Psychosocial Concepts and Support Systems Flashcards
List and briefly discuss the stages of change.
Precontemplation -the person is not ready to change his behavior and may not be aware of the need to change.
Contemplation - the person is getting ready to change his behavior (within six months); at this stage, the pros and cons are relatively equal.
Preparation - the person is ready to change and plans to effect changes within 30 days.
Action - the person has changed his behavior within the last six months but needs to focus on forward movement.
Maintenance - the person has achieved positive results and will need to strive to maintain these results.
Termination - the person has not returned to unhealthy behaviors/habits and has no desire to temptation to do so.
List and discuss end-of-life issues.
End-of-Life Issues may include adequate pain control, avoidance of prolonged suffering and a prolonged dying process, adequate discussion with the patient and family members, a sense of control, appropriate preparation for death with a sense of completion, reinforcing relationships, and a sense of not being alone. End-of-life care my utilize hospice.
Hospice is a holistic approach that utilizes the entire care team to make the dying patient as comfortable as possible and stresses pain control, natural death, and the quality of life that is remaining.
Palliative Care stresses symptom management and relief of pain.
Drug Therapy is common, but alternative methods may also be used, including acupuncture, message therapy and aromatherapy.
Do Not Resuscitate (DNR) is a legal order that recognizes the choice of a patient to not undergo CPR/ACLS and to die a natural death; this order basically. does not affect any treatment other than that which may necessitate intubation or CPR. DNR patients will receive chemotherapy, dialysis, antibiotics, and other therapies.
Define and give examples of respite care.
Respite care is the psychological and physical support provided to caregivers. Respite care takes many forms. Especially in cases involving long-term care, caregivers, need to be encouraged to talk with others in similar situations. To better understand illnesses, support services are available for spouses, family and children/siblings of individuals suffering from long-term illness.
Respite care may be in the form of camp for a child suffering from an illness (cancer, diabetes) allowing the family to be free of responsibility for the time while the patient is away.
Respite care may be placement of an elderly person at an assisted living resident for a weekend giving the family care providers a weekend off.
Respite care may be someone residing in the home of a patient allowing the family caregivers to take a vacation.
Case managers can assist by identifying when caregivers need respite care by supply resources for respite care.
Discuss ways the care manager can show respect for patients from diverse cultures.
The case manager should first assess his/her own background, values, and beliefs in order to consciously avoid biases.
Obtain further knowledge in order to understand the background being addressed and to show acceptance of differences even when they may diverge from his/her own comfort zone and culture.
Acknowledge differences concerning end-of-life care, be sensitive, and be open to the individual patient’s belief rather than trying to predict behavior.
Assumptions regarding care, needs, or beliefs should NOT be made based on race or ethnicity.
Discuss the functions of a health coach.
A health coach basically serves as a personal medical trainer. Coaches may work with patients who have chronic illnesses and help to provide information about lifestyle changes and services available.
A health coach can be a nutritionist, nurse, or a health educator.
Coaches are trained to help patients identify health risks and to motivate them to change their behaviors to bring about a healthier lifestyle.
A health coach may also provide information regarding medical conditions, concerns, and issues. Some many even suggest questions that a patient might ask at the next doctor visit.
Health coaches form a team with the patients and help them to set manageable goals and provide positive reinforcement.
Discuss patient activation and patient empowerment.
Patient Activation is the ability of the patient to express health concerns, to adequately question, and develop skills to collaborate with health care providers. Patients should be encouraged to discuss concerns and should be guided in formulating questions: “What questions do you have?” and “What information do you need?”
Patients should be assessed to determine their lever of activation:
- Level 1 - Patient is overwhelmed and disengaged, remains passive and leaves healthcare providers in charge.
- Level 2 - Patient has increased awareness and can set simple goals but lacks adequate knowledge.
- Level 3 - Patient feels part of the health team and begins to take action while building skills.
- Level 4 - Patients realize the importance of self-management and remain goal orientated but may falter at times.
Patient Empowerment is the ability of the patient to speak on his/her own behalf, to participate in healthcare decisions, and to manage personal healthcare to the maximal degree. Patient empowerment is often secondary to patient activation.
Describe the health literacy assessment.
A health literacy assessment is the determination of a patient’s ability to read, comprehend, and utilize information related to health care to make informed decisions and to follow treatment plans.
More than 50% of patients cannot comprehend even basic healthcare information.
A low score on a health literacy assessment reduces treatment success and furthers the chance of medical error.
At the very least, health literacy skills include communication with healthcare providers, reading and comprehending health information, medication information and understanding information on various treatment options.
Discuss outcomes of self-directed care.
The outcomes a patient has when establishing self-directed care may include health restoration and disease prevention. Lifestyle changes and optima level of health maintenance may be the result of illness or disability limitation. Such changes could include those undertaken by patients, their families, and their children to stay active and meet personal mental and physical goals. This may involve treating an acute condition and cold also involve meeting psychological and social needs.
A patient should also be cognizant of trying to prevent minor accidents or illnesses and any long-term issues. A patient with such issues should attempt to maintain his health and well-being after an exacerbation or admission to the hospital by needed lifestyle changes and maintenance of a pleasing quality of life.
List physical signs of abuse.
Physical signs of abuse include bruise, contusions, cuts, black eyes, ligature marks, bone or skull fractures, open sores, punctures, burns, joint dislocations, unexplained sprains, broken hearing aid/glasses, medical evidence of under/overdose of medications, diarrhea or dehydration, fecal impaction, malnutrition, incontinence with evidence of rash, unkept appearance/smell, lice, fleas, undergarments that are dirty/stained/bloody, absence of needs adaptive aids (prostheses, hearing aids, glasses), trouble with sitting/standing/walking, multiple ER visits or hospital admissions, sexually transmitted diseases/infections not explained by medical history, genital/anal trauma, patient’s report of being mistreated physically/sexually/ emotionally.
Give examples of government programs.
Government programs were initially established in the US during the 1930s as a result of the Great Depression.
Such government programs usually involved the following;
a) welfare payments
b) . Medicaid health care
c) . Food Stamps
d) . Provisional aid to pregnant women/young mothers
e) . federal and state housing benefits
Government programs are considered to be a means of social protection. Such programs are usually created to enable those in need to overcome adverse condition.s
Government programs vary widely from state to state and from nation to nation. Some examples include:
a) . substance abuse
b) . mental health services
c) . SSI/disability services
d) . emergency food assistance
e) . Medicaid
Give examples of physical and emotional wellness strategies.
Wellness Strategies are often called the health triangle.
The Health Triangle incorporates physical, emotional, and social wellness concepts.
Physical wellness strategies include exercise and fitness, nutrition and diet, lifestyle choices/habits, safety, medical self-care, and health screening.
Currently, many companies and employers are implemeting wellness programs in the workforce. Such programs may include nutrition seminars, tobacco cessation, and the importance of physical activity and exercise in maintaining health and wellness.
Emotional Wellness Strategies include stress control, expressing feelings, problem solving, assessment of personal limitations, outlook-optimism/pessimism, recognition of success/failures, maintaining a sense of humor, and understanding and recognizing consequences of one’s actions.
Discuss the wellness concept.
The wellness concept is a balanced model in which the body, spirit, and mind must coast in harmony.
Such a concept indirectly came from the Eastern philosophies of Buddhism and Taoism that suggest that mind, body, and spirit join together as one.
Wellness was defined in the 1950s by Dr. Halbert Dunn. Dr. Dunn defined wellness as “an integrated method of functioning which the individual is capable of functioning within the environment.”
The wellness concept has 6 elements of health:
a) physical
b) emotional
c) intellectual
d) social
e) spiritual
f) vocational
The extent to which h a patient internalizes the concept of wellness and takes personal responsibility determines his success in obtaining wellness.
Give examples of intellectual, spiritual, social, and vocational wellness strategies.
More and more, it is being realized that wellness not only involves physical and emotional strategies but also involves integrating strategies for intellectual, spiritual, social, and vocational wellness to achieve an optimum wellness balance.
Intellectual
a) lifetime learning
b) using the mind
c) investigating new ideas
d) making decisions
e) following directions
f) maintaining speaking and listening capabiities
Spiritual
a) develop purpose and meaning in life
b) connect with one’s higher power
c) prayer
d) meditation
e) morals/ethics
f) contemplate one’s death
Social
a) interaction with other people and the environment
b) instigate and maintain relationships
c) participating in various groups/social causes
Vocational
a) goal setting
b) learning new skills
c) identifying abilities
d) determining personal goals/mission
e) volunteering
Describe a ‘change agent’ illness and the case manager’s role in intervention.
Any illness that affects an individual’s life in physical, social, or psychological ways is considered a change agent illness.
Change agent illnesses result in loss, anger, fear, anxiety , depression, dependency, and loss of self-respect, social status or independence.
Catastrophic illnesses, such as closed head or spinal cord injuries are easily recognized as change agents.
Case managers must recognize that many cares fall into the category of ‘change agents’ due to physical or emotional effects (e.g. a carpenter loses use of a hand or the main breadwinner can no longer function in that capacity).
During the intake interview, it is important to document education, support mechanism, counseling and/or medications that may be needed.
Case follow-up needs to reassess the individual’s success at coping with the illness and treatment as well as the effects on their family and community support group.
Addressing the effect on the later group maintains the patient’s support group - the individual providing social, psychological and even financial support to the patient.
List various change theories.
Learning theory, social cognitive theory, reasoned action theory, planned behavior theory, the trans theoretical model, and the health action process approach are all change theories.
Discuss strengths model case management.
Strength’s Model Case Management focuses on patient’s rather than deficits in planning interventions based on the belief that people have inner resources that can help them to cope.
The relationship between the case manager and the patented is considered essential. This model was initially used in psychiatric facilities.
Strengths Model Case management is goal-oriented and begins with an assessment to help identify goals and develop a plan to treatment with interventions planned to meet the individual’s needs based on self-determination.
The case manager assists the patient to identify abilities, skills, and environmental factors that may promote recovery. Patients’ problems are viewed in the context of goals, and methods are developed to overcome the programs rather than viewing them as barriers to recovery.
Patients collaborate and are encouraged to remain involved in treatment.
The case manager must consistently seek the patient’s opinion about interventions.
Discuss pharmacy assistance programs.
Pharmacy assistance programs often are conducted by pharmaceutical companies to enable patients to obtain their medications free or at low cost. These companies may provide discount cards and/or waivers to aid uninsured or low-income patients with purchasing medications.
Some pharmacy assistance programs are conducted by or through the state.
Currently, 28 states have pharmacy assistance programs, and 6 states utilize waiver programs that are foundered by both the federal and state governments via Medicaid.
Provide information on how case managers can provide assistance to families facing a crisis period.
Families of patients must del with the effect of the patient on the normal operation of their family life. Realignment of family responsibilities occurs each time someone suffers from illness or injury, and prolonged illness puts unique burdens on the family dynamics. It is important for the case manager to understand the family dynamics and provide intervention resources when needed.
If the family was fractured before the illness, chances are the fracture will intensify, causing problems in addressing the treatment plan of the patient.
To assist families through periods of crisis, a case manager can suggest family counseling or support groups for the family or the caregiver; recommend books on the illness or coping with illness; direct families to sources for financial assistance; remind the family that maintenance of their regular routines, appointments and activities is important to their physical and psychological health; and encourage the family to communicate with one another.
Describe the case manager’s role in dealing with end of life issues.
Although death is inevitable, more than 50% of Americans 45 years or older have never discussed end of life (EOL) issues with their families, including thoughts about death when someone is terminally ill.
Case Managers have the unique position to be able to assist individuals and their families with fact-based information and alleviate their fears. It is important for case managers to know the laws in the state in which they practice.
The Patient Self-Determination Act (PSDA) of 1991 requires all Medicare and Medicaid agencies to recognize living wills and powers of attorney for advanced directives in healthcare; however, states have their own definitions and practices regarding guarantees for individual rights to determine treatment.
Do not resuscitate (DNR) orders, living wills, healthcare proxies (wishes regarding life-prolonging measures), and other legal documents are ares where case managers make an impact on the treatment their clients will receive. The advance directives assist families during crisis situations by allowing discussion and decisions to be made in advance.
Explain the difference between an adaptive and maladaptive family.
An Adaptive Family is able to adapt to a crises, specifically a catastrophic illness, with flexibility, reasonable problem solving, effective communication between the family and the care providers, and the ability to maintain their link to the community.
When a family cannot continue with their own daily functions while meeting the patient’s needs, they are a Maladaptive Family. Maladaptive actions include overindulgence of the patient and/or abandoning other family members, denial of the patient’s condition, relying on a single person to provide all assistance to the patient, a failure to seek help from others.
Case managers must assess the family/support group at the start and throughout the course of an illness by asking probing questions to make sure the family and community resources may determine the level of involvement necessary by the case manager to ensure the best result is achieved for the patient.
Explain why case managers must be aware of a patient’s belief system in order to provide appropriate services to the family.
Currently 1 in 10 people living in the US are foreign born; over 40% speak a language other than English at home; and others seek little to no English.
This presents cases managers with clients having diverse cultures, religions, and other factors that present barriers or issues in developing treatment plans. Case managers must understand the patient’s attitudes towards accepting treatment from healthcare providers since their knowledge of illness and health and healing maybe based in custom rather than science.
Cultural Idiosyncrasies must be taking into account in creating treatment plans that will be followed and thus successful.
As examples, Hispanic families usually hold physicians in high regard and may not question their suggestions, however they will to the case manager with questions.
Northern European descendants want to be empowered in their treatment choices.
Many African Americans believe healthcare providers are motivated by profit in relation to treatment options.
Asian Pacific Americans may concede medical decisions to the family with the eldest son having responsibility to preserve their parents’ lives by any means available.
Some cultures believe home death is desirable. Through education, case managers can become aware of the cultural needs of the community they serve.
Define a religious organization and give examples.
Define a fraternal organization and give examples.
Religious Organization - a nonprofit entity that does one of the following - conducts worship, supports religious activities of nonprofit organizations, or propagate the tenets/teaching of religious faiths. Religious organizations are typically organized around a shared religious belief and may include various benefits. Benefits may include mutual aid and assistance to those in need. Examples would include the Aid of Association of Lutherans, American Friends Service Committee, Faith and Light, and Missionaries of Mary.
Fraternal Organization - an organization implying a formal fraternity or brotherhood. Examples include the Knights o Columbus, Fraternal Order of Moose, Sons of Norway, and Sons of the American Revolution.
Describe ways in which spirituality affects health behavior.
Spirituality has been linked to health behaviors. Studies show that patients who are spiritual have fewer self-destructive behaviors such as suicide, smoking, and alcohol or drug use.
All major religions promote the idea that the body is a gift from God or a higher power/spirit and prohibit self-destructive behaviors.
Spirituality has been demonstrated to lower blood pressure, decrease depression, and to boost the immune system. Some religions, however, prohibit certain forms of medial care, such as Jehovah’s Witnesses reusing blood transfusions.
Spirituality also enables a patient to have additional social support and improved coping skills through prayer. Studies show that spirituality affects mental health by providing a patient with optimism, increased coping ability, and a sense of a greater purpose.
Define community resources and list examples.
Community Resources are a collection of assistance programs or services provided to community members. Such resources may be organizations serving a certain geographical are or certain groups of people. Typically, the goal of community resources is to positively impact community growth and to improve the quality of life for community members.
These resources may be at no cost or at low cost and may be run by the government, local businesses, or other community members.
Examples include:
a) fraternal/religious organizations
b) government programs
c) pharmacy assistance programs
d) educational organizations
e) financial assistance organizations
