Midterm Study Guide

5 intrinsic dimensions of personal transformation

-Mission, Vision, Values, Beliefs, identity

• Mission: purpose, what called to do

• Vision: future you imagine and pursue

• Values: sum of your beliefs; what matters most and guides conduct

• Beliefs: ideas and assumptions you hold to be true; from multiple experiences

• Identity: story and characteristics you hold about yourself

5 extrinsic dimensions of personal transformation

-Experience, Preferences, Behaviors, Competences, Personality

• Experience: what you encounter, live through, and learn from

• Preferences: what you naturally lean toward or away form

• Behaviors: observable actions and reactions

• Competences: Knowledge, cognitive skills, and attributes integrated in practice

  • “KSA”; ability to do something properly and successfully

• Personality: patterns of thinking, feeling, behaving

competence

ability to do something properly and successfully

“KSA”

-knowledge: practical and theoretical knowledge

-cognitive skills: things you can do

-attributes: inherent characterstics often expressed through things you think, do, and feel

what shapes how we behave?

expereince → personality, preferences, competence → behavior

true colors assessment

-Orange (spontaneous, action-oriented), Gold (organized, tradition), Green (analytical, independent), Blue (empathetic, authentic)

-Use colors to build shared language for communication and teamwork, NOT to label people

• Know yourself, read the room, adapt respectfully, collaborate better

Small l vs Big L Leadership

-Small l: leadership through behavior; leading self

-Big L: formal leadership through position

• Key point: Position does NOT equal leadership!

Leadership vs Professionalism

-Leadership: how do I influence progress, “I do”

• Influence, action, change, initiative

• Leadership begins with leading yourself

-Professionalism: who am I expected to be, “I am”, expectations

• Identity, expectations, standards, accountability

-Shared characteristics: accountability, integrity, excellence, social responsibility, collaboration

Values, Ethical Principles, Commitments, Standards

-Values

• Personal: what matters to me

• Professional: what matters to this profession

-Ethical Principles: help us determine what we should do; understand right/wrong

-Ethical Commitments: pledges

-Standards of Conduct: written ex of behaviors tolerated; translate values into action

Define social and structural determinants of health

-Social determinants: conditions in which people are born, grow, live, work, and age, and the wider set of forces and systems shaping the conditions of daily life

• Are NOT characteristics of pt, they describe the conditions and systems surrounding them

• 5 domains: health care and quality; neighborhood and built environment; social and community context; economic stability; education access and quality

-Structural determinants: structures that drive inequities and predetermine many of the social determinants impacting an individual community

Health disparities vs inequities vs equity

-Health disparity: the quantity that separates a group from a reference point on a particular measure of health

-Health inequity: differences in health status or distribution of health resources between different population groups arising from social conditions that people are in

-Health equity: highest attainable level of health for all people, supported by fair opportunity and access

How social and structural conditions influence health and access to care

Structural predetermines many social determinants

*structural → social

Fundamental Cause Theory

-explains why socioeconomic inequities in health emerge and persist over time

• Socioeconomic status

• Racism

• Stigma: can create new mechanisms; requires power to make labels socially meaningful and translate them into consequences

  • Mechanisms=policy or law

-Fundamental cause=the cause has the capacity to cause casual relationships and reproduce reliable relationships over time

• Flexible resources help people avoid risks, adopt protections, and access new opportunities

Why and how screen for social needs

-Increased structural competency can increase awareness of social drivers that may affect outcomes; common barriers=time, inadequate resources, lack of experience, uncertainty what to do after positive screen

-Do NOT ask about need you have no plan to acknowledge, document, or appropriately refer

-How introduce SDOH screen: normalize → explain → ask; use respectful and nonjudmental language and allow pt to decline

-Consider a combined approach when one tool does not cover all relevant domains

3 types of stress

-Positive: brief, mild-mod response to normative stress

-Tolerable: greater hardship or threat with at least one protective relationship that helps recovery

-Toxic: strong, frequent, or prolonged activation without the buffering protection of a supportive relationship

*note=stress is not inherently harmful; duration, intensity, context, and buffering relationships matter

How Poverty and Adversity Affect Health

-Social conditions can shape both exposure to risk and the body’s response to that risk

-Direct pathways: food insecurity, housing instability, transportation barriers, unsafe environments, reduced health care access

-Indirect pathways: physiological responses when don’t have protective mechanisms, cumulative; repeated stress activation, increased cortisol, heightened anxiety, disrupted development, cumulative toxic stress

Consequences of ACE’s across Lifespan

-Increase risk early death

-ACEs more common in populations experiencing poverty and other forms of disadvantage

social/strucutral driver pathway + where PT encounter

-strucutral drivers -> social conditions -> individual experiences -> stress + behavioral responses -> health and function

-PT encounter occurs INSIDE this pathway, not outside

Where can PT act: BARHII Framework

-dowstream: treat pt; typical provider

-midstream: screen, refer, coordinate resources

-upstream: pattern, advocated, improve systems

Resilience definition

-Resilience:the capacity to respond in healthy and productive ways when faced with adversity or trauma

-Factors: poverty, divorce, mentally ill parents

7 abilities that make up resilience

Emotional Regulation, Impulse Control, Empathy, Optimism, Causal analysis, self efficacy, reaching out

-Emotional Regulation: ability to stay calm under pressure

-Impulse Control: ability to resist desire and translate into action; fight initial urge and what what you should do

• Daniel Goldman experiment: left kids in room w/ candy, kids who delayed did extremely better longterm

-Empathy: understand what someone is experiencing and reflect back understanding; how well you can read non-verbal cues

• Cognitive: perspective taking

• Affective: taking on feelings

-Optimism: belief things can change for the better; Pollyanna optimist=ignore real threat

• Strong optimist cognitively better at: identifying problems, see problems as challenge vs threat, identify what they can control or influence

• Strong optimist behaviorally better at: purposeful action

-Causal analysis: habitual way you explain the good and bad things that happen to you; 3 dimensions=personal, permanent, pervasive

-Self efficacy: sense of your effectiveness in the world, faith in ability to succeed

-Reaching out: show enough interest that prompts an effort to act or try

8 thinking traps

(What fall into: we like to fill in the blanks based on information we have)

-Jumping to conclusions: making assumptions without relevant data; “umbrella term” bc all traps involve making assumptions

-tunnel vision: only seeing the negative or positive aspects of a situation; often triggered when violation of rights, beliefs, values

-magnifying and minimizing: overvalue and undervalue certain events

-personalization: attribute everything to one’s own doing

-externalizing

-overgeneralization: attribute cause of problems to other people’s character rather than behaviors (characteristics can’t change, but behaviors can)

-mind reading: when we believe we know what others thinking; lot in relationships

-emotional reasoning: drawing false conclusions based on your emotional state

Inductive vs Deductive processes

-Inductive: logical approach where your progress from specific ideas to general conclusions

-Deductive: logical approach where you progress from general ideas to specific conclusions

causal vs implication beliefs

-Causal=”why” belief, why did this happen

-Implication=what will happen next

-To build resilience: 1) know yourself (ticker tape, ABC, icebergs) 2) change (challenging beliefs, putting it into perspective)

Iceberg/Core beliefs

Iceberg/Core Beliefs

-Achievement: success is the most important thing in life

-Acceptance: need to be liked, accepted, praised, and included by others

-Control: importance of being in charge and in control

conflict definition + Hammers 2 dimensions

-Conflict= disagreement + affective/emotional response

-Hammer’s 2 dimensions: 1) how disagreement is communicated 2) How affect is expressed

4 different ways conflict communication can be communicated

-Direct or Indirect

• explicit words vs context, implication, relationships, or questions

-Emotionally Expressive or Emotionally Restrained

what do BAP studies generally find?

-20% better outcomes if build therapeutic alliance

-Subjective > objective: listening to pts was variously depicted as a trait of master clinicians, important to their clinical reasoning

5 qualities of therapeutic alliance

1. Meeting a competent and warm therapist

2. Being understood as a whole person

3. Feeling appreciated, tolerated, and supported

4. Gaining strength and hope for the future

5. Helping overcome fears and apprehension

amygdala hijacking

immediate and intense emotional reaction that’s out of proportion to the situation

2 ways to avoid amygadala hijacking

-Engage your prefrontal cortex: name emotion -> give attention what physically happening -> self talk choices right now

• GABA secreted and helps calm amygdala/fear and anxiety centers

-Wait 90 seconds and use physiological sighing: inhale twice and slowly exhale all air out through mout

3 Stages of Health Literacy

1. Functional health litearcy: basic skills necessary to function effectively in a health context

2. Interactive health literacy: understand and discuss info

3. Critical health literacy: able to critically analyze info and use it to exert greater control over life events and situations; knows rights and wrong

Who has limited health literacy

-9/10 adults

-even people with high literacy skills may have low health literacy skills

health literacy skills

-reading, understanding, analyzing info

-interpreting instructions, symbols, charts, diagrams

-considering risks and benefits

-making decision and taking an action

key takeaway health literacy videos

-Dr. Lisa in the Street: Doctors should speak in language pts understand!

Generelly

1. Keep it simple; limit education to 1-3 points

2. Avoid medical jargon

3. Focus on what the client needs now

4. Use teach back to ensure understanding

health literacy research

-individuals should not be blamed for not understanding info that isn’t clear

-anyone, despite education level, is at risk for misunderstanding health info

-individuals may be embarrassed to admit they don’t understand 

-can be challenging for individuals to find evidence-based info, especially online

impacts low health literacy

-increased hospitalization; longer hospital stays; more frequent emergency room

-higher rates chronic disease; higher mortality rates

-poor preventive care for children

rehab team members

-Patient and family: Most important team members!

-Physiatrist/Physical Medicine and Rehab MD: MD who specializes in rehabilitation; has completed training in Physical Medicine and Rehabilitation (PM&R)

-Rehabilitation nurse

-Physical Therapist

-Occupational therapist: Improves participation in daily life activities, including basic task (dressing, toileting) and higher-level activities such as driving, work, school, and leisure tasks.

-Speech language pathologist: Treats patients with problems related to cognitive, communication, or swallowing issues

-Social Worker: Counselor who acts as a liaison for the rehab treatment team; provide support and coordinate discharge planning, referrals, and coordination with insurance

-Recreational therapist: Coordinates programs to help promote recreation and leisure activities

-Vocational therapist: Counselor who assists people with disabilities to plan careers and find and keep satisfying jobs

-Respiratory therapist: Treat clients with lung disease or breathing disorders.

-Psychiatrist, psychologist, or neuropsychologist: Conducts cognitive assessments of the patient. He or she also helps the patient and family adjust to the disability.

-Audiologist: Evaluates hearing and treats hearing loss.

-Dietician: Evaluates and provides for the dietary needs of each patient.

-Orthotist: Fabricates braces and splints

-Prosthetist: Fabricates prosthetic limbs

-Chaplin: Spiritual counselor

BAP: partnership

-Partnership: sharing power and expertise

• PT is the clinical expert; pt is expert of their experience

• Clinican is a guide who offers experience and paths of success taken by others with permission

• Ultimate decision-maker is the pt

BAP: Acceptance vs Compassoin

-Acceptance: pt as autonomy; we should acknowledge strengths; pt past choices do not negatively affect our perception of him/her

-Compassion: towards the pt struggle and experiences; its normal for all people to have reasons to change and reasons to not change, for many the immediate experience of a challenging exercise is not pleasurable and is resource intensive

BAP: Evocation/Empowerment

-Standard of Care: assume pt empty class and we fill them w/ our experience

-MI: empower them to make changes themselves

BAP: how offer a behavioral menu

-offer when a pt is interested in making a plan but doesn’t quite know where to start

-”can I share with you some things that have helped others in your situation”?

-with permission, share 2-3 ideas briefly all together, then say “maybe on of these would be of interest or maybe YOU have thought of something else?”

BAP: flowchart

why do medical improve?

-Allows you to build off pt idea

-”Yes And”: allows ideas to merge, welcoming them into conversion; doesn’t mean necessarily agree but more accepting. ”Yes But” shuts down ideas

• Should move towards “yes and” feeling easier than “yes but”

-Important to actively listen to pt first and then speak; be in the present (ex: not just thinking about the next exercise)

-Dual tasking can be hard/not good for your pt

*Sentiel events: finds that lack of/bad communication root cause; know increase communication → increase pt outcome, pt more likely to forgive mistakes

*Medical Improve=application of improvisational theather prinsciples and techniques to healt care settings

essay prompt/reflection idea

-Mission: purpose/what you are called to do

-Why am I pursuing PT: I am called to be a PT because my mission is to help individuals improve their overall quality of life through physical activity

-Vision: future you imagine and pursue

-I imagine myself in 3 years graduating with my DPT so that I can move back to northwestern Wisconsin and work in rural healthcare

-(Personal) Values: what matters most and guides conduct

-I value learning, balance, and compassion

-Identity: story and characteristics you hold about yourself

-I am a SPT

-Beliefs: ideas and assumptions you hold to be true

-I believe every patient should be active participants in their rehabilitation