Personal Identity and Its Effect on Pre-procedural Anxiety

Personal Identity and Its Effect on Pre-procedural Anxiety1.0 IntroductionIn contemporary healthcare systems, one of the line slipway of diagnosing and treating medical conditions is through invasive and minimally invasive subprograms on forbearings. Some of these procedures are accessing the intravenuous system for treatment (venipunctures), blood collection for investigations (phlebotomy), lumbar punctures and biopsies. disregardless of age, sex or ethnicity, patient roles endure fretfulness and infliction associated with these invasive procedures (American Pain Society, 2001). In spite of minimal tissue damage in these procedures, anguish somewhat the procedure and associated pain, whitethorn cause witnessable distress in patients. This whitethorn affect the coping mechanism, even in a well functioning mortal. This has been analyze by McCleane and Cooper (1990), Augustin and Haynes (1996) and Garbee (2000).A twist of look fores have been conducted to determine and con trol anxiety in patients who are subjected to such procedures. Based on these studies, patient rearing programs (McDonald and Green, 2002), alternative therapies (Noreed, 2000), pharmaceutical therapies (Smith and Pittaway, 2002) and musical therapies (Elliot, 2004) have been proposed to a varying extent. An grave point to none is that musical therapies, education programs and patient educational programs may be time-consuming and may be of limited practicality in a busy hospital environment. On the other hand, pharmaceutical therapies may cause side-effects associated with drugs. Therefore, a simplistic approach, which could provide comfort and relieve the pre-procedural anxiety, is the need of this surgical era. No research has been found on invoking soulal identity and its effect on pre-procedural anxiety. Therefore, this research aims to fit this gap.Hospitals and health care institutions are unpleasant environments with a general appearance of illness and death. It is an e nvironment where one is sepa countd by friends and family and is surrounded by str kindles. A person 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). fit to Spielberger et al (1970) anxiety is divided into two factors, state anxiety (also know as somatic anxiety) and trait anxiety. State 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 activation of the sympathetic nervous system and the hypothalamic pituitary adrenal axis. This is characterized by increased thrill rate, blood pressure, respiratory rate and increase cardiac output (Bally et al, 2003). Research by Hayes et al (2003), asserts that reducing the state anxiety is important earlier a diagnostic proce dure 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 postpone or cancel the procedure, placing the patient at a disadvantage.Addressing patients emotions through an evidence-based management is important for nurses to increase the patient outcome. Psycho brotherly nursing interventions, emotional presence and establishment of trust between the nurses and the patient, has the potential to mitigate patients fear and anxiety or stress to a greater level.1.1 Pain and Anxiety Associated with Invasive ProceduresStudies have reason that pain associated with a procedure may be severe than that unquestionable illness that needs investigation (Finley and Scheter, 2003). The procedure itself may have an effect on the pain that is experienced 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 non gender, age or ethnicity-specific. A number of studies have confirmed the psychological effects of pain, which include anxiety, anger and fear as well as physical 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 there is a positive relationship between anxiety and pain, in a clinical setting (Sternbach, 1968 Melzack, 1973). According to Kain et. al. (2001), severity levels of pain are directly proportionate to anxiety levels due to activities in the hippocampal network, which causes demeanoural conflic t in the brain. This is resolved by sending and amplification signal to the neural representation of the painful event, which causes anxiety in the person. This was verified by Ploghaus et. al. (2001) using a series of event-related functional magnetic resonance imaging (FMRI) studies, which reason out 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 immediately after the procedure as well as during follow-up timelines.1.2 Psychological Techniques used to Reduce Pre-procedural AnxietyHealthcare personnel have discovered a number of methods to precipitate anxiety of patients through psychological intervention techniques. One of the methods employed by clini cal nurses is through therapeutic touch. Cox and Hayes (1997) performed a quasi-experimental conceive 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 reduction of blood pressure, respiration rate and heart rate.A study performed by Hawley (2009), explored nurse strategies which were perceived as comforting by patients. The sample size was 14 patients in the emergency section of a hospital in New York. The study concluded that positive talk, vigilance and atte nding 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 dashing 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 most important trait in reducing the anxiety of emergency room patients, followed by knowing what they were doing, being kind and considerate, treating the patient with respect, giving the patient their full attention, knowing how to administer injections and insert intravenous catheters.1.3 Self Esteem and AnxietyFrom the beginnings of scientific psychology, the conception that bulk wish to discover high levels of self-consciousness has been a central t heme in many studies (Horney, 1937 James, 1890). The idea of self-esteem generally means ones throw military rank 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 core 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. Through empirical evidence, the researchers have concluded high-level of self-esteem reduces anxiety and behaviour that relates to anxiety. Three st udies 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 acquire positive and negative feedback slightly their personality, which was false. Then one group was shown a video which threatens of death, whereas the second group was shown a neutral video. The dependent variable in this study was state anxiety and the possibility 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 second study was partaken with participants being devoted bogus feedback on an intelligence test (Greenberg el. Al. , 19922). Following the feedback, participants were told that they would receive an electric shock or a neutral stimulation. The dependent variable was physiological arousal and the hypothesis was that the participants with bolstered self-estee m would experience reduced physiological arousal in anticipating electric shocks. The termination 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 anticipation 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 onese lf and issues that hold up by the virtue of being an individual and it has its own attributes that make a person unique and different from the rest. Personal identity has its own properties, such as bring in, appearance, preferences which make a person unique. At present, an estimated 120 million babies are born on earth in a year (Deluzain, 1996). Sooner or later, they undergo the process of receiving a name. Names 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 people know or interested in knowing the effect of name on us and our electric razorren in this world although we are considered as the consumers of names. Researches show that one of the reasons for couples to have children is to perpetuate the family name (Arnold and Ku o, 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 ancient civilization, which did not allocate first names to people, in the recorded history.Many ancient cultures believed that not having a name is equivalent to not having an identity or honour (Frommer, 1982). At present, in most countries, parents are required to register the birth of a child through the childs name. This is a legal requirement, which is the first time a child is given a legal 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 becaus e our identities are associated intuitively through the name. When ones name is mispronounced, it may sound resentful to the person. Most people, 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 distortion of ones identity (Deluzain, 1996).Freud identified the psychological effects of distortion 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 explanation 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 ass, where the character Philip Faulconbridge was found to be the illegitimate son of Richard the Lionheart, which made 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 clear 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 letters 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 letters in their names, as they are considered to direct reflection of the person, although there doesnt appear to be any matter-of-fact reason for this association. This positive association of ones name and even the letters of the name with oneself has a gen eral 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 lead-in 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 history. 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 strive to keep a high level of motivation maintain high-level of self-esteem is widely accepted and is considered as a cope or an accepted fact. Theories suggest that behaviours such as aggression, love, deviance and even altruism 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, 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. This study asse rts 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 stated that they were treated as, an object and on deep exploration, Coyle identified that the patients were referred by numbers 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. One 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 private 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.