Biomedical and Biopsychosocial models of care Essay

Competing views of the military personnel body as either a biological phenomena or a complex microcosm borne of its environment, pick up provided the basis for the development of two different puts of attending the bio checkup gravel, and the rec overy- infantryd psycho social mildew. The theoretical account of c atomic number 18 adopted by c argon providers firmly influences the nature of the manipulation given, and the trajectory of a forbearings expedition through unsoundness, to wellness. Historically, the bio checkup precedent of cope has been the foundation of Western medicine, and has remained generally unchallenged as the dominant case of care ingestiond in the de outlastry of psychiatric treatment. It is workoutd with a direction on affection, pathology, and repossess.The emergence of the biopsychosocial model (Engel, 1977) and psychosocial renewal has provided the affable wellness arena with an hard-hitting resource to the biomedical model. With an a ttack that is person-centred and convalescence foc employ, it aligns with contemporary attitudes somewhat psychological disorders having their origins and impacts in a social stage setting. This paper will critically contemplate and compare the benefits and limitations of both(prenominal) models of care, through an geographic expedition of three key areas (i) dominance/dis authorization of the affected role, (ii) implications for nursing practice, and (iii) outcomes.In psychiatry, the biomedical model emphasises a pharmacological cuddle to treatment, and supposes that intellectual disorders are brain diseases powerd solely, or by a combine of chemical imbalances, genetic anomalies, defects in brain structure, or neurotransmitter dysregulation (Deacon, 2013). This supposition makes up one positioning of a Descartian divide that exists between biological psychiatry and a biopsychosocial memory access to intellectual wellness care. Engel (1977) viewed the biomedical mo del as reductionist, and posited that it neglected the social, psychological and behavioural dimensions of illness.He proposed a biopsychosocial model that takes into account the patient, the social context in which he lives, and the complementary outline devised by society to deal with the disruptive acts of illness (p. 131). It is at heart this biopsychosocial theoretical account, thatrecovery-focused psychosocial renewal takes place (Cnaan, Blankertz, Messinger & Gardner, 1988 King, Lloyd & Meehan, 2007). Less aim than the biomedical model, psychosocial rehabilitation focuses on the subjective experience of recovery and wellness, that is, the presence of signs and symptoms whitethorn not inevitably align with the individuals sense of self and wellness.(i) Empowerment/dis presentment of the patientA persistent criticism of the biomedical model is the assertion that the patient is disempowered. Firstly, the nature of the doctor-patient kindred suggests that the patient is a passive recipient of treatment the patient is pressd to a diagnosing, and offered diagnosis- peculiar(prenominal) treatment options. The role of personal plectron exists, however in a limited capacity. Secondly, the ideology underpinning the biomedical model assumes disease to be a deviation from the biological norm, with illness silent in terms of causation and remediation (Deacon, 2013 Shah & Mountain, 2007 Engel, 1977). This sight assumes the existence of some underlying pathological cause for symptoms and behaviour, and focuses on objective indicators of recovery (King et al., 2007). The implications of this emplacement are that the patient tushnot, from his own resources, do some(prenominal)thing to ameliorate his illness, and to affect any change in his behaviour, he must adhere to diagnosis-specific treatment peculiar(a)ise out by the psychiatrist. It is argued that the focuss in which a patient can be disempowered by a psychiatric diagnosis ( target, coerce hos pitalisation, long-run pharmacotherapy etc.) far outweigh any benefits they might receive (Callard, Bracken, David & Sartorius, 2013).Comparatively, recovery within the framework of psychosocial rehabilitation is widely considered to be empowering for consumers of mental health work (Shah & Mountain, 2007 Callard et al., 2013). Two key principles of psychosocial rehabilitation are an emphasis on a social rather than medical model of care, and on the patients strengths rather than pathologies (King et al., 2007). Similar to the doctor-patient relationship of the biomedical model, there exists a relationship between patients,caregivers and clinicians in the psychosocial framework.The emphasis however is on the formation of a remediation alliance (King et al., 2007) in which recovery is owned by the patient, with professionals and function facilitating this ownership (Mountain & Shah, 2008). The aim of psychosocial rehabilitation is for the patient to have self-rule over their ill ness and health, and a fulfilled sense of self contempt the assertable continuation of symptoms (Barber, 2012). This is in stark contrast to the biomedical model in which illness is managed by the practitioner, and health is hallmarked by the absence of symptoms and disease (Wade & Halligan, 2004).The psychosocial perspective must also be considered in terms of its potential limitations. By placing an emphasis on self-determination and self-management of mental illness and well existence, there runs a parallel risk of instilling a sense of responsibility or blame within the patient when less than desirable health outcomes occur. This is of particular relevance in mental health settings, where low health outcomes are unfortunately, likely (Deacon, 2013). In the biomedical model, the psychiatrist would offer some baseborn consolation to the patient in the form of shouldering the bulk of the responsibility.With regard to dominance of the patient, this notion of care versus cure su ggests that the biomedical model of care and psychosocial rehabilitation are two competing models of care that are divorced from one another. They are not, however, mutually exclusive, and it is worth noting that contemporary definitions of the biomedical model at least(prenominal) attempt to consider the incorporation of recovery-based treatment approaches (Barber, 2012 Mountain & Shah, 2008 Wade & Halligan, 2004). It has been suggested that newfangled day doctor-patient relationships are far more aligned with the nature of the psychosocial therapeutic alliance, founded on engagement and the recognition of skills and knowledge of each partner (Mountain & Shah, 2008). specifically in a mental health setting, it might be argued that the biomedical model parts ways with psychosocial rehabilitation by use of compulsion (Mountain & Shah, 2008).The intent behind much of todays mental health legislation is guided by the ideologies of the biomedical model. Thisresults in patients with a psychiatric diagnosis being frequently disempowered, by having their right to self-determination overridden by legal powers of compulsion (Thomas, Bracken & Timimi, 2012). Despite a shift towards self-determination by the biomedical model, mental health patients may be forced to accept treatment against their wishes. In opposition to this, the psychosocial framework favours a community-based, case-managed flare of care (King et al., 2007), which seeks to empower the patient and maintain independence.(i) Implications for nursing practiceThe medical model is a useful framework to assist the psychiatrist in the identification of disorders and diseases. However, scientists have identified neither a biological cause nor a reliable biomarker for any mental disorder (Deacon, 2013), and arguably, most mental disorders have their origin and impact in a social context (McAllister & Moyle, 2008). Therefore, the validity of the biomedical model as a nursing model of care in mental health sett ings must be questioned.The across-the-board nature of the care delivery required by a psychosocial framework may, at times, appear to be at odds with more traditional concepts of nursing. It is understood that the biomedical model is the model on which galore(postnominal) maintains base their practice. It is also the model that has long dominated the field of psychiatry (Stickley & Timmons, 2007), despite a plethora of literature espousing the importance of the interpersonal domain and psychosocial factors. Findings from a require by Carlyle, Crowe & Deering (2012) showed that mental health nurses working in an inpatient setting described the role of mental health services, the role of the nurse and nursing interventions in terms of supporting a medical model of care. This was despite recognition amongst the nurses that they used a psychodynamic framework for understanding the aetiology of mental distress, as being a result of interpersonal factors.The problems with the use of the biomedical model in mental health nursing are varied. The overriding goal of the biomedical model is cure, andtherefore nurses that base their practice on it must also aim for this outcome. This is obviously troublesome for a speciality that treats disorders that may not have a determinable cause, and typically have poor outcomes (Deacon, 2013). Regarding care versus cure, the challenge for nurses working in mental health settings where their practice is underpinned by the medical model, is the inability to procure the outcome of care that they believe to be appropriate, that is, a cure (Pearson, Vaughan & FitzGerald, 2005).In terms of the readiness of nursing care, the biomedical models focus on disease and the objective categorisation of people by disease can serve to depersonalise patients and so too, the nursing care provided to them (Pearson et al., 2005). It may well be argued that the biomedical model devalues the role of the nurse, because the humanistic side to care is diminished in favour of a medical diagnosis and cure. Overall, the ideals of mental health nursing practice are constrained by the biomedical model (McAllister & Moyle, 2008), however, nurses feel comfortable using this model to formulate their practice, in the absence of a defined alternative.Psychosocial rehabilitation as an alternative to the biomedical model not only has positive implications for consumers of mental health services but also to the nurses who provide their care (Stickley & Timmons, 2007). Indeed, a riches of literature supports a shift from the medical model to a recovery-based, psychosocial approach (Engel, 1977 Barber, 2012 Caldwell, Sclafani, Swarbrick & Piren, 2010 Mountain & Shah, 2008). In contrast to the biomedical model, the nurse-patient therapeutic alliance is at the heart of the psychosocial framework (King et al., 2007). In this way, the role of the nurse moves away from being task-focused, to actively developing, coordinating and implementing strategies to facilitate the recovery process (Caldwell et al., 2010). Additionally, this model of care strongly aligns with nursing perceptions of their role as care providers, their beliefs regarding the aetiology of mental disorders, and their attitudes towards best practice (McAllister & Moyle, 2008 Carlyle et al., 2012).(i) OutcomesGenerally, the biomedical model has been associated with vast improvements in medical care throughout the 20th century. Despite its persistent dominance of both policy and practice, the biomedical model in regards to the delivery of mental health care is characterised by a lack of clinical innovation and poor outcomes (Deacon, 2013). It does, however, have its redeeming qualities. The primary strength of the biomedical model is its core knowledge base derived from objective scientific experiment, its intuitive appeal, and relevance to many disease-based illnesses (Pearson et al., 2005 Wade & Halligan, 2004). Evidence-based medicine allows the psychia trist to access objective evidence about the safety and in force(p)ness of their interventions (Thomas et al., 2012). Shah & Mountain (2007) argue that the models hard methods used to gather evidence that have resulted in numerous effective psychopharmacological treatments, cannot be translated in helping to identify which specific elements of psychosocial treatments are effective.This assertion is evidenced by a check documenting the efficacy of a psychosocial rehabilitation programme (Chowdur, Dhariti, Kalyanasundaram, & Suryanarayana, 2011) in patients with severe and persisting mental illness. The content showed significant improvement for all participants across a range of parameters used to measure levels of functioning. However, the results did not reveal the specific cause of various components of the rehabilitation programme, making it difficult to isolate each component and to study its effect. Regardless, the overall benefits of psychosocial rehabilitation should no t be ignored simply due to study limitations.Despite the biomedical models rigorous study methods and evidence-based core, actual signs of progress are few and far between. Indeed, the biomedical approach has failed to irradiate the very biological basis of mental disorder, and also failed to reduce stigma (Deacon, 2013 Schomerus et al., 2012). Kvaale, Haslam & Gottdiener (2013) determined that biogenetic explanations for psychological illnesses increase prognostic pessimism and perceptions of dangerousness, and do niggling to reduce stigma. This conclusion has obvious implications in a society where the investmans, and in fact, nursing students understanding of mental illness is a biogenetic, medicalised one (Kvaale et al., 2013 Stickley & Timmons, 2007).Incontrast, psychosocial rehabilitation programmes may have the effect of reducing stigma. As previously discussed, psychosocial rehabilitation is underpinned by an ideology that seeks to empower the patient. Research has shown that empowerment and self-stigma are opposite poles on a continuum (Rsch, Angermeyer & Corrigan, 2005). By enhancing the patients sense of self, insight, societal roles, and basic self-care functions (King et al., 2007), psychosocial rehabilitation programmes have the ability to reduce the negative effects of stigma. In a study particular to patients with schizophrenia (Koukia & Madianos, 2005), caregivers and relatives reported lower levels of objective and subjective payload when the patient was engaged in a psychosocial rehabilitation programme.In their exploration into the validity of evidence-based medicine in psychiatry, Thomas et al. (2012) differentiate between specific factors (e.g. pharmacological interventions targeting specific neurotransmitter imbalances), and non-specific factors (e.g. contexts, values, meanings and relationships). They determined that non-specific factors are far more main(prenominal) in relation to positive outcomes, which would support a psychoso cial approach.In juvenile years, public opinion and policy has become more aligned with the recovery model, evidenced by the wealth of literature echoing Engels (1977) overture of a new medical model founded on a biopsychosocial approach. Recently, the Australian Government surgical incision of Health acknowledged the positive outcomes associated with a recovery-based model, and released the topic framework for recovery-oriented mental health services (2013). Despite their ideological differences, psychosocial rehabilitation need not be viewed as the antithesis to the biomedical model, with literature suggesting a degree of compatibility between the two that is becoming more apparent in the modern delivery of mental health care (Barber, 2012 Mountain & Shah, 2008 Shah & Mountain, 2007). deductionRecent years have seen significant changes in the perceptions of mental illness, and the provision of mental health services that are available. Themove towards community-based care, psyc hosocial rehabilitation programmes, and empowerment of the patient through self-determination has been accompanied by a gain in research, and positive outcomes for mental health consumers. Despite this progress, modern mental health care is still largely dominated by the biomedical model. Whilst contemporary interpretations of the psychiatric biomedical model recognise the value of social and psychological factors, they appear to do so in a way that relegates those factors to an order below that of biological factors. This occurs in the absence of any definable biological causes for mental disorders (Deacon, 2013).A contemporary model is required in modern mental health services. Indeed, Barber (2012) suggests that recovery should be intellection of as the new medical model for psychiatry. Psychosocial rehabilitation is associated with improved objective and subjective patient outcomes, and emphasises the role of the nurse. As observed by Engel (1977), the dogmatism of biomedicine inadvertently results in the frustration of patients who believe their genuine health call for are being inadequately met. 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