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Pyschology
Course: PSYCH 3410, Spring 2011School: Georgia State
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ChapterNine: HealthPsychology ClicktoeditMastersubtitlestyle 4/9/11 PatientProviderRelations WhatisaHealthCareProvider? 4/9/11 Nursesasproviders: advancedpracticenurses: nursepractitioners nursemidwives clinicalnursespecialists nurseanesthetists PhysiciansAssistantsas providers: performmanyroutine healthcaretasks Obj100 PatientProviderCommunication 4/9/11 Judgingqualityofcare:...
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ChapterNine: HealthPsychology
ClicktoeditMastersubtitlestyle
4/9/11 PatientProviderRelations
WhatisaHealthCareProvider?
4/9/11
Nursesasproviders: advancedpracticenurses: nursepractitioners nursemidwives clinicalnursespecialists nurseanesthetists PhysiciansAssistantsas providers: performmanyroutine healthcaretasks
Obj100
PatientProviderCommunication
4/9/11
Judgingqualityofcare: themannerinwhichcareisdeliveredis usedasthecriteria Patientconsumerism: patientshaveadesiretobeinvolvedin decisionsthataffecttheirhealth toconvinceapatienttofollowatreatment planrequiresthepatientscooperation patientsoftenhaveconsiderableexpertise abouttheirhealthproblems
Obj100
PatientProviderCommunication(cont.)
4/9/11
Thesetting: themedicalofficeisanunlikelysettingfor effectivecommunication Structureofthehealthcaredeliverysystem: private,feeforservicecare HealthMaintenanceOrganizations(HMOs) PreferredProviderOrganizations(PPOs)
Obj100
PatientProviderCommunication(cont.)
4/9/11
Patientdissatisfactioninmanagedcare: providernotalwaysoverlyconcernedwithpatient satisfaction someevidencethatqualityofcarehaseroded DRGsandpatientcare: DiagnosticRelatedGroup(DRG): aclassificationschemethatdeterminesthe natureandlengthoftreatmentforparticular disorders DRGshavepositiveandnegativeeffectsoncare
Obj100
PatientProviderCommunication(cont.)
4/9/11
Changesinthephilosophyofhealthcaredelivery: physiciansroleischanging patientsmustassumemoreresponsibility Holistichealthmovementandhealthcare: healthisapositivestatetobeactivelyachieved WesternmedicineincorporatingEastern approaches Greateremotionalcontactbetweenpatientand provider
Obj100
PatientProviderCommunication(cont.)
4/9/11
Providerbehaviorsthatcontributetofaulty communication:
notlistening useofjargon babytalk nonpersontreatment stereotypesofpatients
Obj100
PatientProviderCommunication(cont.)
4/9/11
Providerbehaviorsthatcontributetofaulty communication:
notlistening useofjargon babytalk nonpersontreatment stereotypesofpatients
Obj100
PatientProviderCommunication(cont.)
4/9/11
Patientcontributionstofaultycommunication:
patientcharacteristics patientknowledge patientattitudestowardsymptoms
Obj100
PatientProviderCommunication(cont.)
4/9/11
Interactiveaspectsofthecommunicationproblem: providersrarelyreceivefeedback whenapatientdoesntreturn: thetreatmentmayhaveledtoacure thepatientmayhavegottenworseandgone elsewhere thetreatmentmayhavefailed,butthepatient gotbetteranyway thepatientmayhavedied *Feedbackisessentialfortheproviders
Obj100
ResultsofPoorPatientProvider Communication
4/9/11
Nonadherencetotreatmentregimens: nonadherence: patientsdonotadoptthebehaviorsand treatmentstheirprovidersrecommend estimatesrangefrom15%to93%of patientsdonotheedtheirphysicians advice
Obj100
ResultsofPoorPatientProvider Communication(cont.)
4/9/11
Measuringadherencetotreatmentregimens: yieldsunreliableandartificiallyhigh estimates Factorsimpactingadherence: communication treatmentregimen creativenonadherence
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ResultsofPoorPatientProvider 4/9/11
Patientprovidercommunicationandmalpractice Communication(cont.)
litigation: malpracticesuitshaveexplodedoverthepast decadesbecauseof: increasesintechnicalcomplexity administrativecomplexity incompetenceandnegligence poorcommunication
Obj100
ImprovingPatientProviderCommunication
4/9/11
Teachingprovidershowtocommunicate: trainingproviders: patientcenteredcommunication improvespatientproviderdialogue nonverbalcommunicationskills practicecommunicationskills
Obj100
ImprovingPatientProvider Communication(cont.)
4/9/11
Teachingpatientshowtocommunicate: trainingpatients: teachingpatientsskillsforeliciting informationfromphysicians thinkinguponesownquestionsor perceivingthatphysiciansareopento questionsimprovescommunicationduring officevisits
Obj100
ReducingNonadherence
4/9/11
Reducingnonadherence: healthcareinstitutioninterventions Presentationoftreatmentinterventions skillstraining probingforbarriers
Obj100
ThePatientintheHospitalSetting
4/9/11
Morethan37millionpeopleadmittedyearlytonearly 6,000hospitalsintheU.S. structureofthehospital: dependsonthehealthprogram Cure,CareandCore: Curephysiciansresponsibility Carenursingstaff Coreadministrationofthehospital
Obj100
ThePatientintheHospitalSetting(cont.)
4/9/11
Functioningofthehospital: occupationalsegregationinthehospitalishigh nosocomialinfectioninfectionthatresultsfrom exposuretodiseaseinthehospitalsetting hospitalworkers,especiallyphysicians,likelyto breakrulesdesignedtocontrolinfection Burnout Exaustion,cynicism,lowsenseofefficacyin onesjob
Obj100
ThePatientintheHospitalSetting(cont.)
4/9/11
Recentchangesinhospitalization: alternativestotraditionalhospitalservices Costcuttingpressures: hospitalshavevacancyratesashighas70% almosthalfofU.S.hospitalsarepartofa multihospitalsystem RoleofPsychologists Increasingnumber Expandingrole
Obj100
ThePatientintheHospitalSetting(cont.)
4/9/11
Impactofhospitalizationonthepatient: patientsarriveathospitalwithanxiety hospitalpatientsshowproblematic psychologicalsymptoms patientsaregivenaroadmapofprocedures theycanexpect
Obj100
InterventionstoIncreaseInformation inHospitalSettings
4/9/11
LandmarkstudyJanis(1958) fearfulpatientsaretooabsorbedwiththeir preoperativefearstoprocesspreparatory informationadequately patientswithmoderatefearswereableto developrealisticexpectationsofwhatpost surgerywouldbe *Preparationforpatientsisverybeneficial
Obj100
TheHospitalizedChild
4/9/11
Anxiety: notalladversereactionscanbeattributed entirelytoseparationanxiety awarm,nurturantrelationshipwitha caregivercanoffsetsomeoftheadverse effectsofhospitalizationforchildren motherneednotbethepersonwho providesthatrelationship
Obj100
TheHospitalizedChild(cont.)
4/9/11
Preparingchildrenformedicalinterventions: conscioussedation distractionformanagingpainanddiscomfort exposingchildrentomodelingfilm copingskillspreparation explainingtheirillnessandtreatment encouragingchildrentobevigilantcopersof stressinsteadofavoidantcopers parentalsupportbutnotnecessarilyparental presence
Obj100
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