27. PSYCHOSOCIAL ASPECTS OF HOSPITALISATION

Question 1

1. What are the aims of hospital work for the staff there?

Answer 1

• detection of the patient’s problems
• selection and application of the most appropriate
  treatments

Question 2

2. Why is the experience of hospitalisation much more complicated for the patient?

Answer 2

• they face psychosocial disruption
• they face limitations in hospital life
• this can produce a number of psychological
  responses
  (some which can be very severe)
  (severe enough to warrant psychological or
  psychiatric help)

Question 3

3. What guides the architects and the designers who construct the hospital buildings?

Answer 3

• financial limitations
• they are unlikely to get information about the design from the patient themselves
  (even though this is the person who spends most of their time in the building)
• hospital personnel are consulted
• but they do not spend their whole day in the building

Question 4

4. What are the emotions associated with hospital patients when they change physical environments?

Answer 4

• they are more sensitive
• they are more readily disturbed
• they feel that their spacial needs are not respected

Question 5

5. How is individual privacy intruded on in hospital settings?

Answer 5

• it is clinically impersonal
• it is invasive
• staff can be cold to patients
• patients are confined to a bed
• they are usually surrounded by a large number of
  strange people
• patients can be exposed to the suffering and even
  death of those around them
• the patient’s daily routine is very different from their one at home
• this can take much getting used to

Question 6

6. Patients in which conditions show less
   psychosocial distress:
   
   • home treated patients
     OR
   • hospitalised patients

Answer 6

• home treated patients

this is because a patient’s world at home consists of:
- familiar places
- specific habits
- these provide order and consistency

Question 7

7. Who does the hospital remove the individual from when they are hospitalised?

Answer 7

• the patient is removed from their families
• they are removed from their environment
• they are forced into a different environment that is
  different in every which way

Question 8

8. People at home can normally come and go as they please. How is this different in hospitals?

Answer 8

• patients are completely dependent on others for most basic functions
  (washing, feeding)
• patients are restricted to one place
• they are surrounded by new sights
• they are surrounded by new sounds and smells
• they are surrounded by new people

Question 9

9. In psychosocial terms, what two terms define hospitalisation?

Answer 9

1. uprooting
2. dislocation

Question 10

10. What are the three social changes that a patient experiences when they are hospitalised?

Answer 10

1. invasion of privacy
2. loss of independence and individualism
3. reduced opportunities for social contact

Question 11

11. What are the five manifestations of distress that patients usually encounter when they are hospitalised?

Answer 11

1. fear
2. increased irritability
3. loss of interest in the outside world
4. unhappiness
5. preoccupation with one’s body processes

• there can also be a sharp increase in the need for social reassurance
• this reassurance is needed from both relatives and professional personnel

Question 12

12. Why do patients usually need social reassurance from relatives and professional personnel?

Answer 12

• these needs are related to fear and anxiety
• they feel these emotions because they are uncertain of the nature of their illness
• they are also uncertain of their prognosis

Question 13

13. What aspect are most hospital patients dissatisfied with when it comes to their hospital life?

Answer 13

• communication
• 40% to 50% of hospital patients are critical of the communication aspects of their stay
• even doctors who have made a special effort to
  inform their patients
• still have dissatisfied patients
• who believe that there are gaps in the
  communication

Question 14

14. Patients are often unwilling to ask for
    information.
    What are the causes of this unwillingness?

Answer 14

• fear of ridicule
• fear of reprisal
• a feeling that nothing would be done to help them
• they do not want to cause trouble
• they do not know how to complain
• they feel that complaining or asking for more
  information is inappropriate behaviour

Question 15

15. What behaviours have been shown to lower the anxiety levels of patients in the hospital setting?

Answer 15

• good communication
• explanations of their condition

Question 16

16. What are some examples of stressful medical procedures?

Answer 16

• Endoscopy
• Barium x-rays
• Cardiac Catheterisation
• these types of procedures could cause serious psychological effects
• these can be uncomfortable and physically distressing
• they can also pose the threat of a serious medical condition

Question 17

17. What is the Psychological Impact of surgery dependent on?

Answer 17

• the procedure
• the condition
• the outcomes of the surgery
• psychological factors:
  - patient’s expectations
  - coping styles
  - communication
  - patient’s reaction to the medical procedure
  (this has a specific effect on the recovery)

Question 18

18. What will patients that have the highest pre-surgical levels of stress-response tend to experience?

Answer 18

• more harmful psychological reactions post-surgically
• they will be more likely to have a poorer physical recovery
• they will require more analgesia
  (medication that acts as pain relief)
• they tend to recover more slowly
• they will experience delays with hospital discharge

Question 19

19. What has been shown to reduce or minimise the psychological impact of the medical procedure?

Answer 19

• providing psychological intervention

Question 20

20. How many types of Psychological Intervention are there?

Answer 20

• there are five main groups/types
• they are based on the technique involved
• they are also based on the aim of the intervention

Question 21

21. Name the 5 main groups of Psychological Intervention when it comes to stressful Medical Conditions?

Answer 21

1. Psychological Support
2. Information Provision
3. Skills Training Intervention
4. Modelling
5. Cognitive Behavioural Interventions

Question 22

22. What is Psychological Support?

Answer 22

• these are interventions that allow the patient to:
  
  • talk
  • discuss
  • come to terms with their fears
  • come to terms with their concerns
    (about the medical event and any associated
    issues)

Question 23

23. What is Information Provision?

Answer 23

• it is a Psychoeducation
• it provides sensory and procedural information

Question 24

24. What is Skills Training Intervention?

Answer 24

• it is the learning of specific behaviour
• this helps patients cope with specific medical
  procedures
• it also helps patients to have an easier post-
  operative recovery
• the training includes:
  - breath control training
  - bodily control training

Question 25

25. What is Modelling?

Answer 25

• it is allowing patients to see other patients
  undergoing similar procedures, treatments or
  surgeries
  (they usually see this on film or videotape)
• this has been especially helpful in preparing
  children for surgery

Question 26

26. What are Cognitive Behavioural Interventions?

Answer 26

• they are the identification of negative automatic thoughts
• it also includes the challenging of these thoughts
• as well as thought modifications