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Psych 365 Ch 6.docx

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PSYC 365
David Cox

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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