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The World Health Organisation (WHO) defined health
in 1948 as a, “state of complete physical, mental and social wellbeing and not
merely the absence of disease or infirmity.” (WHO, 2018). This definition
highlights the fact that it is not merely the physical ill-health of a service
user that should be considered by healthcare professionals, but also the
factors relating to their psychological and social wellbeing. Since the 1990’s,
the idea of person-centred care has appeared with increasing regularity in United
Kingdom health policy (The Health Foundation, 2014). As a result, a transition
has emerged from the traditional medical model of healthcare, which focussed on
the anatomical and physiological symptoms of the service user, to a more person-centred
model of healthcare. This more holistic approach considers their entire
wellbeing, as individuals within their own community, who have specific needs
and values that are important to them. Research has shown that if the broader
wellbeing of the patient is addressed, they are more likely to be treated with
the respect, dignity and compassion that they deserve (British Medical
Association, 2011).

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This essay summarises some of the underlying
psychological and social factors that may affect service users attending the
radiography department. These important factors should be considered by radiography
department staff when communicating with patients in order to achieve
person-centred care. There are numerous factors that could be discussed; examples
include gender roles, disabilities, income, social class, wealth, occupation, culture,
educational background, media influence, relationships, mental illness, anxiety,
anger and alienation (Collins, 2013).  This essay will however focus on socioeconomic
factors and patient stress and anxiety.




The association between a person’s health and their
social class is one that is well documented and applies to all aspects of
health including mortality rates, life expectancy and likelihood of accessing public
health services.  In spite of the fact
that the NHS is a service accessible to all, a report on England from the
Office for National Statistics highlighted major differences in a number of
health related issues across the different social classes (Knott, 2015).

A person’s social class is usually determined by
their educational background, occupation, income and wealth.  People in the United Kingdom in higher social
classes tend to have jobs that provide substantial income, favourable working
conditions and a higher status. As a result, they experience better than
average health and wellbeing (Collins, 2013). 
In contrast, lower social classes tend to have more manual, less
stimulating jobs that tend to have poor working conditions and a lower status.  Therefore being part of a low social class can
have a detrimental impact on a person’s physical and emotional wellbeing,
compared with people belonging to the higher social classes, who tend to have
better paid jobs with more favourable working conditions.  The more manual, uncomfortable nature of low
income occupations puts members of the lower social classes at more risk of
occupational hazards. Direct effects on their health and wellbeing include
accidents leading to fractures and soft tissue injuries, musculoskeletal pain
from repetitive actions and respiratory problems due to poor air quality in
places such as factories and workshops (Knott, 2015).  A study carried out by Court-Brown et al.
(2013), investigated the relationship between social deprivation and the
incidence of adult fractures. The investigation was performed at The Royal
Infirmary of Edinburgh and concluded that fracture incidence significantly
increases in the most deprived 10% of the population.  The study suggests that people belonging to
the lowest social classes are more prone to falls and accidents and, in
particularly, high-energy proximal tibia fractures.

Individuals belonging to high social classes
usually have a greater income and as a result become wealthier. Consequently,
this gives them levels of disposable income that members of the lower social
classes do not have. Wealthier families tend to have a better quality of life
and have more potential to reduce their health risks because they have greater
opportunity to make positive health decisions. More disposable income means
that wealthier people can invest in gym memberships and are more likely to
exercise for leisure. Although the lower classes tend to have more manual
occupations, this physical activity does not adequately effect their
cardiorespiratory system for it to be beneficial and, after a hard day’s work,
they are unlikely to want to partake in even more physical exercise (Knott,
2015).  Wealthier families are more
likely to have healthier diets as they can afford to buy better quality and
more nutritious foods, whilst poorer families tend to eat more fatty, processed
and convenience foods.

Studies have also linked lower socioeconomic groups
with heavier alcohol consumption and increased tobacco use. Research into
alcohol consumption of members of the adult population of Wales found that
participants from the most socially deprived areas were most likely to binge
drink. Suggested reasons for this are that people of low social class use
alcohol as a coping mechanism to deal with the stresses of everyday life, and
also that cheap alcohol is more readily available in socially deprived areas
due to there being a higher density of alcohol outlets (Fone, et al., 2013).  Whilst on clinical placement in a hospital
emergency department, it was observed that the majority of people who were
referred for ultrasound scans specifically to look for liver problems, were
people of middle age who had alcohol dependencies. Some were unemployed and
others had no fixed abode. The vast majority were unkempt and some were still under
the influence of alcohol at the time of the scan. All of them were found to
have varying degrees of fatty liver disease and cirrhosis.

The cumulative effect of poor diet, inadequate
physical exercise, excessive alcohol consumption and tobacco use means that
being part of the lower social classes is related to increased risks of
obesity, heart disease, myocardial infarction, liver disease, diabetes and
increased susceptibility to certain cancers (BMA, 2011).




Psychological factors refer to the thoughts and
feelings that affect the functioning of the human mind (Reference, 2018). These
factors affect a person’s behaviour, attitude and decisions towards their
healthcare. Psychological factors subconsciously influence how people deal with
the dynamics of different health issues during their lifetime.

Physical illness and pain can have a profound
negative impact on a person’s emotional wellbeing. Attending hospital inflicts
added stress onto a patient due to the unfamiliarity of the clinical
environment, particularly the technical equipment and surroundings of an imaging
department. Anxiety is an important psychological factor that must be
considered by radiography staff in order to get the best possible outcomes for
the patient (Ehrlich and Coakes, 2016). Service users undergoing radiographic
examinations for diagnostic purposes will have increased feelings of anxiety due
to the uncertainties of the outcome of their illness and fear of the unpleasant
nature of certain radiographic procedures. A study carried out in 2011 on
behalf of the Radiological Society of North America assessed the levels of
distress of women sitting in the waiting room of an imaging department. All were
attending for radiological procedures. The results showed that the women that
were attending for diagnostic breast biopsy, and the women attending for
invasive treatment of malignant liver cancers and uterine fibroid treatment,
experienced abnormal levels of perceived stress, depressed mood and negative
impact of events. Interestingly however, it was only the women attending for
breast biopsies that experienced highly alleviated levels of anxiety.  This suggests that the invasiveness of the
procedure has less influence on patient anxiety than the uncertainty of the test
results (Flory and Lang, 2011). The patients attending for treatment rather
than diagnostics already knew that they had cancer or fibroids and so the fear
of the unknown was not as influential on their emotional wellbeing.

Feelings of anxiety and stress can stop patients from
retaining information and can also affect how they respond to instructions.
During was an extremely anxious lady came for a barium swallow examination. The
high anxiety levels of the lady meant that she found it difficult to follow
basic instructions such as holding the barium in her mouth and swallowing at
the correct time. Even after the examination when the radiologist explained to
the patient that there was nothing significant to worry about, the lady could
not believe the positive outcome. The patient’s abnormal level of anxiety was partly
a result of the fact that prior to her appointment, she had convinced herself
that she was going to be diagnosed with a tumour. Cancer diagnosis is so
frequent in modern society that service users often fear the worst and
attribute symptoms of ill health with having a malignant tumour. The temptation
of patients to self-diagnose is also prevalent issue in modern healthcare, and
can often increase feelings of depression and anxiety in service users. People
are now less passive in their attitude towards their healthcare and will use
online resources to try to have greater understanding about healthcare issues
(Collins, 2013).  Unfortunately, when
this information is not accurate and a healthcare professional has not also
been consulted, it can cause unnecessary worry to an already anxious patient
and as a result has a profound negative influence on their psychological health
and wellbeing.

Feelings of intense anxiety or stress can cause
physiological changes in the body that mirror the symptoms of other illnesses.
People who are abnormally anxious can experience increased heart and breathing
rates, profuse sweating, trembling sensations and gastro-intestinal problems
(Healthline, 2018).  Patients will often
have numerous radiographic examinations because of these symptoms and will
still not get an answer because their symptoms are anxiety related. They may be
referred for a chest X-ray or electrocardiogram (ECG) because of an increased
heart rate, or for a virtual colonoscopy (CTC) because of bowel problems, but
the imaging will often not show any physical cause of the symptoms.

Psychological factors such as stress and anxiety
must be considered by radiography staff to ensure that service users do not
feel like their psychological wellbeing is being ignored. Radiographers are
therefore faced with the challenge of not letting the technicalities of the
radiographic examination distract them from being attentive to the patient’s
mental health and wellbeing.


and Reflection  


Ill-health makes service users vulnerable and
scared. They are forced to trust that the healthcare professionals they
encounter on their patient journey will do the best for them as individuals and
will consider their entire wellbeing, not just their anatomical and
physiological symptoms (The Health Foundation, 2014).

The traditional passive role of the patient is
becoming a thing of the past and they are now encouraged partners in their own
care, collaborating with healthcare professionals in decisions regarding their
treatment. The Planetree model encompasses this patient-centred approach to
healthcare suggesting that cultural transformation and staff engagement is
essential if we are to provide a more value-based health service. It is the
responsibility of all healthcare workers to consider the psychological and
social factors that may affect service users on an individual basis (Planetree,
2018). The Society of Radiographers Professional Code of Conduct (2013) states
that all of the professional workforce for diagnostic imaging and radiotherapy
must, “Listen to and respect the wishes of patients, seeking to empower them to
make decisions about their care and treatment.” The code of conduct puts
patient-centred care at the heart of radiographic practice which it insists
must be based on values such as respect, trustworthiness and empowerment
(Society of Radiographers, 2013). Radiographers consequently have a
responsibility to consider the broader wellbeing of the patient, including the
social and psychological factors that may influence their everyday lives.

Correlation between socioeconomic status and health
shows that health improves incrementally moving upward through the social
classes (Matthews, 2015).   Members of lower social classes are more
likely to suffer from chronic illnesses, it could therefore be deduced perhaps
that diagnostic radiography departments in particular will see more patients
from the middle to lower social classes.

Psychological factors such as stress and anxiety
put emotional strain on service users attending radiographic examination
appointments, and can create added challenges for radiographers who already
have to contend with consistently stretched resources and time constraints. Radiographers
must use effective communication to help to reassure anxious patients and to
make them feel as though they are being respected and taken seriously. If the
radiographer has the emotional intelligence and skill to do this successfully,
patients will be more likely to cooperate and retain information (Ehrlich and
Coakes, 2016). This is particularly important where the examination requires a
large degree of patient participation as they will be more able to follow
instructions, making it less likely that the examination will need to be
repeated or rearranged. A qualitative study carried out in a Swedish hospital
in 2010 aimed to describe patients’ expectations before, and experiences during,
a head-first magnetic resonance imaging scan (Carlsson, S. and Carlsson, E.,
2013).  It concluded that, although
patients had received written information regarding the scanning procedure,
communication with the radiographer was described as being crucial in order for
the patient to manage their feelings of anxiety and loss of self-control.  This shows the significance of patient-radiographer
interaction and how the technicalities of the examination must not detract from
addressing the emotional needs of the patient.

The brevity of the encounter between patient and
radiographer means that psychological and social factors affecting the patient
have to be rapidly deduced. They have very little time to make the patient feel
as though they are being attentive to their emotional wellbeing, whilst
carrying out a diagnostic examination and keeping a busy department
moving.  Radiographers must therefore
possess impeccable skills of communication and be able to adapt their
communication style to meet the needs of individual service users.






The health and wellbeing of service users
undergoing radiographic examinations is shaped by both psychological and social
factors. These important influences must be considered by healthcare
professionals in order to deliver patient-centred care and to allow the patient
to feel like they are receiving the compassion and respect that they deserve. Radiographers
have an obligation to provide compassionate care that promotes the best
interests of each individual patient. Effective communication is essential in
achieving the best patient experiences as all elements of verbal and non-verbal
communication has the potential to either increase or decrease feelings of
distress and fragility in the service user.

The increasingly complex psychological and social
needs of a diverse and aging population means that radiographers cannot just be
experts in the technicalities of diagnostic imaging, they have to also be
experts in patient care, support and empathy.


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