The aim of this assignment is to critically analyse and evaluate the biological, psychological and sociological perspectives, holistic care needs and its influences on the health and well-being of a patient from placement. The patient suffers from Crohns disease and was admitted to the hospital for Ileocaecal resection. This surgical procedure will result in the patient having her terminal ileum and the caecum removed. To maintain the professional requirements of the Nursing and Midwifery Council (NMC) on confidentiality (NMC, 2015), the name has been changed and the patient will be referred to as Anne. Healthcan be defined as the ability to adapt and self-manage in the face of physical,social and emotional challenges, to satisfy lives demand that comes with personsage and cultural responsibility (Bircher, 2005., Campbell, Pleic and Connolly,2012). This definition gives a clear understanding of what health should beidentified as and provides a holistic approach to health, as it takes intoconsideration the changes in an individuals lifestyle and it allows a betterunderstanding of the determinants of the disease (Lane, 2014). Diseases andsicknesses are some of the factors identified to impact the health andwell-being of individuals in society today (Kwam, 2013). This research,therefore, emphasises on the fact that diseases and sicknesses are able toinfluence an individuals behavior and emotion which could further lead to theadvancement of health problems (Lane, 2014). Overthe last century, there have been controversies about the use of nursing modelssuch as Orems self-care model as some research have deemed it to be complex inits understanding and information is likely to be misinterpreted (Kharis,2016). Nevertheless, other research has disagreed as they have identified thatnurses experience is not enough to guide them and nurses are also able todevelop nursing practice by being able to think in depth and enhance insight onthe needs of the patient (Williams, 2015). Therefore, for this assessment, thebiopsychosocial model will be used to explore the present holistic andindividualized nursing care available for a patient suffering from Chronsdisease. This is because this model relates to the study of the human being asa whole rather than its individual parts (Williams, 2015). Whilst on a clinical placement on a surgical ward, a 36-year-old white British lady named Anne was admitted to the hospital with abdominal pain, vomiting and diarrhoea and has been scheduled for an Ileocaecal resection surgery. Anne was diagnosed with Crohns disease about six years ago and has had numerous hospital admissions due to the nature of the disease which presents with periods of remission. She was prescribed with anti-inflammatory drugs, antidepressant drugs and immunosuppressant drugs and occasionally takes antibiotics to reduce the symptoms and maintain remission of the disease. Anne is a divorced mother of two children, and currently living alone with her children who are 8 and 6 respectively. She lives in a two-bedroom social housing apartment situated miles away from the urban area, where she has less access to transportation and other social amenities such as GP surgery and supermarkets. Her mother and sibling all live abroad, and her mother also has a history of inflammatory bowel disease (IBD). Anneleft school at the age of 18 and has worked as a classroom teaching assistantsince she was 21 however, because of her divorce which was less than a year agoand her constant admissions, Anne decided to work part time instead to manageher illness and family. Her lifestyle includes smoking approximately tencigarettes a day since the age of eighteen. Due to the loss of her father at that age, thestress of the divorce and her constant concerns for her health, she consumes abottle of wine every night. Her body mass index is currently 16.5 which isidentified as being underweight. This assignment will focus on thebiopsychosocial model to explain and understand its influence in Annes healthand wellbeing. According to Lane (2014), the term biopsychosocial refers tofactors which can be categorised as biological, psychological and social andwhen combining these three determinants, they all identify aspects of anindividuals life.Crohns disease (CD) is a chronic, relapsing and an incurable inflammatory bowel disease (IBD) that causes inflammation in the bowel and currently affects over 3 million individuals in the Western World (Boyapati, Satsangi and Tzer Ho, 2015). CD is an immune-mediated disorder that causes inflammation, ulcer and tissue destruction anywhere along the gastrointestinal (GI) tract, from the mouth to the anus, however it most commonly affects the distal small intestine, which is between the terminal of ileum and start of the colon (De Mattos et al., 2015). This condition is also known as a transmural disease because it extends and affects the entire thickness of the intestinal wall (Fernandes et al., 2017). Thecause of Crohns disease is unknown; however, some scientists claim that thereis an interaction between the genes, the immune system and the environment(Parkes, 2012., Marks et al., 2009., Wilson et al., 2015). Crohns disease isbelieved to be related to abnormalities in the bodys immune system which isusually aimed at protecting the body from infections or other foreign invaderslike bacteria and viruses (Boyapati, Satsangi and Tzer Ho, 2015). Inindividuals with CD, the immune system reacts to the bacteria in thegastrointestinal tract, which causes inflammation, bowel injury and ulceration(Anaya et al., 2012). Furthermore,as the lining of the GI tract becomes inflamed, it affects its ability toeffectively function, therefore it becomes difficult for water to be absorbedand for certain nutrients from the digested food to be processed (Kaser andBlumberg, 2014). This results in abdominal pain and diarrhoea which explainsAnnes presentation at the hospital. In addition to this, the vitamin deficiencyis also likely to have caused Annes weight loss. However, the symptoms of CDvary within individuals depending on the location and severity of the disease(Parkes, 2012).ConsideringCD is incurable, the treatments available are aimed at alleviating symptoms andminimizing complications (Cheifetz, 2014). For the management of the disease,restoring and maintaining good nutrition is essential (Fernandes et al., 2017).In addition, there are several medications that can be prescribed to patientswith CD such as antibiotics, corticosteroids, immunomodulators, biologicaltherapies and amino-salicylates however, as each persons CD symptom isdifferent depending on the severity, so does the pharmacological therapies andtreatments (De Mattos et al., 2015). Further analysis on how the biologicalconsequences and symptoms of Crohns disease affects Anne will be identifiedbelow.Researchhas identified a link between CD and genetics as epidemiological studiessuggest that at least one mutation of the NOD2/CARD15 intracellular proteingene and the IBD1 gene on 16q deletions is present in nearly 30-40% ofindividuals with CD (Klocker., 2016). This research, therefore, shows thatthere is a high probability of Anne having the gene, which therefore increasedher chance of being diagnosed with CD. Additionally, this condition is believedto be genetically inherited because having an affected relative is an importantrisk factor for the onset of CD (Parkes., 2012). Furthermore, Parkes (2012),insisted that an individual with the NOD2 gene has an increased risk ofdeveloping this condition however, there is no definite evidence that Anneinherited the gene from her mother. This is because her mothers history of IBDcould be Ulcerative colitis or any other IBD which according to the researchdoes not show a link of heredity. On the other hand, considering Anne and hermother both suffer from IBD, there is a possibility that the trait wasinherited however, there has been no convincing evidence to show that the traitalone can lead to the development and progression of the condition.Annesgender could also have influenced the cause of the disease as women are threetimes more likely to develop CD compared to men and this is possibly as aresult of hormonal factors (Mills et al., 2011). This is because specificcomplications in womens genitourinary tract, such as genital swelling canresult in the manifestation of this condition (Hauser, Plavsic and Stimac,2013). To support this study, De Lima et al (2015) explained in their researchthat over 40% of women will develop perianal manifestations before the other GIsymptoms develop. This research applies to Anne as she explained that she wouldusually experience rectal pain and incontinence whilst she was pregnant, howevershe assumed it was associated with her pregnancy. This, therefore, means thatthis could have been a symptom of the Crohns disease but because the symptomsof CD slowly develop, Anne might have thought it was not a cause for concern. Thereare several factors that can cause Annes psychological distress and this couldclearly lead to the progression and the detriment of the condition. Stress hasa detrimental effect on an individual and this could also increase anindividuals chance of developing CD (Goodhand and Rampton, 2008). Anne could not cope with the loss of herfather, more recently the loss of her relationship with her ex-husband and herchronic long-term condition that she drank to forget the pain and usedcigarette and the drinking as a coping mechanism to relax and cope better withthe stress she was feeling. Anne also showed signs of worry and concern for herchildren living with her ex-husband while she recovers from her surgery.Brunneret al (2014) puts out that bereavement or a relationship loss can triggerexcessive smoking and drinking and possibly lead to the dependence of bothsubstances. This research is relevant to Anne as the loss of her fatherinitially lead to her drinking and since then, she has become dependent on bothalcohol and smoking, and it has then become used as a coping mechanism for Anneto avoid her emotions. In the long run, this strategy is therefore likely tolead to more medical complications. However, in this situation, if Anne spoketo a psychologist, an approach coping style could have been used and this couldhave led to less or no alcohol dependence, less depression and a long-term goalof dealing with the psychological distress (Tamara., 2015). Accordingto Amato and Anthony (2014), a marital divorce is equivalent to the death of ahuman depending on the attachment. Annes divorce could possibly have led to anincreased level of depression as she is not only grieving the loss of therelationship and partnership, but also her own mortality as she explained thatshe is still getting used to the idea of having a chronic condition and hercontinuous remission. As a result of this, it can be argued that Anne may be indenial of her health issues and this could possibly be because she does not wantto be labelled and categorised in the sick role which was identified by TalcottParsons (Varul, 2010). Tobetter understand Annes grief, bereavement of relationship and denial of thecondition is the Elizabeth Kubler-Rosss research on five stages of grief. Thisis because grief can refer to emotional reactions to other losses such as lossof an individuals social status, loss of health due to disease as grief isknown to be individualized (Tamara., 2015). This theory explains that anindividual is able to go through stages while grieving and these stages includesdenial, anger, bargaining, depression and acceptance (Mahmood, 2016). Thistheory is very effective in identifying the stages an individual is likely toundergo whilst grieving, however it does not give a timeline as to how long anindividual can be in that specific grieving stage. It is important for nursesto understand the process of grief because without the understanding andsupport of the nurses and the multidisciplinary team (MDT) during the grievingprocess, the patient is likely to feel more alone, angry and isolated (Ghosh,2013). Research has also shown that when separation occurs, individuals mayfeel strong overpowering feelings of sadness and anxiety, rather than expressingtheir emotions, the emotion is usually concealed (Tamara, 2015). This researchis applicable to Anne because not expressing her feelings could havecontributed to her depression and possibly worsen it. Inaddition to this, it is understandable that Anne is not willing to becategorized in the sick role and she expressed feelings of not wanting to loseher independence, considering she has no family support due to her siblings andmother living abroad. Therefore, in this situation, it is important for nursesto educate Anne about her mindset and reassure her that she would not be losingher independence or adopt feelings of helplessness, but rather by adopting thesick role, she could be more involved with her condition by working alongsidethe health care professionals and making significant changes in her lifestyle choices(Baumgartand Sandborn, 2012). It is alsoimportant for the professionals to communicate effectively with Anne in a non-judgmentalmanner and make her feel comfortable (Mahmood, 2016). Furthermore, adopting thesick role could also lead to more health promotions, for instance, helping Annelimit or quit smoking and drinking, eating healthier foods and being involvedin exercise programmes which she can be referred to by the nurses (Flinkfeldt,2017). However, this intervention will require her working alongside the MDT tohelp Anne become healthier in terms of her diet and provide her with moreinformation regarding the effect that her unhealthy lifestyle choices has onher condition. Toprovide adequate individualised nursing care to Anne, Neumans system model isconsidered to be relevant to the psychological issues relating to hercondition. This model focuses on the issues of stress and its relationship withpatients in care (Barrett et al, 2009).Additionally, the model insisted that most of thepatients human factors are surrounded by some dense mechanism, which are theseveral lines of resistance, normal lines of defence and the flexible lines ofdefence (Gonzalo, 2011). This model can be applied bythe nurses informing Anne of the importance of taking her antidepressantmedications and other drugs to maintain remission of CD. Also, educate her aboutthe effects of stress and depression, whilst preparing for her surgery. Archeret al (2012) study explained that during surgery, stress and depression can detrimentallyaffect patients quality of life resulting in a poor patients outcome.This research definitely applies to Anne as she believes that her unhealthylifestyle does not have anything to do with the prognosis of her condition,rather it is the appropriate method of managing the stress associated with CD.This is because individuals who live unhealthy lifestyles most times believethat it reduces their level of stress (Flitz, Kaufman and Moore, 2013). Therefore, as a result of this, it isimportant for nurses to identify Anne as an individual and analyse the healthbeliefs and health behaviour specific to her. Thereare several social factors including income, socialisation, lifestyle choicesand housing that affects Anne and the management of her disease. Smoking cigarette is regarded as alifestyle choice which have detrimentaleffects on the human body as it contains over 300 harmful chemicalsincluding carbon monoxide, nitrosamines and nicotine (Flitz, Kaufman and Moore,2013). Anne smoked ten cigarettes a day and was aware of the complication thatsmoking could have on her health. These substances and Annes reluctance toquit smoking will have a harmful effect on her condition and her recoveryfollowing the surgery (Hanauer, 2008., Panes et al., 2014). This is becausethere is a direct correlation between smoking and CD as smoking has been knownto aggravate CD and this could, in the long run,worsen her health and cause further cardiovascular complications such aschronic obstructive pulmonary disease (COPD) (Parkes, 2012). However, Annesreluctance to give up smoking may be a result of the fact that she has usedsmoking as a coping mechanism with the loss of her father at a younger age andafter finalising her divorce (Kaser and Blumberg, 2014). On the other hand, herreluctance of quitting smoking could also be a result of her socialisation. Individualssocial group and support system have the ability to influence ones healthawareness and health belief (Flitz, Kaufman and Moore, 2013). However,considering the fact that her family lives abroad and she does not have a lotof friends to socialise with, due to her hectic schedule of managing thechildren alone, therefore her smoking lifestyle may be her personal choice. Millset al (2011) study showed that CD could cause significant disability as 75% ofthe patients are capable of working within the year of diagnosis and 15% of thepatients are not able to work after 5 to 10 years of the diagnosis. Annesexperience is contrary to this research as she has been able to continueworking full time for at least four years after her diagnosis. However,changing her working pattern from full time to part time will affect herfinances tremendously as she would not be able to conveniently fend for herselfand her childrens financial and material needs without the help of herex-husband. Individuals from low socioeconomic status groups have feweropportunities to undergo regular preventive medical checkups and screening(Pampel, Krueger and Denney, 2010). In addition to this, the research alsoidentifies an inability for individuals from a low socioeconomic group such asAnne to buy fresh fruits and vegetables or lean meats, joining gyms forexercise and pay for counselling. This research is relevant to Anne because herlow-income rate does not provide her with enough to live a healthy life as Anneexplained that she is only able to afford food items high in carbohydrate andfat which is not identified as an appropriate diet for her condition. As aresult of Annes situation, it is important that the MDT provide her withrelevant information regarding the care of her children or rather refer her tothe social worker who would be better equipped to provide support for hercircumstance. Inconclusion, the term health and well-being is described as the absence ofdiseases, mental distress and physical illness. The idea of health and well-being differ between peoples life stages,various cultures and changes over time. The biopsychosocial model of health andwell-being was used to explore Annes perception of her overall physical,social and psychological well-being. CD affects any part of thegastrointestinal tract ranging from the mouth to the anus with symptoms rangingfrom abdominal pain, diarrhoea and weightloss. It was vital to emphasis on how anindividuals gender, age, genetics, emotion and economic status could havecontributed to the development and progression of her condition. Thebiopsychosocial model of health and well-being has proven to be effective inidentifying Annes holistic care needs and providing individualized and person centred care to the individual. Varioustheories and emphasis on the nursing role wasapplied to relate the holistic nursing approach tothe patient.ReferencesAmato, P. and Anthony, C. (2014) Estimating the Effects of Parental Divorce and Death with Fixed Effects Models, Journal of Marriage and Family, 76(2), pp.370-386.Anaya, J., Rojas-Villarraga, A. and García-Carrasco, M. 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