‘Biology is the study of life and living things (organisms), and is an enormous, rapidly developing subject involving many allied disciplines such as chemistry, physics, mathematics, geology and psychology’ (Roberts et al, 2000, p.1).
‘Psychology is a science in which behavioural and other evidence (including individuals’ reports of their thoughts and feelings) is used to understand the internal processes leading people (and members of other species) to behave as they do’ (Eysenk, 2009, p.36).
‘Sociology provides a critical and systematic understanding of the processes which structures the society in which we live’ (University of Surrey 2009).
The above quotations shortly define biology, psychology and sociology as three individual topics, which will be discussed throughout the whole assignment in order to gain an understanding of the relation of their individual influences to the outcome of my chosen patient’s current health status, a cerebrovascular accident (stroke). Rana and Upton (2009) were the first to research these three factors individually, relating them to poor health and well-being. Roberts’ (2000) definition above describes the certain issues explored within biology today; however, psychological and sociological issues can influence the biological status of the human body. Despite sociology influencing ones behaviour, it is also based around the effect it has upon groups and external events. Sociology does not only target the individual involved, but the way the individual relates and interacts with their social surroundings. Sociologists explore interactions within relationships, social class, gender, race and family life.
Through an experience of nursing a patient during a six week clinical work placement who had suffered a cerebrovascular accident, this assignment will aim to critically evaluate the bio-psychosocial perspectives and the influences they each have on the health and well-being of my chosen patient, distinguishing the actions undertaken during and within the patient’s lifestyle and how these have had a negative impact on their health and wellbeing. I will define the meaning of health and proceed to demonstrate my knowledge on both the biomedical and the bio-psychosocial models approach in order to recognise how care for one’s health and social well-being is delivered specifically to the individual. My focus will not only be addressed on the patient’s biological and current health status, but also the psychological and sociological factors leading to the health outcome. The psychological and sociological factors are important in establishing the patient’s biological result and outcome as many of the factors increase the chance of suffering a cerebrovascular accident, which will be discussed further within the assignment. A conclusion will be completed at the end of the assignment, established around the findings throughout. A patient profile will also be included in order to deliver and present a brief understanding of my chosen patients bio-psychosocial influences participated in developing the current health outcome.
The patients name will be changed within the assignment and I shall not disclose any information which may reveal the identity of any other individuals or places discussed, as the Nursing and Midwifery Council Code of Professional Conduct (2008) states that you must respect people’s right to confidentiality. Therefore I shall name my patient Eric.
Numerous individuals pay little consideration to their own health and well-being until they themselves become a patient in hospital due to their physical/biological health status becoming an issue. The World Health Organization (2006) defines health as being a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. Not only does this definition imply that one’s health and well-being consists of being biologically healthy but it also includes the social humanistic perspective through recognising the mental and social well-being of an individual. Although the definition implies all biological, psychological and sociological aspects its target is the word ‘disease’ which is the centre of the biomedical model.
Two models focused upon in regard to this assignment are the biomedical and bio-psychosocial models. The biomedical model has often been discussed, and in some cases discussing what is approached and the sets of beliefs within the model. Elliott (2009) states how the biomedical model, historically, has approached health and social care from a physical/physiological perspective, but has failed to account for any psychological and/or social aspects. Wade and Halligan (2004) also recognise that the biomedical models approach believes disease is solely based on the breakdown of biological mechanisms within the body, due to factors such as age and genetics etc. and that the approach shows no consideration towards any psychological and sociological aspects which may inflict the health and well-being of a patient. Chapman (1985) believes that diagnostic labelling and considering an individual to be seen from their biological state only, for example a patient victim of a stroke dehumanises the individual and therefore criticises the biomedical model approach for this very reason. This definite diagnostic labelling may create distress within the nursing environment according to Armstrong (2005) as a patient may rely on this label they have been given to explain their illness/disease which may cause a detachment between the health care professionals and their patients, as the patient is unknown holistically. It is apparent that there is no clear evidence to suggest and prove that the approach of a patient considering their well-being biologically only (as included in the biomedical model) and the related sets of beliefs provide a positive effect on the patients health outcome and the care provided.
A number of models have been produced and further modified during the past years, as Engel (1977) an American psychiatrist had effectively done. He believed that lifestyles can have major impacts on one’s health and therefore there was a need for a development upon the biomedical model, in order to include all dimensions of ill health and disease of which include the biological, psychological and sociological factors, as ones illness/disease cannot be treated with the consideration to their biological factors only. Thus Engel (1977) combined psychological and sociological factors with the biological factors of the biomedical model, creating the biopsychosocial approach/model. Sarafino and Smith (2012) recognise that when a person is added to the biomedical model, the picture becomes much broader of how ones health and illness have come about. This is known as the bio-psychosocial model. By including all three aspects of health and not only the biological aspect alone within the healthcare profession, Engel (1977) concluded that studying and exercising holistic care would be of benefit as this would provide patients with a higher quality of care and increase healthcare professionals knowledge of the biological, psychological and sociological issues of health. Santrock (2007) distinguished that the psychological elements within the biopsychosocial model involve identifying any possible causes for the particular disease diagnosed. Psychological components may include those aspects such as lack of self-control, emotional turmoil and negative thinking. Sociological components may be indentified through recognising how different social factors may influence ones health; this can include the individual’s culture, religion, social background and/or socioeconomic status. Engel (1977) considered that the holistic care qualities are required and are in need of being continued to be taught and practiced by health care professionals in order to deliver high standard effective care, and not only the physiological diagnostic skills. The Nursing and Midwifery Council (2008) state that it is an essential requirement for nurses to keep their knowledge and skills up to date. Although models are used everyday within nursing, some individuals today still debate whether models are useful or have their limitations. The Public Health Agency (2009) simply suggests that models provide a plan for investigating and/or addressing a phenomenon, as does The Royal College of Nursing (2012) agree by stating that models enable nurses to engage with their patients through a culturally sensitive manner. Although some may criticise nursing models as Miller (1984) does so by stating ‘models were idealised, lacked relevance to the reality of nursing practice and, as such, increased the gap between theory and practice’. However it must be noted that models are still used by a wide range of different healthcare professionals today, to allow for the assistance and direction of a delivery of high quality care to their patients.
In order to develop an insight into not only the biological status but also the psychological and social aspects of my chosen patient, for Eric, a fifty-nine year old gentleman, I have established a patient profile. Eric’s wife passed away after being involved in a road traffic accident six years ago and he has since continued to live alone in the small town in the bungalow they shared. Eric and his wife had a daughter, who is currently living in New Zealand with her husband and two children. Although Eric spoke to his daughter and grandchildren often, he had not had any family support other than his wife. His mother and father divorced during Eric’s’ early adolescence years as a teenager and did not ever meet with his mother again after this family event. His father passed away when he was in his early seventies from a stroke. Eric worked as a self employed electrician however gave up his business as he considered it to be a highly difficult and stressful task of running a business with the workload after having to cope with the loss of his wife. Eric stated that he smoked fifteen cigarettes a day and has done since the age of twenty one. Visiting the local pub for a ‘few’ pints of beer became a frequent event for Eric as he stated that he enjoyed to socialise with his close friends here. It was very rare that Eric would cook healthy, nutritious meals for himself as he described how he did not enjoy eating alone and it was much easier for him to collect something to eat on the way from the pub from the local fast-food or takeaway stores. However, one evening when meeting with a close friend at the local pub, Eric began to lose the physical movement in the left side of his body; he had difficulty with his speech, before then becoming unconscious. Eric was admitted to hospital by ambulance following the loss in the left side of his body, the difficulty with his speech and this episode of unconsciousness. Eric was diagnosed with a cerebrovascular accident (more commonly known as a stroke) in which further significant diagnostic tests were carried out to reveal a diagnosis of the type of stroke, ischaemic.
Elton and Valentene (2003) define a cerebrovascular accident (CVA) as occurring when the blood supply to part of the brain is interrupted, resulting in damage and/or death to a certain area of the brain. Facts and figures are presented by The Stroke Association (2012) who recognises that there are an estimated 150,000 people who have a stroke each year within the UK. Stroke is the third most common cause of death within both England and Wales, after heart disease and cancer which the World Health Organisation (2008) predicts will still be the case in 2030, accounting for 12.1% of all deaths.
Following Eric’s admission it was clear there were a number of risk factors within his current lifestyle known to be associated with a stroke. Risk factors are categorised into two key sections by Kennedy (1999), showing why individuals become victims of a stroke (see appendix one). Of Eric’s risk factors recognised which included cigarette smoking, alcohol consumption, improper diet and positive family history of a stroke, three of the factors are categorised as modifiable and can therefore be adjusted or withdrawn from his current lifestyle. Phillippe and Whittaker (2004) discovered that if people had control over these modifiable risk factors, as Eric may have over his smoking, improper diet and alcohol intake, there would be a probability of reducing the prevalence of a stroke by as high as 80%. The above findings therefore reveal that numerous components of an individual’s life can have major impacts on the outcome of people’s current or future health status. Eric’s father was also victim of a stroke, however this risk factor is non-modifiable and it is not possible to change or withdraw this from Eric’s life.
Strokes can occur in a wide range of severities within individuals who become victims of this condition, depending on the type of cerebrovascular accident suffered. Although Eric was diagnosed with a cerebrovascular accident the type of stroke was diagnosed specifically as an ischaemic stroke. The Department of Health (2007) report that ischaemic strokes are the most common type of stroke and occur when a narrowing or blockage in a blood vessel is present, caused by a clot; this restrains blood from reaching the brain. The reduced blood flow will then cause brain cells in the affected area to die due to a lack of oxygen. This generally happens within a localised area of the brain. Richards et al (2007) refer to the brain as the nerve centre within the body, controlling everything we do physically, and everything we think about psychologically, including those functions (such as breathing and digesting etc.) which we do automatically. The brain demands 20% of the body’s oxygen supply according to Allan (2006), despite being only 2% of the total body weight. Nutrients are also required as a constant supply, as the brain is a highly active organ. A stable blood flow of approximately seven-hundred and fifty millilitres every minute is transported to the brain; however, if this blood flow (transporting nutrients) to the brain is for any reason incapable of reaching the precise nerve tissues, this can result in a loss of physiological function or in some circumstances, death.
Eric suffered with long term stress due to having to and still trying to cope with the loss of his wife and then having to give up his own business. A study conducted by Surtees et al (2007) set out to determine whether people who are unable to cope well with stressful life events are at a higher risk of a stroke than those who are able to cope and adapt well after having to experience a stressful life event/s. The study ran for seven years and more than 20,000 participants were involved. All together 452 strokes were recorded and 100,000 stressful life events. Results concluded, shown that there was a 24% lower risk amongst those able to adapt well with stressful events than those who were not. The findings suggested that there are more questions which need to be answered through further research; however this particular study has shown that the possibility of improving the ability to adapt well to stressful events can be beneficial for vascular health. Thus these findings show that in Eric’s case if he had been able to adapt to the stressful life events of the loss of his wife and having to give up his own business he would be at a lower risk of suffering a stroke. According to Smith (2010) short term stress is believed to be good for health, however long term stress can cause damage to the lining of the blood vessels. Cholesterol levels and blood pressure can be raised when long term high stress levels are present which are known to be harmful to the heart. Smith et al (2003) express how a continued existence of stress can possibly deplete the body’s resources, thus making it vulnerable to a number of health conditions/illnesses, as individuals may venture to adapt to the current situation. As it has become apparent in Eric’s case, cigarettes and alcohol, for example, can be two addictive substances for those people who are stressed and will begin to use or increase the use of, in order to try and cope with their present or past stressful life events. A study was undertaken by The Royal College of Physicians (2000) to gather knowledge and become of aware of any benefits smoking has on individual’s psychology. A number of British adult smokers (n=500) were involved in the study and each individual delivered their own opinion based on their personal views of the likelihood of them being able to relax and feel more positively about themselves. 77% of the participants felt that they would be able to relax if they continued to smoke, with a small quantity of 8% considering that they would not feel relax by continuing to smoke. 40% of the participants admitted they would be able to relax if they stopped smoking cigarettes and 38% considered that it would be unlikely they would feel relax if they stopped smoking cigarettes completely. With the above evidence Eric can be in relation to this study, as he has continued to smoke after the stress he has had to cope with, and would agree with the 38% of participants that he would not be able to relax if he stopped smoking cigarettes. Thus as a result, demonstrating that smoking cigarettes accommodated Eric to feel more relaxed. The feeling of being relaxed is psychological, and in opposition, cigarettes increase the blood pressure according to Davison (2009) and therefore do not relax the body physically.
Eric had continued to smoke due to the stress with having to cope with the loss of his wife a number of years ago, however it became apparent that Eric had smoked since he was the age of twenty-one and his father was a heavy smoker. Hankey (2005) confirms that cigarette smoking or even passive smoking is a casual risk factor, increasing the chances of suffering a stroke, which Smith (1998) implies heavy smokers of 20 or more cigarettes a day, have a 2-4 times greater risk of a stroke than a non-smoker. As Eric was a smoker of fifteen cigarettes per day, this was one clear risk factor identified for him. Smokers are at double the risk of having an ischaemic stroke according to Lawrence et al (2011) and heavy smokers are twice as much at risk than light smokers (less than ten a day). Bull (2009) clarify that carbon monoxide (one of the four-thousand chemicals within cigarette smoking) in tobacco smoking enters the blood through the lungs, generating a negative effect on the heart. Carbon monoxide attaches itself, much easier to haemoglobin (oxygen-carrying pigment within red blood cells), than oxygen is able to according to ASH (2011), this will have a reduction on the amount of oxygen available to the tissues within the body. Cooke (2001) recognises that as nicotine (an addictive chemical) is released from cigarette smoke; adrenaline is dispensed, which results in a release of stored fats into the blood stream. These stored fats (released by the nicotine) will stick to the walls of any blood vessels which have already, previously been damaged by carbon monoxide. Smokers are therefore at a higher risk of developing a type of atherosclerotic disease, which develops when coronary arteries become narrowed through a gradual build up of the fatty material within their walls. As this process progresses, it becomes difficult for blood to flow through these narrow arteries and the blood is much more likely to form a thrombosis (clot). A blockage as such may then lead to a heart attack or stroke. Although Eric recognised he was a heavy smoker, he continued to do so as he was unable to recognise the impact smoking was causing on his health and as Percival and McEwan (2012) report, smoking cigarettes is highly addictive.
Marsh et al (2009) state that sociology studies involving the where about of our ideas surrounding the actions we take (in Eric’s case smoking) come from and that throughout our lives these social actions/processes affect our health. ‘Smoking usually starts during the teenage years, and psychosocial factors provide the primary forces that lead adolescents to begin. Several aspects of the social environment are influential in shaping teenagers’ attitudes, beliefs and intentions about smoking’ (Sarafino, 2002, p.205). Cancer research (2012) recognised that parents act as role models for their children and if parents smoke, as Eric’s father did, their children are three times more likely to smoke themselves. Some people continue to smoke after they first try a cigarette for a number of reasons, as research has found. Chassin et al (1991) conducted a study to examine the role of psychosocial factors within the development of smoking, in order to underpin whether teenagers’ social environments and their individual beliefs surrounding smoking were in relation to changes within their smoking behaviour. Thousands of adolescents answered the questionnaires produced over two separate different years. Smoking was found to be higher amongst those who had at least one parent who smoked, those who held positive attitudes about smoking such as ‘smoking is enjoyable’ and those who did not believe smoking harms own health and well-being. Relevant to Eric, his father was a heavy smoker, he found smoking helped him to relax and deal with stressful situations and he was unable to recognise how smoking was causing an impact on his health.
Gross (2010) found that the psychological sector of the biopsychosocial model explores a number of behaviour types, including mental and cognitive processes. Eric’s individual personality, motivation, emotions and perception can be considered at this stage of the model; however these are only a small quantity of the individualised topics associated within psychology today which influence our behaviours. One psychological model focusing on the different attitudes and beliefs people as individuals obtain is known as the health belief model, which can be used to explore Eric’s personal attitudes and beliefs for smoking cigarettes and drinking alcohol and examine the actual and/or potential reasons as to why he has continued to do so. This models purpose is to explain and predict health behaviours, which acts as a framework to guide health behaviour interventions. It was first established during the 1950’s by Hochbaum, Rosenstock and Kegels, a group of public health, social psychologists. Ogden (2007) state that the model was initially developed to predict patients (of acutely and/or chronic illnesses) behavioural responses to the treatment they were receiving, however in more recent years, the model itself has been used in order to predict much more general health behaviours. Rosenstock et al (1988) acknowledge that the health belief model does suggest that both ones belief in a personal threat and your belief in the effectiveness of the proposed behaviour will predict the likelihood of that certain behaviour. The motivation people acquire to undertake health behaviour can be categorized into three within the health belief model as described by the National Institute for Health and Clinical Excellence (2007). The first category is the individual perceptions. Individual perceptions involve such factors in which affect the perception of the illness/disease, alongside perceived susceptibility (the person’s assessment of the risk of him/her developing the illness) and perceived severity (the person’s assessment of how serious the illness is and the potential consequences). Eric did not acknowledge that his choice of lifestyle would result in suffering a stroke, therefore becomes evident as to why he did not change his actions within the lifestyle he led. The second category is modifying factors of which involves demographic valuables (ones age, gender, ethnicity etc), perceived threat, thus the current danger is imposed as recommended health actions were not undertaken. Cues to action are also involved within the modifying factors, which is the promoting of desired behaviours due to external influences such as information provided by someone whom may seem powerful, communications of persuasive nature and any past or current personal experiences. If Eric had become aware (which he had not) that he was at a risk of a life threatening illness, due to his actions (smoking, consuming large quantities of alcohol) or if he was cued to action, surrounding the risks to his health, it would be possible and much more likely for him to reduce or withdraw his cigarettes and alcohol in order to enhance his risks. The third category is the likelihood of action which entails the probability of health actions being carried out. Thus, if Eric thought changing any of his health behaviours would be of any inconvenience to him, cause him high expense or even pain, then it would be very unlikely he would want to change his current lifestyle. The health belief model allows us to understand the reasons as to why individuals take the decisions they do to begin or continue their lifestyle health behaviours in such ways; however the model has its certain limitations as it neglects and does not incorporate the social elements included within life.
One theory which incorporates both the psychological elements and the sociological elements of an individual’s life are brought together and are included within the theory of reasoned action, and are both seen together as an equal value. This theory was developed further by Fishbein and Ajzen (1980) who state that the theory of reasoned action indicates that individual’s behaviours are determined by the person’s intention to perform in that certain behaviour and the intention is the function of their attitude leading towards that behaviour and the subjective norm. The former and previous research began merely as a theory of attitude alone, which then led to the study of both attitude and behaviour together. Miller (2005) recognises that there are three components within the theory of reasoned action which include: attitudes, subjective norms and behavioural intention. The ‘attitude’ component is ones beliefs surrounding a certain behaviour which is weighed by evaluations of these beliefs. In Eric’s case this would suggest that if he did have a positive attitude towards his health and wellbeing as a whole, which he did not, he may be more likely then to change his current actions (smoking and drinking large quantities of alcohol) which would transverse him to live a much healthier lifestyle. The second component ‘subjective norms’ looks at peoples influences on an individual’s behaviour, in this case, at the influence the people surrounding Eric and who he has social contact with. It is these people who have an effect on Eric’s motivation to change his health behaviour. Thus Eric may have just one or a number of friends who believe drinking alcohol at a moderate or high level will not harm your health and encourage you to do so too, however, another friend may believe that alcohol has a detrimental effect on your health, no matter how much you drink. All these different beliefs may be weighed up by the individual, Eric, and will influence his intention to drink alcohol on a regular basis or not. It is clear that Eric drank with close friends for a number of years, drinking alcohol on a regular basis after he finished work, consuming a high level of alcoholic beverages each day. Eric would sometimes try to avoid travelling past his local pub to reach his home; however as it was a small town he would usually see a friend walk past who would encourage and tempt Eric to go to the pub with them, as recognised above as a subjective norm. The final component Miller mentions is the ‘behavioural intention’. This is both the attitude of the individual and the subjective norms combined, which has been seen to lead to the individual’s certain behaviour. For Eric, whether he did have a positive attitude towards drinking alcohol or if he had a negative attitude and not do so, would either lead him to the intention to do so or not, furthermore leading to his actual behaviour and his actions chosen to undertake.
As Eric went to the pub daily his intake of alcohol was moderately high. Lifestyle statistics (2011) reported that in 2009 it was recognised that 10% of men drank alcohol on a daily basis. The Department of Health (2011) recommend that men should not drink and consume more than three to four units of alcohol a day and women should not exceed more than two to three units a day. Consuming more than eight units a day would then be classed as ‘heavy’ or more commonly known today as ‘binge’ drinking. As Eric was consuming three to five pints of beer each day after work, he exceeded the recommended daily allowance as one pint of standard beer includes around 2.3 units of alcohol. In total Eric was drinking approximately 6.9 units a day. However, weekends Eric was drinking throughout the day and would therefore consume more than triple the recommended daily allowance, recognised as stated above as ‘binge’ drinking. Although there is no evidence to suggest alcohol intake causes better health, Levenson (1986) suggests that the greatest benefit, if any, may be in reducing coronary heart disease and stroke. Drinking may not protect individuals from cardiovascular disease as a whole however there is evidence to suggest two possibilities. Firstly Levenson (1986) found that alcohol affects the body’s response to stress, resulting in a reduction in cardiovascular reactions. The second part of evidence then found by Stein (1999) stated that substances within alcoholic drinks, and wine in particularly, can improve blood cholesterol levels. This is very little evidence to determine whether there are any positive effects of alcohol physically on the human body, and to recommend even a moderate use will not be suitable. Blood alcohol information (2012) describes the negative physiological effects alcohol has on the human body and how alcohol enters the body and into our blood stream. It is said that when alcohol reaches the stomach within our body, 20% of the alcohol is absorbed into the blood stream, through the small blood vessels. The outstanding 80% of alcohol continues to travel down to the small intestine where it is absorbed into the blood stream there. Travelling through the blood stream, the alcohol is metabolized by the liver, and then broken down by enzymes. On average, the liver is able to metabolize one drink every one hour (for example one bottle of beer or one glass of wine), any further amounts of alcohol consumed are unable to be processed by the liver at that time. The blood in this case will become saturated and the excess alcohol will proceed to travel to the body tissues and blood stream prior to eventually being able to be processed by the liver. Alcohol can harm the body when drank in large quantities, although a number of these effects on the body can be reversed when alcohol consumption is controlled, many effects remain permanent. Conditions within the blood, as a result of large alcohol consumption, can include types of anaemia or in some cases blood clotting abnormalities, causing further complications such as a stroke.
Sociology is a scientific study of society according to Ashley and Orenstein (2005), which allows us to understand human social activity. This dimension of the biopsychosocial model does not only apply its’ attention on the individual alone, but also the values and interactions the individual has with his/her social surroundings, which are greatly taking into consideration here. Social surroundings may include key areas such as social groups, family, relationships and religion, of which sociologists are always continuing to explore and investigate. Eric mentioned he had easy access to the local pub and described that he would spend every evening after work, including all day during the weekend there. Although Eric recognised himself that he did drink too much alcohol, he was however cautious that if he did not attend his frequent visits to the pub to socialize with his friends he would not have much else to do in his spare time, besides being alone at home. According to McCarty (1985) during adulthood, alcohol drinkers’ drink frequently and always socially with friends, and the social aspect is important in two ways. The first aspect in social drinking and the modelling processes affect individuals’ behaviour, for example adjusting their drinking rates to match the rates their companions drink. This is evident as The Nursing Times (2009) explains how social drinking can direct the individual (with in time) to increase the amount he/she drinks. However, this will furthermore increase the chances of the individual becoming dependent on alcohol, which an estimated one in thirteen people within the UK are dependent on alcohol today, putting their health at risk. The second aspect recognised by McCarty (1985) is that social drinking creates a subjective norm in individuals believing that their behaviour is appropriate. Subjective norms can therefore (in some cases) have an influence on people’s alcohol intake. Sociologists describe these norms as laws which govern the behavior of the societies in which we live. These norms can be enforced by social groups of which include friends, family or the society as a whole. Hewstone et al (2008) state that when we adhere to social norms already established, we consider our behaviour to be appropriate, correct and socially desirable and according to Posner (2000) if individuals do not follow these norms, he/she may be labelled as a ‘deviant’ which may then lead to being left out of that certain social group. Although Eric had his friends he met with regularly at the pub, he did not have any good social support from his wife anymore and from his daughter as she and her family lived in New Zealand. The World Health Organisation (2003) describe that good social support and social relations such as friends and marriage can have a positive contribution to our health, as this can deliver the emotional and necessary resources we need, reducing the negative stress we may encounter. It may not be evident that marriage alone protects individuals from bad health; however Eric became stressed and increased his intake of alcohol after the death of his wife. Martin (2004) found that it is apparent and recognised amongst divorced and widowed men (such as Eric) that as a result of being alone and suffering from high levels of stress that this leads to the increase in the consumption of alcohol. Cockcroft (2007) also found similar results to Martin (2004) and report that research surrounding bereavement shows how the bereaved are much more likely to suffer from a number of medical problems. Medical problems such as depression or anxiety etc. can usually be associated with the increased use of alcohol and stress due to the loss of their close friend/family member of who would have been of support throughout their health and well-being.
Through examination of both the individuals’ psychological and sociological beliefs with the use of a model such as the biopsychosocial model, this enables nurses to gain a holistic understanding of the individuals’ way of life, including how the patient copes and adapts to those situations affecting them. When delivering care, nurses must understand the patient as a whole by recognising the patients’ beliefs and psychological thoughts as these can be linked to parts of their individual social life.
There is a great need for more public education including the promotion of health in general, as The Department of Health (2007) identified, there is a thorough need to improve public awareness of stroke specifically as Yoon (2001) recognised that the symptoms are stroke are known however the psychological and sociological causes are not yet found. This need is also identified by Mooney (2012) who states that as people are now living longer and that obesity and sedentary lifestyles are increasing, there is a definite need to identify those at-risk individuals in order to prevent or delay severe health events. If people considered their psychological and sociological beliefs and actions, this can be of benefit and possibly help to prevent a stroke or other illnesses occurring, rather than depending on the medical cures undertaken following the development of the illness already.

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APPENDIX ONE
Kennedy (1999) Stroke risk factors.

Kennedy, T, L. 1999. Stroke: Putting Assessment and Primary Prevention Strategies into Practice. The Internet Journal of Advanced Nursing Practice. 2(2), 1523-6064. http://www.ispub.com/journal/the-internet-journal-of-advanced-nursing-practice/volume-2-number-2/stroke-putting-assessment-and-primary-prevention-strategies-into-practice.html accessed 13/6/2012