Chapter 6 and 7

Question 1

Patient has a story and their expeirence and telling of it is a narrative

Answer 1

Beginning
Starring role
Supporting roles

“The practice of medicine is lived in stories: ‘I was well until . . .’ ‘It all started when I was doing . . .’ are common openings of the medical encounter.

Question 2

By recording record of story and contributing to it along with the patient

Answer 2

Health care team members contribute and can decide what to leave in and leave out. So to can the patient make editorial decisions.

different voices offer different stories of the patient’s predicament

Question 3

Form of Health record

Answer 3

Full of health jargon,
a series of Monologues.
Is a method of communication between members of the health team

Question 4

The act of interpretation

Answer 4

begins by really listening to what the patient is trying to say. The health professional must listen with a narrative ear.

Question 5

Language as imperfect medium for truth

Answer 5

Language isn’t colorless or neutral. Word choice changes meaning.

Question 6

Language Creates Reality

Answer 6

Yet the language used creates the reality of the case insofar as it frames the kinds of questions, we ask about it, how we seek answers, and how we interpret what we find.

Question 7

Point of view

Answer 7

who is speaking

Question 8

Third person of health record

Answer 8

distances us from what is going on in the narrative

Question 9

Textbook objectivity

Answer 9

The description is objective, one written for health professionals—hence the use of abstract terms—and one that can be applied to all patients

Question 10

Characterization

Answer 10

background information on principals in the story

Question 11

Plot

Answer 11

The series of events in the story. (Another way to view plot is a series of questions you want answered. A series of disconnected events alone would not be a plot.)

Question 12

Motivation

Answer 12

Why characters act the way they do.

Question 13

Imagery

Answer 13

Not as prevelant in clinical communication

Question 14

Pathography

Answer 14

borrows from autobiography or biography to describe personal experiences of ilness.

share, support, insight-guidence, make meaning.

Question 15

Dialogue and exchange

Answer 15

patient and health care pro - co-creators of the story which is fuller by the collaboration.

Question 16

Familiy centered care

Health care as a partnership

Answer 16

• better health outcomes
• improved patient and family care experiences
• increased patient satisfaction
• decreased clinician burnout
• wiser allocation of resources

Question 17

Familiy centered care

Health care as a partnership

Core concepts

Answer 17

• Dignity and Respect
• Information Sharing
• Participation
• Collaboration

Question 18

Family: evolving concept

Answer 18

Context for delivery of patient centered care ->

Family as integral part of the care team ->

Socially created and definced.

Family-centered care is “an approach to the planning, delivery, and evaluation of health care that is grounded in mutually beneficial partnerships among health care providers, patients, and families.”

Question 19

Definitions of family

Answer 19

Nuclear and extended, contemporary and traditional
Generations of blood kin
Mix of parents, grandparents, step-parents, aunts/uncles same gendered
Friends who share in household responsibilities

Question 20

Family Health Systems Approach

Answer 20

• Interactive - communication, family relationship, and social supports.
• Developmental - family developmental stage
• Coping - problem-solving, adaptation to stress and crisis
• Integrity - family values, rituals, history, and identity
• Health Process - health status, health beliefs and practices, and lifestyle practices

Question 21

Family Health Systems Approach

Interactive

Answer 21

communication, family relationship, and social supports.

Question 22

Family Health Systems Approach

Developmental

Answer 22

family developmental stage

Question 23

Family Health Systems Approach

Coping

Answer 23

problem-solving, adaptation to stress and crisis

Question 24

Family Health Systems Approach

Integrity

Answer 24

family values, rituals, history, and identity

Question 25

Family Health Systems Approach

Health Process

Answer 25

health status, health beliefs and practices, and lifestyle practices

Question 26

Family and other close relationships
Stress

Answer 26

A psychological motivator

Question 27

Family and other close relationships
Distress

Answer 27

Negative outcomes of stress

Question 28

Family and other close relationships

Eustress

Answer 28

Positive results of stress

Question 29

Respect for Family and other close relationships

Major stressors

Answer 29

• Altered status and roles bring out fragility in close relationships.
• Patient suffers from feeling that loved ones are losing interest.
• Some conditions carry social stigma affecting patient and family alike. (Substance abuse/mental illness.)

Question 30

Respect for Family and other close relationships

In distressing situations for patient and family:

Answer 30

• Listen carefully for the deep source.
• Offer basic human comfort and hope.
• Try to help all parties prepare for future disappointments and setbacks.
• Provide positive suggestions for getting through the difficulty.

Question 31

Respect for Attempts to Face Changing Relationships

Family and other loved ones may have to:

Answer 31

• Reckon with someone who has become almost a stranger.
• Deal with their own loneliness or guilt.
• Live with caregiver-related exhaustion.
• Experience social isolation.
• Patients and all involved often are haunted by having to endure uncertainties.

Question 32

Uncertainty

Answer 32

Varying degrees of uncertainty is a problem patients face during recovery or adjustment, and negative stress reverberates into his or her significant relationships, as well as presenting challenges to professional caregivers.

Question 33

Respect for Attempts to FaceUncertainty

Helpful professional caregiver responces to patient uncertainty

Answer 33

• Listen for root causes of uncertainty
• Call on colleagues most qualified who have authority to clarify information
• stick with the truth
• Assure patient that confidential information will be respected
• Assist families with values clarification

Question 34

Health Care Costs

Answer 34

Patients who decide to make a highly desirable change in life direction or lifestyle with a loved one may feel prohibited from doing so by the reality of the desperate financial distress

many instances of so-called nonadherence on the part of patients are occasioned by the cost of medications, treatments, devices, or services

Question 35

Values clarification

Answer 35

Self conciousness of one’s values is the focus of values clarification.

Question 36

Many people faced with illness or injury

Answer 36

discover that it prods them to reflect on the value of significant relationships, past and present.