There are two schools of thought regarding care within the healthcare industry. One is Medical Model. Easily understood and used almost exclusively throughout the industry. The other is Psychosocial Model. This is a lesser understood, rarely intentionally used plan of care. They are referred to as “the battle between the two forms of care.”
The two models of care are not options
The models are thought of as options. “Do I pick Medical Model or Psychosocial Model?” Let’s look at a quick scenario. It may help create a clearer understanding as to why both are 100% necessary.
Let’s use this example, for instance. The loved one cut their finger and is now bleeding. Without thought we automatically know to begin using the Medical Model of care to bandage the wound. Yet in reality both models of care are necessary. The loved one also needs assurance they are going to be okay. That addresses their psychosocial needs in doing so.
Think of it this way. Would you merely bandage your child’s wound and send them on their way? No, you would comfort them. Probably adding something like, “All better now,” once the wound was taken care of. The loved one needs these same assurances.
Quality of life only occurs when there is a blending of both models of care. This becomes crucial for the dementia population. Their ability to reach out for help is diminishing. In fact, they may find “acting out” is their only means of communicating unmet physical, medical and psychosocial needs anymore.
Ironically, an infant uses this same form of communication to get their needs addressed. The loved one’s communication abilities are cognitively reversing. They are returning once again to those very same survival skills they started out with in life.
Medical Model minus Psychosocial Model ≠ quality of life
Medical Model is easy to understand. You can tangibly see when and why you are using it. Like when you “bandage a wound,” or “shower someone,” for instance.
Psychosocial Model, however, carries a completely different value. It is seen more like a nebulous “option.” Better defined as a vague idea that’s “sort of important, in some obscure way.” With uncertainties diminishing its value, we choose to ignore its application. “Mustn’t be that important,” we logically concur.
Instead, psychotropic meds and geropsych visits are used when unwanted behaviors begin to emerge. Quick and easy. Well, quick and easy for the caregiver. The unwanted behaviors stop. In fact everything stops. Usually the loved one falls asleep for a time.
Their psychosocial needs continue to go unmet. Plus their frail body now endures all those toxins it received in the mood altering medication. They eventually wake up, still with their unmet need, but now feel quite confused and anxious as well.
Psychosocial needs
Psychosocial needs are needs. In fact they are as important as every medical need. Many find difficulty in measuring their value because they are simplistic in form.
Their very core is merely kindness, love, respect, support, and nurturing. Omitting care of a person’s psychosocial needs will induce unwanted behaviors in the loved one. Furthermore, prolonged lack of meeting psychosocial needs can result in early death.
Interesting to know, an orphanage study discovered this very fact to be true. Their infant death rates were running disproportionately higher than anywhere else. It all came down to the realization they were ignoring the psychosocial needs of those infants. As a result of that study the phrase “Failure to Thrive” was born.
Maslow’s hierarchy of human needs theory
What motivates us humans to get needs met? Maslow’s Hierarchy of Human Needs Theory addresses that very question.
The pyramid below illustrates how he differentiates between medical/physical and psychosocial needs. Each step up the pyramid correlates with higher quality of life. We become motivated to fulfill other unmet needs once our needs on current level are met.
Medical needs are viewed as mandatory care. Ironically, psychosocial needs are rarely addressed.
In dementia facilities charting medical and physical needs of residents is absolutely mandatory per State-mandated regulations. For instance such tasks as “showered Mr. Jones,” or “invited Mary B. to attend singing activity,” must be charted. But as far as I know nobody has ever charted psychosocial needs.
Things like, “Helped Mr. Brown take his sweater off to cool down,” aren’t charted. “Comforted 91 y/o Nellie S. as she grieved over the loss of her parents.” Nope, you won’t find that either. In reality, charting these moments most likely would be seen more as “a waste of time.”
Emotional and mental well-being
Consider the ways Psychosocial Model places focus on our emotional and mental well-being:
- Our sense of self-worth is restored.
- Increases our desire to feel we are loved by others.
- Reinforces our sense of being valued by others.
- Bolsters our desire to be a contributor to our community.
- Enhances a constant calm, reassuring us we are safe and we will survive. Hence we know we are supported.
Psychosocial Model is like a calming sedative. It will address and strengthen one’s ability to adjust and relate to their social environment. Specifically:
- We remain calmer.
- Restores feelings of hope, worthiness, and success.
- Loved ones find they are able to remain encouraged in the midst of an ever-changing, anxiety-inducing cognitive-declining process.
- Those without dementia experience this strengthening calm as well.
The battle between using the Medical Model and Psychosocial Model needs to come to an end. It never was meant to be a matter of choice. They are both needed throughout the loved one’s day, all day long. Truly without it the loved one will never be able to attain those higher-quality-of-life levels. Left to no other options, exhibitions of unwanted behaviors will begin to be expressed.
Psychosocial Encouragement
- Validate their feelings
- Continually show them you have their back, i.e., ask if too hot, too cold, need help, etc.
- Give them choices throughout the day to strengthen their sense of autonomy: sweater or jacket?
- Hugging and/or caressing them in a nonclinical way shows they are lovable.
- Make sure you are using appropriate facial expressions, intonations, and body language.
