URJHS Volume 12

I Can Fix That: Manageable Factors in Patient Rehabilitation and Recovery

Michelle Mathews
University of Texas

Abstract

Recovering from injury and debilitation is a gruesome process for any patient. It is painful, unpleasant, and uncomfortable. It is the responsibility of staff in the health care industry to make it their number one priority to make the recovery process as easy and stress-free as possible for patients. If all the factors affecting recovery were to be determined and categorized, they could then be turned into manageable methods of regulating and speeding up the recovery process. By understanding what factors influence rehabilitation, we can further our attempts in making the recovery process more efficient, encouraging, positive, and comfortable for patients.

Introduction

When Sylvie was diagnosed with cancer in 2003, doctors concluded that it was an aggressive form of cancer, with a tumor that had already metastasized. Although doctors wanted to operate right away, Sylvie wanted to wait a few months before undergoing treatment. Three months later, when doctors opened her up in surgery, they found that the cancer cells had disappeared and a complete remission had occurred (Healingcancernaturally). Time and time again, stories have made the front-page news about patients who have miraculously recovered from hopeless comas and fatal diagnoses. What if those stories were not so miraculous and were somehow able to be regulated? The general public tends to believe that the recovery process is a purely medical and medicinal-based process, but there are a multitude of non-prescription factors that greatly affect injury and recovery. Research suggests that social interaction, in addition to a variety of other factors, plays a huge role in rate and success of recovery from injury and debilitation. Humans are social creatures, making it only logical that social factors affect the recovery process.

If all the factors affecting recovery were to be determined and categorized, they could then be turned into manageable methods of regulating and speeding up the recovery process. The ability to speed up and improve the recovery process is what drives me to answer these questions: To what extent does support provided to a patient by family and the community have an influence on a patient's attitude, recovery time, and degree of improvement? What kind of support (emotional, tangible, or informational) is most effective? And does it vary based on circumstance? What are other non-social and manageable factors that may influence recovery?

In order to effectively answer these questions, empirical examples and studies of recovery rates will be presented in addition to an analysis of how each of these factors affects recovery time and degree of improvement. The effects of these factors will then be applied to various types of injuries to determine how the effects of support and recovery vary. We will examine what implications for the future these results may have. By categorizing these factors, a general set of guidelines has been created to help organize and generalize aspects of support that may help improve rehabilitation. By understanding what factors influence rehabilitation, we can further our attempts in making the recovery process more efficient, encouraging, positive, and comfortable for patients.

Terminology

It is necessary to clarify the various terms being used to answer these questions. First, it is important to make a distinction between "social networks," the number of relationships one has, and a person's "perceived social support"—the amount of support one perceives and believes that they have (Schaefer et al., 1981). Schaefer concluded that it "seems possible that perceived social support might be more strongly associated with health outcomes because it is a more direct measure of the support afforded a person." Although people may have equal numbers of social networks, perceived social support varies for individuals and how many people they want to have in their life in addition to the number of people they personally feel will support and encourage them.

It is important to understand the different categories of support in order to be able to analyze what specifically benefits rehabilitation and healing and what kind of support is most effective. Three categories of support that must be considered are emotional, tangible, and informational support. Emotional support has to do with attachment, relationships, trust, and the knowledge of being loved and cared for. Tangible support deals with resources and services that can be provided that will help take care of a person, including money, food, help with chores, and things that can be done to generally make one's life easier. Informational support is purely information that can be used to help a person understand situations better through information or giving them advice (Schaefer, 1981). Each of these possible aspects of support are likely to produce different results in terms of how it affects recovery and in what scenarios each type is most effective.

Emotional support, tangible support, and informational support are all important aspects of social interaction. Every situation is different and may require something different. In some situations, it may be more helpful to have financial support as opposed to having visitors in the hospital. Still in other cases, "self-esteem or social esteem may be better managed by indications of positive regard or affection than through any tangible help" (Schaefer 381).

Social and Emotional Support

It has long been known that social facilitation influences rehabilitation and the will to live. Director of the Behavioral Medicine Research Center at Duke University, Redford Williams reported that in 1992, the Center conducted a study that revealed that "heart patients with a spouse, a confidant or both had a 5-year mortality rate of only 18 percent, compared to only 50 percent in those with neither spouse nor confidant" (ABC News). Relationships and companionship create a will to survive within patients, possibly due to their own fear of leaving loved ones or because they worried about how others would handle their death. Survival and recovery rates for those who have a will to fight and survive are many times higher than those who feel socially isolated. David Spiegel, Professor and Associate Chair of Psychiatry & Behavioral Sciences at Stanford, reported that many studies revealed how social isolation had just as strong of an association with all-cause mortality as smoking or high cholesterol levels. Reports also revealed that individuals were much more likely to die after rather than before their birthdays and holidays, suggesting some psychological process that manages survival to some extent until achieving a meaningful goal (ABC News). This indicates that, subconsciously, humans have some degree of control over their fate and that external social and emotional factors influence recovery. Although we have known for years that support has some kind of influence on recovery, it is necessary to hone in on what specific factors influence recovery and to what extent recovery can be controlled.

Environment and social interaction play a huge role in the recovery process. An optimal healing environment is defined as an environment where positive, resilient relationships among participants exist and qualities and resources of those relationships help to enhance health (Frankel et al., 2005). When patient expectations of care are aligned with their doctors' quality of treatment and care, optimal healing environments are created and the likelihood of optimal healing increases (Frankel et al., 2005). This is because humans are social creatures and require a certain standard in their interactions. Thus, the most significant and manageable factor in aiding recovery for patients is social interaction, and it has been proven on numerous occasions as an important stimulus for healing. Positive interactions between people provide a two-fold means to promote healing. First, having someone to share interactions and burdens decreases stress, which in turn decreases cortisol levels that promote wound healing. Second, social interactions release oxytocin, a therapeutic neurotransmitter that leads to improved healing of injury and relieves other stress-related illnesses (Detillion et al., 2004).

In addition to physical injuries, studies have reported social interactions increasing recovery rate for both strokes and surgery. Stroke patients who reported positive interactions after a stroke indicated that support from friends, family, and health care workers resulted in better cognitive functioning and more stimulated mental activity (Stephens et al., 1987). A study recently conducted at Ohio State University revealed that patients who have positive interactions with familiar persons have wounds that heal twice as fast as patients who are socially isolated. Patients who have families visit them and support their recovery heal much faster than patients who face their injury alone (Adams, 2013). Studies conclude that social support leads to quicker recovery time for a variety of injuries and ailments ranging from physical injury to stroke to surgery, affecting various, unrelated body parts and body systems.

Although social interactions decrease cortisol and release oxytocin that stimulate recovery, social interaction promotes recovery in yet another way. Patients who have friends and family visit them in the hospital cause hospital staff to feel more connected to patients. If families believe in a patient's ability to recover, the staff will be more hopeful and dedicated to the cause (Landau, 2013). Patients with dedicated families are more likely to build stronger relationships and get to know staff better than isolated patients who hospital staffs  know little about. In general, higher quality of life is associated with increased rates of recovery and rehabilitation.

In a study of patients who experienced traumatic injury, economic and personal resources were reported as important factors in rate of rehabilitation. Marital status, higher education, higher working status, higher income, and confidants were all positively correlated with increased rate of rehabilitation (Mackenzie et al., 1987). These are all factors that may promote oxytocin and stimulate healing as oxytocin is released in response to more positive, stress-free experiences, particularly physical contact, social contact, and social bonding (ABC News, 2013). Although a majority of examples are associated with social support as a key factor for recovery, this study suggested that tangible support is also an important contributor. There are a variety of interactions associated with social interactions and support.

Other Factors that Influence Recovery

Although interactions and support are key contributors to recovery rate and success, attitude is also an important factor to consider. Mood plays an important role on successful recovery and healing rate for injuries. For example, anger is among the emotions that contributes to slower wound repair (Gouin et al., 2008). In response to the expression of anger, a stress hormone, cortisol, is released. Increased cortisol production is associated with slower rates of healing. Longer hospitalization and increased post-surgery complications have been reported for patients with higher levels of anger (Gouin, 2008). Therefore, mood regulation is key for both the onset of injury and effective recovery.

Although certain factors influence recovery, those same factors also have an effect on the onset of injury as well. A study conducted by LaVallee and Flint (1996) found that psychological factors, including stress play an important role in the frequency and extent of an incurred injury. Studies have revealed that tension, anxiety, anger, hostility, negative mood, and competitive nature are all associated with higher rate and greater severity of injury. It has been found that emotions such as these are associated with physiologic responses such as increased muscle tension and physical and mental fatigue that can be associated with a higher likelihood of physical injury (LaVallee & Flint, 1996). Emotional and mood-related factors are all things that can be controlled or managed with proper training and education.

Relationship and personality-based factors are both important components in recovery rate, but there are still many other environmental factors to be considered for more effective patient recovery. Studies have found that daylight in a hospital room is associated with reduced pain, requests for medication, depression, length of stay in a hospital, and higher patient satisfaction (Herman Miller, n.d.). According to a study conducted at the University of Milan's Department of Neuropsychiatric Sciences, bipolar patients assigned to rooms with more sunlight had a mean 3.67 day shorter hospital stay than patients with the same diagnosis in rooms with little or no sunlight (AHRQ, n.d.). Research also found that patients who had cervical and lumbar spinal surgeries "who stayed on the bright and sunny side of a hospital unit reported less stress and pain, took 22 percent less analgesic medication, and had 21 percent less pain medication costs than patients cared in the dim side of the same unit. Myocardial infarction patients who were assigned to sunny intensive care rooms experienced significantly lower mortality than those patients assigned to north facing dull rooms within the same unit" (Joseph et. al, n.d.). Simply having a room with windows and sunlight can decrease mortality rates, decrease the need for pain medication and length of hospital stays, decrease pain levels, and increase pain satisfaction. With this many benefits for patients, it is imperative for factors as simple as sunlight and windows be considered when taking patient care and recovery into consideration.

Studies have also found that scenic views, such as nature, are related to reduced pain, stress, and length of stay in hospitals (Herman Miller, n.d.). Nature is associated with more positive moods and attitudes resulting in reduced stress, an indicator of quicker recovery. A study conducted by Roger Ulrich found that patients who had abdominal surgery had a quicker recovery rate, better emotion regulation, and lesser need for strong medications if the view from their windows was of trees as opposed to a brick wall (Joseph et. al, n.d.).

On a much greater and more costly scale, patient's comfort and privacy level is also a contributing factor to their recovery process. Studies have found that single-patient rooms are associated with lower levels of stress for patients, significantly low rate of transmitted infections, lower medical errors, improved privacy, and improved sleep quality: all factors associated with quicker recovery rates (Joseph et. al, n.d.). As decreased stress has already been associated with lower cortisol levels, this is yet another stress reliever to be associated with wound healing. For reduced infection rates, Bronson Methodist Hospital, found that completely switching from semi-private rooms to private rooms reduced the rate of infection by 45 percent. "The reduction in infection resulted in significant operational savings that offset the initial capital expense of single rooms" (Joseph et. al, n.d.) Although costs may be high for investing in single rooms, reduced infection means happier and healthier patients as well as reduced length for hospital stays, which can increase hospital profits and efficiency.

The implications of these factors affecting recovery can be instrumental in benefitting both patients and hospitals. Social support, attitude, and non-social, environmental factors such as sunlight, scenic views, and privacy are all factors that can increase rate of recovery and decrease hospital stays for patients. With so many manageable factors that can influence and affect recovery, it is necessary for medical staff to take all of these factors into consideration when determining the most effective method for treating patients.

Principles for Recovery

The various factors affecting rehabilitation can be categorized to create a list of principles that help generalize characteristics that improve recovery rate. This will create almost a checklist of factors to go through when evaluating how to better manage and regulate recovery. I was able to make connections between Human Development and Family Sciences and rehabilitation and recovery. Early Childhood Intervention (ECI) is a "coordinated system of services and supports for Texas families who have children, 0-3, with a qualifying medical diagnosis, an auditory or visual impairment, or a developmental delay" (Seely, 2012). ECI's mission statement is "ECI assures that families with young children with developmental delays have the resources and support they need to reach their goals." By adjusting the mission statement and the key principles that ECI abides by, a mission statement and set of principles can be created to improve recovery rate for patients. A mission statement for rehabilitation for any injury or illness can be modified from ECI's mission statement to say, "Employees in the health care industry assures that recovering patients have the resources and support they need to reach their goals." The purpose of working in health care is to promote the most efficient and tolerable treatment for patients. Their recovery experience should be quick, positive, supportive, and comfortable.

There are several key principles of Early Childhood Intervention that can be adjusted for improving the patient recovery process.  The first principle of ECI is that "infants and toddlers learn best through everyday experiences and interactions with familiar people in familiar contexts" (Seely, 2012). Through this research, it is evident that familiar people and familiar contexts are key factors in recovery and rehabilitation. This first principle can be adjusted to say, "Individuals recovering from injury heal best through everyday experiences and interactions within familiar contexts." Everyday experiences and interactions are key factors in recovery because changing routine and familiarity adds another item to a patient's list of things to adjust and acclimate to in addition to an injury. Keeping everything else the same allows for patients to recover in an environment in which they are comfortable with their surroundings, as opposed to getting to know a new environment and new people.

The second principle of ECI is "all families, with the necessary supports and resources, can enhance their children's learning and development" (Seely, 2012). This means that with the appropriate resources, anything is possible. This principle can be adjusted in terms of recovery to say "All patients, with the necessary support and resources, can enhance their progress and recovery." This goes back to emotional, informational, and tangible support. People in different situations have different needs and require varying types of support based on their own situation. If the necessary support and resource required is available, the progress and recovery of a patient will be enhanced. Staff in the health care industry can work towards creating systems that make these resources readily available for patients. For example, if a patient didn't have any family or friends and had a resource that provided them with social support to talk to them, encourage them, interact with them, it could help to improve their stress level, their happiness level and mood, all affecting recovery rate.

The third principle of ECI is "the early intervention process, from initial contacts through transition, must be dynamic and individualized to reflect the child's and family members' preferences, learning styles and cultural beliefs" (Seely, 2012). When working with children with developmental problems or patients who are recovering, it is necessary that treatment plans be individual and personalized as per the needs and requirements of the patient. Although two people may be diagnosed with the exact same thing, it is possible that they will require two different treatment plans based on their individual personality and needs. Therefore, this principle can be adjusted to say, "The treatment and recovery process, from diagnosis through recovery, must be dynamic and individualized to reflect patients and their family members' preferences, diagnoses, and cultural beliefs."  This goes back to how each patient may require a different type of support—informational, emotional, or tangible. This also has to do with a doctor's efforts to personalize their treatment and get to know his/her patients. Defending this guideline is the study by Frankel, Sung, and Hsu (2005), which reveals that when patient expectations of care are aligned with their doctors' quality of treatment and care, optimal healing environments are created and the likelihood of optimal healing increases. This principle also entails going through the checklist of specifics that may work for some patients but not for others, including environmental factors like daylight, scenic views, comfort, and privacy.

Summary

These three principles create a comprehensive list of guidelines that can help improve recovery rate and satisfaction levels during the rehabilitation process. It is the responsibility of staff members in the health care industry to make it their number one priority to make the recovery process as easy and stress-free as possible for patients. If patients have the necessary resources available, including support, privacy, and options to increase comfort and happiness, recovery and satisfaction rate for patients would be much higher. It is necessary to have comprehensive principles that affect recovery in order to be able to use them as viable options when figuring out how to manage the recovery of a patient. Although many patients truly believe that prescription medication and treatment is the key to recovery, there are also a multitude of non-medicinal factors that are crucial factors to consider when improving rehabilitation. The principles described above have the potential to revolutionize the rate of patient recovery and improve the recovery process as a whole.

Works Cited

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