PSYC 3170 Chapter Notes - Chapter 9: Nurse Practitioner, Registered Nurse, Baby Talk

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24 Apr 2012
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Patient-Provider Relations Notes
Nurse practitioner: is a registered nurse (RN) who has an additional education in health
assessment, diagnosis, management of all illnesses and injuries order tests and
prescribe drugs
o Work with physicians in private practice but also provide care in public
clinics such as nursing homes; emphasize prevention
o Advanced proactive nurses- autonomasly and collabritvly
o Complement rather than replace other health care providers
Physician assistants: are skilled health care team members who perform a wide range
of medical services
o Their duties: medical histories, physical examination, diagnosis, and
treatment
o Physician assistances will become more popular in the future
o Main employer of assistants is the candian military forces
o
We often judge technical quality on the basis of the manner in which care is delivered.
o A warm, confident and friendly provider is judged better than someone
who is unfriendly
o Uncertainty kills liking
Patient consumerism- Another factor in which where there is a heavy influence on
patient-provider interactions is the patient’s increasing desire and need to be involved
in the decisions that affect their health
Increasing emphasis on maintaining and achieving good health in Western societies has
contributed to patient consumerism in recent years
o More proactive role in managing their health
o Practitioner must have patients full cooperation
o Patient must plan for better health and that will ensure commitment
o Modify lifestyles such as no smoking and exercise
o Ppl who see health under ones control liely to alter it positively
The internet is also used in the patients being more proactive in their treatment
Patient has more expertise about their illness especially when it is chronic or returning
The relationship between patent and provider is changing in the ways that make better
communication essentials
Setting:
o Unlikely source for good comms; likely interupted
o is in a practitioners office for 12-15 mins
o Provider has to extract information quickly
o Difficulties: patient uses over the counter remedies that mask the symptoms
o And they think that some symptoms are more important that the practitioner’s
knowledge of symptoms
Structure of health care delivery system
Primary are health care facilities and coordinates the provision of the services that are
delivered to ensure community of care (family doctors)
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Secondary health care: need to record any necessary tests or procedures that are
passed along to primary physician
o Gatekeeper systems is receiving specialized care or tests require referrals from
physicians
o Even having a regular physician may not have time to see them or have a
referral because of the few physicians and many people
o The long wait for consultation can be stressful and frustrating for patients
o Add to this even a longer wait for specialized care such as for cardiac or cancer
care
o Ontario one of the lowest ratios; Canada is lowest to primary health care
o STUDY: primary care users in southwestern Ontario had a primary physician
majority had to wait and could not get an appointment
o CAM complematary and alternative medicine
o Chiro, massage, acupuncture
o Socio demographic affects usage of cams
o Cam=consumersit approach
o Consultations are longer,
Changes are occurring in the health cares system
More women and becoming doctors and increase acceptance of contemporary and
alternative therapies
Responsibly that were before only for doctor now change to other doctors and patients
Holistic health: the idea that merely is a positive state to be actively achieved not
merely the absence of disease, has gained a strong foothold in Western medicine
Viewpoint both spiritual and physiological influences on health and patients
responsibility for achieving health and curing illness
Emphasizes self-help, health education, and self-healing
Changes alter relationship between provider and patient making more open, equal and
reciprocal (emotional contact)
Provider behaviors that contribute to faulty communication
A problem between practitioner and patient is not listening
o Beckham and Frankel (1984): studies 74 office visits, 23% patients could
finish their explanation, 69% physicians interrupted (directing to a
disease), patient can only talk for 18-22 seconds
o This is not good because it can leave out important information
The use of jargon and technical language is another factor in poor communication
o Physicians have sued medical jargon for a very long time
o Also can be contributed by the technical training and may forget that
patients are not ad expertise as they are
Physicians may underestimate patients understanding and may use baby talk to them
o This includes overly simple explanations coupled with infant zing baby
talk that make the patient feel like a helpless child
Depersonalization of the patient is another problem that impairs the quality of the
patient-practitioner relationship
o This may be done to keep the patient quiet when an explanation is
being told or when there is a test being conducted
o May be employed when the practitioner is stressful to keep the patient
quiet and them concentrating
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