Man is a social being. Social factors play important role in health. Social conditions and not only promote the possibility of illness and disability, they also enhance prospect for disease prevention and health maintenance. Health life style and the avoidance of high-risk behaviour, advance the individual’s potential for a longer and healthier life. The recognition of the fact that the health of an individual is more than biological phenomena has brought in to the forefront the significance of behavioural dimension of health.

Mr. AS, a 73 years old, Muslim, male patient admitted in ---ward of ---Hospital with a diagnosis of prostate cancer. Data regarding psychosocial aspects of his life and illness were collected through interview. He was cooperative and interactive with me for most part. But later he was found to be reluctant to talk ...as he was frequently expressing his financial troubles which could not be helped by anyone related to him.

Cancer Prostate

Prostate cancer is the fifth most common type of cancer in men and its incidence rises with advancing years. It occurs in 1 in 10 in the men living to the age of 70 years. Early clinical features are indistinguishable from those of BPH and the gland may feel normal on digital examination. The PSA may be elevated (>4 ng/ml). As the tumour grows locally it may produce bladder neck obstruction, obstruct the ureters and rapidly lead to renal impairment. In late disease rectal examination shows the prostate to be large, hard and irregular. Rectal ultrasound may show the spread of the cancer and this should also be used for directing needle or aspiration biopsy. Prostatic biopsy is important in giving prognostic information- prognosis being poorer with poorly differentiated tumours.

Therapy depends on staging. Early disease is treated with local radiotherapy and more advanced disease by orchidectomy and hormone therapy with oestrogen. It has been suggested that all men over the age of 50 years should be screened by rectal examination, transrectal ultrasound and PSA measurement.

General information

Name : Mr. AS

Age : 73 years

Gender : Male

Marital status : Married

Place : ---/ ----

Hosp. No. : ------

Date of admission : 1-4-08

Ward/Unit : --------

Education : No formal education

Culture & life-style

Religion : Islam, Muslim, believes in 'Durgas', and has gone too.

Food habits : four time in a day

: Non-vegetarian once in a day

Socioeconomic condition

· Lower socioeconomic status

· Occupation

· Fisher man for 12 years

· He was a beedi worker for 10 years

· went to gulf and worked there for 4 years

· Cook for 35 years

· His son is in Gulf country, but earns only Rs.5000/month

· His residence is about 80 km away from ----,

to and fro journey costs rs.50/ person

Role in the family

· Head of the family, earning member, and father

· These role are affected due the illness “ everything is disturbed at home”

Social Support Network

· Patient has poor social support network

· There is no one to support him financially for treatment of his illness

· His daughter visited him twice in the hospital, no other person visited him or enquired him about his illness after coming in the hospital

Patient complaints (on the first meeting)

· Pain at the genital area (on catheterization)

· Urine tube needs to be removed

· No taste for anything he eats

· No money in hand to pay the hospital bill

· No sleep at night

Identification of patient needs

Collection, observing/ performing activities relating to caring

Interpretation and analysis

Needs arising from present illness and the consequent response to cope with

· “I have pain at genital region”

· “I have problem of passing urine without control, that is why tube is inserted”

· “I want to get this urine tube removed”

· “Who will pay my hospital bill of Rs.50,000?”

· Patient complains that he is not getting adequate sleep during night

· He sleeps during daytime

· Patient’s main complaints are pain, irritation at the site of urinary catheter, and sleep disturbance

· He was a cook, working most of his life in night time for marriage parties

· Currently, he is hospitalised for cancer, prostate and is receiving radiotherapy for the last one month

Basic physical needs

· He is advised not to take bath till the end of radiotherapy to avoid skin excoriation at the site

· He maintains adequate cleanliness

· He visits toilet with assistance from his wife

· He is catheterized for the last 2 months

· He says is a practicing Muslim

· He is taking bath means it interferes with his religious practices

· He is advised not to take bath because he may wet the irradiation area, but the cultural issues are not addressed.

Needs related to life style

· He is a non-vegetarian

· But he not getting any non-veg food in the hospital

· His life style related needs hindered in this hospital environment

Needs related to habits

· He does not take tea or coffee

· He does not smoke or take drinks

· As he has any regular habits of taking tea or coffee or drinking alcohol

Individual’s knowledge and experience of illness

Patient’s Knowledge of Present illness

Patient explains his illness:

· “I have pain and urine block for the last 6 months”

· “My illness is serious”

· “I have diabetes for the last one year”

· “I underwent a surgery for urinary block and pain in ----- 4 months back”

What the patient wants to know about the illness?

“will this illness get cured”

“I have come here because, doctors in ---- told me my illness can be cured only in Manipal”

· Patient has understanding of the illness as his illness is serious.

· Patient underwent orchidectomy and TURP in -------- 4 months back and later referred to Manipal for further management

· Patient wants to know whether his illness will get cured.

· He says he has no money to spend her.

· But his expenses are met by his daughter and one brother

Experience of illness

What has been his past experience with illness?

Past Illness History

· “Earlier I went to many local folk doctors, they only made all these illness”

· “I have sugar illness for the last one year”

· “ The doctor in Kundapura told me to check sugar, so I know I have sugar problem”

· “I have not had any major illness in my life other than this”

Family History

· No major illness in his knowledge

Whether patient has accepted his illness

· “I don’t have any habits, drinking, smoking or taking even coffee since childhood. I don’t know why I got this illness”

· Patient has consulted many folk doctors for minor illness and never satisfied with them.

· He had minor troubles with urinary frequency for about 4 years

· So he consulted some folk people for some remedies

· But never satisfied

· Patient has accepted the illness as some thing which he does not deserve.

· He puts it on fate

Knowledge of formal and alternative therapies

· He has adequate information about formal and folk medicines

· “I have gone to them, but no benefits”

He had tried alternative medicines and found to have no benefit in his illness

Knowledge at present and future course of action.

What is the treatment plan

Does the person knows about it

· Patient says he has one month duration of x-ray treatment

· “nobody tells me what is my illness”

· “I’m taking medicines regularly”

· Patient has only partial knowledge of his illness and treatment plans

· He is illiterate, but nobody has explained him about his treatment plans

Coping with the illness and its outcome (Patient and family)

· “What will we do?”

· “We have to suffer everything”

· He looks depressed and tries to avoid visitors

· “I don’t have money pay here, I don’t know what to do”

· Patient is not showing adaptive responses

· He has depressive cognitions

· He has financial problems

Analyse the individuals and family’s views on

· health team

· doctors

· nurses

· “Doctor People come and asks how you are? (he explains sarcastically), nothing else”

· “They do not want to know about my pain”

· “sometimes, nurses come asks about me”

“Doctor has told something to my daughter”

He is not satisfied with the psychological attention given to him by nurse or doctor

His wife too has the same opinion

Doctor has explained about the illness to his daughter about the diagnosis and prognosis

Distinguish between the meanings of the patient, doctor, nurse

Patient: “they are not asking me anything”

Doctor: “he will not understand anything, it is explained to his daughter”

Nurse: “doctor has explained everything to him, we cannot tell anything to the patient”

Patient wants to know about his illness, and course of treatment, but doctor is preoccupied with the patient’s educational status.

Nursing staff is bothered whether they may convey wrong message to the patient.

There is a communication gap exists among these people.

Observe the patient, doctor and nurse interaction

What patient says has reason.

· Doctor has advised him RT for 1 month, so he feels there is nothing more to talk to the patient than enquiring any problems

· Nurse is largely functionally oriented and interact with patient only in such occasions

The mutual interaction among the treating team and patient is missing in this situation

Suchman’s Stages of illness Model

Application of Suchman's Model

Conclusion

Mr. AS has been suffering form Prostate cancer for the last 1 year. But his symptoms started about 4 years back. For about 3 years he tried folk remedies based on the advice of other people. He approached medical advice when his symptoms aggravated. He is currently undergoing radiotherapy for prostate cancer and medications for diabetes and other symptoms. This case study helps to understand the psychosocial aspects of illness development and application illness behaviour model in nursing practice.

Reference

Guptha MC, Mahajan B. Text book of Social Medicine, 3rd Edn. JayPee, ND,2003
Coe RM. Sociology of Medicine. McGraw-Hill Inc. New York, 1978.