Behavioral and psychosocial responses

Behavioral and psychosocial responses
Behavioral and psychosocial responses

Behavioral and psychosocial responses

Order Instructions:

In the discussion part explain the behavioral and psychological responses identified in the patient/family to their illness in relation to the literature presented in your introduction and literature review section. Use evidence to support the key issues you’ve identified in your literature review. To do this effectively, you’ll need to critically analyse and evaluate your Literature.

  • Also, consider external (e.g., social and physical environmental) factors – NOT just the internal causes such as the illness, biology,or personality etc
  • In this section, also discuss how the nursing/paramedic care management issues contributed to the patient/family’s behavioural and psychological responses and how they affect the patient’s outcome. Link it with case study.


Behavioral and psychosocial responses

As mentioned by Abdel-Kader, Unruh, & Weisbord, 2009, patients diagnosed with chronic kidney disease (CKD) have difficulty in falling asleep. One of the main causes of disturbed sleeping pattern is restless leg syndrome (RLS).  RLS occurs when the patient legs are at rest, and is associated with itchy, painful and irritating feeling. This experience is exacerbated by alcohol, tobacco and caffeine. In addition, it has been hypothesized that inadequate dialysis clearance can lead to poor sleeping pattern. This is because build up of waste in blood causes the patient to feel uncomfortable and ill due to toxins build up in the patient’s body. Emotional health such as anxiety, sadness and worry can keep the patient up at night, thereby altering her sleeping pattern (Iliescu, Yeates, & Holland, 2004).

Depression and anxiety is also another common psychosocial response in patients diagnosed with CKD. According to Boer and colleagues 2007, depression is associated with multiple outcomes such as rates of hospitalizations, poor treatment compliance and impaired health related quality of life. In this Mr Jacobs case, the most likely cause of depression is that he has a lot of information to process about his health, leading to strong emotions about changes in his life that could bring up despair. For instance, some restrictions such as fluid intake, control of diet and discomforts associated with insertion of arteriovenous fistula, central venous catheters and the sound of the dialysis machines are other sources of depression in patients diagnosed with CKD. These complex daily functioning and fear of future influence patient’s level of anxiety. This is because they cause unfavorable self image causing negative emotions such as anger, disappointment, dissatisfaction and despondency.

Jenifer and Veronica 2013, report that socio economic status also affects the psychological and behavioral responses to CKD. The study indicates that patient’s income, occupation, wealth and education influences their responses, with people from low economic and education background experiencing the most negative responses.  Smoking and alcohol use also increases risk for CKD progression through oxidative stress, tubular atrophy, endothelial dysfunction; which in turn increases risks for depression. When these environmental factors exceed the adaptive capacity of the patient’s psychological and physiological responses, they develop   a condition known as stress. This is associated with tissue damage and progression of the diseases

Nursing care management and its influence on patient’s outcomes

According to Siedel and colleagues 2014, classical social relationships affect the patient’s well being. Evidence based research indicates that patients that have sparse social support have high risk of dying. The exact mechanism of dense social support as a protective mechanism in patients diagnosed with CKD is unknown, but it is hypothesized that such support protects the patients against the environmental threats to their health. Mr. Jacob condition is deteriorating because he is not receiving the adequate social support. He has the difficult of going to social functions and the feelings are overwhelming. Janice feels overwhelmed with taking care of taking care of Mr. Jacobs because she performs all her household chores and Mr. Jacobs is uncooperative.

Włoszczak-Szubzda ,Jarosz, & Goniewicz, 2013 argue that elementary duty of nurses is to give assistance and  CARE-  which is an acronym referring to “Comfort, Acceptance, Responsiveness and Empathy.”  The psychological comfort of the patient is determined by the nurse’s skills in undertaking sensitive health issues. Poor nursing care plans results into greater patient’s discomfort and risk of getting depressed. The concept of acceptance refers to respecting of patient’s feelings as well as their attitudes. For instance, the nurse accepted Mr. Jacobs’s decision of refusing to take sedatives. To ensure positive behavioral and physiological responses, the nurse must be cultural competent.

Responsiveness refers to Nurse’s perceptions on the patient’s verbal and non-verbal communication, listening and observing the patient, paying attention to the patient’s gestures, hesitation, and the body sign language. For instance, the nurse in the dayshift observed that the patient was irritable and anxious. However, no interventions are made to manage the patient anxiety, which is probably the reason why Mr. Jacobs could not sleep. The last aspect is empathy, which is basically the nurse’s capability to experience the psychological states of the patient, and the skills of understanding their thinking and disease perception. This aspect is important especially when designing patient education on effective coping strategies (Włoszczak-Szubzda ,Jarosz, & Goniewicz, 2013).


Abdel-Kader, K., Unruh, M.L., &Weisbord, S. D. (2009).Symptom burden, depression, and quality of life in chronic and end-stage kidney disease. Clin J Am Soc Nephrol. 4(6):1057-64. doi: 10.2215/CJN.00430109. Epub 2009 May 7.

Boer, K. R., Mahler, C. W., Unlu, C., Lamme, B., Vroom, M. B., Sprangers, M. A., … Boermeester, M. A. (2007). Long-term prevalence of post-traumatic stress disorder symptoms in patients after secondary peritonitis. Critical Care, 11(1), R30. Retrieved from

Iliescu, E. A., Yeates, K.E., & Holland, D.C. (2004). Quality of sleep in patients with chronic kidney disease. Nephrol Dial Transplant. 2004 Jan;19(1):95-9.

Jennifer F., and Veronica J. T,  (2013).“The Psychosocial Experience of Patients with End-Stage Renal Disease and Its Impact on Quality of Life: Findings from a Needs Assessment to Shape a Service,” ISRN Nephrology, vol. 2013, Article ID 308986, 8 pages, 2013. doi:10.5402/2013/308986

Seidel UK, Gronewold J, Volsek M, Todica O, Kribben A, et al. (2014) Physical, Cognitive and Emotional Factors Contributing to Quality of Life, Functional Health and Participation in Community Dwelling in Chronic Kidney Disease. PLOS ONE 9(3): e91176.

Szubzda A, Jarosz MJ, Goniewicz M. (2013). Professional communication competences of paramedics – practical and educational perspectives. Ann Agric Environ Med. 20(2): 366–372.

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