Nursing as a profession has since time immemorial strived to deliver a high quality holistic care to clients and patients. The holistic care targets physical, spiritual, psychological, and social well-being of a patient, and is often tailored to suit individual context (Rice, 2007). Context is hereby construed to mean patient’s diagnosis, its chronicity, and stage of recovery amongst others.
According to Goldsmith (2008), social support refers to the material, emotional, and informational assistance that a patient obtains from his social networks. Social network may include the family, neighbors, friends, co-workers, and formal agencies. Whatever the source, the purpose is to speed up the process of recovery from a disease and/or improve the quality of life in case of terminal illnesses (Radomski & Trombly, 2007).
Conspicuously, patient’s perception of the quality of social support is underlines the concept of social support (Dorman & White, 2010). Moreover, all components of social support need be incorporated as per the patient’s needs for an optimum outcome to be achieved. More often than not, it is primarily a nurses’ role to mobilize social support. Mobilization specifically refers to the process of identifying, contacting, and securing sustained support (Leininger, 2007).
Unequivocally, the patient must be involved in the process of social support mobilization to the greatest extent possible because patient’s perception on quality of social support is the strongest determinant of effectiveness rather than availability. Paradoxically, Rice (2007) contends that ineffective mobilization of social support networks may equally add to patient’s predicaments (psychological distress) in a situation where the patient no longer feels safe with the identified sources: a dysfunctional family is but an example.
Radomski & Trombly (2007) conceptualize comprehensive social support as one that incorporates an emotional, informational, instrumental, and companionship aspect. To begin with, informational social support involves provision of guidance, suggestions, and advice relevant in the care of a patient. Although nurses are majorly seen as agents of mobilizing social support for patients, informational support is one aspect in which nurses directly offer social support: Health education, guidance, and counseling are authentic examples in this case.
Emotional support refers to encouragement, love, trust, affection, and general concern extended to a patient with an aim of raising his self-esteem by creating a perception of being valued and loved despite the medical condition (Radomski & Trombly, 2007). In the annals of nursing, this is one of the indomitable tools of fighting stigma, which has for long plagued humanity especially with respect to HIV and AIDs.
The third category of social support is tangible or instrumental support. This form of support involves provision of material and financial assistance required in patient’s care (Goldsmith, 2008). It could vary from clearing hospital bills to purchasing essential supplies like gloves, catheters, and drugs especially with respect to home based care. Even though the nurse must not necessarily offer this kind of support, nurses play a vital role in justifying that a patient requires such support by providing information to social support agents, or merely linking the two.
The fourth variety of social support is companionship that entails involvement in social activities to cultivate a sense of social belonging (Radomski & Trombly, 2007). These authors contend that this aspect is vital in disease conditions associated with a high stigma rate such as tuberculosis, HIV/AIDS, and mental illness. However, XXX () posits that people’s knowledge regarding these diseases is often a common challenge to the desired integration.
Rice (2007) posits that much emphasis has hitherto been put on instrumental and informational components of social support. Indeed, marked development has been realized in informational social support where patients no longer require meeting face-to-face with each other or with nurses for this kind of support: Virtue informational social support is increasingly proving to be an equally effective, yet affordable mode of delivery (Dorman & White, 2010). This is realized via social media like twitter, skipe, and electronic-mail-chat that has since grown immensely.
The significance of social support per se is diverse and must be realized for patient’s care to be said to be comprehensive. Each of the four components of social support has its own advantages to not only the patient and family but also the community, healthcare system and the nation. To begin with, experts agree that effective social support targets and indeed achieves psychological and physical well-being (Rice, 2007). In fact, these are the priority aspects of health to many patients in evaluating the outcome of all health-related interventions.
Quality psychological support especially to patients suffering from chronic, life threatening, or terminal conditions reduces the risk for psychological distress manifesting with anxiety states, depression, or even psychiatric disorders like schizophrenia. Moreover, incidences of suicidal attempts and drug abuse are common in patients receiving low or no social support. Noteworthy, psychological support is an important aspect of emotional social support that can also be offered by family members (Radomski & Trombly, 2007).
In fact, deficient emotional support is directly related to the severity of some disease conditions like hypertension and cardiac arrests: anxiety states increases the sympathetic output, which in turn raises blood pressure or increases the workload of the heart. The morbidity rates of some of the diseases as exemplified by stroke in hypertension is high and are best prevented through psychological support. Besides, incidences of disease related depression especially with cancer and HIV/AIDS patients poses an additional challenge in their management (Rice, 2007).
Because the quality of life of the patients’ immediate family is likely to be compromised, emotional support extended to spouse and children help, promote their psychological well-being and prevent anticipated problems (Goldsmith, 2008). Substance abuse amongst adolescents whose parent suffers a chronic illness has been noted. Besides, the family functioning may be compromised in terms of output; poor academic performance is but an example. Generally, it suffices to say that emotional support helps improve disease prognosis and prevents incidence of co-morbidity especially with respect to psychiatric conditions. It also preserves the psychological well-being of the family members (Rice, 2007).
On the other hand, the benefits of instrumental social support are magnificent especially in chronic disease conditions like inoperable malignant cancers. Radomski & Trombly (2007) contends that astronomical health care costs for diseases like cancers often drain family resources thus exposing them to poverty. The scenario is even gross in developing countries where technological advancement is yet to be realized making procedures like chemotherapy, radiotherapy, and surgery unaffordable to majority patients.
Although the nurse may not directly contribute money towards the patient’s upkeep especially after discharge home, nurses often advice patients on existing social support organizations that give financial and or material aid. Moreover, the nurse often helps justify how needy a patient is. In the home based care scenarios for palliative care in terminal illness, the family is likely to be resource constrained by virtue of chronicity of the disease, yet various resources would still be required.
Taking advanced stage AIDS patient as an example, drugs, food supplements, catheters, and gloves are essential in care delivery. Lack of gloves for instance exposes the family member offering care to the virus. Other family responsibilities such as education and housing are likely to be compromised too. This justifies the role of the nurse in helping the patient identify all potential resources within and beyond the family: This includes linking the patient with relevant support organizations offering financial or service assistance. Consequently, the direct implication of inadequate instrumental social support ranges from delayed recovery because of lack of essential supplies like drugs to poverty affecting the entire family (Leininger, 2007).
The other important aspect is informational social support. Informational support may involve patients’ groups or a health care provider. Patient groups often involve peer counseling where newly diagnosed patients discuss their disease condition with former patients. In such a discussion, the patient receives moral support essential in enhancing coping to management however displeasing it is. An example in this case is chemotherapy and radiotherapy in cancer (Dorman & White, 2010).
Drug adherence remains a challenge in most bacterial disease conditions because of resistance. Indeed, this is the case with tuberculosis, which not only requires prolonged therapy but also involves several adverse effects. Consequently, the role of the nurse goes beyond sensitizing the patient on possibility of resistance and its health and economic implications to helping the patient identify a reliable person for support. This social support agent could be a family member, co-worker, or friend and his role is to oversee that the five rights of drug administration are observed. It is no less true that this agent requires to be well versed with all the antimicrobial agents used and this is principally the role of the nurse (Dorman & White, 2010).
Diabetes mellitus, a chronic metabolic disorder is another example of a clinical scenario in which the nurse remains an informational social support agent. Failure by nurses to offer relevant support carries various socioeconomic and health implications on the patient, family, and the health care system. Multidrug resistant tuberculosis is but an example of a global health implication; increased morbidity and mortality are the other implications.
Stigmatization continues to plague humanity despite several counteractive measures. Rice (2007) contends that health education measures targeting stigmatization reduction should be reflected in the level of available companionship of a patient, the diagnosis notwithstanding. The most affected here are the HIV/AIDs patients especially in the developing countries. Radomski and Trombly (2007) posit that failure to provide companionship washes down any other support offered by pushing the patient into psychological distress. Stigma explains the low HIV programs coverage rate the world over, the resultant HIV pandemic and associated morbidity and mortality.
In conclusion, social support is an integral aspect in holistic care that cannot be ignored whatsoever. For it to be comprehensive, the informational, emotional, companionship, and instrumental aspects must be incorporated and tailored towards the patient’s condition. The importance of social support includes prevention of poverty, maintaining psychological stability, prevention of stigma, and faster recovery. In general, social support leads to improved quality of life of the patient and reduces both morbidity and mortality. In fact, social support is a major pillar even in terminal illnesses and palliative care. The nursing implications of inadequate social support includes slow recovery, prolonged hospitalizations, more global disease burden, high poverty indices, increased morbidity and high mortality rate all of which negate the health care system.
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