Maternal-Infant Bonding

 

 

The overview page explains how the Bonding Process establishes Social Needs for approval and acceptance in everybody. When these are met they give the individual self-confidence and a sense of worth, which motivates them to be altruistic and cooperative with others, as they live their lives in the various groups and communities in which they find themselves.

The Neuro-Sociology page shows how the interaction between individuals is the mechanism by which by which Social Needs are met. They are most rewarding when the two people have plenty of things in common, and there is a balance between their achievements and levels of self esteem. Friendships develop as they share new experiences and ideas over time.

People live their lives in a variety of groups and communities that form for different purposes. These roughly divide into ‘work’ and ‘leisure’. However, underlying the purpose and activity of all groups is the necessity that every member’s Social Needs are met in some degree, and that they are all in accord to some degree, about the purposes and activities, for the group to be successful. It is the total, and the organisation of all the individual interactions that make up the social lives that are unique to humans.

The members of communities and groups gather to achieve some purpose and each of the members will try to maximise their feelings of achievement and pleasure in their individual relationships which will be constantly monitored in each individual. But over and above that they will also be monitoring the success of the group as a whole, as it judged by others. Approval of the group from others increases individual well-being, while lack of success diminishes it.

Organisations are made up of sub-groups that have different tasks that are needed for achieving the overall objectives, and it takes ‘socially skilled’ leadership to maximise cooperation by enabling the meeting of, in some degree, the Social Needs of all the members.  (See link to Bonding: psycho-sociology)

There are some organisations, such as hospitals and schools, that exist to serve different purpose for sub-groups of the  ’needy’ (patients and pupils) and the ‘enablers’  (e.g. doctors, nurses and teachers), and  ’supporters’ (the rest of the employees) There is always potential conflict in managing disparity in the groups that make up such an organisation and the great imbalance between the groups of the the ‘enablers’ in terms of aiming for high standards of care/education, and ‘supporters’ where the aim is efficiency within the prescribed budget.

At the interpersonal level, in the wards and departments and the classrooms, both the ‘enablers’ and the ‘needy’ have ongoing Social Needs that will have been met in some degree in their lives elsewhere and will be met in some degree, by the organisation, but most importantly it is the enabling personal exchanges that occur while carrying out the daily tasks that will have the most positive effect, and can sometimes be the most difficult.

In usual interactions between people they are motivated to find things held in common between each other and all the others in the group, and it is the sharing and reinforcing of each others attributes and ideas that meet the Social Needs of individuals  within each of many situations. It is the sum of all the situations in life that lead to the degree of contentment and self-confidence that define individuals, but the situation is never static. As with food, the quality and quantity is constantly being monitored, and distress is triggered when there is insufficient, so it is when Social Needs are not met or are threatened. To some extent, memory and experience can sustain peoples’ self-confidence when they find themselves in situations where they feel they are unwelcome and do not fit in., and this can mitigate the level of anxiety experienced for a short time.

When people are admitted to hospital they are very likely be feeling some degree of anxiety for a variety of reasons:- worries about their illness and what is going to happen; experiencing pain;  being separated from their usual support systems; and there can be other severe concerns about disruption in the lives from which they have become separated. On top of these worries, coming as a stranger into an unknown situation and not knowing what is expected of them is a huge threat to having their Social Needs met.

With an excess of adrenalin in the body there are many adverse effects. These include:- strain on heart and lung function; less ability to concentrate and remember things and possible confusion; less resitance to infection; slowing of healing processes; and experience of pain exaggerated. In addition the person feels miserable and may be unable to produce socially rewarding behaviour towards others. It is for these reasons, as well as a kindness to the patients, that the prime concern of Caring has to be the allaying of the patients’ anxiety from whatever cause.

The individual nurses, by virtue of doing the job, have knowledge and skills which they can be expected to share equally with all the patients, but these carry little weight in terms of meeting any Social Needs. It is not what you do, but it is the way in which you do it that is all important in meeting Social Needs.

In the psychology section it was explained that ‘time’ and ‘attention’ are the two most important things that are given and received in social relationships, and these are both problematic in unbalanced groups.

The patients have a lot of time to give, but they have to be there and it is of no social value to the nurses. The nurses time is limited and has high social value, but in social terms it is devalued, because it is paid time, but is also worth more to the patients, because the amount available is fixed (by duty rosters) and has to be shared, not only with all the other patients, but with innumerable other people who come and go. Every patient will be evaluating how much individualised time they are receiving, compared with everybody else, and it is unlikely that anyone receives as much as they feel they need.

With this in mind, it is the nature of the attention that is paid to each patient that becomes most important, alongside carrying out the necessary tasks and routines. Natural eye contact and a friendly smile of themselves allay anxiety, and friendly chat that brings in things the nurse remembers about the person will meet Social Needs. You have to ‘listen’ in order to find things to remember, and this is the ‘time’ factor of the sharing. It does not have to take long and it is the remembering the small particulars in an unobtrusive way that is most effective in enhancing feelings of worth and belonging.it is important to distinguish between the ‘time’ that is given carrying out the tasks of care, and ‘time’ that is given by choice, just to be friendly. I call these interactions ‘unsolicited time’ and it can be for as little as a few moments, and should not be too long. They are friendly listening chats that are nothing to do with ‘duty’ tasks, and by using the ‘time’  to elicit things to remember and then showing you have remembered  them by making reference to them later, you will have provided the ‘attention’  aspect of meeting Social Needs.  In a ward it is important that ‘unsolicited time’ is given, just in passing, to all the patients, because they will each be monitoring who gets what.

When caring for people with mental health problems, the nature of the care is most effective when it is given in an ‘informal’ group setting, with the staff adopting a parental style role. This is where the individuals are nourished and kept safe, while enabling the development of all physical, mental and social attributes. Along with this they will gain self confidence and self reliance. The explanation about ‘unsolicited time’ above is of central importance in Mental Health nursing. There is a word of warning about how ‘teaching people social skills’ is very different from ‘enableing sociability’ because it does not provide the experience of earning approval and acceptance.

In a person’s home ‘unsolicited’ time is equqlly important, because the carer may be the only, or one of a few people to be able to help the person to feel valued and acceptable. Some relaxed ‘switch off’ time should be given, where some topic or activity can provide opportunity for the client to give something of themselves that can lead to a rewarding sharing relationship, even if it is only in the short term. If it can lead to some shared smiles or laughter, that will be an added bonus.

When this attentive way of relating to a patient becomes habitual, it can be termed a ‘therapeutic’ relationship – because, besides meeting Social Needs and allaying anxiety, it ensures that all other treatment ’inputs’ are more effective.

The interpersonal relationships play a large part in ensuring the well-being and safety of the patients, but they are dependent on the morale and skills of the nursing team as a whole. This is dependent on a variety of factors, both physical and psychological, within the organisation, that can be more, or less, enabling. The team must be well resourced, in terms of having knowledge and skills and adequate numbers and equipment, and then they must have acknowledgement that their work is approved and appreciated by the organisation. When this is the case it enables the ward to be run in a way which instils hope and inspires confidence for patients, visitors and the staff.  Where morale is low over time, individuals turn to each other for the meeting of their social needs and form a ‘deviant group’. This is a joint expression of the reflex ’attention seeking’ behaviour of individuals. In the same way, it will not be changed by punishment or sanctions, but only by improving the overall morale of the situation.

 All of this applies equally to community teams but it is much more difficult to make the social aspects effective.

Caring for patients has been the focus in this paper but the principles are equally important for Teaching in all  situations, because it is most effective when pupils are self-confident, well motivated and cooperative. This occurs when the teachers and learners have their Social Needs adequately met within and outside the organisation. Where learners come from ‘socially deprived areas’ it is useful to remember that punishment exacerbates the problems, and strategies to enhance esteem and enable sociability are likely to be effective in the long term.

    (Last edited January 2012)