Chapter 10: Hospital, patient provider relations, palliative care/terminal illness Flashcards
What Healthcare services are offered in Canada?
Family doctors, walk in clinics, specialists, hospitals, nursing home/hospices/longterm care, outpatient & home health services, telehealth
Although Canadians are generally satisfied with healthcare system, what problems are present?
Access to care (disparities in access- like provincial or rural vs. urban) and wait times
What percentage of people are admitted through emergency department?
more than 50% (non-childbirth)
Who works in hospitals?
Doctors Medical specialists Nurses Students, residents Other practitioners like physiotherapists, psychologists, social workers Researchers Social support staff psychiatrists Administrative personnel
What is the average wait time and top reasons to be admitted to the ED
Average wait time is 4.4 hrs, 90% of people seen within 7.6 hrs and top reasons include abdominal/pelvis pain, throat or chest pain and respiratory infection
What is the Canadian triage and wait time acuity scale
-High acuity Level 1 (resuscitation) Level 2 (emergent) Level 3 (urgent) -Low acuity Level 4 (less urgent) Level 5 (non-urgent)
What changes when entering a hospital?
- Unfamiliar and strange environment
- Requires psychological and social adjustment (e.g. lack of privacy, new schedule, restricted activities, loss of control, being dependent on someone)
Patient-provider relationships often result in…
depersonalization, loss of autonomy/control
What are qualities of a Good Patient
cooperative, uncomplaining and stoical
What are some qualities of a Problem Patient
uncooperative, complaining, overemotional and dependent.
Types of Problem Patients
- Seriously Ill patients with complications/poor prognosis that require a lot of attention (staff usually forgives their behaviour)
- Not seriously ill but take more time than is needed for their condition (staff often responds by administering sedatives or early discharge)
Emotional Reactions to Hospitalization include…
High anxiety levels at admission/prior to operation but declines over the next few weeks (sometimes increases over time)
- Adjustments differ depending onager, gender, illness (e.g. younger people tend not to cope as well)
What is Problem Focused Coping
driven to solve the problem
What is Emotion Focused Coping
don’t try to solve the problem, but use distraction techniques
- People with uncontrollable illnesses tend to use emotion focused coping more
Coping Styles with Hospitalization
- Problem focused vs emotion focused coping
- Blaming self or others
- Helplessness and Loss of Control
How to Help Patients Cope
- Provide Info
- Psychological counselling
- Increasing control (behavioural, cognitive, and informational strategies)
- Rooming with someone recovering from a similar illness
- Humour
What are Behavioural strategies for increasing control
teach techniques specifically designed to help them cope
What are Cognitive strategies for increasing control
how to change thought patterns, reappraise things, focus on benefits
what are Informational strategies for increasing control
giving more information about the condition, and more info about how they can cope and deal with systems, support they can get
Humour Aids in Coping as it…
- Helps patient communicate stressful/difficult feelings
- Serves a social function to equalize the patient-provider
- Can help with psychological function and emotional state
Preparing Patients for Surgeries
- High anxiety is associated with poor recovery (patients who go into surgery with low anxiety recover faster)
- Psychological Preparation
Why is Psychological preparation helpful?
enhances sense of control, addresses expectations (inform patients of what will take place, some patients like all the information - all possible outcomes)
Preparing patients for Nonsurgical Procedures
- Some are not painful but produce strange, frightening sensations (not knowing about the sensations can lead to higher anxiety). Important to inform patients about sensations they’ll experience.
- E.g. cardiac catheterization, endoscopy
Attention-focused coping/preparation
less stressed with more information
Avoidance-focused coping/preparation
do better with less information
Effective coping…
matches a patients coping strategy (attention-focused vs avoidance-focused)
What is Discharge planning
process by which post-hospital care is organized and risks are assessed (e.g. give a schedule on when to come back)
- Further treatment/follow-up is often required
What are the Problems in Hospitals?
- Wait Times
- Nosocomial Infection
- Medical Mistakes
Wait times (problems in hospitals)
ED admissions - 1/10 wait more than 30 hours for a hospital bed
Nosocomial Infection (problems in hospitals)
- From exposure to disease in hospital
- Found for 1/9 admitted patients
- 8000-1200 deaths in Canada per year
Factors that lead to satisfaction with hospital experiences
- Respect in communication (avoiding jargon, and provide better info about procedures)
- Maintenance of dignity
- Day-to-day control
Prevalence rates of mental illnesses
10% of ontarians experience mental health disorders or addictions
20% of children are diagnosed with mental health disorders or addictions
When talking about symptoms 40-50% of children experience anxiety/depression but only 20% are clinically diagnosed
For 1/3 of those with substance/alcohol abuse who go to the ED it was their _______ ___________ with a healthcare provider
first contact (other options - community organization)
Role of Health Psychologist in Hospitals
- Assess adjustment (find out how well patients are coping)
- Help patients and families prepare and cope with stress or treatment (e.g. teach coping techniques)
- Assist with rehabilitation, medication adherence, and lifestyle change
- Research on making hospitals more effective and safer
Women’s average life expectancy in Canada is…
83.3 years
Men’s average life expectancy in Canada is…
78.8 years
In Canada average life expectancy is…
81.1 years old
Death in Infancy/Childhood
- Infant Mortality Rate: 4.8 per 1000 in 2012
- Areas in Canada differ with SES and location
Death in the first year of life is mostly due to?
- Congenital abnormalities
- Sudden Infant Death Syndrome (SIDS)
Death between ages 1-15 is mostly attributable to?
- Accidental deaths (accidents are becoming fewer as years go on)
- Cancer (leukemia accounts for 80% - survival rate with being diagnosed with leukemia in childhood is high)
What are the causes of Death in Adolescence or Young Adulthood (15-24)
- Unintentional Injury (car accidents)
- Suicide
- Cancer
- Homicide
- Other diseases (e.g. heart disease)
What are the causes of Death in middle age
- Chronic illness (e.g. heart disease)
- Premature Death (where modifiable factors are most effective)
What is Premature Death
death before the average life expectancy age - before the age of 81. Usually sudden from heart attack or stroke.
Death in old age
- Fear of death is reduced
- Most often die from degenerative disease (e.g. heart disease) or organs start to decline
Why do women live longer than men?
- Research suggests that women are more physically healthy than males, and oxygen is more easily spread throughout the body.
- On average men engage in riskier behaviours (higher on sensation seeking)
- Men are more likely to have hazardous or higher stress jobs
- Social support may be more protective to women (more involved in social networks)
- Women are more likely to see doctors
Understanding Death - Infants (0-2 years)
don’t understand death, only understand what people around them are feeling. (don’t understand that death is the cause)
Understanding Death - Preschool (2-5 years)
don’t have a full understanding of death, of that its permanent. May believe the person has gone away, or is sleeping. Don’t understand why death occurs, may think they caused the death with their thoughts. Because of this they may think they can bring the person back. They don’t think death is something that can happen to them, they just think it happens to other people.
Understanding Death - School age (5-11 years)
Understand death and that it is final. Still have some hesitation, and may feel that it can be reversed. Begin to realize its final around the age of 10, and understand biological aspects to death. May begin to link it to religion. Depending on the age, younger ones may think death is something that is coming to get you until they link death to biological factors. Older ones begin to link death to violence.
Understanding Death - Teenager (12-18 years)
Understand death, and its biological basis of death. Still aren’t fully developed and may put some blame on themselves, which is impacted by the cause of death. Depending on their religion or beliefs they may believe they can still join the person in another life/form. Most teenagers have a religious understanding of death.
Ernest Becker “the denial of death” (1973)
- Our notion that death is inevitable is incompatible with self-preservation instinct
This leads to an ever looming potential anxiety (“death anxiety”). For most people this isn’t a conscious fear (according to this theory).
Terror Management Theory
Awareness of death creates terror. That terror (death anxiety) propels you to engage in certain behaviour, or have certain feelings.
- Managed by cultural world views (shared beliefs about reality that reduce existential dread by conferring meaning)
- Can reduce “death anxiety” by making your life meaningful through shared beliefs about the people in your culture
- Self-esteem buffers “death anxiety”
Support for Terror Management Theory
- Elevated self-esteem related to lower anxiety
- Thinking about dying increases defense of cultural world views
- Non-conscious death thoughts arise easily when cultural beliefs or self-esteem are threatened
Terminal Illness
- Condition is worsening
- No treatment available to reverse or stop progress of condition towards death
- No options to prevent further deterioration
Palliative Care
- Focus on reducing pain and discomfort
- Terminal illness is typically when palliative care is initiated
Psychological issues related to terminal illness
Changes in self-concept. Due to the fact they don’t have control, may not be able to communicate.
Kubler-Ross’s 5 stages
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
Advantages and Disadvantages of Kugler-Ross’s 5 Stages
- Advantages: Helped specify importance for counselling
(Helped counsellors identify stages of the process) This model spawned more research on death and how people cope with the dying process.
Disadvantages: not everyone goes through all the stages in those exact orders, and not everyone goes through every single stage. The model doesn’t acknowledge anxiety.
Life-sustaining treatments
life support; no longer providing treatment to halt the progression of the disease, just providing treatment to keep the person alive and keep their organs functioning.
What is Palliative care
reducing pain and discomfort in terminally ill patients. Can be initiated at any phase of the terminally ill process.
Care for the Terminally Ill: 8 C’s
- Compassion
- Competence
- Confidence
- Conscience
- Commitment
- Courage
- Culture
- Communication
What is DNR
Do not resuscitate
- Living will. Person will have a statement about how they would like their care to proceed (e.g. how long they would like to be put on life support, type of pain management pain, when to stop medication, and DNR)
What is Assisted suicide
providing another with the knowledge or means to intentionally end his or her own life
What is Euthanasia
a deliberate act undertaken by one person with the intention of ending the life of another person to relieve that person’s suffering where that act is the cause of death
What is Hospice Care
Care for terminally ill-patients that focuses on palliative care, patient’s psychological comfort and maintaining quality of life.
- Done at a hospital, nursing home, in-patient facilities, and at home
- Helps family members cope with the grieving process
Essential Elements in the Hospice Approach:
- People should be able to die in their place of choice
- Care should be aimed at maximizing the patient’s potential
- Care should address the needs of all family members
- Follow-up care should be provided for family members
What is Grief
primary emotional reaction to the loss of a loved one through death
What is Bereavement
the objective situation of having lost someone
What is Mourning
the public display of grief, the social expressions or acts expressive of grief that are often shaped by society and culture
Factors Influencing Loss and Grief
- Developmental stage (age)
- Significance of lost
- Cultural differences in how grief is expressed, and how social support is provided
- Spiritual beliefs (some evidence suggests it helps the grief process)
- Cause of death
- Social support
- Emotional regulation
Early Models of Coping
- Working through grief. Cognitive processes of confronting the reality of death (think about the person and their life) which was thought to begin detachment from the grief process
- Finding Meaning. Confronting the bereavement in order to come to terms with the loss.
Meaning-Making Model (Coping)
- Meaning is the need to make sense of loss and desire to find benefit in one’s experience with loss
- According to this model, searching for meaning without finding answers can be problematic for ongoing grief
- Those who found meaning reported that they continued to find new sources of meaning even a year after the death
Dual process model of coping with bereavement
Coping fluctuates between two coping processes: Loss-orientation, Restoration-orientation
Gender Differences in Coping
- More women with physical and mental health problems following bereavement (but also seem to have had them before bereavement)
- Men are more likely to develop new physical and mental health problems.
Trajectories of Grief
- Resilience
- Recovery
- Chronic Dysfunction
- Delayed Grief or Trauma
- Chronic Depression
- These 5 trajectories weren’t evident in their findings. Rather found very few people show delayed grief.
Loss-orientation
coping with issues related to the loss (e.g. sadness, loneliness) Helps people to work through emotions.
Restoration-orientation
coping with issues related to secondary changes from the loss (e.g. financial, and family demands) Helps people focus on adaptive life changes (e.g. learning new skills). Related to distraction from dealing with the emotions of the grief.
