Chapter 2: Optimal Healing Environments Flashcards
What is the Optimal Healing Environment?
An environment in which the social, psychological, spiritual, physical, and behavioral components of health care are oriented toward support and stimulation of innate healing capacities and the achievement of wholeness. Organized into four environments:
1. Internal (healing intention + personal wholeness)
2. Interpersonal (healing relationships + healing organizations)
3. Behavioral (healthy lifestyles + integrative care)
4. Extenrial (healing spaces + ecological resilience)
From Engel’s biospychosocial model & the Samueli Institute
What is the internal dimension of the healing environment?
- Consists of healing intention and personal wholeness
- Each person has an inner unique interaction of mind, body, and spirit that can be directed and suported towards healing.
- Individuals have to self-reflect and become aware of their internal wholelenss and trust in its healing potential
- We as providers need to explore our own inner nature in order to truly connect.
What is the Interpersonal Dimension of the healing environment?
- Consists of healing relationships & healing organizations
- Importance of personal, family, professional, and organizational therapeutic relationships that support healing
- This relathionshp is intentional nad covenantal in nature. It includes the art of the clinician who intentionally learns about the patient in context of their life
- The organizations provide the structures, processes, and resources to support healing
What is the Behavioral Dimension of the optimal healing environment
- Consists of healthy lifstyles and integrative care
- These involve actions that promote health and enhance self-healing mechanisms
- Should be motivated and directed by the patient in order to be major (main) drivers of health outcomes
- Integrative care providers should facilitate individuals to care for themselves most successfully
- The behaviors can have epigenetic influences on the expression of a healthy phenotype
What is the External Dimension of the Optimal Healing Environment?
- Consists of healing spaces and ecological resilience
- Using and sustaining a physical place that suppotrts the helath of living beings and the global enviornment
- Our health is impeded if we are not able to live within a healhty ecosystem (ecological resilience)
Why is spiritual connection important in an Optimal Health Environment?
It can give life meaning. Connection to meaning is a strong motivation for behavior change. This empowers the OHE to be effective & sustainable.
What are Frank & Frank’s 4 foundations that are present in a healing encounter?
- emotionally charged relationship with the helping person
- A healing setting, can also be virtual
- Explanation of symptoms that result in sense of control and understanding
- Ritual, procedure, or personal plan that involves active participation of both parties who BELIEVE will restore a state of health
used to be Art of Medicine… now has become known as the Placebo Effect
These may be more effective in healing than the actual prescription you give. Example of sertraline vs placebo for depression (same effectiveness for mild-mod depression, and both altered levels of serotonin!)
True or false: Adding a steroid to epidural injections works no better than injecting xylocaine alone for low back pain.
True.
What are some of the nonspecific variables that can be used in an optimal health environment to enhance the effect size of a therapy? What are some examples of them?
meaning and context (MAC). Examples include clinician’s choice or words and matching treatment to patients’ cultural beliefs.
List techniques that can be used to maximize healing through an optimal healing environment.
- skilled clinician communication, create positive expectation
- listen, provide empathy & understanding
- match therapy to pt’s cultural beliefs
- provide explanations that increase pt control & understanding
- deliver therapy with confidence and from credible source
- include therapeutic setting, elements of nature
- research treatment. prescriber should believe in it too!
- touch the pt, cut or stick skin when thought to be important
- use newest therapy, brands well known to culture, brands with label info
- charge higher price but not too high
- therapeutic rituals with tools (knife, pin, laser, pill)
- write down a plan that both parties agree on (a therapeutic contract)
What factor in a therapists’ control influences the most positive health change in psychotherapy?
the establishment of a therapuetic relationship in which the patieint felt a sense of trust. (examples: a placebo delivered by a therapist that the pt trusts is more effective to treat depression than an antidepressent delivered by therapists rated low in relationship and rapport. Providers who spent more time on empathy had patients with better diabetes outcomes)
Define multidisciplinary, interdisciplinary, and transdisciplinary teams
- Multidisciplinary = Additive. Professionals from different disciplines provide care for a patient independently of each other.
- Interdisciplinary = Interactive. Professionals develop collegial relationships with joint decision making. They interact, support, as well as question each other’s opinions and negotiate to develop health strategies.
- Transdisciplinary = Holistic. Professionals learn from each other and in the process transcend traditional disciplinary boundaries that may result in the emergence of new knowledge. (Often, the greater the difference between professions e.g., engineering and humanities, the more likely insight will develop toward the creation of a new way to solve a problem).
Describe how optimal healing environments and healing practices can influence genomes.
- diet can suppress expression of certain genes
- lifestyle habits can trump genetic risk of certain conditions
- lifestyle can affect telomerase levels and oncogene expression
- stress can decrease telomerease levels, exercise can increase it
Are optimal healing environments more costly for healthcare practices?
While the cost per patient / encounter per day may be higher than average, overal health care costs longer term are reduced.
What is the HOPE note?
Stands for Healing Oriented Practices and Environments. Assesses core facilitators of healing during an encounter.
Asks questions in 4 domains :
1. Body & external (home, work, nature)
2. behavior & lifestyle (diet, sleep, stress, activity)
3. social & emotional (childhood, social support)
4. spiritual & mental (why do u want your health, what matters to you)
