Part II Ch 4-8 Flashcards
Communicating with someone in a way that doesn’t disparage or put down the other person or their actions, whether or not you disagree
tactfulness and diplomacy
Showing consideration for other people’s feelings and needs
courtesy
To be completely yourself when dealing with others in all of your words and actions
genuineness
When you are genuine in human interactions, you do not just go through the motions, but you ____ fully
engage
To open up, or show something about one’s self
appropriate self-disclosure
Self-disclosure is best used when it does these 2 things
- shows another person that you have had experiences similar to theirs
- it has significance because it allows you to show empathy for what that other person is feeling as a result of their experience
What 4 things you should avoid re: self disclosure?
- telling a story about yourself simply for the sake of telling a story about yourself
- telling a story that is not about you but about the problems of someone else the patient doesn’t know
- one-upping the patient by trying to outdo their story
- removing the focus in any way from the patient
To be able to stand up for what you believe is right without any undue anxiety about what others may think of you
assertiveness
_____ communication uses clear and direct language while remaining relaxed and respectful
assertive
_____ communication uses confrontational and even sarcastic language, while maintaining a tense and often superior attitude
aggressive
Communication that advances the patient’s well-being and care
therapeutic communication
HCPs should avoid giving easy reassurance because the patient has the right to feel any way they may feel and such reassurance ____ the patient’s feelings
diminishes
HCPS should avoid giving easy reassurance because it may give ____ in the face of a negative outcome
false hope
Approving or disapproving of the patient can falsely give the patient the impression that a _____ exists between them and their HCP
power relationship
Agreeing/disagreeing with a patient is an ineffective communication behavior because it turns the discussion of the patient’s health into a matter of the patient’s being ____
right or wrong
Prying is distinct from encouraging discussion; HCP with effective communication skills will understand how to strike the balance between ____ and ____
pushing too hard and helping a patient open up
Defensive HCPs inappropriately changes the terms of the relationship from patient/provider to _____
attacker/defender
T or F. Patients may not understand why they have acted a certain way; to ask them for their reasons can inhibit, confuse, or even anger them
T
Cliches can cause the patient to feel that the HCP is giving a _____ response
mechanical, thoughtless
Ineffective coping behavior: overemphasize a certain trait or behavior in one area because they believe they must make up for what they perceive as a deficiency, or failure, in another
compensation
Ineffective coping behavior: patient attempts (unconsciously) to reject or deny the existence of feelings, needs, thoughts, desires, or even facts
denial
Ineffective coping behavior: when it is impossible for the patient to accept ownership of certain thoughts, feelings, needs, desires; attributes them to a more acceptable substitute–someone or something outside of themselves
displacement
Ineffective coping behavior: patient attempts to disconnect the emotional significance of certain ideas or events from those ideas or events
dissociation
Ineffective coping behavior: patient mimics the behavior of someone else in order to conceal their own natural behavior
identification
Ineffective coping behavior: patient projects onto another person or object their own feelings, as if the feelings originated in the other person or object
projection
Ineffective coping behavior: using false reasoning to justify inappropriate or unacceptable behavior, hoping to make the behavior tolerable
rationalization
Ineffective coping behavior: unconsciously returning to immature, or even infantile, behaviors or thoughts
regression
Ineffective coping behavior: patient simply puts out of their mind painful or difficult thoughts, feelings, ideas or events
repression
Syndrome where a patient may feel anxiety just because they are present in a medical practice
white coat syndrome
T or F. If conflict with a coworker is serious (sexual harassment, quality of patient care concerns), you should speak with the other party first before involving a supervisor
F; involve a supervisor immediately
Initially enacted to protect workers in the US from being denied health insurance coverage when changing jobs
HIPAA: Health Insurance Portability and Accountability Act
Workers could change jobs with the confidence that their health insurance would not have to be interrupted between jobs or at the start of a new job
portability
Rule that protects patients’ rights by ensuring the privacy of patients’ health information
HIPAA privacy rule
Your healthcare organization must have policies and procedures that comply with either the state or federal law, whichever is ____
stricter
States policies and procedures by which patient health information may be disclosed
Notice of Privacy Practices (NPP)
Health orgs must have patients sign this document
Acknowledgement of Receipt of Privacy Practices
The use and disclosure of health information are permitted only for TPO; expand
treatment, payment, healthcare operations
TPO: includes activities like accreditation, employee training, and quality control
operations
4 exceptions to TPO
- court orders
- workers’ compensation cases
- statutory reports
- research
Used to properly diagnose the patient’s condition and develop the appropriate treatment plan; done by obtaining a thorough and accurate medical history
patient interview
3 functions of the medical interview
- information gathering
- relationship building
- patient education
2 common approaches to the patient interview
- primary care provider-only approach
2. team approach
Approach where the patient relates their medical history only once
primary care provider-only approach
Approach where the patient is interviewed more than once
team approach
____ approach is time consuming but may result in a more thorough and complete medical record
team
Primary interviewees are usually the patients themselves but may also be ____
family members, spouses, etc
___ questions quickly provide a great deal of objective information about the patient
closed questions
____ questions establish therapeutic communication and relationship between patient and HCP
open
Avoid using questions that begin with ____
why
Avoid ____ questions which are likely to prompt or encourage the patient to provide what they perceive is the desired answer
leading
Statements that involves obtaining information from the patient without the patient feeling questioned; often starts with “tell me about…”
indirect statements
Interview where the HCP controls the dialog; may interrupt the patient and may prevent the patient from continuing to express all of their concerns
HCP-centered interview
Interview where HCP uses “continuers” expressions that encourage the patient to reveal all of their concerns at the beginning of the interview
patient-centered interview
3 elements of the patient-centered interview
- open-ended questions
- indirect statements
- specific closed questions
The American Academy on Physician and Patient suggests “PEARLS” during a patient-centered interview; expand
Partnership Empathy Apology Respect Legitimization Support
PEARLS: conveys that the HCP and the patient are in this together
partnership
PEARLS: expresses understanding and concern for the patient
empathy
PEARLS: acknowledges that the HCP is sorry that the patient had to wait, that the procedure was painful, that the lab tests will take several days to process, and so on
apology
PEARLS: acknowledges the patient’s suffering, anxiety, fear, etc
respect
PEARLS: acknowledges that the patient may be angry, frustrated, depressed, etc
legitimization
PEARLS: conveys that the HCP will be there for the patient and not abandon them
support
The interviewer should sit approximately ____ from the patient and maintain a relaxed but attentive posture
an arm’s length
____ questions help to eliminate ambiguous responses or confusion on the part of the patient
direct
Another important aspect of listening is being aware of what the patient has ____ of their verbal response
left out
HCPs should ____ the implied; derive a conclusion about what the patient really means
verbalize
Primary goal of an interview is to identify the patient’s ____
chief complaint
Interviews should focus on, or ____, specific symptoms or important medical information that will facilitate reaching an accurate diagnosis
pinpoint
Many children are able to contribute substantially to the patient interview by the age of __ or __ years but must be verified by a guardian
5 or 6 years
When interviewing adolescents, avoid ___ that would tend to elicit brief responses or silence
closed
Discussing a patient with an unauthorized individual is a violation of the patient’s privacy and can turn into an ___ and ___ issue
ethical; legal
The degree to which individuals have the capacity to obtain, process, and understand basic health info and services needed to make appropriate health decisions
health literacy
Health literacy requires basic ____ skills and knowledge of ___ issues
literacy; health and medical issues
Only __% of adults have proficient health literacy
12%
Populations that frequently experience low health literacy
- older people
- racial and ethnic minorities
- people without a high school diploma
- people with low incomes
- non-native speakers of English
- people with chronic disease
4 elements of plain language
- organized info so that the most important points are delivered first
- info broken down into understandable chunks
- language that is simple with clearly defined medical terminology
- use of the active voice
Language barriers can cause an increased use of ____ tests and increased rates of _____
diagnostic; hospitalizations
3 disadvantages in using family members as medical interpreters
- unfamiliar with complex medical information
- more likely to incorrectly translate words and phrases
- loss of patient confidentiality
Employ _____, that is, ask the patient to repeat important instructions or information in their own words
teach back
Tell a visually impaired patient that you will be ____ them before you do so; never surprise them with needles, cold stethoscopes or other medical objects and devices
touching
When providing instructions, be descriptive when conveying info that would be _____ to patients with normal vision
visually obvious
T or F. Do not attempt to guide a visually impaired patient without asking
T
When dealing with visually impaired patients, walk with the patient ____ you and the service dog
between
Lower case “deaf” is used when referring to the ____ while uppercase “Deaf” is used when referring to a ____
audiologic condition; particular group of individuals who share a language
Patients who were born ____ deaf are likely to communicate using ASL; not based on English and uses a different sentence structure and grammar
bilaterally
T or F. If a deaf patient doesn’t understand, never say “it’s not important” as this is dismissive and disrespectful to the patient
T
T or F. Focus on deal patients as opposed to friends or family members; they have lost their ability to hear, not their individuality, dignity or intellectual competence
T
2 types of confusion
- delirium or acute confusion
2. dementia or chronic confusion
Many patients with dementia experience heightened confusion later in the day, also called ____
sundowning
3 objectives of patient education
- changing health outcomes
- improving health status
- improving patient compliance
T or F. Patient education involves more than the transfer of information
T
Estimates of patient noncompliance range from ___% to ___%
50 to 90%
3 steps in the approach to patient education
- assessment of the patient
- design of the instruction
- selection of teaching strategies and resources
To determine the type of instruction needed for a particular patient, 4 categories of variables must be assesses
- contexts for the education
- patient demographics
- patient learning styles
- information and content to be included in the teaching session
Refers to the medical condition that creates the need for the instruction
situational context
Refers to the environment in which the instruction will take place
instructional context
Certain characteristics of the patient that may influence their response to the instruction
patient demographics
3 types of learners
- visual
- auditory
- kinesthetic
Learners respond well to pictures, diagrams, anatomic models, and literature
visual learners
Learners prefer to be engaged verbally with the use of questions and answers or discussion
auditory learners
Learners learn by physical demonstration of a task or technique by the HCP followed by the practice of the technique by the patient
kinesthetic learners
Final component of the assessment phase; determines what info should be included in the teaching session for the particular patient
content analysis
Content analysis focuses on what info is ___ rather than redundant, irrelevant, or simply interesting
essential
HCP must distinguish between ____ and ____ information
need-to-know; nice-to-know
In designing instruction, HCP should begin by establishing _____
behavioral objectives
Behavioral objectives are ____ and ____ behaviors that result from the instruction
specific; measurable
Final step in the development of instruction
selection of which strategies and resources to use with a particular patient
American Academy on Physician and Patient suggests an ____ framework to determine what a patient already knows and what they think about the issue
ask-tell-ask
In instructing patients, add ___ behaviors instead of eliminating ___ behaviors
new; old
Kinesthetic instruction is beneficial in these 3 instances
- use of inhalers
- use of walkers
- use of glucomenters
HCP comes from an understanding of ____ the illness from which the patient suffers, and the patient comes from an experience of the ____ of the illness
what causes; symptoms of the illness
HCP needs to develop an understanding of the complex diversity that will characterize society as well as a strong cultural sensitivity, also called
cultural competence
The knowledge and interpersonal skills that allow providers to understand, appreciate, and work with individuals from cultures other than their own; involves an awareness and acceptance of cultural differences; self awareness; knowledge of the patient’s culture; and adaptation of skills
cultural competence
Model that defines cultural competence as the process in which HCP strives to achieve the ability and availability to effectively work within the cultural context of the client; process of becoming culturally competent, not being culturally competent
the volcano model
5 steps in the volcano model process
- cultural awareness
- cultural knowledge
- cultural skill
- cultural encounter
- cultural desire
Volcano model step: looking closely and honestly at your own biases toward other cultures; includes an awareness that racism and other forms of discrimination exist in healthcare delivery
cultural awareness
Volcano model step: seeking thorough understanding of attitudes and beliefs of other cultural ethnic groups; as well as health conditions and diseases that exist among them
cultural knowledge
Volcano model step: accurate understanding the cultural details surrounding the patient’s presenting problem; physically assessing the patient within the context of their culture
cultural skill
Volcano model step: actively seeking face-to-face encounters with members of other cultures in order to better understand the HCP’s own beliefs about their cultures; prevents stereotyping
cultural encounter
Volcano model step: desire of the HCP to become more culturally knowledgeable and skillful; genuine want instead of merely a need to fulfill a job requirement
cultural desire
Model describing a range of six points on a scale of cultural competence
The Cultural Competence Continuum
6 points in the cultural competence continuum
- cultural destructiveness
- cultural incapacity
- cultural blindness
- cultural precompetence
- cultural competence
- cultural proficiency
The Cultural Competence Continuum point: attitudes, policies, structures, and practices by a system or organization that are destructive to members of a cultural group; openly hostile/racist behavior
cultural destructiveness
The Cultural Competence Continuum point: inability of an individual or institution to respond effectively to the needs and interests of culturally and linguistically diverse groups; afraid to hire POC because of white customers
cultural incapacity
The Cultural Competence Continuum point: viewing and treating all people from different cultures as if they were the same
cultural blindness
The Cultural Competence Continuum point: level of awareness by people or institutions of their capacity for growth in responding effectively to culturally and linguistically diverse groups; recognizing the need to cultural train employees
cultural precompetence
The Cultural Competence Continuum point: demonstrates an acceptance and respect for cultural differences
cultural competence
The Cultural Competence Continuum point: high regard for diverse culture and use this ethical stance as a foundation to guide their endeavors
cultural proficiency
6 universal facial expressions
- happiness
- sadness
- fear
- anger
- disgust
- surprise
14 standards are organized by these 3 themes
- culturally competent care
- language access services
- organizational supports for cultural competence
3 categories with varying levels of stringency within the CLAS framework
- mandates
- guidelines
- recommendations
CLAS: current federal requirements for all recipients of federal funds
mandates
CLAS: activities recommended for adoption
guidelines
CLAS: suggested for voluntary adoption
recommendations
T or F. Do unto others doesn’t necessarily hold in cross cultural communication
T
When communicating with limited-english speakers, speak ___ not ____
slowly; loudly
T or F. When an interpreter is present, look at the patient, not the interpreter
T
