To understand how biological influences may affect an individual psychologically and socially, will be now be explored in more depth. The National Institute for Health and Clinical excellence, (2009), indicate 70–75,000 thousand hip fractures occur within the United Kingdom annually (NICE, 2009). The social and medical cost annually for all hip fractures amounts to a staggering £ 2, billion pounds. (NICE, 2009). Within the United Kingdom demographic projections signify the annual occurrence of hip fractures will increase to 91,500 thousand by the year 2015 (NICE 2009).
A bone fracture medically abbreviated as FX F or # is described as a break in the bones continuity (McRae and Esser 2002; Martini and Nath 2009). Regardless of individual belief there is no medically distinction between the term fracture and break (McRae and Esser 2002). Medically fractures are categorised as closed or open; closed fractures are internal only visible by x- rays. Open fractures conversely present with a break in the epidermis, uncontrolled bleeding can occur and exertion due to micro organisms, entering the fractured location may cause infection (Whiteing 2008; Martini and Nath 2009). Whiteing, (2008), states the mechanism of injury, dictates fracture patterns, and are therefore further classified according to; type, location and complexity.
Hip fractures NICE, (2009), state are the ubiquitous cause for admission to accident and emergency, caused by a fall normally affecting an older person. A fall is described as an event that is unexpected, resulting in the individual landing at ground level from a height (Agostini et al, 2001). Independent active elderly individuals are more prone to falling outside their home, resulting in a higher risk of sustaining a more severe fracture, than an inactive person who has fallen at home. (Sirkka and Branholm, 2003; Coote and Halsem, 2004).
The NHS Institute for Innovation and Improvement, (2006), state a fractured hip has serious consequences for an elderly individual as the mortality rate within one month is 10% after the fall, rising to about 30% within the year (NHS, 2006). Mortality rates are not just attributable to the fracture (NICE, 2009). Vestergaard et al, (2009), believe factors that contribute to mortality rates post fracture are; age, gender, smoking, alcoholism, physical and mental decline and pre-fracture status. Mortimore et al, (2008), argues fracture mortality, remains high in individuals with no overt co-morbidities or physical decline.
Mrs Jones fell outside; she sustained a fracture of the right neck of femur, which disrupted normal physiological functioning of the bone. Bone is a biological dynamic tissue and the only tissue within the human body that that is able to replace itself (Whitening, 2008). As a dynamic tissue bone forms several imperative functions within the human body; the protection of organs, structural support, aid of movement, the formation of blood cells, but conversely acts as a mineral reservoir for calcium and phosphorus, these minerals are essential for cellular activity throughout the human body (Marieb 2009; Martini and Nath, 2008).
Within the human body on a cellular level bone constantly remodels itself. The main cells active within bone are; Osteoclasts and Osteoblasts found present within the connective dense tissue of the bone matrix (Martini and Nath, 2008). Active Osteoclasts re absorb bone tissue whereas Osteoblasts put down new bone tissue, and then Osteoblasts revert to Bone Cells, that sit within the bone Matrix. The ability for a bone to constantly regenerate itself, due to cellular activity means a bone can normally heal fully following a fracture (Kalfas, 2001).
Regardless of bones mineral strength or individual co morbidities fractures can transpire when significant force acts on the bone, often due to road traffic accidents, falls and sports injuries (Whiteing, 2008). Stress fractures conversely present when repetitive trauma occurs, the body eventually does not handle the mechanical force acting on the bone (Martini and Nath 2008). Pathological fractures occur when there is underlying disease that has weakened the bones mineral strength for example; tumours, oesteomalica and osteoporosis (Whiteing, 2008).
Osteoporosis is a chronic degenerative bone disease that causes bone to lose its mineral density. The loss of bone density "silently" and progressively occurs; there are often no symptoms until the first fracture occurs (Nice, 2009). Peak bone mass as strong as the bone will become literature suggests is reached within women at about 30 years old (National osteoporosis society, 2007).
Bones become thinner and weaker due to the natural aging process after the age of 30 years old, 1% of bone mass in women is lost each year. In females when the ovaries stop producing oestrogen due to the menopause the rate of bone mass that is lost increases (NOS, 2007). Genetic factors can determine if an individual is at an increased risk of osteoporosis. Individual lifestyles may influence the development of bone in children and also factor in the rate, of bone loss in adult life. Exercises, good nutritional intake, calcium and vitamin D are factors that determine bone health in later life. (Martini and Nath, 2008; Marieb, 2009).
The fragility of bone due to Osteoporosis increases the risk of fractures and Osteoporosis would not be uncommon in a female of Mrs Jones age. The most common method of measuring the bones mineral density is a dual-energy x-ray absorptiometry (DEXA), this investigation conversely was not carried out on Mrs Jones because she refused to contest to the investigation.
Mrs Jones has been taking the synthetic drug levothyroxine for many years because of hypothyroidism. Thyroid hormone levels should be monitored regular in all patients taken thyroxin therapy (Brown et al, 2005). Mrs Jones whilst in hospital had a thyroid function test (TFT) which came back normal. Mrs Jones was advised not to double her prescribed dose of levothyroxine when she forgot. Weetman, (1999), suggested over supplementation of levothyroxine may increase the risk of Osteoporosis in postmenopausal females, this lead to further research on the topic.
Schneider and Reiners, (2003), conducted an objective systematic review of the literature published from 1990 to 2001 identified by Medline search. The studies that were included in there review involved a total of over 3279 patients, to establish the effects of levothyroxine therapy on bone mineral density. This study was designed to indentify if patients had a reduction in bone mineral density due to thyroid replacement therapy. Schneider and Reiners, (2003), indentified from their study that critical debate between professionals still exists, regarding the effects of synthetic levothyroxine on bone mineral density and its safety on skeletal integrity. Schneider and Reiners, (2003), concluded that no tangible evidence exists regarding the effects of levothyroxine therapy and the extent of a double dose-effect on the reduction of bone mineral density. The use of levothyroxine, in post menopausal females, produced insufficient evidence to support loss of bone density and the increased risk of Osteoporosis.
Fractures start healing from the time the fracture occurs, extensive bleeding and Inflammation frequently occurs due to ruptured blood vessels, a fracture hematoma forms closing off the ruptured vessels (Martini and Nath, 2008). Blood loss can be very severe often requiring a transfusion (Nice, 2009; Whitening, 2008).
Osteocytes then due to the disruption of circulation began to die over several hours. The bone becomes necrotic along either direction of the shaft due to the fracture. Phagocytes then engulf, ingest alien particles, cell waste material, and bacteria (Whitening, 2008; Martini and Nath, 2008). The endosteum which is a layer of single oesteogenic cells do not have any fibrous components, the periosteum however is a tough vascular layer of fibrous dense tissue (Kalfas, 2001). Biological trauma due to a fracture the normal inactive endosteum and periosteum, undergo rapid cyclical cell division. These cells commonly known as daughter cells migrate to the fracture site (Martini and Nath, 2008).
An external callus then forms of bone and cartilage encompassing the bone at the point of fracture. Then the internal callus which is extensive forms within the medullary cavity and the broken ends of the bone shaft. The cells within the external callus differentiate into chondrocytes and hyaline cartilage blocks are produced at each end of the callus, Osteoblasts then construct a bridge like structure that temporarily stabilises the fracture. (Kalfas, 2001; Martini and Nath, 2008).
Within the terms of mobility this temporary structure is very weak however due to the type of fracture, or its severity fortification maybe required in the form of a plaster cast or internal fixation (Kalfas, 2001). Impacted neck of femur fractures occur when bone is forcefully driven into another. Whiteing, (2008), states these fractures come adrift if internal fixation is not achieved.
The central cartilage of the external callus is replaced by spongy bone due to Osteoblasts activity, when this adaptation is finalised both the internal and external callus form an extensive buttress, at the site of the fracture uniting the struts of spongy bone and the fracture shaft ends (Martini and Nath, 2008). The adjacent area is progressively reshaped as the bone fragments’ that are now held securely in situate are able to withstand normal every day stresses. The remodelling of bone due to Osteoblasts and Osteoclasts activity continue for a time period of months to years (Kalfas, 2001).
Complete Remodelling is finalised when bone callus has disappeared and only living bone which is compact remains. The complete healing of a fracture restores bone to its unique and mechanical pre fracture state. (Kalfas, 2001: Martini and Nath, 2008: Marieb, 2009). The remodelling of a fracture may take long time in a patient such as Mrs Jones due to her age and smoking (Whiteing, 2008).
Smoking cigarettes has detrimental effects on the body, contributing to chronic illness such as lung cancer, chronic obstructive pulmonary disease, (COPD), and coronary artery disease (Warner, 2005). Cigarettes contain over 3000 injurious chemicals ranging from; arsenic, cadmium found in batteries, carbon monoxide (CO), nitrosamines (group of DNA damaging chemicals) and nicotine the additive component in cigarettes (Warner, 2005; Al- Mukhtar, 2010).
Studies have shown that bone healing is delayed and complications arise in fracture sites, in individuals who smoke (Adams et al, 2001; Moller et al, 2002; W-Dahl and Toksvig-Larsen, 2004). There is considerable debate within the literature if nicotine directly affects metabolic bone activity, thus delaying fracture healing or is it due to the chemical components within cigarettes (Hollinger and Schmitt, 1999; W-Dahl and Toksvig-Larsen 2004; Warner, 2005).
Hollinger and Schmitt, (1999), believed nicotine suppressed bone cell metabolic activity, thus delaying fracture healing. Current research however suggests nicotine directly simulates, bone metabolic cell activity and fractures my heal quicker (W-Dahl and Toksvig-Larsen, 2007). Gullihorn et al, (2005), conducted research to test the hypothesis that components of cigarettes, rather than nicotine directly were responsible for delayed skeletal healing. They concluded from their analysis, that nicotine directly stimulates metabolic bone cell activity, and absorption of the chemical components of cigarettes they suggest may delay bone healing. This research was however conducted using in vitro cultures of Osteoblasts cells. No individual participates were included in this research.
The national service framework Wales for older people (2007) state that 26% of adults in Wales smoke. Mrs Jones smoked twenty a day; she understood the complications smoking could have on her health such as chronic obstructive pulmonary disease, (COPD), lung cancer and coronary artery disease she was astonished that smoking could delay fracture healing; however she refused to stop smoking as it was her only pleasure left in her life.
Mrs Jones had gone through a severe physical trauma, she however perceived her physical health as good, even though she had the chronic condition hypothyroidism and she smoked heavily. Mrs Jones understood that for a period of time, her activities of daily living would be restricted due to her mobility, this did not concern her. Literature indicates that individuals are more resilient to physical trauma then was once indicated (Bonnona, 2004). She was optimistic that she would return back to her pre fracture status and complied with her rehabilitation programme.
Fredman et al, (2006), conducted a longitudinal study, to establish if elderly patients that had suffered a hip fracture, who were optimists had better post fracture functional recovery. The study included four hundred and thirty two participants aged sixty five years and older. They concluded from their analysis that individual optimism has beneficial effect on post fracture recovery, and elderly patients that had suffered a hip fracture had better recovery. The limitations of this study were data was collected from individuals whilst hospitalised and data samples collected included mainly women; this would limit results within the male population.
Mrs Jones spoke affectionately about her husband, and the life they had together she missed him deeply, she however became extremely upset and cried a lot when talking about her beloved dog Millie. The death of Millie who Mrs Jones was emotionally attached to was an intense loss for her. Durkin, (2009), states the death of an animal is equivalent to that of a human depending on the attachment. The death of Millie could have awoken feelings in Mrs Jones, regarding her own mortality and unresolved grief issues from the death of her husband (Sife, 2005).
Buglass, (2010), states grief is a human’s natural response to separation or loss, often the death of a loved one Greenstreet, (2004), explains grief as being individualised, as the individual experiencing the grief, due to its behavioural, physical, cultural, spiritual and social dimensions. Grief can refer to emotional reactions to other losses; loss of health due to disease, disability or injury and loss of social status. Bonanno, (2010), is dubious that grief associated with these losses is comparable to the grief of a loved one and purposes further research on the topics.
Bereavement is the state of losing someone significant through death. Bonanno, (2010), explains it is a form of depression that may disappear over a period of time and individuals during this period may suffer anxiety, anger, guilt, or a feeling of helplessness due to the loss. Individuals are still classed as bereaved regardless of their behavioural reaction to the loss (Bonanno, 2010). A bereavement response after a significant loss that an individual was attached too is a normal reaction. (Buglass, 2010).
John Bowlbys theory on attachment could be the answer in understanding the complexity of grief (Goldenburg et al 2010). Bowlby, (1980), explains all human beings form attachments or emotional bonds. Bowlby viewed attachment as an affectional bond, resulting from a reciprocal relationship or relationships, which have occurred, from long term interactions; starting from the early stages of childhood to later adult life. Individuals endeavour to keep attachment figures close with whom they have a strong emotional bond too, as attachments are adaptive they give; protection, comfort and strength to the individual (Goldenburg et al, 2010). When separation occurs individuals may feel strong overpowering feelings of sadness and anxiety (Buglass, 2010). Separation sadly due to death is irreversible (Goldenburg, et al, 2010).
An individual such as Mrs Jones is not predominantly grieving the loss of their companion animal. Baydock, (2000), believes it is the loss of a particular individual with whom they have shared a mutual bond with; it is the loss of the relationship that is being grieved. The Death of a companion animal such as Millie in an elderly person’s life, maybe their only emotional support and physical comfort and the very reason they get up in the morning (Walsh, 2009).
Society discourages the display of grief regarding animal loss (Walsh 2009; Durkin 2009). It is often trivialised due to erroneous believes that the animal can be replaced (Sharkin and Knox, 2003). This discourages individuals for reaching out for support and can complicate the grieving process (Durkin, 2009). Individuals are often over powered and embarrassed by the intensity of grief they feel that precedes the death of an animal (Sharkin and Knox, 2003). Baydack, (2000), believes individuals often start to question their own psychological stability.
Health professional are often presented with patients who are experiencing an exacerbation of psychological symptoms in behavioural health settings, following the loss of their companion animal (Durkin, 2009). Nurses conversely within community settings may nurse elderly individuals that have become depressed and lonely following death of their animal (Sharkin and Knox 2003; Durkin, 2009). It is imperative for nurses to understand the process of grief and the reactions and responses to grief, those individuals may go through when loss has occurred (Durkin 2009; Buglass, 2010). Within the literature unfortunately little has been published regarding the process of grief regarding the loss of a companion animal (Durkin 2009; Dunn et al, 2005)
There are many theoretical frameworks found within the literature to explain the physical, psychological and behavioural complexity of grief, all have common stages and themes ((Kubler-Ross, 1969; Parkes, 1975; Bowlby, 1980; Worden, 1991).The best known and widely cited seminal work is that of (Kubler-Ross) who developed a linear model that was originally applied to individuals suffering from a terminal illness. The model consists of five stages; denial, anger, bargaining, depression and acceptance. These stages indentify the emotional aspects that an individual will pass through to resolve their grief and come to terms with death (Morgan and Thompson, 2002). Kubler-Ross expanded on her theoretical model later to apply the stages of grief to other significant life events when a loss has occurred. This model is universally adaptable and used within professional practice (Rana and Upton, 2009). Therefore this model will be used to explore the complexity of grief in relation to Mrs Jones.
Freud used the term denial which is the first stage of the model in psychoanalytical theory, describing denial as the refusal to acknowledge the reality of a situation that’s unbearable or the feelings connected with it (Telford et al, 2005; Chandra and Desai 2007). In the sense of loss denial is viewed necessary for individuals to self preserve during crisis it is a mechanism of coping when faced with psychological trauma (Burgess, 1994; Telford et al 2005). Denial can be viewed as a healthy mechanism of coping, when serving a protective function (Kubler-Ross, 1980; Rana and Upton 2009). If or when faced with a physical or psychological trauma, denial buys individuals time to adjust and mobilise thoughts to cope with the situation (Stephenson, 2004). If denial is prolonged it results in pathological or complicated grief (Telford et al, 2005).
Anger is the next stage next of the grief process Kim, (2009), states anger is a basic human emotional response to loss and separation, resulting in frustration and insecurity. Anger Hayes, (2000), states develops when an individual feels they are losing control over their life. Mrs Jones perceived she was losing controlling of her life and felt very insecure, as everyone she was attached to had died. The intensity and form of anger, Archer (1999), states is subject to the attribution process that individuals seek to make sense of the loss.
The intensity of anger can vary individually when loss has occurred, dependent on unambiguous factors such as; was the loss expected the extent of individual attachment and the circumstances that have surrounded the loss. (McCutchen and Fleming, 2001: Walsh and McGoldrick, 2004). Theorists believe anger is an essential response in seeking an outlet when suffering emotional pain during the time of bereavement (Cerney and Buskirk, 1991; Miles, 1998)
The individual’s experience of anger is often associated with feelings that death is an unjust punishment (Parks, 1996). The anger an individual feels is often directed towards; health care professionals, family members and often directed at themselves (Kubler- Ross 2008). Literature indicates that individuals at this stage such as Mrs Jones need good communicational relationships especially between family, friends and health professionals (Kubler- Ross, 2008; Rana and Upton 2009; Sarafino and Smith 2010). How a nurse communicates with a patient during this stage is fundamental, effectual communication skills are needed to establish and maintain a therapeutic relationship. (Kubler- Ross, 2008). Persistent anger however alienates health professionals, damages social support and interpersonal relationships (Keltener et al, 1993; Lane and Hobfoll, 1992).
The third stage of the grief process is bargaining. Kulber-Ross, (2008), states this is a natural reaction to postpone what is inevitable. When faced with death or impending death individuals may bargain with God or a higher being they religiously believe in (Sarafino, 1998; Kulber-Ross 2008). Mrs Jones was not however a religious individual.
The fourth stage of the model is depression this is when the individual can experience overwhelming feelings of self pity, sadness, and blame. The griever may blame themselves for their losses during this stage. Kulber-Ross, (2008), states it is natural to experience these emotions, it shows the individual has begun to accept the reality of their situation.
Acceptance the final stage of the model is where reality is realised; the loss has happened and cannot be reversed. Individuals begin to focus again on personal growth and daily life (Rana and Upton, 2009). Individually acceptance may not be achieved, acceptance does not mean forgetting the loss it entails coming to terms with a new reality. (Rana and Upton, 2009; Kulber-Ross, 2008).
Bonanno, (2009), states there is little evidence in today’s literature in support of linear models, due to the belief that bereaved individuals who don’t emotional progress through the stages, could be viewed as abnormal within the society they live in and judged. Many individuals in reality may not ever accept death, Cors, (1993), argues identifying emotions and stages to explain the manifestation of grief leads to grief being viewed as simplistic in nature, when in reality it is complex. Buglass, (2010), believes models of grief find similarities and patterns in human behaviour and individuals, who grieve take comfort knowing their experiences are normal.
It was explained to Mrs Jones that the grief she was experiencing was a perfectly normal emotional reaction to any loss. Mrs Jones believed that health care professionals did not understand how she was feeling and she had never felt so angry and alone. When using this model it was difficult to predict what stage Mrs Jones was at within the grieving process, she seemed to oscillate between anger and denial. Kent and McDowell, (2004), believe individuals who are bereaved experience more intense anger, than individuals who have expected the death. Rana and Upton, (2009), states without understanding and support of health professionals, during the grieving process individuals my feel isolated and lonely. The support and care given immediately after death or any signified loss that initiates a grief response, Kent and McDowell, (2004), believe are central to the success of an individual working through their individual grief experience.
An individualised care programme had been put into place for Mrs Jones. The physiotherapist carried out a mobility assessment on Mrs Jones who was now mobilising well with a stick. Home assessments had been done by the occupational therapists. Social support had been arranged until Mrs Jones was back to her pre fracture status. Mrs Jones was happy to go home but was anxious that without Millie she would be lonely.
Fitzsimons, (2010), states one defining concept associated with the growing number of elderly individuals due to longevity is loneliness. The Office for National Statistics, (2009), state there are 9.9 million individuals living in the United Kingdom aged over 65 and above, with 1.3 million in this group aged 85 years and over. The probability of loss of a spouse, multiple losses or ill health, renders the elderly more vulnerable to loneliness which can have a detrimental effect on individual health.
Weiss, (1973), introduced an interactist theory of loneliness and believed that loneliness has two principal dimensions social and emotional. Social loneliness occurs when there is deficient social integration, on a personal or societal level and can be characterised, by feelings of boredom and exclusion (Weiss, 1973; de Jong Gierveld, 1999). Emotional loneliness refers to an absence of reliable attachment figure that an Individual has a bond with, thus characterised by feelings of insecurity hopelessness and anxiety (Weiss 1973; Pettigrew and Roberts, 2008). It can be perceived from this definition of loneliness that Mrs Jones could suffer from negative feelings of emotional loneliness’. Pettigrew and Roberts, (2008), believe social loneliness should not be perceived as a negative experience, individuals may value productive time on their own.
Loneliness Forbes, (1996), describes is an unwelcome feeling, due to loss, or lack of companionship. Loneliness by description or definition conversely is an objectionable feeling, in which an individual feels a sense of emptiness and a loss of belonging. Victor et al, (2000), argues loneliness is a perception that can’t be objectively observed.
Many individuals experience loneliness at some time in their lives, but because of the negative stigma associated with loneliness, it is often overlooked or dismissed so many individuals with deficient social relationships often won’t admit loneliness (de Jong Gierveld, 1999). Riddick and Keller, (1992), indentified loneliness as a major inciting factor, for mental health problems within the aging population. A copious amount of studies have confirmed that there is a clear relationship between loneliness and depression. The studies also identified loneliness to be a feeling, more frequently expressed by elderly women. (Tiikkainen and Heikkinen, 2005; Cacioppo et al, 2006).
Many life events are conversely attributed to the feeling of loneliness (Edelbrock et al, 2001; Pettigrew and Roberts, 2006). Victor et al, (2005), conducted a study investigating risk factors of becoming lonely in later life in Great Britain, using a self rating scale individual loneliness was measured. Interviews with 999 participates over the age of 65 were conducted, who lived at home. They indentified various vulnerability factors, constituted to loneliness in later life; poor health and current ill health, basic education, marital status and living alone. They came to the conclusion that interventions and British government policies need to reflect the variables of loneliness in older people’s lives. Additional factors such as, geographic location, low mobility levels and low socioeconomic status further increases the risk of loneliness (de Jong Gierveld, 1999; Edelbrock et al, 2001).
Research however indicates that loneliness may in fact be hereditary (Boomsma et al, 2005: Cacioppo, et al, 2007). These studies were carried out on adolescent and adult twins, to establish if there was a hereditary characteristic, in the way which people process social relations. The research concluded that some individuals are more prone to the predisposition of loneliness, due to their hereditary genetic makeup but propose to conduct further research on the topic (Boomsma et al 2005: Cacioppo, et al 2007). This study has been included as Mrs Jones father had, been an identical twin and because of her genetic makeup, this may make Mrs Jones more prone to experiencing loneliness.
Individuals need relationships for companionship to belong and feel connected to the society they live in (Larsen and Lubkin, 2009). Individuals all require different interpersonal needs from their relationships, if a relationship is lost, the loss an individual will feel, depends on the social provision that the relationship gave (Larsen and Lubkin, 2009). The social provision Millie gave Mrs Jones was ineffable to her, after the death of her husband. Millie was her only real emotional and physical support, when the curtains closed at night. Mrs Jones enjoyed taking Millie for a walk to her local park; it was her only source of exercise. During these walks she would met other dog owners who she had something in common with, they would chat about their dogs. This was Mrs Jones only real source of social participation she had since her husband died. Weisman, (1991), states a relationship that has involved love, respect and affinity despite inter species is as authentic as any other.
Cacioppo and Patrick, (2008), believe Individuals are more likely to engage in behaviours that damage their health when loneliness is experienced. Mrs Jones as established from the profile, had been consuming a bottle of wine at night, since her husband’s death and had never really drank before, as her husband had been tee total, but it had helped her sleep. When she was drinking her wine she established that she was smoking more. de Jong Gierveld, (1999), believe that the pathological consequences of the individualised experience of loneliness are establish in those who can’t adapt or develop personality disorders and excessive intake of alcohol.
The experience of loneliness is not just a social aspect it is correlated to physiological and psychological conditions that; included dietary inadequacies, overt alcohol consumption and depression (Pettigrew and Roberts, 2006). Since her husband had passed away Mrs Jones had not cooked much for herself she would share a small sandwich in the evening with Millie. Individuals such as Mrs Jones that have experienced and are experiencing loneliness have more problems sleeping. (Cacioppo and Patrick, 2008). Sleep deprivation is acknowledged to have the equivalent effects on hormonal and metabolic regulation as ageing (Cacioppo and Patrick, 2008; Pettigrew and Roberts, 2006).
The British Columbia Ministry of Health, (2004), state social participation and integration of older adults are positive indicators of productive and healthy aging. It is widely cited throughout literature that social support has a strong positive effect on individual health (Umberson and Montez, 2010). It could be argued that it is therefore of even greater importance that Mrs Jones social connectedness be maintained when she returned home since the death of her husband and Millie (BMCH, 2004).
To conclude the biopsychosocial model of health and illness was used to explore Mrs Jones perception of her overall health and social well being. The bio medical model and the biopsychosocial model of health and illness were analysed to give the reader a better understanding, of how the biological, psychological, and social factors combined have influenced, Mrs Jones overall health. Mrs Jones had suffered a fractured neck of femur; it was imperative to explore mortally rates associated with this type of fracture in women her age and examine other factors that could have contributed to her fracture. The psychosocial factors were then explored in regard to Mrs Jones overall health. Mrs Jones had recently lost her husband and her only comfort was her beloved dog Millie, who was put down due to ill health. Mrs Jones was grieving the loss of Millie. Mrs Jones grief led her to feel very lonely and she perceived that she would be very lonely when she returned home.The biopsychosocial model of health and illness has proven to be a very productive nursing a patient such as Mrs Jones. This model has an important place in nursing practice as it helps nurses develop their skills and knowledge to nurse a patient holistically, despite literature arguing that models in nursing practice are not always helpful.
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