Lecture 9 - Patient-Provider relationships Flashcards
what is Nurse practitioner -
=Trained in traditional nursing and has additional education in health assessment, diagnoses, and management of injuries and illness
ì Can order tests and prescribe drugs
ì Responsibilities include providing routine medical care, prescribing treatment, and attending to the chronically ill
what does a nurse have an impact on -
=1. On patient outcomes
2. On satisfaction with health care
what was the traditional patent-provider relationship -
=ì Authoritarian ì Unequal
ì Dominance hierarchy
what is the ‘new’ patent-provider relationship -
=ì Open
ì Equal
ì Reciprocal
what are the three main barriers to Effective Communication -
=setting, structure of health care system and changes in physician’s role
what are the barrier ‘setting’ to Effective Communication -
=1. Patients sick, in pain
- Need for many questions
- Time pressure
what are the barrier ‘Structure of Health Care System in Canada’ to Effective Communication -
=1. GPs are entry point, no specialists
2. Many do not have GP
what are the barrier ‘Changes in Physician’s role’ to Effective Communication -
=1. More interdisciplinary teams (more equality)
- Patients asking for more involvement
- > Physicians dominance, autonomy, authority challenged
what are some Problematic Communication ì Behaviours
- =• Not listening • Jargon • Babytalk and elderspeak • Nonperson treatment • Stereotyping and disparaging language
explain Not Listening -
=ì Only 23% of patients finished explanations before diagnosis
ì Physician interrupted within 18-22 seconds
ì Physicians knew they were recorded!
why is Using Jargon an issue? -
=Many patients do not understand this language
why is jargon still used -
=habitual, cultural (hospital cultural), to educate the patient
what is elder-speak -
=Baby Talk for older adults
ì Using overly familiar terms to address elderly patients, such as
“dear” or “sweetheart”
ì Using pronouns “we”, “us”, and “our” in place of “you” ì Answering questions for the older adult
ì “You would like to have your bath now, wouldn’t you?” ì Talking for the older adult
ì You had a great time with your family today, I saw. And you were watching ‘Gone with the Wind’, which you love. Right?”
what are consequences of elderspeak -
=agist, takes away agent; learned helplessness
why does elder speak happen -
=it is well intended but shouldn’t happen
what is Nonperson Treatment -
=Depersonalizing the patient
ì Not talking to the patient during an exam
ì Not talking to the patient in the presence of other providers
ì Not knowing the patient’s name
what are consequences of Nonperson Treatment - =dehumanizes person, makes them uncomfortable
why is Nonperson Treatment done -
=culture of hospital, bad bedside manners
why is stereotyping an issue in the hospital setting -
=doctors assume that an individuals issue could be one thing and disregards everything else
explain what is included in Other Potential Barriers: Patient Characteristics -
=ì Certain personality traits ì Anxiety ì Knowledge ì Education ì Language proficiency
explain the differing concerns of patients and providers -
=Patient ì Pain ì Symptoms interfering with activities Provider ì Underlying disease ì Severity ì Treatment options
Why it is Difficult for Practitioners to Change Some Maladaptive Communication Behaviours? -
=ì Little feedback from patients
ì If the patient does not return, it is unclear what it means
essentially few opportunities for practitioner to learn
what are some options for Improving Patient-Provider Communication -
=ì Teaching providers patient-centred communication
ì Teaching patients how to elicit information from providers
what are the three types of Treatment Adherence -
=adherence, non-adherence and creative non-adherence
explain adherence -
=Following a prescribed behavioural and/or treatment regimen
or routine
explain Non-adherence -
=Patients don’t adopt behaviours and treatments their
providers recommend
explain Creative non-adherence -
=ì Patients modify or supplement a prescribed treatment
regimen (e.g., adjusting dosages, supplementing treatments)
ì May be a patient’s attempt to reassert control over their illness and its treatment.
what are some diseases with high adherence -
=ì HIV
ì Arthritis
ì Gastrointestinal disorders
ì Cancer
what are some diseases with low adherence -
=ì Pulmonary disease ì Diabetes
ì Sleep disorders
what are the Causes of Non-adherence -
=Many 'valid' reasons ì Faulty patient-provider communication is the greatest cause of non-adherence to treatment! ì Forgetting ì Memory overload ì Side-effects ì Not agreeing with the treatment ì Does not believe in the treatment's effectiveness ì Uses other ways to treat it
how many patients cannot repeat what they need to do within minutes of discussing it! -
=1/3
how to Improving Adherence -
=Establish effective & empathic communication
- Improve patient understanding
- Improve patient satisfaction
- Provide patient with space to make a decision
- Provide patient with written information about what they agreed on
what is The Placebo Effect and why does it work -
=when patients just believe they are being treated
it works because of psychological and physiological effects
who responds most to The Placebo Effect -
=ì Big Five Factors and placebo
responding
ì People scoring high in extraversion were more likely to experience placebo effects
what makes the placebo effect strong -
=provider behaviours (- Confidence and competence
- Expressing faith in treatment)
Settings that have medical formality
Appearance of placebo (shape, size, colour, quantity)
Regimens hat seem medical (precise instructions)
what are the ethics of placebo -
=ì Placebos cannot be used in regular medical care
ì Placebos unethical in clinical trials when an effective treatment exists
