The biopsychosocial perspective is a comprehensive approach to health and illness that is crucial to improving the quality of life.
The purpose of this essay is to describe a practice experience from a biopsychosocial perspective of a patient admitted to a unit for respite care. The patient has a diagnosis of secondary progressive multiple sclerosis and the area being considered is the patient’s immobility. To begin, biopsychosocial will be defined and a brief description of the patient will be given before discussing how this central nervous system condition has affected the patient. The patient’s primary symptoms affecting their mobility will be described, along with a secondary symptom which the patient is vulnerable to developing. Subsequently, the associated tertiary symptoms affecting the patient psychological state and social systems will be discussed before summarising the knowledge gained and how this will alter skills in future practice experiences.
To respect and maintain patient confidentiality in line with the Nursing and Midwifery Councils (2008) code, a pseudonym will be used and will be referred to as Mary throughout this essay.
Mary is a forty-nine year old female who was diagnosed with Multiple Sclerosis twenty-one years ago. In 2006 her mobility deteriorated after a significant relapse and as a result of her symptoms she has been confined to bed since 2010. Additionally Mary has mild speech difficulties, is doubly incontinent and has a history of depression.
In 1977 George Engle developed the biopsychosocial model proposing that effects on a person’s health are a result of interactions between biological, psychological and social factors and not a single factor alone. Biological signs and symptoms are explored further by establishing the patient’s psychological state and social structure, for example their feelings, beliefs and relationships. This model assists in providing a full picture of a person’s health and illness by looking at the mind and body as linking systems, delivering a holistic approach providing ‘whole person’ care (Sarafino, 2006, p.13-16) and (Engle, 1977).
Although Mary had suffered with enduring paresthesia in her legs and feet for many years, during the relapse she had five years ago this sensory symptom intensified and extended to her back, arms and hands. Additionally she developed ataxia, a symptom affecting her balance and coordination and intention tremors which she described as uncontrollable shaking. Mary recalls holding onto hope for an improvement, however, this resulted with her no longer being able to walk or carry out the simplest of daily tasks (Burgess, 2002, p.83 and p.194). Mary reported that her symptoms continued to deteriorate, eventually confining her to bed.
Medical notes identified Mary as having quadriparesis, a medical term used when all four limbs are affected, resulting from muscle weakness (Genetics Home Reference, 2011). Furthermore, an examination identified that Mary’s symptoms had severely impacted on her musculoskeletal system. Mary presented with acute muscle spasticity in all of her limbs and contractures had fixed some joints into an unmovable position. Mary described a heavy feeling and said that her bones felt so tight they were going to snap. In an article published by Nauen (2010) similar feelings have been described by others.
Muscle spasticity is a symptom that occurs when lesions in the upper motor neurones interrupt the normal transmission of messages. This creates increased muscle tone causing the muscles to stiffen. Consequently the muscles can become abnormally stiff and resistant to movement, increasing the risk of contractures where a joint remains in a fixed position (Swann, 2008).
Barnes (2007) reports that ten to fifteen percent of MS patients will develop severe physical disabilities similar to Mary’s, although Walsh and Crumbie (2007, p.719) imply, the lower limbs are more likely to be affected. Bennett (2009) claims that the most common symptoms affecting mobility are simultaneous weakness and muscle spasticity. However, it is important to address that patients do not present with exactly the same symptoms.
Additionally, a secondary symptom compromising the integumentary system was identified. Due to Mary’s primary symptoms and reduced mobility, she is vulnerable to developing pressure sores and scored as a very high risk patient in a waterlow risk assessment tool. Constant pressure from remaining in a position for just a short while can break down the skin, especially over bony areas (National Institute for Health and Clinical Excellence, 2005). Therefore, prevention was a priority when caring for Mary, however due to the slightest movement being unbearably uncomfortable and painful, she was very reluctant to comply.
Simultaneously, in order to provide ‘whole person’ care as the biopsychosocial model suggests, it is essential to explore for any tertiary complications that may be impacting on her health and wellbeing. Therefore, it is equally important to establish how the profound physiological effects of Mary’s MS have impacted on her psychological state of mind and social structures.
Although Mary’s physical symptoms appeared to be the main focus of concern on admission, it was possible to gain an advanced insight into the tertiary complications due the nature of the placement and her length of stay. Mary’s symptoms and decreased mobility have been life changing and extremely challenging and it was evident that she was finding life in general very difficult.
Psychological implications were discovered when staff reported wide and extreme variations in Mary’s temperament. Sometimes she would speak to staff abruptly, refuse medication or cry uncontrollably, yet at other times she would appear happy and chat with staff. NHS Choices (2010) suggest that mood changes are a common sign presented in people who are suffering with anxiety and stress. However, the Multiple Sclerosis Society (2011) believes that only a small number display such extremities.
More specifically, there was a particular occasion when Mary spoke of her deterioration repeating how she held on to hope after her relapse. When exploring further, Mary revealed that sometimes she hoped to wake to a miracle, but at other times she felt so low that she wished never to wake up. She admitted to being frightened of not knowing what the future held and said she was worried that there was worse still to come. Furthermore, Mary reported that she got angry and embarrassed not being able to do anything for herself and felt guilty that she had become a burden on others.
Consequently, staff believed that Mary was suffering with recurring depression. Her general practitioner was asked to visit and this was confirmed. According to Duddy (2009), half of people diagnosed with MS will experience depression at some time during their life. Embarrassment, guilt and considerations of death are all commonly described thoughts and feelings. However, mental health problems still seem to be a taboo, suggesting that many people do not report signs of depression and consequently go untreated. Furthermore, it is recognised that depression is more commonly seen in those that have poor social systems. Clarke (2005) suggests that this is a main factor which impacts on health and wellbeing, especially in those experiencing physical and psychological difficulties.
Evidently, during a multi-disciplinary meeting, Mary’s husband (who I will refer to as Fred) indicated that social factors have had a major impact on Mary over time. He described how Mary was formerly an upstanding member in the community, with a very busy social life and lots of friends. However, he stated that many friends had stopped calling and visiting since Mary has become more physically disabled and that she often kept family members at a distance.
Finally, a significant factor that must be considered is the impact all of this has had on Mary’s family. Mary was admitted for respite care, as Fred and their two children had been struggling to cope. During the meeting, Fred explained that he had given up work over a year ago to become Mary’s full time carer and described how difficult and extremely challenging this had proved to be. He also reported that caring for Mary had compromised his own health and that he had started to resent her as she was never happy or thankful for anything he did. When asked if he received any support, he said that the children were very helpful and would often relieve him so that he could get a break. However, he never went far from home and was only gone for an hour or so as this left him feeling guilty. Additionally, Fred emotionally described how this had impacted on the children, suggesting that they had to grow up far too quickly and had missed out on far too much.
It is reported that one in seven households contain a carer, many of which experience difficulties as mentioned by Fred. Additionally, it is estimated that fifty-two percent of carers are risking their own health whilst caring for others (The Health and Social Care Information Centre, 2010). This suggests that many people caring for someone at home are putting their own health at risk and as a result cannot provide the adequate care and support needed.
To summarise, the biopsychosocial model defines that health and illness are a result of combined interactions between biological, psychological and social factors. This proposes that in order to provide ‘whole person’ care all of these factors must be considered. By using this perspective it has been possible to gain a greater insight into how Mary’s Immobility has significantly impacted on her psychological state of mind, causing depression which can affect or be affected by social complications. Additionally, it provided information on the impact all of these affects have had on her family.
From this experience, I have learnt to be more alert for signs of underlying difficulties and have gained the confidence to encourage patients to communicate more openly. In future practice, I feel that I have the confidence to identify and explore beyond the most obvious signs and symptoms that a patient presents with in order to provide a better quality of care.
(1631 Words)

References
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