Unit 5 PDF
Unit 5 PDF
Unit 5 PDF
PSYCHOLOGICAL FACTORS
INVOLVED IN HEALTH CARE.
SERVICES
Contents
5.0 Objectives
5.1 Introduction
5.2 Socio-economic and Psychological Factors Involved i n
Health Care Services
5.3 Concept of Patient as a Person and Rights of the Patient
5.4 Role of Social Worker in Health Care System
5.5 Study, Diagnosis, Treatment, Discharge, Follow-up and Rehabilitation
5.6 Working with Open Community, Health Care Team,
Hospital Staff and Various Levels
5.7 Let Us Sum Up
5.8 Key Words
5.9 Suggested Readings
5.10 Answers to Check Your Progress
5.0 OBJECTIVES
The aim of this unit is to explain the various psychological, social and economic
factors in health and to examine the scope of social worker in community
and in the hospital.
5.1 INTRODUCTION
Health is multifactoral. The factors which influence health lies both within the
individual and externally in the society in which heishe lives. It is a truism
to say that what man is and to what disease he may fall victim depends on
a combination of two sets of factors-his genetic factor and the environment
factors to which he is exposed.
These factors interact and the result of these interactions may be health of
individuals and whole communities may be considered to be the result of
many interaction. Some of the important variables are indicated in the diagram
below:
The present unit attempts to explore these determinants and also the role of
social worker at various levels.
Health Information for
Social Workers 5.2 'SOCIAL,ECONOMICAL AND PSYCHOLOGICAL
FACTORS INVOLVED IN HEALTH CARE
SERVICES
According to WHO, "Health is state of complete physical, mental and social
well-being and not merely the absence of disease or infirmity. Providing conditions
for achieving normal health for all is the duty of the state and society. In
fact it is the deepest urge of humanity to be healthy. Health is one of the
essentials of life without which nothing can be achieved. The sick and hungry
child can't learn and the sick and hungry adult can't produce. Health is a
means of social development and vice versa. The success of any health care
delivery system to meet health needs of a society is depending upon the
extent of people's participation or utilization of services by the people. Various
factors social, economic and psychological have important significance in
Health Care Service. On the basis of some of the studies by sociologists,
anthropologists, social workers and medical scientists it has been advocated
that health and diseases are not merely biological phenomena. The socio-
cultural and economic environment, faith in supernatural powers and other
related belief style, nature of medical profession and services and their utilization
also affect the health and disease profile of a community. It indicates that
the consideration of such factors is indispensable to planning, organizing,
implementing and monitoring the medical and health care programmes in any
community for far reaching results.
Social Factors
There are several swial factors which determine the health and disease profile
in a community. The social factors are various like religion, caste, education,
occupation, family, life-style, income and living conditions. The health status
of a social group cannot really be maintained and safeguarded unless the
importance and interrelationship of these factors with health and disease is
understood. The study of religion and caste in a community is relevant to
ensure people's participation in comprehensive community health care programmes.
Various infections and respiratory diseases occur more in particular religious
and caste groups because of their life-styles. It is due to certain rituals and
religious observances which people practise out of belief and faith in their
cult. This factor renders particular religious groups unable to prevent illness.
For example, when small-pox was widespread, Hindus used to refuse for
small-pox vaccination due to the fear of Mata Maiya (Bari Mata) a goddess
- which was considered to cause this epidemic; Muslims for example are reluctant
to accept family planning for obvious religious reasons. Similarly there are
certain occupations which are still caste specific. The unhygienic conditions
related with these occupations are responsible for appended diseases more
prevalent in these castes. Education is supposed to generate understanding
which facilitates utilization of health and social welfare facilities and accomplishes
people's accessibility and participation in such programmes. Education again
prepares individual to make proper choices of therapeutic alternatives, appropriate
medical technologies, physicians and institution. The lifestyle components such
as proper path, proper rest, exercises, smoking, alcoholism etc. also affect
health accordingly.
Economic Factors
Economic conditions have long been known to influence human health. For
the majority of the world's people, health status is determined primarily by
their level of economic development, e.g. per capita GNP, education, nutrition, Social, Economic and
Psychological Factors
employment, housing, the political system of the country etc. The per capita Involved in Health Care
GNP is the most widely accepted measure of general economic performance. Services
The concept of "right to health" has generated so many questions viz., right
to medical care, right tojesponsibility for health, right to healthy environment,
right to food, the right not to procreate (family planning, sterilization, legal
abortion). Rights of the diseased persons (determinations of death at autopsies,
organ removal) and the right to die (suicide, hunger strike, discontinuation
of life support measures), etc. Many of these issues have been the subject
of debate.
Restoration of Impaired Capacities of the Patient
Negative behaviour of his family members' relatives and hardship is harmful
to patient, and compel the patient to feel inferior and gradually maladjusted.
Restoration of impaired capacity of the patient is required harmonious behaviour
and he may be provided all that is needed to restore his self-respect, to
provide equal opportunity, to participate in every activity in family, as well
as in society. The wardship must be effective to provide all the opportunities
belonging honorable placement in society. The financial establishment is also
an important factor to restore his previous personality. He should not feel
ignored by family.
Diagnosis and Therapeutic Activities
Medical social worker is skilled to study the patient's problem and then,
diagnose for recommending appropriate treatment. The primary function of
a medical social worker is to secure the maximum effectiveness of medical
care for the patient. The problems for which the patient needs the help of
a medical social worker include:
Economic problems like inability to pay for the medicines and prosthetic
aids, transport to attend the clinic or hospital or to return home after
discharge, temporary financial assistance to support the family when bread-
winner is ill etc.
Problems of shelter when the patient after discharge has no place to go
to or the relations do not accept him because of some handicap or the Social, ~ c o n o m i eand
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Psychological Factors
other, arrangements for his stay when hospitalization is not possible so Involved in Health Care
Services
that he can continue the treatment.
Problems of irregularity in treatment e.g. refusal to accept the suggested
treatment, inability to follow the instructions of doctors, and problems
in adjusting to the hospital.
Problems in rehabilitation, like difficulties in retaining the job or unemployment
due to illness or desertion by the family members;
Problems in social relationships due to illness, like strained relations with
parents or spouse or empioyers.
An act in the name of "Indian Mental Health Act" was passed by Parliament
of India in 1987 where it was suggested that a mentally ill person would be
called psychiatrically ill person here after.
Rights of Patient
Any Indian who is suffering from any disease, has following rights:
Patient has the right that he can take treatment from any government
hospital or primary health centre free of charge.
Patient has the right to take medicine from hospital (Govt.) free of charge.
Any patient who is admitted in hospital, has right to meet his relatives
time to time.
Patient has the right to have breakfast and lunch free of cost or on
subsidized rate.
There is a provision of concession in particular hospital fees for the
patients living below poverty line.
There must be an emergency treatment arrangement for the vitally and
seriously ill person.
Recreational facilities for patients must be provided in the hospital campus
that may be indoor and outdoor according to the needs of the patient.
The patiefit has right to live in a neat and clean atmosphere and he must
not be deprived of it.
There is a provision of health insurance scheme for the prevention of
health of the individuals.
The state government affords the cost of treatment for economically poor
patient.
i aged etc.
Create an awareness of root causes of illness in the community, mobilize
people, discuss and suggest ways and means of techniques and problems
and take action outside and within the community.
Develop training programmes for volunteen in community for implementation
of projects, develop direct leadership in the community for administration
or projects and coordinate the various programmes.
Encourage the use of medicine approved by the treatment team.
Create contacts with other community people facing similar type of problems
to enlist their support.
Provide consultation services through periodical meetings with the community.
Work through contacts with the individual and family and various groups,
with the available health resources in the community.
Administrative Task
Participating in decision making regarding discharge, placement and transfer
of patients.
Programme planning implementation and evaluation of activities related
to own unit.
As representative of social service department participation in planning
and administration of hospital's programmes including hospital's committees.
Maintaining diaries for adequate organisation and ongoing evaluation of
I workload maintaining register, correspondence, files and case records.
I Preparing monthly and annual reports of social work activities and pdcipating
in the preparation of annual report of the social work department.
Interpreting the role of institution to other agencies and the community
at large.
Utilizing various media like T.V., Radio, Newspaper, journals for public
relation with the larger community.
Fund raising for various activities of social work department.
Role in Teaching, Supervision, Staff Developnient and Research
Participation in teaching programme of social work student, medical
students, physiotherapy and occupational therapy, nursing and others.
Training and guide to:
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Social work students, for their field work.
NSS students.
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Health Information for Profession and volunteers.
Social Workers
Make the liaison between the hospitals and social work institution to
make the curriculum and field work more relevant to the need of the
people and make the hospital understand the relevance of the institution.
Participation in seminar, conferences, case presentation and other staff
development programmes inside and outside the hospitals conducting
social surveys and research with other social workers and team workers.
The fact-gathering process receives its impetus and direction from two sources-
the client's desire to tell about his difficulties and the worker's desire to
understand how they came about and what capacities exist for dealing with
them.
Diagnosis
"The attempt to arrive at an exact a definition as possible of the social
situation and personality of given patient."
Medical social worker helps the patient and help his patient feel independent
and also show his capability and power.
Medical social worker also helps his patient to be self dependent and adjust
with his environment and social relationship.
Discharge
When any patient feels better and does not need hospital care and also wants
to get discharged, medical social worker can suggest the doctor accordingly.
Follow-up
Medical social worker does not end with the discharge of his patient. He
should do appropriate follow-up. This is specially needed in diseases like
tuberculosis where there is a danger of relapse. The social worker should
observe his patient whether the patient is adhering to the instructions given
to him by the medical team. He should also see whether the patient is able
to adjust to the new situation or not. The attitudes of the family members
and colleagues also can be observed and changes suggested if need be.
Rehabilitation
Rehabilitation has been defined as "the combined and coordinated use of
medical, social, educational and vocational measures for training and retraining
the individual to the highest possible level of functional ability." It includes
all measures aimed at reducing the impact of disabling and handicap to achieve
social integration.
The patient must be restored and retrained not only "to live and work with
in the limits of his disability but to the hilt of his capacity." As such medical
rehabilitation should start very early in the process of medical treatment.
Thus every step is very important to remove patient problem and also very
helpful to patients. Without these steps patient does not feel better and with
these steps patient achieves his goal.
On the individual level, they provide their services through social casework
method while on group level, they provide services through social group
work in which emphasis is laid on interaction among members and participation
in group activities or therapies but individual casework is also done alongside.
a) extend health services to the places where the people live and work,
b) support communities in idenwing their own health needs; and help people
to solve their own health problems.
Several community health workers may work as a team in the same village
with their Supervisor. Their duties will cover both health care and community
development, but what they do is restricted to what they have learned in
training. Certain health tasks may be tackled best by a male CHW and others
by a female CHW, depending on the wishes of the community, its customs
and its resources.
A medical social worker, while working with the health care team has to
maintain his own position and show hisher true worth. They interpret their
work to the other members of the team like the doctor, psychiatrist, psychologist
etc. He interprets to them the psychosocial needs of the patient. Also, he
contacts the family and acquaintances of the patient and finds out the economic
and social background of the patient and discuss with other members of the
team. He also participates in diagnosis and planning for treatment, rehabilitation
and intervening programmes. He consults to and from other members of the
team and work with them to extend better and best possible care to the
patient. Worker also individually contacts the patient and makes home visits
till they are completely healthy in all sense: physical, mental as well as social.
Medical Social Worker has certain roles to play with the hospital staff and
responsibilities towards the public. They participate in decision making regarding
discharge, placement or transfer of patient. They plan out the programmes,
implement them and also evaluate the activities related to their own units or
Health Information for department. Besides, they participate in planning and administration of hospital
Social Workers
as a representative of hospital social service department. They maintain diaries
for adequate organisation and evaluation of areas workload maintaining registers,
correspondence, file or case records. They have to prepare monthly and
annual reports of social work activities and participate in the annual report
of the social work department. They utilize the various media like TV, radio,
newspapers, journals for public relation with the larger community.
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The social workers do not work in isolation in medical field. They are a part
of the health system and should be regularly supervised. He should know
when and how to seek guidance and to refer patients who are seriously ill
to a doctor for treatment. In spite of the fact, that in present scenario, the
role of medical social worker is very beneficial for the team, community and
the society at large. Their appropriate recopition and true worth is still
awaited in our country. At present the government is running many community
development programs whose success depends largely on the efficiency and
skill of social workers. But even then social work is still not as developed
in our country as its scope actually is and according to the needs of the society.
Roles of Social Worker
A medical social worker can use technical knowledge in preventing the various
diseases. He can play following roles in the medical setting-
1) As an enabler.
2) As a guide.
3) As a counsellor.
4) As a mediator.
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5) As an advocate. i
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A medical social worker uses various methods like-social casework, social I
group work, community organization and Social Action in promotion of Health.
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2) What are the objectives of community health worker?
Social, Economic and
3) What is the role of social worker in a hospital setting? Psychological Factors
Involved in Health Care
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We identified the various task of the medical social worker that are rendering
direct services to the client, working with the team, the administrative task
in the hospital, promotion of community health and teaching, supervision of
the various students in the hospital.