Exam Flashcards
Health care is the responsibility of which branch of the government?
Provincial
What is the lowest and highest per-person health care cost in Canada?
Lowest: Quebec ($3,359)
Highest: Nunavut ($17,493)
Why is it important to have a family physician?
Because people see them regularly so it provides a chance for early detection
Percentage of family doctors who report patients can get same or next day appointments in Canada
22%
What percentage of patients wait more than 2 months to see a specialist?
29%
What are the satisfaction rates of health care?
85.7% are very to somewhat satisfied
Do physicians think they get enough time with patients?
55% don’t feel they do
What percentage of physicians think they can provide quality care to their patients?
Less than half
How many people are admitted to the hospital every year?
2.8 million
How are most people admitted to the hospital?
Through the emergency department
Why would a person be seen in a hospital but not be admitted?
- Emergencies that can be solved quickly
- Day procedures
How many visits to the emergency room are there every year?
15 million
90% of people in emerg are seen in what time frame?
within 7.6 hours
What proportion of people seen in emerg get admitted?
1/10
30% of emergency room visits are made for__% of people
10%
What aspects of a hospital stay must people adjust to?
- Lack of privacy
- strict schedule
- restricted activities
- dependent on others
Often times people are seen by a team of people with frequent changes, what does this result in?
Depersonalization,
Patients feel a loss of autonomy and control
What will guide a person’s sick behaviour?
Both their own and the doctor’s expectations
Characteristics of an ideal patient according to the medical staff:
Cooperative, uncomplaining and stoical
What do doctors consider a bad patient?
Uncooperative, complaining, overemotional and dependent
Two types of “problem patients”
- Seriously ill patients with severe complications or poor prognosis who require a lot of attention
- People who are mot seriously ill but take more time than is warranted by their illness
> Usually get sedated or discharged early
When is anxiety the highest in a hospital?
At admission and prior to surgeries
Coping with hospitalization
Problem vs Emotion Focused
Blaming self and/or others
Helplessness or loss of control
Things that help patients cope in a hospital ?
- Provide information
- Psychological counselling
- Increased control
- Room with a roommate recovering from a similar thing
- Humour
How to help patients prepare for surgical procedures
Enhance their sense of control and address expectations
Does information make attention-focused people more or less stressed?
Less
Does information make avoidance-focused people more or less stressed?
More
Discharge Planning
A process by which post-hospital care is organized and risks are assessed.
How long are wait times for a hospital bed?
1 in 10 people wait more than 30 hours
How many people contract infections from hospitals and how many people die from them?
As many as 1 in 9 get infections
8000-12000 die from the infection every year
Factors that enhance satisfaction with hospital experience:
- Respect through communication (avoid jargon, providing info)
- Maintenance of dignity
- Day-to-day control
What roles to psychologists play in hospitals?
- Assess adjustment
- help patients and families cope
- assist in rehabilitation
- research on making hospitals more effective and safer
What is pain
Unpleasant sensory or emotional experience with actual or potential tissue damage
What is the function of pain?
- Information (if something wrong)
- Warn of potential serious injury
- Promote learning to avoid the same situation later
- Limit physical activity and promote rest
A-delta peripheral nerve fibers
Small, myelinated fibers that produce a feeling of sharp pain
>Terminate in sensory cortex
C Fibers in peripheral nervous system
Unmyelinated, produce a diffuse, dull, aching pain
>terminate in brainstem and forebrain
Referred pain
Pain that originates in internal organs, but it is perceived as coming from other parts of the body
Organic Pain
Comes from the body, tissue damage
Psychogenic pain
No visible tissue damage
> Experienced like organic pain
Gate control theory of pain
Pain is not just the result of a linear process from sensory stimulation to brain receptions & the experience of pain
Modulation of pain in the spinal cord
Small A-delta & C Fiber activation –> opens gate –> pain
Large A-beta fiber activation –> closes gate –> inhibits pain
Pain modulation descending from the brain
Central Control Trigger = activates cognitive processes that can open or close gate
Emotional triggers that open the pain gate
Anxiety
Tension
Depression
Emotional triggers that close the pain gate
Positive emotions
Relaxation
Cognitive factors that open the pain gate
Attention
Boredom
Cognitive factors that close the pain gate
Distraction
Involvement
Physical factors that open the gate
Level of injury
Activity level
Physical factors that close the gate
Medication
Counter stimulation
Acute pain
Temporary, lasts less than 6 months
Recurrent acute pain
Intermittent pain for longer than 6 months
Chronic pain
Lasts more than 6 months and gets worse over time
What cells in the brain are responsible for pain distortion
Glial cells
Criticism for pain questionnaires
It requires a high level of language and many people cannot tell the difference between the different descriptions
What is highest and lowest on the McGill pain index?
Highest: Causalgia
Lowest: sprain
What are the common pain behaviours
- Facial and audible expressions of distress
- Distortions of posture and gait
- Negative affect
- Avoidance of activity
How is pain induced in the lab
Cold pressor test (sticking hand in ice water)
The ____ attached to pain influences its experience
Meaning
> feeling pain for a good cause makes it feel less severe
Learning and pain
Learn to associate cues with pain such that cues can produce distress and may heighten pain perception
What are the secondary gains of pain?
Get more attention from others
Get treated well
Disability pay
Social support is associated with more or less pain?
Less
How can support make pain worse?
If it is given too much attention or if a person is helped too much then they feel a lack of control
Pain-prone personality
Neuroticism, introversion and passive coping
What is the most common factor in care seeking?
Pain
How do different genders experience pain differently
Men and women have similar pain thresholds
- differences in intensity
- differences in frequency
Socio-cultural differences in pain
- Culture differences in dealing with pain
- SES diffs in frequency and intensity of pain
What are ways to deal with pain?
- Coping
- Medication
- Behavioural and relaxation techniques
- Cognitive techniques
How many people in hospitals are under medicated?
About half
Who are at most risk for poor control of medication and why
Children
>Doctors are afraid to over do it
What 2 ways are medications given?
- PRN “as needed”
2. On a schedule
Behavioural and relaxation techniques in coping with pain
Rear reduction
Resuming daily activities
Biofeedback
Cognitive techniques for dealing with pain
Distraction
Guided imagery
Redefinition of pain
Has swearing been shown to reduce pain?
Yes
What are the goals of a multidisciplinary approach to chronic pain management?
- Reduce pain experience
- Improve physical functioning
- Decrease medication and use of other medical services
- Enhance family life
Lifestyle changes for dealing with illness
Diet, exercise, developing regular activities
Strategies for coping with high mortality illnesses
- Finding meaning in illness
- Gaining a sense of control over illness
- Restoring self-esteem
____ perceived social support is relates to poorer adjustment
Low
What is coronary heart disease
A general term that describes the narrowing of the artery that causes less blood to through through
How can arteries narrow?
Clogged with plaque and fat
What is bad about arteries narrowing?
There is insufficient oxygen to the heart
May feel pain and lead to a heart attack or stroke
2 groups of risk factors for coronary heart disease
- Non-modifiable risk factors
- genetics, gender, age - Modifiable risk factors
- lifestyle and cognition
What are 3 positive factors that lead to less mortality with CHD?
Exercise
Optimism
Being religious
What is the leading killer of women in Canada?
Coronary heart disease
Why is CHD not identified or treated well in women?
Because doctors use a model created for men
3 treatment approaches to CHD
- Medical (surgery, pump implant, drugs)
- Rehabilitation
- Psychosocial interventions
Clot dissolving medication only works if administered in the first ____ hours
3
What factors do the best cardiac rehabilitation programs have?
Both education and counselling
___ is most important for predicting short term behaviours, ____ is most effective for predicting long term change
Self-efficacy
Motivation
Psychosocial consequences of recovering from CHD
Work (most return within 1 year) Family (support makes recovery go faster, over protection and past problems might make it worse) General adjusting (can be anxious and depressed for 1-2 years)
Neoplasm
Unrestricted cell growth
Metastasize
Spreading of cancer
5 types of cancer
- Carcinomas - skin or organ cells
- Melanoma - skin
- Lymphomas - lymph system
- Sarcomas - muscle, bone or connective tissue
- Leukemias - blood forming organs
Cancer is the ____ cause of death world wide and number __ in canada
Leading
1
What percentage of males and females get cancer in their life?
45% males
41% females
What are the chances of dying from cancer
29% males die from it and 24% of females
Physical effects of cancer
- Interfere with normal cell functioning
- creates pressure on tissue and nerves, blocks blood and liquid flow
- Pain comes later
How does cancer directly kill?
By spreading to vital organs and taking nutrients so organ dies
How does cancer indirectly kill
By weakening the victim, impairing appetite and immune function
2 Types of risk factors for cancer
- Non-modifiable (age, gender)
2. Modifiable (lifestyle)
Warning signs of cancer acronym
CAUTION
Detecting cancer
Physician and self administered tests
Diagnostic Procedures
- blood or urine tests for abnormal levels of hormones or enzymes
- Imaging to look for tumours
- Biopsy
What does treatment of cancer depend on?
Size, site(s), and quality of living tissue
Cancer treatment options
Surgery - if cancer is localized
Radiation - destroys cancer cells so they cannot divide
Chemotherapy
Adherence to cancer treatment is not good for which population
Adolescents
Side effects and problems of cancer treatment
- health tissue can be damaged
- physical side effects
- Anxiety
- treatment is demanding, requires a change in lifestyle
Factors that influence adjustment from cancer
Physical condition
Site of cancer, age, gender
Interventions to help people adjust with cancer
CBT
Exercise
Disclosure
Therapy
What are characteristics of chronic illnesses?
Persist for a long time
Do not go away by themselves
Rarely cured completely
Stages of coping with a chronic illness
Crisis –> Initial Reaction –> Coping Strategies –> Long-term adaptation
When can emotion focused coping be beneficial
At the beginning of a chronic illness
Is anxiety and depression normal in chronic illness?
Normal at first but them is maladaptive in the long term
Factors that contribute to illness being a crisis
Illness related factors (visibility, intrusion on life)
Background and personal factors (age, SES, religion)
Physical and Social Environment (hospital vs home, social support)
Cognitive appraisal in the coping process of a chronic disease
- Meaning or significance of illness
- Beliefs about nature, cause, controllability of illness
Adaptive tasks in coping with chronic illness
Tasks related with illness or treatment
Tasks related to psychosocial functioning
How can making beating an illness like a game helpful?
Gives person control
What does AIDS stand for?
Acquired Immune Deficiency Syndrome
What does the HIV virus attack in the body?
T-cells
How long between HIV and AIDS?
The time varies
Risk factors of HIV
- sexual activity
- sharing needles
- birth by infected mother
Groups most at risk for HIV in North America
IV drug users
Homosexual men
Can HIV be managed?
Yes, people can use medication and lead a relatively normal life
> It will never turn into AIDS
Stigma around AIDS
Associated with drug users and homosexuality
What is the main thing that adaptation to HIV is affected by?
Access to medication to decrease symptoms
How do psychological factors affect the course of AIDS?
Stress makes it worse
Hope, self compassion and optimism help adjustment
What is the new initiative to abolish AIDS
Universal HIV testing
How many people who have AIDS are unaware of it?
1 in 4
What is the average lifespan in Canada
- 1 years
men: 78.8
women: 83.3
Why is infant mortality rate relatively high in Canada for a developed country?
We have recently started making more of an effort to deliver premature babies
What are the 2 most common sources of death for children between 1 and 15
Accidents
Cancer (especially leukemia)
Most common causes of death age 15-24
Accident
Suicide
Cancer
Homicide
When is fear of death highest and lowest?
Middle age highest
Old age lowest
Why do women tend to live longer than men
- Less risk taking
- Hormonal differences
- Men have more risky jobs
- Women are more likely to seek help when they have a problem
What misconceptions to children have about death?
0-5 dont understand, think death is like sleep
5-11 begin to grasp finality of death
Teenagers understand death, tend to blame themselves
Terror Management Theory
The cultural world views that protect us from the idea of death
What is the goal of palliative care?
Reducing pain and discomfort
Kubler-Ross’s 5 stages of dying
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
Are the stages of dying correct?
Has not been proven but they have provided a useful framework
Benefits of stages of dying theory
- Helped specify importance of counselling
- initiated death research
Limitations of 5 stages of dying theory
- Not everyone goes through all stages
- no universal order
- does not acknowledge anxiety
Types of care for terminally ill patients
Life support
Palliative care
Hospital, nursing home, hospice
Hospice care
Medical and social support for patient and families to provide a better quality of life and death
8 C’s of hospice care
Compassion Competence Confidence Conscience Commitment Courage Culture Communication
Ways of ending life
Do not resuscitate order
Assisted suicide
Euthanasia
Conditions for Euthanasia in Canada
- Untreatable condition
- Voluntary
- Advance stage of disease
- Suffering cannot be relieved
- Over 18 and of sound mind
What happens to the survivors
Grief - emotional reaction to loss of loved one
Bereavement - objective situation of having lost someone
Mourning - public display of grief
Early models of coping with the loss of a loved one
Working through the grief, have to come to terms with it
Does finding meaning in the loss of a loved one help?
Yes
But looking and not finding meaning makes it worse
What affect does losing a loved one have on death
People are more likely to die after losing someone
Different trajectories of Grief
Resilience Recovery Chronic dysfunction Delayed grief or trauma Chronic depression
