuals give up the role of patients and play the role of healthy people. With the recovery of physical strength, patients gradually become independent, willing to help themselves, actively participate in rehabilitation activities, make more decisions, and gradually increase their interest in things around them, indicating that they are recovering. The maladjusted patient behavior will stay in the second stage.
Common psychological reactions after illness:
(1) Behavior degradation: The behavior of patients is not commensurate with their age and social role, and appears childish. If the body groans, cries or even shouts at inappropriate times, it will attract the attention of people around it and get care and sympathy. I have to rely on others to do my own daily life, hoping to get meticulous care and care from my family, friends and nursing staff.
⑵. Emotional fragility, excitability and anger: The patient is upset, often angry about trifles, prone to fluctuation and crying, inexplicably angry, resentful of fate, self-reproach and self-shame.
⑶. Increased sensitivity and abnormal subjective feeling: Patients are particularly sensitive to changes in the natural environment, such as sound, light, temperature, etc., and will be nervous if there is a little noise. The tolerance to physical discomfort is reduced, and the subjective experience is enhanced, such as feeling the abdominal aorta beating violently, trembling somewhere, fear and so on. These changes will aggravate the condition. I will also find fault with other people's intonation, movements, etc. , I will be disgusted.
(4) Suspicion: Patients who have not recovered from a long illness are prone to blind suspicion and are particularly sensitive and suspicious of other people's expressions, demeanor and behavior. Even for diagnosis, treatment and nursing, there will be doubts and distrust, and it is necessary to ask for examination and treatment in detail; If family visits are not timely or the frequency decreases, they will also suspect that they are indifferent to him or have another new love.
5. Enhanced self-esteem: Patients want to be respected, cared for and valued by others. Willing to listen to comfort and persuasion, I think I deserve special care and respect, paying special attention to the attitude of medical staff. If anything is wrong, it will be regarded as disrespect and anger, and I will not cooperate with the treatment.
[6]. Anxiety, fear: Patients have made too serious estimates of their own health or objective things, which is often a complex emotional reaction when their condition has not improved or deteriorated and there is no hope of recovery. Its main characteristics are fear and worry. You can also be anxious and fidgety because of social factors such as family, work, economy, study and marriage. The anxiety of patients is manifested as muscle tension, sweating, rubbing hands and stamping feet, clenching fists, pallor, rapid pulse and high blood pressure. Insomnia and headache may also occur.
(7) Loneliness: When patients come to the new environment of the hospital, they feel lonely when they get along with strangers, and their hospitalization life is monotonous. From morning till night, eating, making rounds, taking medicine, treating and sleeping, day after day, especially for long-term hospitalized patients, is like a year. Loneliness can make people worry, worry and panic; It makes people feel desolate, abandoned and negative.
(8) Pessimism and depression: patients lose their ability to work due to illness, or their image changes, and their emotions become extremely pessimistic and they are not interested in external things; Cry silently or complain bitterly; Some patients give up on themselves, give up treatment, and even have suicidal thoughts.
Tax. Helplessness: When a person thinks that he can't control his environment and can't change it, he will feel helpless. This is an emotional reaction of helplessness, disorientation, laissez-faire and passive beating. This sense of helplessness can also be generalized and lead to clinical manifestations such as disappointment and depression. Patients are indifferent and silent, or feel inferior and self-pity, or resentful, or reminisce about life nostalgia, or die silently.
⑽. Expectation: refers to the patient's pursuit of a beautiful imagination in the future. When a person is ill, not only will his body change, but he will also be tortured psychologically. Therefore, both acute and chronic patients hope to get sympathy and support, get serious diagnosis and care, and look forward to an early recovery. Those patients with high expectations often regard the comfort of their families and the encouragement of medical staff as signs that their condition is improving or even about to recover. Expectation psychology is the spiritual pillar of a person's desire for survival, and it is a positive psychological state, which is objectively beneficial to treatment. However, it is necessary to prevent patients from falling into confusion, depression and even mental breakdown once the expected goal fails.
⑾. Habituality: Habituality is a psychological set. In the early stage of illness, patients always fantasize that they are not sick. Maybe the doctor made a mistake, which is caused by habitual thinking. However, when their condition improved, they thought that they had not fully recovered, and they still wanted to stay in the hospital for observation and treatment, rather than leaving the hospital. This is an inertial performance that they are used to the patient's identity.
The above generally summarizes the psychological problems of ordinary patients, but due to the influence of gender, age, disease, cultural background, social experience and other factors, one or more of them can be manifested in different course of disease, so it is necessary to make specific analysis and treatment for each patient.
Psychological characteristics of inpatients;
(1). Need to be recognized; Once every patient is admitted to the hospital, the new environment makes him feel strange. At this time, in addition to eager to know others and be familiar with the environment, he also needs to be recognized and valued, that is, to get a better treatment environment and better treatment.
(2) Need to be accepted: After the patient is admitted to the hospital, he needs to know the people in the same room and strive to be accepted as a full member of the ward emotionally to satisfy his sense of belonging.
(3) Need to adapt to the environment as soon as possible: When a person faces a new environment, he will often be at a loss and even feel anxious. It is very necessary for patients to know the rules and regulations of the hospital, the rules of diet and daily life, the time of rounds, the treatment and treatment, and then understand the treatment principles and prognosis of their own diseases.
(4) Need recreation and fun: Ward is a narrow world and a special semi-closed society. When the patient first entered the hospital, he felt strange everywhere and everything was novel. Soon, this feeling of being at a loss was replaced by boredom. If you continue, you will feel bored and live like a year.
5. Safety requirements: Safety is the immediate needs of patients and the main purpose of patients seeking medical treatment.