Personal Identity and Its Effect on Pre-procedural Anxiety

Personal indistinguishability operator and Its Effect on Pre-procedural anguish1.0 IntroductionIn con passing health complaint systems, matchless of the key ways of diagnosing and treating medical conditions is through incursive and minimally invasive military operations on patients. Some of these procedures are accessing the intravenuous system for treatment (venipunctures), blood collection for investigations (phlebotomy), lumbar punctures and biopsies. Regardless of age, sex or ethnicity, patients endure attention and pain associated with these invasive procedures (American Pain Society, 2001). In spite of minimal tissue damage in these procedures, anxiousness about the procedure and associated pain, whitethorn cause considerable incommode in patients. This may affect the coping mechanism, even in a well functioning individual. This has been studied by McCleane and Cooper (1990), Augustin and Haynes (1996) and Garbee (2000).A modus operandi of enquiryes relieve onese lf been conducted to posit and control fear in patients who are subjected to such(prenominal) procedures. Based on these studies, patient education programs (McDonald and Green, 2002), alternative therapies (Noreed, 2000), pharmaceutical therapies (Smith and Pittaway, 2002) and melodious therapies (Elliot, 2004) have been proposed to a varying extent. An essential point to none is that melodic therapies, education programs and patient educational programs may be time-consuming and may be of limited practicality in a busy infirmary environment. On the other hand, pharmaceutical therapies may cause side- gists associated with drugs. Therefore, a simplistic approach, which could fork out powderpuff and relieve the pre-procedural anxiety, is the need of this surgical era. No research has been free-base on invoking psycheal individuality and its effect on pre-procedural anxiety. Therefore, this research aims to run into this gap.Hospitals and health care institutions are un pleasant environments with a general display of infirmity and death. It is an environment where star is separated by friends and family and is surrounded by strangers. A individual who is being subjected to a procedure at a hospital may already contemplate on the potential illness that the person may be subjected to. This may lead to a temporary feeling of anxiety (Coyle, 1999).According to Spielberger et al (1970) anxiety is divided into twain factors, state anxiety ( alike kn deliver as somatic anxiety) and trait anxiety. differentiate anxiety is temporary or circumstantial arousal and trait anxiety is the permanent change of personality characteristics associated with anxiety. According to Kent (1998), state anxiety may cause physiological arousal, and activating of the sympathetic nervous system and the hypothalamic pituitary adrenal axis. This is characterized by increased pulse rate, blood pressure, respiratory rate and increase cardiac output (Bally et al, 2003). Resea rch by hay et al (2003), asserts that lessen the state anxiety is important before a diagnostic procedure to promote relaxation and to prevent possible complications such as procedure becoming more painful, difficult, prolonged and increased hazard of after effects. When a procedure becomes difficult to administer, doctors may also submit or cancel the procedure, placing the patient at a disadvantage.Addressing patients emotions through an evidence- found focussing is important for nurses to increase the patient outcome. Psychosocial nursing noises, emotional presence and validation of trust between the nurses and the patient, has the potential to mitigate patients tending and anxiety or stress to a greater take.1.1 Pain and care Associated with Invasive ProceduresStudies have cerebrated that pain associated with a procedure may be severe than that actual illness that needs investigation (Finley and Scheter, 2003). The procedure itself may have an effect on the pain that i s puzz direct by the patient, which is based on the patients perception, which in turn, can be influenced by factors including past experience, mental state, hearsay knowledge and the patients level of understanding (Rawe et. al., 2009).According to Brennan, Carr and Cousins (2007), effects of pain can be short and long-run, which are not gender, age or ethnicity-specific. A material body of studies have confirmed the psychological effects of pain, which include anxiety, anger and fear as well as fleshly effects, such as changes in metabolic functions, heart functions and functions related to blood (Ferrell, 2005 Gordon et al., 2005 Mertin, et.al., 2007). Most common long-term effects of pain are, insomnia and depression (Berenholtz, et. al., 2002). Several studies have noted that in that respect is a imperious relationship between anxiety and pain, in a clinical setting (Sternbach, 1968 Melzack, 1973). According to Kain et. al. (2001), severity levels of pain are at present proportionate to anxiety levels overdue to activities in the hippocampal network, which causes deportmental conflict in the brain. This is resolved by sending and amplification signal to the neural example of the painful event, which causes anxiety in the person. This was verified by Ploghaus et. al. (2001) using a serial publication of event-related functional magnetic resonance imaging (FMRI) studies, which concluded that anxiety-induced hyperalgesia is associated with activation in the entorhinal cortex of the hippocampal formation. Van den Broek, Hejimans and Van Assen (2012) focused on the emotional distress caused by the procedure of implanting a cardioverter defibrillator (ICD), an invasive procedure, in 343 patients.. All subjects demonstrated distress through anxiety and depression outright after the procedure as well as during follow-up timelines.1.2 mental Techniques used to Reduce Pre-procedural AnxietyHealthcare personnel have ascertained a number of regularitys to reduce anxiety of patients through psychological intervention techniques. One of the methods employed by clinical nurses is through curative touch. cyclooxygenase and Hayes (1997) performed a quasi-experimental probe based on patients at a district General Hospital in East London, which concluded that therapeutic touch aids in reducing anxiety of the patients.Another method which has been researched is, on the effect of music as an intervention for reducing the pre-procedural anxiety in hospitalized adult patients (Gillen, Billey Allen, 2008). This was performed through Randomized Controlled Trials (RCTs) of 832 adult patients The researchers concluded that psychological outcomes show anxiety was reduced to a greater extent as a result of music listening interventions, demonstrated by decrease of blood pressure, respiration rate and heart rate.A piece of work performed by Hawley (2009), explored nurse strategies which were perceived as comforting by patients. The sample su rface was 14 patients in the emergency department of a hospital in New York. The study concluded that positive talk, vigilance and attending to physical discomforts were among the top five factors that reduced anxiety. Hawley (2009) concluded that the study supports the provision of comfort as an integral part of emergency nursing practice and a critical aspect of care.A research with 580 mentally alert adults were selected for a study by Whelchel (2004) to identify the effect of caring behaviour by nurses on ED patients. At the end of the study and data analysis, the researchers inform that treating the patients like an individual, was considered to be the roughly important trait in reducing the anxiety of emergency room patients, followed by knowing what they were doing, being contour and considerate, treating the patient with respect, giving the patient their full attention, knowing how to administer injections and tuck intravenous catheters.1.3 Self Esteem and AnxietyFrom th e beginnings of scientific psychology, the idea that mint wish to maintain high levels of egoism has been a central source in many studies (Horney, 1937 James, 1890). The idea of self-esteem generally means ones have got evaluation of him or herself. Self-esteem is also seen as a critical function for social and mental well-being of a person. Self-esteem induces and maintains personal goals and motivations and according to a study by Mann et. al. (2001), conclusive evidence exists that self-esteem leads to better mental health. Mann et.al. (2001) assert that a series of psychological problems, both internalizing and externalizing can be caused by poor self-esteem. The researchers conclude that self-esteem acts as a protective factor and is a centre element in the promotion of mental health.Greenberg, Pyszczynski and Solomon (1986) argue that self-esteem provides a buffer against anxiety, focusing primarily on the fear of human beings towards mortality. done empirical evidence, the researchers have concluded high-level of self-esteem reduces anxiety and behaviour that relates to anxiety. Three studies were conducted by Greenberg, et. al. (19921, 19922, 1993) to identify the direct evidence for the effect of self-esteem on anxiety. In the first study (Greenberg et. al., 19921), participants received positive and detrimental feedback about their personality, which was false. Then one group was shown a video which threatens of death, whereas the sec group was shown a electroneutral video. The underage variable in this study was state anxiety and the hypothesis was that bolstering self-esteem would reduce anxiety in response to the threat. The study concluded that participants with low self-esteem had the highest anxiety.A piece study was partaken with participants being given bogus feedback on an intelligence tribulation (Greenberg el. Al. , 19922). Following the feedback, participants were told that they would receive an electric shock or a neutral st imulation. The dependent variable was physiological arousal and the hypothesis was that the participants with bolstered self-esteem would experience reduced physiological arousal in anticipating electric shocks. The finis of the study was that neutral self-esteem-threat the participants having highest anxiety.A third study by Greenberg et. al. (1993) was with participants, who were provided with either positive or neutral feedback regarding their personality and a emotionality scale test, where the dependent variable was emotionality and the hypothesis was high self-esteem would reduce the participants prospect of a short life-expectancy. The study concluded that participants with negative feedback information led to low self-esteem. Based on these studies, researchers Greenberg et. al. (19921, 19922, 1993) developed anxiety-buffer hypothesis which led to the conclusion that self-esteem provides protection against anxiety and one who has an increased self-esteem becomes less-prone to anxiety when exposed to threatening situations later.1.4 Personal Identity and NamePersonal Identity deals with oneself and issues that arise by the virtue of being an individual and it has its own attributes that call for a person unique and different from the rest. Personal identity has its own properties, such as represent, appearance, preferences which make a person unique. At present, an estimated one hundred twenty million babies are born on earth in a year (Deluzain, 1996). Sooner or later, they undergo the process of receiving a break. bear on calling are part of all cultures and they are equally important to the person who receives the name as well as the society which the person lives in.The most important part of a persons identity is the name. It is of important for the individual and the society as a whole. Inspite of its importance, not many quite a little know or interested in knowing the effect of name on us and our children in this world although we are co nsidered as the consumers of call. Researches show that one of the creators for couples to have children is to perpetuate the family name (Arnold and Kuo, 1984 Callan and Kee, 1981 Ramu and Tavuchis, 1986). A research by Howard et. al. (1997) concluded that students felt proud when professors in their university remembered them by the name. A century ago, anthropologists identified that there has never been an superannuated civilization, which did not portion first names to populate, in the recorded history.Many ancient cultures believed that not having a name is equivalent to not having an identity or award (Frommer, 1982). At present, in most countries, parents are required to register the relationship of a child through the childs name. This is a jural requirement, which is the first time a child is given a effectual identity. The birth certificate received by the parents becomes an essential document for admitting a child to school, obtaining healthcare and other basic services from the society.The existence of a name of a person is not only important to the person psychologically, but it is also of religious, social and legal importance because our identities are associated intuitively through the name. When ones name is mispronounced, it may sound obstinate to the person. Most populate, especially when communicating with persons of different cultures, take extreme care to ensure the names are not mispronounced. Studies have revealed that mispronunciation of the name amounts to aberrancy of ones identity (Deluzain, 1996).Freud identified the psychological effects of torment of ones name, deliberately or accidentally. According to Freuds observations, people of aristocratic class, who wielded economic and political power tended to mispronounce their doctors names (Deluzain, 1996). The definition for this was the aristocrats psychological need to show their superiority over the doctors, who wielded the power of ones life and death. A similar event is seen in Shakespeares play, King John, where the character Philip Faulconbridge was found to be the illegitimate son of Richard the Lionheart, which make him King Johns half-brother. In the aftermath, King John orders Philip Faulconbridges name to be changed to Richard Plantagenet and deliberately refers to Philip as Peter (Shakespeare, 1623). This is a make it example of how Shakespeare presented the idea that mis-representation of a persons name amounts to mis-representation of the person.The psychological significance of names are so high, that two separate researches have concluded that people have a strong affiliation with garner of the alphabet in their own names than ones which are not in their names (Koole, Dijksterhuis, and van Knippenberg, 2001 Nuttin, 1985 Greenwald and Banaji, 1995). The research by Greenwald and Banaji (1995) concluded that people positively associate themselves with garner in their names, as they are considered to direct reflectivity of the person, although there doesnt appear to be any pragmatic reason for this association. This positive association of ones name and even the letters of the name with oneself has a general tendency to make a person feel good (Greenwald and Banaji, 1995 Hetts and Pelham, 2001).The connection between name and identity is also emphasized by research that portrays changing of ones name leading to changing of ones personal identity (Lawson, 1984 Kang, 1972). In certain villages in China, men are allocated an additional name based on the social transitions, such as marriage. On the contrary, women do not receive additional names, which imply that they never attain complete personhood (Watson, 1986). A research by Howard et. al. (1997) concluded that students felt proud when professors in their university remembered them by the name. A century ago, anthropologists identified that there has never been an ancient civilization, which did not allocate first names to people, in the recorded histor y. Many ancient cultures believed that not having a name is equivalent to not having an identity or honour (Frommer, 1982).1.5 Self-Esteem and Personal IdentityThe idea that people sieve to keep a high level of motivation maintain high-level of self-esteem is widely accepted and is considered as a postulate or an accepted fact. Theories suggest that behaviours such as aggression, love, deviance and even selflessness are due to ultimate belief that humans wish to be seen as valuable (Heine et al, 1999). Studies have been done only recently to determine whether this is always true and whether it is universal (Baumeister, 1998 Heine et al, 1999). However, still, a significant majority of psychological theories consider the need of humans to maintain high-levels of self-esteem as a postulate.Coyle (1999), presented a concept called personal identity threat in healthcare settings which is one of the key concepts of patient dissatisfaction in healthcare. According to Coyles research, pe ople who were generally hard put with the overall healthcare experience they receive, is mainly due to them being tough as non-persons, which is also termed dehumanization. This study asserts that the persons name has a significant effect on ones own identity. According to Coyles research (1999), people who were generally unhappy with the overall healthcare experience they receive, is mainly due to them being treated as non-persons, which is also termed dehumanization. 40 out of 41 patients interviewed by Coyle verbalise that they were treated as, an object and on deep exploration, Coyle identified that the patients were referred by meter on a file (such as patient number 49) instead of the name, which gave the patient the notion of being dehumanized. This study asserts that the persons name has a significant effect on ones own identity.The above studies indicate that self-esteem is connected with personal identity, where invoking personal identity increases ones self-esteem. O ne of the most key attributes of personal identity of an individual is the name. A number of studies, particularly by Greenberg et. al. (19921, 19922, 1993, 1996) concluded that self-esteem acts as an anxiety buffer. The aim of the present study is to investigate the effect of addressing a patient by name on pre-procedural anxiety level of in-ward patients, who are undergoing basic blood investigations in a large insular hospital in Colombo. The hypothesis tested in this research was, talking to patients by addressing them by name, before an invasive procedure, reduces the pre-procedural anxiety level of hospital patients, than talking to them without referring by name or not talking to them at all.