Psychosocial Aspects
Ego identity is distorted by immobility. The integrated personality a person develops through socialization and the meanings he assigns to situations are threatened when he is confronted by restriction of free movement.
Learning and motivation are affected, and problem solving becomes less direct when a person is isolated or immobile. Drives, expectations, and emotional responses are altered: the first two are diminished, and the latter are expressed in behaviors not typical of the person`s usual pattern. Withdrawal, apathy, aggressiveness, or regression may occur where no such behavior previously existed. Lack of self-determination in activities changes behavior.
The immobilized person views the environment, including people, from a different physical position; the feedback upon which he relies to tell him who and what he is may seem unfamiliar. He may incorporate the apparatus of hospitalization into his body image. Thus traction equipment, casts, intravenous or any other tubing attached to or inserted within him may alter self-perception.
Changes in the way sensory stimuli are perceived occur because the sensory processes are slowed during prolonged bedrest or isolation. Form and substance, weight, pressure, and temperature may be perceived differently. Time is now ordered by others` activities. Direction often means one place-where he is. There is no east, west, north, or south.
The social institutions of the family, education, religion, work and recreation ordinarily define a person`s roles. During immobility, roles are reserved, changed, or eliminated according to the restrictions imposed. In American culture, youth, vigor, upward mobility, and energy expenditure are stressed as desirable attributes. During prolonged disability, the loss of os diminished capacity for these highly valued goals is interpreted by the patient, and sometimes by those with whom he associates, as a loss of personal worth. It is no wonder that under such circumstances a person develops behavior patterns misunderstood by and unaceptable to others.
Nursing intervention for psychosocial adaptation should concentrate on helping the patient move from dependency to independence, providing him with sensory stimuli, helping him adjust to a temporary or permanent body image threat, orienting him to time and place, and supporting him during necessary role change.
Through your astute assessment, you can make a systematic and complete care plan that can be used by the entire staff. A clock and a calendar are necessary to a patient`s orientation to reality, for even the short-term patient often misjudges the passage of time. Describing the location of this room in relation to the points of the compass and in relation to other parts of the unit can be extremely helpful. You might move the patient`s bed to a courtyard or lounge when long-term disability precludes his being moved on a cart or using a wheelchair. In this way, the patient`s environment is extended, and he experiences increased sensory input.
Patient teaching is essential for psychosocial as well as physical adaptation to immobility. Explain procedures and equipment to the patient and teach him ways of participating in his care and of making use of increased leisure time. Work with the family or friends to help stabilize the patient`s societal roles. Encourage those he loves and relies on to treat him with the same respect as in the past. As soon as possible he should be allowed to participate in the same decisions and role expectation that his family assigned to him before his illness.
Immobilization disability is one of today`s major health hazards. Mobility supports autoregulatory processes. Through patient teaching and intervention based on scientific rationale, you can help each patient and family experiencing some immobility to adapts as fully as possible.
References :
Olson, Edith V., “The Hazards of Immobility”, American Journal of Nursing, 67: No.4, 1971.
Murray, RB and Zentner JP., Nursing Concepts for Health Promotion, Second Edtion, Prentice-Hall, Inc, Englewood Cliffs, N.J, 1979.
