BPS Flashcards
how developed the BPS model?
American psychiatrist George Engel
whats the difference between the BPS model and the biomedical model?
the biomedical model focus only at the biomedical aspect, but the BPS model sees the patient as a hole
What are the biomedical aspects?
illness manifested only on physiological grounds
what are the social aspects?
family, friends, work environment, personal belief, economics and even technology
what are the psychological aspects?
psychological health, motivation, self control, personality, behavioural patterns ect
what are the benefit of the BPS model?
they see the patient in a holistic point of view. they treat the patient not the problem, so the patient will have a greater success rate in rehab
that are the negative sides of the BPS model?
they may not focus enough on the actual problem, and takes longer time. they also may miks biomedical and physiological problems
explain fear avoidance behavior
they avoid the problem making it worse
What is the most important reason for lower back pain
fear avoidance behaviour, as chiropractors we need to take this into consideration
what in the physical environment do we need to take into consideration as chiroprators?
weather, housing conditions, furniture, availability of money, means of transportation.
who gets affected by lower back pain
the patient, their family, their job, friends, health care providers
what are the red flags
-Fever of 38ºC (100.4ºF) or above -Unexplained weight loss -History of cancer Abdominal bruit (AAA) -Swelling of the back -Signs / symptoms of infection -Constant back pain that does not ease after lying down -Pain in your chest or high up in your back -Pain down your legs and below the knees -Pain caused by a recent trauma or injury to your back -Loss of bladder / bowel control -Inability or difficulty passing urine -Perineal numbness, numbness around your genitals, buttocks or back passage -Pain that is worse at night -Unable to reduce symptoms mechanically -History of trauma (mild + osteopaenia) -Family hx inflammatory arthropathy
what are the cauda equina syndrome, symptoms
-Low back pain -Bilateral leg pain -Perianal sensory loss; altered sensation around the back passage and genitals. -Bladder symptoms include: loss of bladder sensation, abnormal sensation on passing urine, urinary retention (more common in men), urinary incontinence (more common in women). -Bowel symptoms are rare but include incontinence. -Sexual / erectile dysfunction -Progressive weakness in the legs
information communication
to transmit information from one person to another
supportive communication
to provide understanding, sympathy or encouragement to patients
successful treatment outcomes are partially determined by…..
……effective communications
paternalistic
doctor uses doctor-centred style, closed question
cunsumeristic
the patient knows exactly what they want and “force” the doctor into patient centred approach
default
the doctor attempts to assume control but the patient is unwilling to accept it
mutuality
the doctor uses open questions to encourage the patient to talk about his complaint
doctor-centred communication
-one way communication - patient is passive
patient-centred communication
-two way process -the patient is active and have more influence over the consultation
what are the 5 basic communication tasks?
1) Initiating the session 2) Gathering information 3) Building the relationship 4) explanation and planning 5) closing the session
different verbal communication
closed question and open question
what techniques are used to reduce the probability of misunderstanding?
paraphrasing, summarising and clarifyring
active listening Technics
mirroring, empathy, silence(let the patient have time to think)
the use of jargon
dont use words like cancer
difference between leading and open questions
dont use leading questions
what are the factors that may affect doctor patient communication?
-your emotional state -negative attitude towards patient(ex pedofile) patient: -nervous or anxious -emarressed -in pain -very tired or influenced by drugs
what are the social factores affecting communication?
-age -socioeconomic groups -gender
what to keep confidential?
-indentity(name, adress, marital status) -medical history -social circumstances -Psychological factors ( emotional state, metal health stress leves ect)
non verbal communication?
-facial expression -Gaze -gesture -body movement -posture -touch -spatial behaviour -clothing and appearance -timing?
different facial expression to look out for..
happiness, surprise, fear, sadness, anger, disgust and contempt.
what not to do with your posture when you are a chiropractor..
-arms crossed -bad posture in general -to relaxed ect
personal space differences:
1) intimate zone 0-60 cm 2) personal zone 60-120 cm 3) social zone 1,2-3,3 m 4) public zone 3,3m +
what does SOLER stands for
Sitting posture Open posture Lean sometimes forward to the patient maintain Eye contact try to Relax
Paralinguistics
what is expressed other than words
what is important when dealing with older patients?
Dignity
how do elderly patients often explain pain?
under-reporting, cognitive impairment and dementia can be obstacles to pain assessment.
common problems among the elderly?
malnutrition - look for abuse
how to ask qusetion about changes in cognition over recent years..?
-who does the shopping at home? -who does the cooking? -who is paying the bills? -are you still drivng?
What is Piaget 4 stages of cognitive development?
- Sensorimotor - (0-2 yrs)
- experience of the world through movements ans sensations - Preoperational - (2-7 yrs)
- symbolic thinking
- Egocentrism - Concrete operational
- (7-11 yrs)
- Logical thinking about concrete events - Formal operational
- (12 yrs-up)
- Abstract thinking and reasoning concerning hypothetical problems
what is John Bowlys attachment theory.
- The most important principle for infant development is the relationship with at least one primary caregiver(for social and emotional development)
- the emotional bond stimulated brain growth and affects personality development and lifelong ability to form stable relationship.
when does childern have separation anxiety?
around 7-12 months
what are typical for the pre-operational stage? (2-7 yrs)
- example: “granny gave me tummy ache” if the tummy ache started at grannys house.
- they tend to focus on one symptom. asthma= coughing
- because of this the child may not report all of the symptoms
- The child grasps the idea of contamination but may over-generalise the conditions that are infections (e.g. did you catch your broken arm from your brother?) and methods of transmission (e.g. believing they can catch measles from a friend over the telephone).
- -Implication: Child may fail to recognize an actual route of condition so they will not report it.*
What are typical for the concrete operational stage? (7-12 years)
- the child may recognize that diseases may have range of symptoms. so their ability to report their bodily sensations and possible causative agents improve.
- they see good health as absence of illnes.
- they start seeing health risk behavior.
- smooking is bad for them
- they see the biological causes of health and death, germs and diseases.
- -they are more likley to follow health advice as they understand the impact of their actions on their own heath.*
what are typical for Formal operational stage? (12 years +)
- Factors such as exposure to education increases understanding about body structure, e.g. organs and both its function and dysfunction
- increasingly capable of understanding scientific explanations of illness. -understands the purpose of treatment
- -Implication: children are able to follow logical arguments so they are more able to discuss alternative treatments.*
name some of the common myths associated with childhood pain:
- Children do not feel pain
- Children do not remember pain
- Analgesics can do more harm than good
- Addressing and treating pain takes too much time
- Pain builds character
what are some Psyhosocial factors associated with pain in childern?
- Toddlers and preschool aged children, especially under 8 yrs, mainly demonstrate behavioural distress and pain during medical procedures.
- Girls display more expressive responses such as crying and clinging and may report more pain whereas boys use different forms of behaviour and report less pain.
- Child’s sex: parents more likely to use distracting activities with girls (links with above?)
- Difficulty of the procedure: the more difficult the procedure, the greater the distress of the child.
- Ability of health care provider, experience, communication skills and healthcare skill.
- Family and parents in particular: previous experience of parents, belief that intervention will be helpful, parenting style and parental anxiety.
what metodes are used to reduce pain in childern?
- Positive reinforcement
- Explain procedures using age-appropriate pros
- pictures, diagrams, approriate language ect.
- Distraction
- Useful interventions during painful procedures
- music, controlled breathing and imagery
What are the negative consequences of parents behavior?
- Children are often sensitive to their parents’ behaviour and feelings, they can pick up signs of anxiety or fear, or the complete opposite.
- Therefore, spend time with parents reassuring them and ensuring they fully understand the situation to reduce their fear / anxiety.
- Parents need to agree to be involved.
- Some parents may not be able to help and feel guilty and helpless if clinical staff force them to become involved.
what is adolecence?
•Adolescence: transitional developmental period between childhood and adulthood. This stage can have more biological, psychological and social changes than any other stage except in infancy.
how should approch children as a chiropractor?
- Approach the child in a gentle and calm manner.
- Maintain eye contact.
- When starting the interview, start by addressing the child by using age appropriate dialogue. Have an ice-breaker ready.
- Use words that can be understood by the child and the parents.
- Do no direct all your attention to the parent.
- Use play therapy, story-telling, painting and other strategies to understand the child’s experience.
Encourage the expression of feelings and fears
- Ask young children if they would like to tell their story or would prefer the parents to do it.
- Parents tend to interrupt children during medical interviews and may disagree with the child’s perspective. Be attentive to such cues especially if there is a behavioural problem.
should you use open or closet qusetion with childern?
- Closed questions workes best with young chideren
- Open questions workes best with older childs
