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APPLICATION OF SUCHMANS STAGES OF ILLNESS

MODEL

Introduction

Man is a social being.Social factors play important role in health.


Social conditions and not only promote the possibility of illness and disability, they also enhance prospect for disease
prevention and health maintenance.
Health life style and the avoidance of high-risk behaviour, advance the individuals potential for a longer and healthier life.
The recognition of the fact that the health of an individual is more than biological phenomena has brought in to the forefront
the significance of behavioural dimension of health.

Mr. AS, a 73 years old, Muslim, male patient admitted in ---ward of ---Hospital with a diagnosis of prostate cancer. Data regarding
psychosocial aspects of his life and illness were collected through interview. He was cooperative and interactive with me for most part. But
later he was found to be reluctant to talk ...as he was frequently expressing his financial troubles which could not be helped by anyone
related to him

Cancer Prostate

Prostate cancer is the fifth most common type of cancer in men and its incidence rises with advancing years. It occurs in 1 in 10 in the men
living to the age of 70 years. Early clinical features are indistinguishable from those of BPH and the gland may feel normal on digital
examination. The PSA may be elevated (>4 ng/ml). As the tumour grows locally it may produce bladder neck obstruction, obstruct the ureters
and rapidly lead to renal impairment. In late disease rectal examination shows the prostate to be large, hard and irregular. Rectal ultrasound
may show the spread of the cancer and this should also be used for directing needle or aspiration biopsy. Prostatic biopsy is important in
giving prognostic information- prognosis being poorer with poorly differentiated tumours.

Therapy depends on staging. Early disease is treated with local radiotherapy and more advanced disease by orchidectomy and hormone
therapy with oestrogen. It has been suggested that all men over the age of 50 years should be screened by rectal examination, transrectal
ultrasound and PSA measurement.

General information

Name

: Mr. AS

Age

: 73 years

Gender

: Male

Marital status

: Married

Place

: ---/ ----

Hosp. No.

: ------

Date of admission

: 1-4-08

Ward/Unit

: --------

Education

: No formal education

Culture & life-style

Religion

: Islam, Muslim, believes in 'Durgas', and has gone there too.

Food habits

: four time in a day & Non-vegetarian once in a day

Socioeconomic condition

Lower socioeconomic status


Occupation
Fisher man for 12 years
He was a beedi worker for 10 years

went to gulf and worked there for 4 years


Cook for 35 years
His son is in Gulf country, but earns only Rs.5000/month
His residence is about 80 km away from ----,
to and fro journey costs rs.50/ person

Role in the family

Head of the family, earning member, and father


These role are affected due the illness everything is disturbed at home

Social Support Network

Patient has poor social support network


There is no one to support him financially for treatment of his illness
His daughter visited him twice in the hospital, no other person visited him or enquired him about his illness after coming in the
hospital

Patient complaints (on the first meeting)

Pain at the genital area (on catheterization)


Urine tube needs to be removed
No taste for anything he eats
No money in hand to pay the hospital bill
No sleep at night

Identification of patient needs

Collection, observing/ performing


activities relating to caring

Needs arising from present illness and the I have pain at genital region
consequent response to cope with
I have problem of passing urine without
control, that is why tube is inserted
I want to get this urine tube removed
Who will pay my hospital bill of
Rs.50,000?
Patient complains that he is not getting
adequate sleep during night
He sleeps during daytime

Interpretation and analysis


Patients main complaints are pain, irritation
at the site of urinary catheter, and sleep
disturbance

He was a cook, working most of his life in


night time for marriage parties
Currently, he is hospitalised for cancer,
prostate and is receiving radiotherapy for the last
one month

Basic physical needs

He is advised not to take bath till the end


of radiotherapy to avoid skin excoriation at
the site
He maintains adequate cleanliness
He visits toilet with assistance from his
wife
He is catheterized for the last 2 months

He says is a practicing Muslim


He is taking bath means it interferes with his
religious practices
He is advised not to take bath because he
may wet the irradiation area, but the cultural
issues are not addressed.

Needs related to life style

He is a non-vegetarian
But he not getting any non-veg food in
the hospital

His life style related needs hindered in this


hospital environment

Needs related to habits

As he has any regular habits of taking tea


or coffee or drinking alcohol

Individuals knowledge and experience of


illness

Patients Knowledge of Present illness


Patient explains his illness:
I have pain and urine block for the last 6
months
My illness is serious
I have diabetes for the last one year
I underwent a surgery for urinary block

He does not take tea or coffee


He does not smoke or take drinks

Patient has understanding of the illness as


his illness is serious.

and pain in ----- 4 months back


What the patient wants to know about the
illness?
will this illness get cured
I have come here because, doctors in ---told me my illness can be cured only in this
Hospital

Experience of illness

What has been his past experience with


illness?
Past Illness History
Earlier I went to many local folk doctors,
they only made all these illness
I have sugar illness for the last one year
The doctor in Kundapura told me to
check sugar, so I know I have sugar
problem
I have not had any major illness in my
life other than this
Family History

No major illness in his knowledge


Whether patient has accepted his illness

I dont have any habits, drinking,


smoking or taking even coffee since
childhood. I dont know why I got this
illness

Patient underwent orchidectomy and TURP in


-------- 4 months back and later referred to a
tertiary care hospital for further management
Patient wants to know whether his illness will
get cured.
He says he has no money to spend her.
But his expenses are met by his daughter
and one brother

Patient has consulted many folk doctors for


minor illness and never satisfied with them.

He had minor troubles with urinary


frequency for about 4 years

So he consulted some folk people for some


remedies

But never satisfied

Patient has accepted the illness as some


thing which he does not deserve.
He puts it on fate

Knowledge of formal and alternative


therapies

He has adequate information about


formal and folk medicines
I have gone to them, but no benefits

He had tried alternative medicines and found to


have no benefit in his illness

Knowledge at present and future


course of action.
What is the treatment plan
Does the person knows about it

Patient says he has one month duration


of x-ray treatment
nobody tells me what is my illness
Im taking medicines regularly

Patient has only partial knowledge of his


illness and treatment plans
He is illiterate, but nobody has explained him
about his treatment plans

Coping with the illness and its outcome What will we do?
(Patient and family)
We have to suffer everything
He looks depressed and tries to avoid
visitors
I dont have money pay here, I dont
know what to do

Analyse the individuals and familys


views on
health team
doctors
nurses

He is not satisfied with the psychological


attention given to him by nurse or doctor
His wife too has the same opinion
Doctor has explained about the illness to his
daughter about the diagnosis and prognosis

Doctor People come and asks how you


are? (he explains sarcastically), nothing
else
They do not want to know about my
pain
sometimes, nurses come asks about
me
Doctor has told something to my daughter

Patient is not showing adaptive responses


He has depressive cognitions
He has financial problems

Patient wants to know about his illness, and


course of treatment, but doctor is preoccupied
with the patients educational status.

Distinguish between the meanings of


the patient, doctor, nurse

Patient: they are not asking me anything


Doctor: he will not understand anything, it is
explained to his daughter
Nurse: doctor has explained everything to
Nursing staff is bothered whether they may
him, we cannot tell anything to the patient
convey wrong message to the patient.
There is a communication gap exists among
these people.

Observe the patient, doctor and nurse


interaction

What patient says has reason.


Doctor has advised him RT for 1 month,
so he feels there is nothing more to talk to
the patient than enquiring any problems
Nurse is largely functionally oriented and
interact with patient only in such occasions

Suchmans Stages of illness Model

The mutual interaction among the treating team


and patient is missing in this situation

Application of Suchman's Model

Conclusion

Mr. AS has been suffering form Prostate cancer for the last 1 year. But his symptoms started about 4 years back. For about 3 years he tried
folk remedies based on the advice of other people. He approached medical advice when his symptoms aggravated. He is currently
undergoing radiotherapy for prostate cancer and medications for diabetes and other symptoms. This case study helps to understand the

psychosocial aspects of illness development and application illness behaviour model in nursing practice.

References

1.

Guptha MC, Mahajan B. Text book of Social Medicine, 3rd Edn. JayPee, ND,2003

2.

Coe RM. Sociology of Medicine. McGraw-Hill Inc. New York, 1978.