Chapter 6 and 7 Flashcards
Patient has a story and their expeirence and telling of it is a narrative
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.
By recording record of story and contributing to it along with the patient
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
Form of Health record
Full of health jargon,
a series of Monologues.
Is a method of communication between members of the health team
The act of interpretation
begins by really listening to what the patient is trying to say. The health professional must listen with a narrative ear.
Language as imperfect medium for truth
Language isn’t colorless or neutral. Word choice changes meaning.
Language Creates Reality
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.
Point of view
who is speaking
Third person of health record
distances us from what is going on in the narrative
Textbook objectivity
The description is objective, one written for health professionals—hence the use of abstract terms—and one that can be applied to all patients
Characterization
background information on principals in the story
Plot
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.)
Motivation
Why characters act the way they do.
Imagery
Not as prevelant in clinical communication
Pathography
borrows from autobiography or biography to describe personal experiences of ilness.
share, support, insight-guidence, make meaning.
Dialogue and exchange
patient and health care pro - co-creators of the story which is fuller by the collaboration.
Familiy centered care
Health care as a partnership
- better health outcomes
- improved patient and family care experiences
- increased patient satisfaction
- decreased clinician burnout
- wiser allocation of resources
Familiy centered care
Health care as a partnership
Core concepts
- Dignity and Respect
- Information Sharing
- Participation
- Collaboration
Family: evolving concept
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.”
Definitions of family
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
Family Health Systems Approach
- 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
Family Health Systems Approach
Interactive
communication, family relationship, and social supports.
Family Health Systems Approach
Developmental
family developmental stage
Family Health Systems Approach
Coping
problem-solving, adaptation to stress and crisis
Family Health Systems Approach
Integrity
family values, rituals, history, and identity
Family Health Systems Approach
Health Process
health status, health beliefs and practices, and lifestyle practices
Family and other close relationships
Stress
A psychological motivator
Family and other close relationships
Distress
Negative outcomes of stress
Family and other close relationships
Eustress
Positive results of stress
Respect for Family and other close relationships
Major stressors
- 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.)
Respect for Family and other close relationships
In distressing situations for patient and family:
- 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.
Respect for Attempts to Face Changing Relationships
Family and other loved ones may have to:
- 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.
Uncertainty
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.
Respect for Attempts to FaceUncertainty
Helpful professional caregiver responces to patient uncertainty
- 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
Health Care Costs
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
Values clarification
Self conciousness of one’s values is the focus of values clarification.
Many people faced with illness or injury
discover that it prods them to reflect on the value of significant relationships, past and present.
