Human behaviour is intrinsic to say the least and certain unintentional actions by a person can reveal the state of that person. Human behaviour is influenced by culture, attitudes, emotions, values, ethics, authority, rapport and so on. A person can become aggressive when he or she is faced with an unsettling situation, and their aggressiveness need not necessarily be in the form of physical or vocal outbursts. It can be in the form of non-cooperation, or by showing signs of anxiety and restlessness. Elizabeth Hutchinson (2011), in Dimensions of Human Behavior, looks at certain theories that can be applied to understand human behavior better. In studying the case related to the case manager’s intake to assist his client with her rent arrears, this paper applies some of Hutchinson’s theories such as her humanistic, and cognitive perspective, and Em Griffin’s effective communication perspective to recommend a possible leadership perspective of intervention to assist in the case.
A 68 year-old, White American female patient finds it difficult to make her ends meet and is forced to live off her Social Security Disability (SSD) of $1,828.00, which was paid to her for her treatment of ‘implanted cardiac rhythm,’ which meant that she had to pay for medication such as, digoxin, Coreg, Coumadin, and Edecrin. Apart from this, she went to Beth Israel Hospital at least twice a month for treatment, where she has a good relationship with the doctors, nurses, and other support staffs. In addition to this, the 68 year-old also has a daughter; 38 year-old Christine, staying with her, who also receives SSD for $1,346.00 because of her illness called, ‘Juvenile Diabetic,’ because of which, she too had to comply with medication of Mexiletine, Vevoxine, Atenolol, Losartan, Asthma Pump, Advair, Crestor, Aspirn, Tylenol, Zolpidem, Furosemide, and Dizapam. She too, like her mother, went to Beth Israel Hospital at least once a month for treatment. Both, mother and daughter said that they were otherwise alright, and didn’t have any other medical issues or any mental health diagnosis. She too, like her, had a good rapport with the doctors, nurses, and other support staff there.
The 68 year-old said that her daughter didn’t work and stayed home watching television in the morning and late evenings. She would, however, go out shopping with Velma, their home attendant, from Heart to Heart. Velma was a trusted home attendant and would work at least five days a week from 10.00 am to 3.00 pm. Velma cleans the house, cooks food for them, goes to the supermarket, and escorts the mother–daughter couple to the doctors’ appointments. Every time they visit the doctors’, they have to pay $20.00, and with the money they have, they find it difficult to maintain themselves. They have to buy medicines, pay the doctors fee and Velma for her services, pay rent, and pay for the food and clothing. The client has to pay a rent of $1,480.00, but is eligible to receive DRIE (Disability Rent Increase Exemption) for $657.00 towards her rent. Therefore, from a rent of $1,480.00, all that the client has to pay as rent is $823.00. Despite, this, the client has run into rent arrears and needs to find ways to protect her and her daughter from running into debts.
When the case manager invited the 68 year-old to discuss her issues, he gave the lady a lot of options to enhance their social living standards. It was a fact that the client and her daughter were unemployed and despite claiming to be educated and well-informed, they chose to live on the combined SSD they got for their illness. The case manager, it can be said, showed immense patience and hearing to understand the plight of the client. Under the circumstance, it can be said that the case manager exhibited exemplary humanistic behaviour in dealing with the client. The worker gave a patient hearing to all that the client said, and from time-to-time, gave suggestions and information that could help the old lady and her 38 year old daughter lead a better social life if they chose to. The worker asked the client whether her daughter, who was healthy and in a better physical condition than her, would be interested in volunteering at a center working with animals and/or VESID, to which she, answered in the negative. He asked her whether she was alive to the Helen Keller Program, to which she said that she and her daughter were well aware of the programs for blinds, but were not interested in them. When the worker considered numerous perspectives including environmental scanning to meet client needs and to provide her with different alternatives to change her, and her daughter’s life condition such as information on different programs that could help her and her daughter enhance their abysmal living standards, and social life, she either ignored, or refused to listen or participate in them altogether. The worker tries hard to find a solution to the problem, but whenever he comes up with an alternative, the client just negates them. None of his inputs on community and agency works seemed to instigate the client.
‘Humanistic perspective,’ according to Elizabeth Hutchinson, deals with understanding human values and acting in support of their needs. According to Hutchinson (2011), humanistic perspective deals with understanding and treating all people with dignity, knowing well that each person is unique in his or her own way. Having understood her predicament, the case manager considered a number of perspectives including environmental scanning to meet the client’s needs and provide her with different possibilities that could help her, and her daughter, change their social life. The case manager was quite open in his suggestions and recommendations, and gave the lady information on various other programs that she and her daughter could do in support of his client’s needs. The manager was also forthcoming in his communicating to his client the services that were available to them through communities and agencies.
He was attentive, supportive, and readily recognized the old lady’s predicament, to which he gave advice and encouragement. Each person is responsible for the choices he or she makes within the limits of freedom, and therefore, it was appropriate that the case manager sought to give advice and information in an effective manner rather than force something on the old lady. The worker believed that despite her negative response to some of his recommendations, she would in time; change herself to accept what was necessary for her and her daughter to survive. She couldn’t hope to live the rest of her and her daughter’s lives with the combined SSD they were getting for the treatment of their illness. Doctors’ fees, accumulating rent, salary to Velma, medicines, food and sundries were only going to add further pressure on them in the coming months and years, and without any supplementary income, they would both slide down the social ladder and end up in debts beyond recovery.
What makes this case so interesting is that the 68 year-old white woman and her 38 year-old daughter Christine lives in abysmal social condition. They both live on the money that is provided to them for treatment of their ailment. The worker, after a patient hearing, understood that the mother and daughter were not able to make their ends meet and required help. The mother’s attitude toward the worker belies her actual trauma. She seems to defend herself from uncertainties, and by stepping out of her comfort zone, she actually reveals her insecurity. However, she was not ready to accept any form of assistance, other than financial help, if available. She negated any and all possible solutions the case manager gave her and her daughter to enhance their living conditions. It is obvious that she, the client, at 68 years, would not be able to go out and earn a secondary income to overcome their financial misery, but her daughter, Christine, just 38 years, and relatively healthy, could use some of her spare time to earn extra money for the household. The worker was not able to influence or motivate the client to change her view on life. The client was unreceptive to change, and had accepted her and her daughter’s fate in seclusion. Human behaviour is intrinsic to say the least and certain unintentional actions by a person can reveal the state of that person. Human behaviour is influenced by culture, attitudes, emotions, values, ethics, authority, rapport and so on. A person can become aggressive when he or she is faced with an unsettling situation, and their aggressiveness need not necessarily be in the form of physical or vocal outbursts. It can be in the form of non-cooperation, or by showing signs of anxiety and restlessness. In dealing with this situation, it is clearly evident that a leadership intervention is must, and that, the case should be handled using humanistic, and cognitive perspectives, and through effective communication.
The Cognitive Perspective
In Hutchinson’s ‘Cognitive behavioural theory,’ Hutchinson suggests that behaviour is formed by imitating or observing others, in addition to personal beliefs and expectations. In other words, the ‘learner,’ “develops his or her behaviour by using the cognitive process.” Fritscher (2014) says “Cognitive theory is a learning theory of psychology that attempts to explain human behavior by understanding thought processes.” There is a feeling that humans are logical thinkers who can take decisions that they feel is right, and Libby et al (1987), says that the ability to recognize expertise depends on the type of task in hand. In this case, the worker knew that the problem with the client was her lack of motivation to live a better life. The daughter was at home at most times in front of the television. She could have been called and told about the problem they faced if they continued to live the way they did. The worker should have taken the initiative to approach the daughter rather than intervene with the 68 year-old who was not alive to the situation. The worker lacked the leadership drive or intervention needed at the time. The worker lacked the knowledge that motivation, an influencing factor to development, was missing. It’s no secret that employees stay in their job because of their managers. Fleming (2004), quoting from United States @Work Study 2000 states that a manager’s ability to create a ‘sense of pride and spirit’ in an organisation is the most effective way to recruit, retrain, and motivate a high-performance workforce. The worker needs to lead from the front and motivate the client to ‘wake up’ from the slumber of accepting her condition, and look at various possibilities through which they can enhance their social condition. The cognitive process here involves making the client understand the personal gains she and her daughter could get, if they followed the worker’s views. By citing people who are common to both parties in the case, the worker could quote or show people who, with similar physical and mental conditions, have succeeded and live a better life today. This is leadership intervention. As Glanz (2002, p.2) says, “An employee’s role in an organisation is largely determined by his or her relationship with his/her immediate supervisor.” Therefore, if the worker is effective as a manager or leader, the client will obviously listen and accept his or her role and recommendation.
Bandura (1986, p.28), in Hutchinson & Charlesworth (n.d) Theoretical Perspectives on Human Behavior, says “human behaviour is driven by a sense of personal competency and an expectation that a person can achieve a desired goal.” Having understood the predicament the old lady and her daughter were in, the worker should take the responsibility and don the role of a leader, and motivate the old lady to believe that she can achieve anything she desires with a little effort. Not having enough money, and forced to live a life of struggle, the old lady was never keen on exerting herself beyond her miserly means to lead a better life with her daughter, and this is where the leadership perspective of motivation can be applied.
Under Griffin’s Social Penetration theory, a close relationship develops gradually from “a superficial to an intimate level of exchange in anticipation of present and future outcomes” (Altman & Taylor, p.113-115). Lasting intimacy requires continual and mutual vulnerability through breadth and depth of self-disclosure (Socio-psychological tradition). Effective communication is the borderline to a good relationship between company managers and their employees, and the same can be said in the case of a worker-patient relationship. Carlisle (1976), defines organisational communication as, “the use of systems to convey information to large number of people within and outside an organisation,” and the same principle should apply in the case of the worker and the 68 year-old client. In reading the various theories of communication in Em Griffin’s (2011) A First Look at Communication Theory, it can be said that effective communication can assist in conflict resolution. One theory that is evident in this case is “humans act toward people, things, and events on the basis of the meanings they interpret them to be.” This is evident in the way the worker, after hearing the 68 year-old client, reacted after listening to her. The idea of communication is to share and understand information, and unlike the case where the worker listened and recommended solutions to her problems, the communication was ineffective. In an organization, leaders express themselves clearly and precisely so that employees understand what is required of them. Greenbaum, in Richard Barrett (2003, p.64), Vocational Business Training, Developing, and Motivating People, says organisational communication has four objectives; regulating employees to conform to organisational needs, promote changes to improve performance and production, develop an exclusive identity among the team and raise their morale, and finally, exchange information to enhance performance.”
Urban (2009) in his research says that service quality gaps existed in many companies because of the “gap between managers’ perception of customers’ expectation and service specifications existing in organizations.” When it comes to dealing with patients, it is necessary to be effective in communicating opinions and views. Every patient is different and their behaviour is also unpredictable. Case managers must consider the effectiveness of clear and concise communication, when dealing with patients. Just like how organizational managers communicate effectively to their employees on how they should carry their work, case managers must don the role of leaders and express themselves in such a way that patients understand them very well. If communication is weak, they will never be able to influence or motivate their patients to strive for success.
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