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VCU PSYC 412 - Exam 3 Study Guide
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Psyc 412 1st EditionExam# 3 Study Guide Lectures: 13 -19Chapter 9- What is a Health Care Provider?o Nurses as providers: advanced-practice nurses:- nurse-practitioners - nurse midwives- clinical nurse specialists- nurse anesthetistso Physicians’ Assistants as providers: perform many routine health care tasks- Patient-Provider Communicationo Judging quality of care: the manner in which care is delivered is usedas the criteriao Patient consumerism: patients have a desire to be involved indecisions that affect their health- to convince a patient to follow a treatmentplan requires the patient’s cooperation patients often have considerable expertiseabout their health problemso The setting:the medical office is an unlikely setting foreffective communicationo Patient dissatisfaction in managed care: provider not always overly concerned with patient satisfaction some evidence that quality of care has erodedo DRGs and patient care: Diagnostic-Related Group (DRG):a classification scheme that determines the nature and length of treatment for particular disorders- DRGs have positive and negative effects on careo Changes in the philosophy of health care delivery: physician’s role is changing patients must assume more responsibilityo Holistic health movement and health care: health is a positive state to be actively achieved Western medicine incorporating Easternapproaches Greater emotional contact between patient and providero Provider behaviors that contribute to faulty communication: not listening use of jargon baby talk nonperson treatment stereotypes of patientso Patient contributions to faulty communication: patient characteristics patient knowledge patient attitudes toward symptomso Interactive aspects of the communication problem: providers rarely receive feedback when a patient doesn’t return:- the treatment may have led to a cure- the patient may have gotten worse and goneelsewhere- the treatment may have failed, but the patient got better anyway- the patient may have died *Feedback is essential for the providers- Results of Poor Patient-Provider Communicationo Nonadherence to treatment regimens: nonadherence:patients do not adopt the behaviors andtreatments their providers recommend- estimates range from 15% to 93% of patientsdo not heed their physician’s adviceo Measuring adherence to treatment regimens: Self-report yields unreliable and artificially high estimateso Causes of adherence: good communication treatment regimen creative nonadherenceo Patient-provider communication and malpractice litigation: malpractice suits have exploded overthe past decades because of:- increases in technical complexity- administrative complexity- incompetence and negligence- poor communication- Improving Patient-Provider Communicationo Teaching providers how to communicate: training providers: “patient-centered communication” improvespatient-provider dialogue nonverbal communication skills practice communication skillso Teaching patients how to communicate: training patients:- teaching patients skills for eliciting information from physicians- thinking up one’s own questions or perceiving that physicians are open to questions improves communication during office visits- Reducing Nonadherenceo Reducing nonadherence: health care institution interventions treatment presentation interventions skills training probing for barriers- The Patient in the Hospital Settingo More than 37 million people admitted yearly tonearly 6,000 hospitals in the U.S. structure of the hospital:depends on the health program Cure, Care and Core:- Cure – physician’s responsibility- Care – nursing staff- Core – administration of the hospitalo Functioning of the hospital: occupational segregation in the hospital is high nosocomial infection – infection that results from exposure to disease in the hospital setting hospital workers, especially physicians, likely to break rules designed to control infectiono Recent changes in hospitalization:alternatives to traditional hospital serviceso Cost-cutting pressures: hospitals have vacancy rates as high as 70% almost half of U.S. hospitals are part of a multihospital systemo Impact of hospitalization on the patient: patients arrive at hospital with anxiety hospital patients show problematic psychological symptoms patients are given a road map of procedures they can expect- Interventions to Increase Information in Hospital Settingso Landmark study – Janis (1958) fearful patients are too absorbed with theirpre-operative fears to processpreparatory information adequately patients with moderate fears were able todevelop realistic expectations of whatpost-surgery would beo *Preparation for patients is very beneficial- The Hospitalized Childo Anxiety: not all adverse reactions can be attributed entirely to “separation anxiety” a warm, nurturing relationship with a caregiver can offset some of the adverse effects of hospitalization for children mother need not be the person whoprovides that relationshipo Preparing children for medical interventions: conscious sedation distraction for managing pain and discomfort exposing children to modeling film coping skills preparation explaining their illness and treatment encouraging children to be vigilant copers of stress instead of avoidant copers parental support but not necessarily parental presenceChapter 10- The Significance of Paino Some pain is critical for survival. medical consequences: pain is the symptom most likely to lead an individual to seek treatmento medically significant: pain can be a source of misunderstandingbetween a patient and the medical providero Pain has a survival function Leprosy: suffer nerve damage and become insensitive to pain; they do a lot of damage to their bodieso Sometimes the pain doesn’t go away even after injury has been healedo Source of friction between patient and doctors Doctor can’t determine what patient’s pain level is-pain killers aren’t always prescribed (can be addictive) Some people with chronic pain go to doctor not for the pain but to get the drugso Doctors don’t have an objective way to measure paino Lower back pain-very commono Pain is prevalent and costly in the U.S. ~ 30 billion spento Psychological significance: depression and anxiety worsen the


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