PSYCHOSOCIAL ASPECTS OF

CHRONIC RENAL FAILURE

MEDICAL & PSYCHOSOCIAL EVALUATION
PRESENTED BY
NAOMI MASILAMANY
MEDICAL SOCIAL WORKER
HOSPITAL UMUM SARAWAK
 HEALTH DEFINED

• HEALTH IS A STATE OF COMPLETE

PHYSICAL, MENTAL AND SOCIAL WELL
BEING AND NOT MERELY THE ABSENCE
OF DISEASE OR INFIRMITY

(World Health Organisation)

 PSYCHOSOCIAL
• “A due consideration of social and
emotional factors is absolutely essential
if the hospital is not to become just
‘repair shop’ but a link in the chain
between a period of broken health and
one of health restored”

Banerjee ( 1950)
BIOPSYCHOSOCIAL APPROACH
STRESS
 PATIENT STRESS
Bolehkah
keluarga saya
menerima
keadaan saya? Siapa akan
menjaga
saya selepas
Takutnya
ini?

Bolehkah aku
bekerja
semula?
 WHAT IS STRESS

• Stress is the body’s reaction to harmful

situations..whether they are real or perceived. When
you feel threatened , a chemical reaction occurs in
your body that allows you to act in a way to prevent
injury.

• This reaction is known as “fight or flight” or the stress

response.
CHEMICAL REACTION WHEN STRESSED

• When a stress response is triggered the body releases a

group of stress hormones including cortisol,
epinephrine (or adrenalin) and dopamine, which lead
to a burst of energy as well as other changes in the
body.
• For example, cortisol can improve the body’s
functioning by increasing available energy, but can lead
to suppression of the immune system as well as a host
of other effects. Epinephrine can also mobilize energy,
but create negative psychological and physical
outcomes with prolonged exposure.
 BIOLOGICAL RESPONSE TO STRESS
• In response to acute stress, the body's sympathetic nervous system is
activated due to the sudden release of hormones. The sympathetic
nervous systems stimulate the adrenal glands triggering the release
of catecholamines, which include adrenaline. This results in an
increase in heart rate, blood pressure, and breathing rate. After the
threat is gone, it takes between 20 to 60 minutes for the body to
return to its pre-arousal levels.
• In the face of something frightening, your heart beat quickened, you
begin breathing faster, and your entire body become tense and
ready to take action. This response can happen in the face of an
imminent physical danger (such as encountering a growling dog
during your morning jog) or as a result of a more psychological threat
(such as preparing to give a big presentation at school or work).
 GOOD STRESS VS BAD STRESS
GOOD STRESS BAD STRESS

• SMALL DOSE • LONG TERM

• HELPS ACCOMPLISH A TASK • PREVENTS A TASK FROM BEING

e.g : prepares you for exams COMPLETED
e.g : feeling helpless, hopeless, defeated

• PREVENTS YOU FROM GETTING HURT • ILL HEALTH

e.g : slams on the breaks to avoid an e.g mental health problems, GI & Cardio
accident.
PSYCHOSOCIAL CONCEPT OF STRESS
 MANIFESTATIONS OF STRESS

•PHYSIOLOGICAL
•EMOTIONAL
•PHYSICAL
•COGNITIVE
•BEHAVIOURAL
•SPIRITUAL
PHYSIOLOGY
 EMOTIONAL

• MOODY • CAN’T RELAX

• FRUSTATED • LOW SELF
• AGITATED ESTEEM
• LOSS OF • WORTHLESS
CONTROL • BURDENED
• LOSS OF HOPE • LONELY
 PHYSICAL

• LOW ENERGY • CHEST PAIN

• HEADACHE • INSOMNIA
• STOMACH ACHE • NERVOUS
• GENERAL ACHES • DRY MOUTH
• CONSTIPATION
• CLENCHED JAW
• NAUSEA
• GRINDING TEETH
• DIARRHEA
• TENSE MUSCLES • SHORTNESS OF
BREATH
 COGNITIVE

• CONSTANT • ALL OR NOTHING

WORRYING ❖ If I can’t get better I
• RACING THOUGHTS might as well die.
• FORGETFULNESS • THINKING BASED ON
• INABILITY TO FOCUS EMOTION
• POOR JUDGEMENT ❖ How can there be any
good living like this
• PESSIMISTIC
• SELF BLAME
❖ Why was I so stupid.
 BEHAVIOURAL
• CHANGES IN APPETITE
❖ Eating too much
❖ Not Eating
• PROCRASTINATING
• SELF HARMING
• ALCOHOL AND DRUG ABUSE
• WITHDRAWN
• NERVOUS BEHAVIOURS
❖ Nail bitting, Pacing, Fidgeting
 SPIRITUAL

•LIFE HAS NO MEANING

•WHY
•ANGRY TOWARDS CREATOR
•LET DOWN
 COPING DEFINED

“constantly changing cognitive and

behavioral efforts to manage
specific external and/or internal
demands that are appraised as
taxing“

(Folkman & Lazarus)

 FUNCTION OF COPING
• PROBLEM SOLVING
❖ Enables the handling of difficult situations
• AVOIDANCE
❖ Develop ways to avoid the stressor
• FEELING BETTER
❖ Brings life into balance
• PREVENTION
❖ Increases confidence in dealing with challenges
 APPRAISAL - FOCUSED

• Involves change of mindset

• Denial
• Distancing oneself
• Altering Goals and Values
e.g by seeing humour in a situation
 PROBLEM - FOCUSED

• Taking control - dealing with the

cause / stressor
• Changing or eliminating the source
of stress
• Information seeking
• Evaluating the pros and cons
 EMOTION - FOCUSED
• Altering one’s emotions to tolerate or
eliminate the stress
• Distraction
❖ Keeping yourself busy and off the stressor
❖ Turning to rigorous activities like sports
• Meditation
• Relaxation Techniques
 COPING TECHNIQUES
POSITIVE - ADAPTIVE
• Anticipating – preparing
• Seeking Social support
• Derive meaning from
stressful situation
• Think positive
• Adequate nutrition,
exercise, sleep
• Relaxation techniques
• Social activites
• Humour
NEGATIVE -MALADAPTIVE
• Disassociation
• Sensitization
• Escape – self medicate
• Avoidance
• Denial
• Substance Abuse
• Self Blame
• Behavioural Disengagement
 ADAPTATING TO DIALYSIS
Life Changes
Fatigue
Challenges in Planning Meals
Challenges in Limiting Fluid
Time required for dialysis
Energy required for dialysis
Alterations to social activities
Alteration to role & responsibilities
(occupation & family)
Changes in body image
Physical Limitation
Contending with Life Threatening Disease
Diminishing Finances
STAGES OF ADAPTATION – (Kubler-Ross)
 LOSS OF CONTROL
HELPLESSNESS
The belief that one has no control over the events in one’s life
Reduces coping ability
Sustained helplessness will develop perceptions of …
POWERLESSNESS
Inability to change an outcome
Dependence on others
The environment in which health care is provided can influence
the recipients perception of personal control
HOPELESSNESS
Feeling of despair that causes a patient to give up
Depression
Suicidal Ideation
Physical and Mental status will deteriorate
 COMPLIANCE

In medicine, compliance describes the degree to

which a patient correctly follows medical advice.
Most commonly, it refers to medication or drug
compliance, but it can also apply to other
situations such a medical device use, self-care,
self-directed exercise or therapy sessions.
COMPLIANCE vs ADHERANCE

COMPLIANCE ADHERANCE

Latin word meaning Latin word

To complete an action,
transaction or process and
to fulfill a promise
To act in accordance with a
request, condition,
direction, consenting to act
in conformity with…
E.g Act of taking
medication as prescribed
Persistence in a practice
or tenet
Steady observance or
maintenance
E.g : Ensuring refill of
medication done as
schedule.
FACTORS INFLUENCING ADHERANCE
 PERBINCANGAN

PERTANYAAN?
PERANAN PEGAWAI KERJA SOSIAL PERUBATAN

• MENILAIKAN KEPERLUAN KLIEN SERTA PENJAGA

• MEMBERI MAKLUMAT

• MEMUDAHKAN PENYEDIAAN
PERKHIDMATAN SOKONGAN

• MEMBANTU MENGHADAPI MASA HADAPAN

• MENJALANKAN PEMANTAUAN SETELAH PULANG

 MENILAI KEPERLUAN KLIEN SERTA
PENJAGA
• Mendengar dari perspektif klien dan penjaga
keperluan mereka.

• Mengidentifikasi kekuatan dan kelemahan

klien

• Bagaimana menangani cabaran baru serta

perubahan peranan
 MEMBERI MAKLUMAT

• Bagaimana memperolehi bantuan peralatan.

• Bagaimana memperolehi bantuan penjagaan.
• Bagaimana memperolehi bantuan kewangan.
• Sumber sokongan untuk pengubahsuaian.
 MEMUDAHKAN PENYEDIAAN
KHIDMAT SOKONGAN
• Penghubung antara hospital dan komuniti.
• Memudahkan perbincangan antara ahli
keluarga serta pasukan multidisiplin.
• Mengidentifikasi khidmat sokongan dalam
komuniti.
• Menghubungkan klien dan penjaga dengan
khidmat sokongan dalam komuniti.
 MEMBANTU MENGHADAPI MASA
HADAPAN
• Meyediakan perancangan discaj bersama
pasukan Multidisiplin.

• Membantu menangani masalah psikologi dan

sosioekonomi yang dihadapi.

• Mendedahkan klien kepada cara berdikari.

 SUSULAN

• Sekiranya perlu klien boleh berjumpa

• Membantu memastikan kemudahan yang
diperlukan diperolehi.
 SECARA RINGKAS

• Melalui proses penilaian dan intervansi

psikososial yang dijalankan serta perancangan
discaj, PKSP membantu klien bergerak dari
situasi ketidaktentuan, kebimbangan dan
kebergantungan kepada peningkatan
keyakinan diri, mempunyai harapan dan
berdikari.
 IN A NUTSHELL

• Through assessment and interventions in the

areas of psycho-social functioning and
discharge planning, the MSW helps the client
and the family move from a situation of
uncertainty, anxiety and dependency to one
of increased confidence, hope and autonomy.
TERIMA KASIH