All persons seek to maintain a high level of health and a feeling of well-being. Health can be defined as the status of an organism functioning without any evidence of disease or disfigurement. Unfortunately, a perfect state of health is rarely achieved; therefore, health is seen as on a continuum (Fig. 3-1). We are all in various places on this continuum depending upon our state of physical and mental health.

Stress in its various forms affects a person’s ability to maintain one’s health status at a high level. Stressors may take many forms, from a simple change in living area or beginning a new job to a major life change such as diagnosis of a potentially terminal illness or losing a significant person in one’s life. Any change in life requires adaptation to that change with its accompanying stressors.

All persons have basic needs that must be met. When basic needs are met, one aspires to higher needs. A person who is in a state of prolonged stress eventually finds that basic needs are unable to be met, and illness may result.

Abraham Maslow, a renowned psychologist, visualized humans as governed by a hierarchy of needs. These needs are viewed as a “building block” in a pyramidal structure. At the base of the pyramid are the basic physiologic needs; at the top is self-actualization, which is the end result of growth of the human spirit. At the lowest end are the basic needs to maintain our bodies (Fig. 3-2).

Persons whose state of mental and physical health is at the most positive end of the health-illness continuum have their basic needs met and have no stressful events affecting their well-being. They are able to begin to pursue higher goals. When illness—whether physical or emotional—overtakes a person, the state of well-being is no longer a perception of one whose basic needs for food, water, air, shelter, love, belonging, and self-esteem are being met. Illness may mean the loss of ability to maintain social and economic status. The person’s place in a social group is threatened. As illness progresses, the awareness of unmet basic needs increases, and a feeling of great anxiety overwhelms the ill person.

Patients are often in a state of anxiety by the time the radiographer comes into contact with them. Persons who are in need of imaging procedures may present themselves for diagnosis and treatment after a long period of feeling unwell. Others may come to the department immediately
after a serious accident has destroyed, or threatens to destroy, their state of well-being. These situations result in a state of severe stress. When one’s level of wellness has been compromised, regressive behavior may result. A person in such a state may have difficulty communicating effectively. The patient may resort to aggressive demands, or may withdraw in silence and not be able to make any needs known at all.

When assigned to care for any person, the radiographer must be able to determine that person’s state of health or illness and must understand that the fulfillment of the patient’s most basic needs may have been compromised by the stress of illness or trauma. Stressful life events may result in unpleasant patient behavior.

Before performing actual imaging procedures, the student radiographer has been instructed in a classroom and laboratory that has cognitively conditioned the student to the profession of imaging technology. Through these settings, the student has been informed with regard to principles, insights, and concepts of the profession.

During this didactic aspect of education, the student radiographer must adapt the material that was taught and process it for utilization in the psychomotor portion of education in the clinical settings.

Each patient care procedure requires a different application of the student’s skill and knowledge. Being able to complete each assignment in a timely and efficient manner, while meeting the unique needs of each patient, is the criterion for an excellent radiographer. To achieve this goal, the use of critical thinking skills is required.

Critical thinking can be defined as an analytical inquiry into any issue presented and requires the following:

The ability to think critically requires effort and self-knowledge. The student must examine all past methods of thinking and be aware of the limits of knowledge, biases, and prejudices. Life experiences must be reviewed because they have contributed to the present manner of one’s thinking and formulating plans. By changing thinking patterns, there is an allowance for expansion of thought and creativity in the thought processes. The critical thinker is an inquisitive thinker who is tolerant of the views of others. Professional maturity comes with increased technical skill and growth in critical thinking skills.

As interactions with patients continue, the student will proceed through levels of thinking. Personal and professional growth will occur, and technical abilities will expand. This occurs because one’s thinking methods grow from the simple to the complex. Not only will the skills to perform radiographic examinations become easier and even second nature, but the ability to understand the patient’s needs and become adept at meeting these needs will increase.

Every patient and every diagnostic procedure present problems ranging from simple to complex. When the radiography student obtains a patient care assignment, it must be decided how to perform the assignment quickly, efficiently, and as comfortably as possible for the patient. This requires going through the problem-solving process before beginning the task. The beginning student should write down the problem-solving process. As proficiency is attained, it will become a mental process. However, when the process is conducted, critical thinking is necessary to achieve a satisfactory outcome. The ability to recall evidence-based scientific principles needed to conduct the procedure is mandatory. This is followed later by an assessment of the patient; collection of data from the patient; analyzing the data; then implementing the plan; and, at termination of the procedure, evaluating the result.

Race and ethnicity are often considered to be the same, but this is not the case. Race is considered to refer to all persons who have the same physical characteristics, such as skin coloration, body structure, hair color and texture, and facial appearance.

Culture is defined as a shared system of beliefs, values, and behavioral expectations that provide social structure for daily living. This includes beliefs, habits, likes and dislikes, and customs and rituals of a particular group of people.

A group within a particular culture usually shares the same ethnicity, or characteristics of social and cultural heritage. For example, the 2000 US Census identified racial categories, as well as ethnic and cultural areas. The following were listed as racial categories in the United States for 2000: White, Black, Native American and Alaska Native, Asian, and Native Hawaiian. Hispanic or Latino is an ethnic category. Within that ethnicity are the following cultures: Mexican, Puerto Rican, Cuban, Dominican, Central American (excludes Mexican), South American, and Spaniard. Within the Asian and Pacific Islander categories of ethnicity, there are Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, and Other Asian; Native Hawaiian, Guamanian or Chamorro, Samoan, and Other Pacific Islander. There are more than 100 ethnic groups and 562 federally recognized Native American tribes in North America. Each tribe is ethnically, culturally, and linguistically diverse. The population of ethnically diverse people is increasing rapidly. The US Census Bureau believes that the population of the United States will remain predominately White; however, based on the 2000 census results, other groups are increasing disproportionately. Hispanics is now the largest minority group, replacing African Americans.

The implications of this influx of varying peoples into the health care system are significant. The patient’s culture and ethnicity will play a major role in the assessment of the patient. The radiographer must not stereotype any person based on cultural or ethnic background. The patient who has been reared and educated in the United States will have an understanding of the Western health care delivery system, whereas those from other countries may have little or no understanding of this system and may wish to return to their own traditions in health care. Critical thinking will be demanded of the radiographer in assessing the patient and planning care. The patient’s reactions to treatments offered, reaction to pain, and other aspects of health care may not be those to which the radiographer is accustomed. Aspects of this assessment will include the following:

The radiographer must realize that there can be no standard model of assessment, plan, and intervention for care for all patients. North America is multicultural, meaning not all cultures have assimilated to the thinking of the area in which they live. Canada embraced this concept in the early 1970s and has accepted the differences among peoples. The United States, however, continues to live under the concept of the “Melting Pot.” There are many different races, ethnicities, and cultures, but there is a belief of national culture, a homogeneous American society. This belief in health care has significant implications. Using only the Western-derived model for all patients may lead to a poor assessment and poor outcome of treatment. All aspects of cultural and ethnic diversity must be a part of the radiographer’s assessment and plan of care.