I had a patient in Karwany-e-Hayat, who is 57 old ages old male with diagnosing of Drug-induced psychosis. Admitted with aggression, irrelevant talk, paranoid psychotic beliefs and insight absent. He is populating entirely, divorced 30 old ages back, one girl who got married 2 old ages back. He was addicted of Cannabis ( chars ) from the age of 20 and continues it till his mid-fortiess and so left it and started taking nicotine coffin nails 3-4 per twenty-four hours. Patient stated that “ I want my portion in belongings but now I do non hold control on state of affairs. I do non hold any support who can assist me or can contend for me because of deficiency of strength to get by. Physically I besides feel powerless as I am acquiring older and unable to contend for my rights. I feel lack of control due to which I could non be able to acquire my portion from step-brothers and their married womans ever behave negatively with me. They consider me as a substance maltreater and mentally ill which is really I am non ” . Patient farther stated that “ I am believing to travel in tribunal but I feel that they have power in society which I do non hold that ‘s why I ca n’t acquire my portion by any agencies ” .
Anne Lee ( 2006 ) defines drug-induced psychosis as “ Psychotic symptoms that arise during drug intoxicationaˆ¦ The reaction mayaˆ¦ re-exposure to the drugs occurs ” ( p.353 ) . Harmonizing to WHO describe “ It is estimated that about 04 million people in Pakistanaˆ¦ mistreating different substancesaˆ¦ is heroin ) ” ( para.4 ) . This information predicts, ongoing crisis on mental wellness of the people.
I took the construct of impotence on the footing of my patient scenario. It is of import to first understand the construct of power. Larsen and Lubkin ( 2009 ) describe power as “ A personal resource inherent in all persons, and is the ability to act upon what happens to one ‘s ego ” ( p.256 ) . Erikson ‘s 2nd phase of psychosocial development, autonomy versus shame can associate with the feelings of impotence as it involves the battle for personal control and separation from others. Missing in this phase, might take to feelings of impotence in ulterior life besides.
Power reflects individual ‘s ability to accomplish and fight for coveted result. Powerlessness, as defined by Wilkinson ( 2005 ) is “ the perceptual experience that one ‘s ain action will non significantly affect an result ; a perceivedaˆ¦ “ ( p. 386 ) . Every single experiences impotence in their life in some point in clip. Although people with physical unwellness experience impotence in their day-to-day life activity but, mentally sick client experience more than others because of stigma associated with mental unwellness and non accepted by society and perturbations in their ideas procedure make this feeling worse. As my patient has no control over his ain state of affairs instead control by people around him.
Concept of hopelessness and impotence consider similar but both are different. Carpenito-Moyet ( 2004 ) clarifies theses two constructs as “ A hopelessness individual sees no solutionaˆ¦ . A powerless individual mayaˆ¦ because of sensed deficiency of control and resources ” ( p.207 ) . Persistent impotence can take to hopelessness, which is more hazard taking behaviour in which individual do non see any options and see self as worthless and this might take to self injury.
Powerlessness can be associated with physical, psychological or/and societal deficiency of control. Feeling of powerless due to any ground, strongly link with the hapless wellness result since it develop weariness, heartache and hopelessness. Peoples feel powerless due to their chronic physical unwellnesss ; some feels due to miss of psychosocial control and threatened to their liberty. There are factors or resources which lead to power and lacking in any of these lead to powerlessness. Resources which retain single power discussed by Larsen and Lubkin ( 2009 ) that “ Individual power resources include physical strength and physical modesty, psychological staying power and societal support, positive self-denial, energy, cognition, motive, and hope ” ( p.258 ) . If these power resources affected, single experience feelings of impotence. As my patient ‘s physical endurance decreased, no household support nowadays and less motivated and positive to cover with state of affairs around him. Failures of these internal and external resources make him experience more powerless.
Feeling of deficiency of control over state of affairs is so much personal to single and people are consider low when they feel powerless that ‘s why they hide their existent feeling because of fright of label as ‘powerless ‘ . Powerlessness can be measuring through subjective and nonsubjective findings. To measure patient ‘s feeling of powerless and lending factors, nurse should clearly measure client ‘s strength, resources and take clip to listen and detect patient ‘s nonsubjective and subjective feelings which lead to powerlessness. To place strengths of a client White and Roberts in ( 1993 ) given Personal Control Model that links personal control with impotence. This theoretical account is comprehensive and covers all facets of impotence. It gives four types of loss of control, associated with impotence. One is physiological loss of control which is associated with biological alterations, second is cognitive loss of control which describe the inability to right construe the effects of a chronic unwellness and is categorized as sensory and appraisal loss of control, third is environmental loss of control when persons are unable to command where they are and what they are sing and 4th is decisional loss of control, is when individual unable to do determinations for themselves or for their attention. After critically measuring patient ‘s feelings, I come to cognize that he has loss of biological, environmental and decisional control because he has no control and power over state of affairs and people around him and was n’t able to take any determination for himself and his brothers are enforcing their power on him and he ca n’t even reason. My patient besides feels physically powerless whereas, cognitive ability was integral as buttocks through mental position scrutiny. From this, I analyze that it was besides discernible that people who ca n’t entree their power and unable to demo it, develop feeling of defeat and showed their aggression. Vogel-Scibilia, et Al. ( 2009 ) speaking about Erikson ‘s phase 2 as “ Anger externalized or internalized is a outstanding characteristic of this phase and may take to the individual coming into struggle with others or prosecuting in self-damaging behaviour ” ( p.408 ) . My patient was besides become aggressive when he felt powerless. By analysing and integrated scenario and construct of impotence with the theoretical account and Erikson ‘s theory, I come to cognize that impotence can poorly affect person ‘s overall wellness.
Braga & A ; Cruz ( 2009 ) develop powerlessness appraisal tool and stated that “ The Powerlessnessaˆ¦ to assessaˆ¦ for the choice and rating of intercessions ” ( p.1062 ) . Although it was used in western civilization but, we can besides utilize it in our context with some alterations. As, this tool will assist intensify understanding, identifying and measuring intercessions of impotence. Unfortunately, I was unable to implement this tool on my patient because he was discharged.
On the footing of assessment findings of impotence in my patient, be aftering stage semen in which my ends are to research patient ‘s feelings of impotence, so motivates him towards developing liberty to take determination and sense of control over state of affairs and environment.
Schemes for impotence divided into single, group and institutional degree. Basic purpose of all degree of intercessions is to do patient empower adequate to cover with the ain state of affairs and state of affairs around him efficaciously. Increase in power makes single powerful plenty to populate in environment with more abundant resources and wagess, able to achieve their ends and feel unrestrained by others.
Client and household degree intercession plays important function in recovering power. Diversional activity like music can be used as curative mode for recreation. This aid patient clearly place their feelings and surrogate treatment of feelings. I involved patient in musical drama activity with other patients, through this I besides utilized group degree scheme. Empowering can be done through concentrating on other supports and resources instead than on feeling overwhelmed by shortages. In my patient he has no household support but still I try my best to research other internal and external resources which can assist him to be independent and enhance authorization. In 2nd hebdomad, I explore that he can make occupation if he gets and his uncle who has concern and might assist him for occupation to gain for himself. Through this, I was able to develop my patient ‘s strength to acquire back to his usual life in society. Though he antecedently confesses deficiency of physical power but now motivated towards independent. Other intercessions are listening to persons ; inquiring them to depict their experience, exposing sort and helpful attitude and being accessible, esteeming and furthering individualised determination devising. Sense of command is of import to get the better of client ‘s impotence by developing sense of control over baleful state of affairs, happening new beginnings of satisfaction and job work outing steps to forestall similar nerve-racking event. It is besides of import for single to analyse ain response at the clip of intense feeling of impotence and researching ain positive strength instead merely concentrating on things which ca n’t be handle.
Taw ( 2006 ) stated that “ For many people, the reciprocally supported and coordinated exercising of power may hold greater possible impact than stray and competitory cases of power to ” ( p.38 ) . Interventions for both institutional and group degree can be done by utilizing self-government theory. This theory is base on three basic psychological demands ; these are competency, relatedness and liberty. The demand for competency aid person to accommodate new challenges. It stimulates adaptative and flexible operation in the context of altering demands. Relatedness is the integrating of the person with the societal universe to develop sense of belonging. For this I involved my patient in all group activities to actuate towards power. Family should affect, as environment outside infirmary besides affair but in my patient I was unable to implemented household degree intercessions because cipher involved in his attention, nor come to run into him. Autonomy better helps to modulate ain actions harmonizing to their demands and capacities. Autonomous people will non develop impotence, which can be achieved through supporting and admiting enterprise, supplying picks for intervention and minimising control environment around patient. I had worked on this theory to assist my patient empower sufficiency in society. At institutional degree, wellness attention squad should follow these intercessions which I have n’t observed at that place. It is overall lacking in our wellness sector that less attending is giving to mental wellness by authorities and by wellness attention scenes.
Fewer researches are conducted for mental wellness in Pakistan ; so I have non found any relevant research on construct of impotence. I found a survey done in Israel by Ronel and Claridge ( 2003 ) said “ Violent behaviour as a mark of impotence and of being out of control, much resembling the symptoms of substance maltreatment ” ( p.62 ) . Further stated that “ It is accepted and even expected that work forces ne’er admit to powerlessness or miss of control ” ( p.62 ) . These words non merely represent the civilization turn toing in this article but besides applicable to Pakistani civilization where demoing impotence is non allowed in society and sing it scandalous so, feeling of impotence must come out in signifier of aggression, violent behaviour or traveling towards substance maltreatment.
Previously, I believed that impotence is merely link with physical failings and merely faced by patients but after reading this construct in depth my bias become clear. I was able to incorporate theoretical account and theories which help in covering and bettering my patient control over state of affairs and recover their power back in society. I am glad after analysing my attempts that my patient realized his feelings of impotence and seek to get by with it by taking determination for him as he admitted that he will make work after discharge. During composing this paper, I realized that most of the intercessions which I already implemented on patient are base on theoretical account and theories.
Power is of import facet of a individual ‘s life without which endurance become hard for single. Powerlessness can be faced by everyone in any point in life. Persistent feeling of impotence greatly affects non merely mental but besides physical wellness. It should be trade at early degree for better mental wellness result. More researches is needed to measure the peoples ‘ position and feeling of power and impotence and on grounds based intercessions.
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