midterm Flashcards
psychologically informed practice vs. biomedical practice
psychologically practice incorporates patient beliefs, attitude and emotional responses into the patient management whereas biomedical practice addresses the physical impairments based on biomedical concepts
informational counseling
education, discussing the nature of a disorder or situation, treatment considerations, prognosis, community resources and health preservation
-provider driven
-not treating the whole patient
-using our knowledge to counsel the patient
examples of informational counseling
discussing HA technologies, discussing realistic expectations when patient expresses frustration
personal adjustment counseling
addressing feelings/emotions/thoughts/beliefs, helping patients and families adjust or cop with feelings about disorders or situations
-patient driven
-treating the whole patient
-understanding the emotions of the individuals and the family
examples of personal adjustment counseling
listen to the patient as they express anger with their HA’s falling out of their ears, nod your head in agreement when patients tell us that they are sad that they will have to wear HAs, patient explaining they are concerned they will lose their license
cultural iceberg
represents how on the surface we can only see so much but below the surface we may not be able to see things relating to culture
-things that are under the surface include family roles, self-concept, rules of conduct, family values and gender roles
how would the difficult to see elements affect audiologist-patient interactions
could impact how the patient received medical help as well as it could lead to us not understanding the whole patient
-could lead to misinterpretations
cultural competence
providers have knowledge of their clients culture and provides services sensitive to differences
cultural awareness
mindful or conscious of similarities and differences, awareness of issues related to power, privilege and oppression
-including self awareness
cultural sensitivity
apply awareness of cultural concerns in your practice, change how you practice based on awareness of discrimination
cultural humility
professionals view themselves as learned and the patient as the expert in their life experiences
-a lifelong process of self reflection and self critique where the individuals does not only learn about another culture but it starts with an examination of ones own beliefs
professional counseling
mental health professional uses their professional training to help clients find ways to solve pervasive life problems
-outside of our area
goals of professional counseling
help patients and families make the practical changes in their lives that will help them develop
-resulting in a more positive adjustment, more positive embracing of the technologies available to them and a more acceptance of the residual communication difficulties they may still experience
when to refer for professional counseling
unremitting parental guilt over child’s HL, persistent intolerance of residual communication needs, family becoming emotionally withdrawn from the patient with HL, families have unrealistically high expectations
considerations for referring for professional counseling
referrals should come naturally out of growing relationships, honestly about the need for referral, consider the terminology, documentation and arrange the follow up
nonprofessional counseling
provides strategies for coping with life in the context of the current problem
-deals with the present moment, the current problems
-within our area of expertise
why is nonprofessional counseling important
important to build rapport with the patient, this relationship is very crucial for counseling as well as for treatment
what are the 4 counseling micro skills
active listening, nonverbal communication, silence and empathy
active listening
fully focused or concentrating on the patient
-observe, listen and note patient behavior before responding
nonverbal communication
bidirectional and can include facial expressions, paralanguage, eye contact, physical gestures, posture, proximity and autonomic display
-be aware of physical or cognitive conditions that affect nonverbal communication
silence
can be used to help organize thoughts, for both our patients and for us
-requires getting comfortable with silence
empathy
understanding or seeking to understand the experience of another while still maintaining your own point of view
-this is not sympathy as it is the ability to understand where someone is coming from, feeling some fraction of that feeling ourselves and expressing that understanding to the person
how to express empathy
understand your own feelings, don’t assume what the other is experiencing and check that you are accurately reflecting back on emotion
three different question types
content questions, confirmation questions and questions with affective base
what purpose do different questions types serve
content (seeking further information or clarification), confirmation (confirm opinion or position an asker holds) and questions with affective base (rooted in emotions)
what is the importance to address underlying emotions
patients may be asking for or giving information, or may be expressing a problem but also have underlying emotions that could impact their healthcare
-if we go straight to content, the patients will likely go along with that and thus the opportunity to talk about emotions is lost
motivational interviewing (MI)
an empathetic, person centered counseling approach that prepares people for change by helping them resolve ambivalence and builds confidence to change
-can use open questions, affirmations, reflective listening and summaries
what does ambivalence mean
this is when someone could go either way in making a change
-they could make the change or not make the change
-it is held toward making a health behavior change
-dependent on how we interact with them that can influence which direction they want to go
what are the guiding principles of MI
RULE (resist the righting reflex, understand your patients motivations, listen to your patient and empower your patient)
resist the righting reflex
resist correcting the patient
-we want the patient to voice the arguments for change
understand your patients motivations
be interested in patients concerns, values and motivations
-explore and evoke patients perceptions about the situation
-asking why a patient would want to make a change
listen to your patient
listen as much as inform, we need to make sure that we understand the patient
empower the patient
help the patient explore how they can make a difference in their health
-support hope that change is possible
core skills of MI
asking, listening and informing
how do different questions help patient interactions
helpful guiding questions, closed questions for specific information and open questions for patients to express their thoughts
listening can encompass…..
reflecting, giving the patient the opportunity to correct our understanding
what to do if our patient wants to talk for hours
summarize what we have understood and suggest next step, be honest about time limitations and acknowledge the value of what the patient has just shared with you
important reminders when it comes to informing patients
we can offer several options, talk about what others do, provide information in chunks and check for understanding, elicit provide elicit and then plant seeds of hope
-remember, not everyone remembers information the same way, so we need to ensure that we are informing the patient in a way that works for them
why not a patient absorb all the information we tell them
they may not be ready to hear it or they may not understand it based on their background
scale questions and the usage of them
on a scale of 1-10 how strongly do you feel that _______ is important
-tells us about the patients motivation
examples of scale questions
how motivated are you to make this change, how confident are you in your abilities to do this
what information do we get by using follow up questions to scale questions
why they selected the number and not a lower number: we gain an understanding of the answer, allowing to understand the change talk, understanding the motivation
what would need to change for it to be a higher number: can discover what is a barrier for the patient
change talk
the patient is considering the change
-there are six types including desires, ability, reasons, need, commitment and taking steps (remember, DARN CTs)
-i.e. i would like to be able to hear my family in conversations
desire change talk
statements about preference for change
-i want, i would like
ability change talk
statements about capability
-i could, i can
reasons change talk
specific arguments for change
-i would probably feel better if
need change talk
statements about feeling obligated to change
-i ought to, i have to, i really should
commitment change talk
statements about the likelihood of change
-i am going, i will, i intend to
taking steps change talk
statements about action taken
-i actually went our and, this week i
explain change talk and sustain talk
often patients will express the change talk and sustain talk (the but phrase) which then often that sustain talk is focused on
-reflecting on the change talk will support moving in the direction of making that change
importance of reflecting back change talk
helps motivate the patient, could help identify why they want to change
how can we reflect back change talk, using DARN statements
desire: what do you want, like or hope
ability: what is possible
reason: why would you make the change
need: how important is the change
what is a screener that we can utilize for depression and anxiety
the DASS screener
-the depression anxiety stress scales
what are the four social style behaviors
analytical, driving, amiable and expressive
analytical
controls and asks
-needs to be right
-slower paced
-more of an asker and slower to respond
driving
controls and tells
-needs for results
-faster paced
-quicker to make decisions and more likely to express emotions
amiable
asks and emotes
-needs for personal security
-slower paced
-slower, wanting to gather more information, more expressive with emotions
expressive
tells and emotes
-needs for personal approval
-faster paced
-showing emotions more but still making decision faster
when there is high tension, what do all social style’s tend to do
-analytical will withdrawal
-driving will take charge
-amiable will get steamrolled
-expressive will confront to reduce personal tension
when looking at the social style quadrant graph, what are the quadrants based off of
-left and right is asks to tells
-up and down is controls emotions to emotes
if you are a driver how may you have to adjust to work with others
understand that other people may need you to slow down a bit and how people may be oriented more towards emotions
if you are expressive how may you have to adjust to work with others
understand that either you need to speed up (driver) or slow down
if you are amiable how may you have to adjust to work with others
understand that you need to pick up the pace or be ready for technical questions (analytical)
if you are analytical how may you have to adjust to work with others
understand that you may need to pick up the pace or offer stories on how people have benefited (amiable)
how would you inform with permission when describing hearing assessment results
asking if they are ready to go over results or if they need a short break
-would the patient like to go in depth or would they like a summarization
-asking what would best help the patient
with ambivalence, the goal is …
to focus on the reasons for change
-how things may be better is the change occurs rather than dealing with the negatives against why to change
