Running head: APPLYING POSITIVE PSYCHOLOGY IN NURSING PRACTICE

Enhancing Patient Well Being: Applying Positive Psychology in Nursing Practice

Shahid Hussain

GN #10038

HU: 322 Behavioral Psychology

Ms. Hadia Pasha

Aga khan University School of Nursing and Midwifery

May 2nd, 2013

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The new emerging field in the psychology is positive psychology, which plays vital role

in every aspect of life. In the health care system it emphasizes on the evidence based practice

which directly relates to the positive outcomes of patients, families and communities. According

to Luthans, (2003) many years ago psychology is not only used for the mental illness, but it was

also helpful to nurture the people in a positive way and identify the God gifted talent which was

the humanistic approach. The realistic steps were led by Slegiman and other research oriented

group in the field of positive psychology recently in 2000. According to their research the

positive psychology is not only divert oneself from negative aspect of people but also the way to

overcome the negative aspect of people, it deals with the positive aspect of the people which

directly or indirectly overcomes weakness of concern group, for example the basic concern

positive psychology is resilience which overcomes vulnerability, and develop wellness which

overcomes pathology and other suffering. The reasons for selecting this topic for scholarly paper

are to define role and responsibilities of nurses in the health setting, apply the learning concepts

of positive psychology in the clinical setting, and evaluate the positive attitude of nurses which

enhance patient wellbeing. Most important reason is possible ways to overcome the stress in

nursing field through the positive psychology, which enhance working efficacy of nurses and

developed wellness in patients.

In the health care system all the gold standards are well defined by the World Health

Organization. The World Health Organization (WHO) declares that health is “A state of

complete physical, mental and social wellbeing and not merely the absence of disease or

infirmity” (WHO, 2004). In the light of above definition wellbeing of patient depends on three

major variables i.e. personal esteem, external environment and health care providers. The

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personal esteem stands for the subjective feeling of the patient, i.e. how patient perceive the

crisis or disease process and surrounding. The second important variable which plays a vital role

in health of the patient is the environment of the patient; environment includes various

components for example social circle, support groups and family members. The third and most

important variable of patient wellbeing is health care providers, like nurses play major role in

enhancing patient wellness in various dimensions.

The subjective feeling of the human being depends on the recurrent phenomena, the way

of the extracting these phenomena, integration of these phenomena and response of human

being. French, et al. (2001) explained in a study that when a person feels good about the incident

its outcomes will be good. The internal feelings reflect goals of human being and esteem to

achieve his objectives. It is my clinical experiences that the patients of positive attitude undergo

major surgeries recover faster as compared to the depressive patients. According to Seligman

(2008) the sense of wellbeing, absence of bothersome thought, internal satisfaction, to be

optimistic about future, and positive emotion are key factors which define the subjective attitude

of patient in positive psychology towards disease process. Above mentioned factors overcome

deteriorating factors like sense of positive physical wellbeing enhances patient’s confidence to

maintain his health. The confidence and vigor are basic needs and fight against the weakness and

low esteem of patient in disease progression. Likewise other factor absence of bothersome

thoughts overcomes anxiety and depression which are the common issues in every patient. In

addition to physical and psychological health positive subjective feelings of patient enhance

physiological health as well. It is common observation that subjectively happy patients maintain

normal physiological state. According to Holger & Hege (2004) stress is the adaptive response of

the human being against the stimuli in the environment. With reference of the activation and

APPLYING POSITIVE PSYCHOLOGY IN NURSING PRACTICE 4

arousal theory they added a patient with the positive subjective feelings more easily can defense

the change. Addition to literature in clinical it has been my experience that stroke patients with

the positive psychic recover earlier as compare to the patient with low esteem and low resilience.

The low self-esteem and low resilience make patient more vulnerable and long hospital stay.

Ann Kristin, R., Shirley, M. M., May Solveig, F., & Cornelia , M. R. (2010) explained the

subjective feeling of patient with the health recovery model. In health recovery model subjective

feeling are assumed as internal health assets of the patient; which includes good mood, optimism,

positive thinking and goal directedness. The powerful internal health assets enhance patient

wellbeing. In short the positive feelings of the patient combat all the negative factors which

distort the patient’s health. Being Nurse it is our prime responsibility to educate the patient about

the importance positive subjective feelings in recovery of disease.

The environment is second important variable in the health recovery of the patient and

wellbeing of patient. Cochrane, (2006) explained that environment includes various components

in it, for example physical elements, social support, social identity of patient, coping resources

and health care providers. The physical elements which enhance the patient wellbeing are water,

food and air. In the perspective of the positive psychology it is necessary to provide patient with

save water, air and food. The poor sanitation of above elements has hazardous effects on health

of common man and patient as well. The domain of the physical element is not only limited to

above mention three elements it also includes physical environment. Murphey, D.A., Lamonda,

K.H., Carney, J.K., Duncan, P., (2004) considered the physical activities like regular exercise

and physical fitness as the component of physical environment. It is my experience in the

hospital setting physical ventilation and sanitation are maintained religiously. Moreover in

psychiatric unit physical environment is maintained according to need of patient wellbeing. The

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society plays dynamic role in patient wellbeing. Haslam, S. A., Jetten, J., Postmes, T., & Haslam,

C. (2009) in study explain human as the social being, every human being makes his identity in

the society, which implies role and responsibilities. The social practices and religious practice

also determine the social identity. From Pakistani context fundamentalist in Pakistan have health

risk behavior. They avoid the polio vaccine; according to Aziz (2012) six polio workers were

killed in Karachi. The health recovery model considers social practice, value, belief and

experience as antecedent. The role of the positive psychology in such areas is very clear, where

counseling of the religious scholar and collaboration with stake holder is prime need. The coping

resources for example family members and support group also play vital role in the maintenance

and building of the resilience, positive emotion and acceptance of social reality. When I firstly

visited the psychiatric ward it was new to know that patients gather at occupation therapy room,

game room, play area and dining area. The outcomes of such planned activities are very effective

to all patients. Patient gatherings with each other increases hope, courage, happiness and

resilience in the patients. According to Junghyun Kim, J. K., Jeong Yeob Han, J. H., & David

Gustafson, D. G (2010) explained in one of his study that the more social support to the patient

enhances the patient emotional wellbeing. It has been found that there is indirect relation

between the social support and emotional wellbeing of patient. In certain situations we usually

observe patient self-blame due to lack of social support. Sometime it leads to major depression

(MD) and suicidal attempts as well. The application of positive psychology is to involve patient

in mini activities such drawing, painting, playing various games, and reading books increase the

self-esteem of patient. Patients feel that he is part of society and their contribution in mini

activities increases sense of responsibility. The role of support group is very important in

reframing of self-blame of patient into positive emotion and sharing of different skills to cope up

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with the situations. One of the best examples is Parkinson support group recently initiated by

AKUH and medical associations Karachi. The support group conduct seminar in Karachi. In the

seminars they inculcate new skills to cope up with Parkinson disease which physically empower

patients. In short, role of the support group is very important in the enhancement of patient

wellbeing. The second important coping resource is family members who are always with the

patient. For the better outcome of the patient’s health family members sacrifice their time and

money. Every member of the patient wants high execution in the health outcomes of patient. The

positive approach of patient family members enhances patient care, maintains the family process

and develops resilience in family members. Sometime head of the family members who supports

family financial suffers from chronic illness. It effects on the finance and emotional support, in

such condition positive approach of patient family members can restore the family process. For

example taking help from welfare organizations, division of labor in family and emotional

support and care of patient enhance patient wellbeing. According study of Esther .Sales (2002)

the family members of the patient are the integral part of the patient care system. It is very

important to consider the psychological, physical and social needs of the family members for the

better outcomes of patient health. The positive regard or reinforcement of family members of

patient, referral to cost effective health care system and appreciate their efforts for patient.

According A.K. Rotegard et al. (2010) the above mentioned environmental factors are known as

the external health asset.

Another important component is the self-awareness of the patient, recognize and realize

of the health asset to patient known as the mobilization. Mobilization leads to optimal health

state and wellness. In the mobilization the role of the nurse is very important that is patient

education, counseling. According to research article by Tayyab (2009) nurses should emphasize

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on the positive factors of internal health assets of the patients. This approach increases the patient

interest and cooperation. The positive psychology does not deny other psychotherapies for

example cognitive behavior therapy, music therapy and occupational therapy etc. It is common

observation in the state of happiness patients quickly adapt new behavior and achieve their goal

in good way. Positive psychology in nursing field is positive ideas and healthy behavior i.e.

vegetable consumption and regular exercise for patient. Nurses should apply the positive

psychology to family members of the patient and nurses themselves to obtain maximum level

outcome of patient wellbeing. The patient wellbeing directly relates compassion, working

efficacy, job satisfaction and work load of nurses. The alteration in above factors can cause

compassion fatigue which further deteriorates the care giver role. Some of studies show there are

mainly four reasons i.e. unfriendly staff policies of lengthy working hours, gender biased male

versus female or profession biased of doctors versus nurses, less competent nurse and less

consideration of nurses emotion (Smith, 1992, 1999, 2005; Allan and Smith, 2005; Hunter and

Smith, 2007; Smith and Lorentzon, 2007). The positive psychology means positive thinking,

resilience, working efforts, professional competence and cooperation with health team

overcomes all malicious factors and enhance working efficacy of nurses in health care setting,

communities and public level.

Taking in consideration each component of health assets as discussed in above

paragraphs i.e. antecedent (value, belief, experience and genetic) internal health assets (positive

thinking, happiness, optimistic view about future, self-efficacy, internal satisfaction and positive

perception of coping system), external health assets (environment, physical element, and coping

resources) and mobilization (awareness of patient, identifying of health asset and understanding

of health assets); the role of nursing profession is very important general in all component

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specially in mobilization of patient or families or community to optimal health state or wellbeing

and positive health behavior for better outcome of health by applying positive psychology in the

profession of nursing. For the better outcomes patient care system or community health it is

recommended that nurses work load should be decrease. There should be job training for

maximum job satisfaction with appropriate salaries. There should be respect for the nursing staff

in the health care setting and communities. The above factors enhance the work efficacy of

nursing staff directly enhance the patient wellbeing. The most important recommendation for

nursing staff is that they should apply the positive psychology on themselves which overcomes

compassion fatigue of staff and enhance direct patient care and patient wellbeing.

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Conceptual model of health assets; Health recovery model taken from A.K. Rotegard et al.

(2010) p. 55

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