Psych 365 Ch 6 (Hospital stays and medical procedures)
• The hospital as a distinct culture:
o Own social interaction rule (ie expect to learn personal info about a patient right
off the bat)
o Average 10% of Canadians hospitalized each year, only 25% of those involving
surgery and those don’t account for longest stays
o Medical stays for longer w/heart disease, diabetes, respiratory diseases
o Outpatient= person who goes to the hospital for a procedure or test but doesn’t
stay over night
o Non-invasive= doesn’t include piercing the skin or entering the body w/an
instrument
o Day care patients= person who goes to the hospital for a procedure or test that is
more involved than, ie radiography, but doesn’t stay overnight
Ie laser surgery for cataracts
o Dif admission patterns- waiting for it (and postponed, never happens, scared,
happy to have it done, etc..) or emergency (may even be unconscious)
o A hospital patient’s loss of Control:
Ppl feel they let go of ctrl when they’re in a hospital (internal, external
and powerful other ctrl)
• Increase in powerful other scores during hospital stay
3 factors affecting satisfaction w/hospital stay are respect thru
communication, maintenance of dignity and day to day ctrl
• The more compromise, the more dissatisfaction
• Satisfaction doesn’t equal not feeling powerless
• Surgical patients feel better when receive adequate info, stronger
the need for ctrl (in patient), the more they value info received
Total institution: any institution, such as a hospital, that takes control of
virtually every aspect of a person’s day to day life
• When facing end-of-life situations ppl react differently (along
continuum of how much ctrl they still want) o “activist”= wants total ctrl, “delegator” wants to relinquish
ctrl
o Generally ppl want to share ctrl w/physician, the more they
trust their physician, the more they will relinquish ctrl
Reactance: behaving counter to recommendatiosn in response to feeling
that one has lost personal ctrl over health behaviours; the non-compliant
behaviros and attitudes of patients who perceive hospital rules and
regimens to be unacceptable challenges to their freedom
• Younger, better educated and accustomed to being in ctrl= more
likely respond w/reactance
Learned helplessness: state where person, b/c of experience
w/previously uncontrollable stressful situations, learns to do nothing about
a new stressor rather than trying to cope constructively w/it
• Explains Empowering care (patient care that yields independence
and results in learned mastery) and Disempowering care (yields
dependence and can result in learned helplessness)
• Learned helplessness- norepinephrine depletion, general erosion
of health and possibility of sudden death?
o Ppl w/reactance more likely experience anger, heightened
stress hormone secretion and poss aggravation of existing
cardiovascular problems
• Study found provision of general info was single best predictor of
patients’ sense of ctrl
• Monitors (seek info) vs Blunters (avoid info)
o Physiological responses to amount of info fitting
preference (stressed when too much info and blunter or
too little and monitor)
• Uniformity myth: belief that all patients should receive the same
amount of info in their preparation regardless of their personal
styles of coping
All patients benefit from relaxation training (esp when encouraged to
focus on distraction rather than physiology)
• Patients even prefer walking to operating room rather than being
wheeled there (more in ctrl, less like a sick person) o Depersonalization: taking away one’s sense of individuality
Dehumanization: tendency to see ppl as objects or body parts rather than
human beings
• Ie technician run thru of procedure (rattling info off)- patient
unlikely to remember all info b/c went so fast and no opportunity
for questions
o How patients appear to cope with hospital culture:
2 main ways to cope w/loss of ctrl= relying on other patients, or adopting
either passive or active approach to stay
• Ideal balance b/w technology and human touch
• Advantages for bringing companion to procedure/consultation
o The Role of nurses in hospital culture:
Largest group in the hospital and “patient advocates”
2 general types of nursing rituals:
• Therapeutic rituals: primarily acitivies that deal w/patient-nurse
interactions; ie the administration of medication nand bathing of
patients
o Med admin and bathing very important, when patients
cooperative nurses appreciative
o If resistance get “assertive empathy”- I know you dont’ like
this and I can understand why but you must take it
• Occupational rituals: behaviours that indicate one has been
socialized in a profession. For nuses, these are communicated
thru interaction w/other nurses
o Focus on interactions w/other nurses
o 3 important components:
uniform (identification, subject to codes of conduct
and ethics)
hierarchy of authority (w/in nursing and b/w it and
other professions) • Nurses get power from knowledge, patients
get it from disclosure and ability to
interrupt/ctrl flow of conversation
Language: help maintain norms of the profession,
ways to communicate b/w nurses w/o patients
knowing what’s going on?
• Medical ethnographers study hospital culture
• Having processes ritualized makes them easier to complete,
maintain controlled and appropriate level of intimacy and firm
hand when necessary
• Need to consider 2 types of care
o Socioemotional care: interaction that helps patients
maintain a sense of optimist and psychological well being
o Technical care: activities involved in prescribed medical
procedures, independent of the psychological needs of the
patient
Patients don’t know about technical care, but do
know about socioemotional
• Satisfaction w/hospital stay largely affected by nurses care
• Burnout: condition similar to compassion fatigue and includes
symptoms of physical exhaustion, depersonalization of patients,
and feelings of discouragement nd low accomplishment
o Exhaustion, cynicism, lack of belief in own competence
• Patient satisfy determined largely by socioemotional care (and
when nurses overtaxed they aren’t as good at giving this kind of
care)
o Patient cetnered care: an ideal in the hospital
Patient centered care: approach where patients and families become
active members of tx team
• The psychological impact of medical procedures:
o The psychology of Mammography: One way to understand ptl negative psycholigcal impact of medical
procedures is to look at its invasiveness (measure of the extent to which
hospital procedures in a physical sense, involve piercing the skin or
entering the body w/instruments, or in a psychological sense have the ptl
to cause embarrassment
• Procedures on continuum of invasiveness
Mammography moderately invasive (fear of what may be found, anxiety,
embarassment)
• Same w/pap tests
• Consider false-positive results (indicate abnormality when there
isn’t actually any)
o Mammograms w/1-14% false positives?
o One form of faslse positive is Benign Breast Biopsy: leads
to women w/abnormal mammograms being called back for
biopsy w/results showing no evidence of malignancy
o False positives d
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