RCC Final Exam

rapport building

being personable, directive, and engaging when greeting the patient; make sure to show interest, smile, and also introduce yourself/your role; USED TO FIND COMMON GROUND

finding common ground

finding something you and the patient both relate to, allowing for the patient to feel welcomed and comfortable

setting an agenda

list all items you intend on covering in this one visit, discuss what you would like to cover and see the amount of agreement between you and the patient there is

summarizing

providing brief summary of what patient said (maybe will help patient remember something they forgot)

clarifying

asking questions to better understand what the patient said

rapid fire questions

overwhelming the patient with a lot of questions & not allowing them to answer the questions

why are rapid fire questions ineffective?

could miss a key component in the chief complaint or sign/symptoms of patient because they might forget to answer all of your questions

directive questions

questions that are aimed at a named individuals (who, where, what, when, how)

jargon filled

questions asking about medical events using medical terms rather than layman terms
(ex. saying myocardial infarction instead of heart attach)

loaded questions

a form of question that contains a controversial assumption

leading questions

a question that prompts or encourages a desired answer

what specific questions are asked when determining a patient's pain level?

location, quality, chronology, intensity, aggravating/alleviating factors, associated symptoms, disability and adaption, patient and family perspective

first S in SPIKES protocol

setting up the interview: make sure you have all correct & organized info

P in SPIKES protocol

assessing the patient's perception: find out how much the patient knows and how serious they think it is

I in SPIKES protocol

obtaining the patient's invitation: find out how much the patient wants to know; respect patient autonomy

K in SPIKES protocol

giving knowledge & information to patient: have an agenda in which you will cover what you planned to go over; don't ignore patient questions (includes diagnosis, treatment plan, prognosis & support)

E in SPIKES protocol

addressing the patient's emotions: done via empathetic responses, give patient time, show patient you are listening to them

last S in SPIKES protocol

strategy & summary: demonstrate that you understand patient's illness

synchronous tele-dentistry

live, two-way interaction between a person (patient, caregiver, provider) and a provider using different modes of technology; commonly live video

asychronous tele-dentistry

store & forward; transmission of recorded health information (ex. radiographs, photographs, video, digital impressions, etc. of patients) through a secure electronic communications systems to a practitioner who uses the info to evaluate the patient's condition or to render a service

social determinants of health that cause/influence a toxic environment in a young child's life

trauma, emotional or physical abuse, poverty, exposure to environmental toxins, parents who suffer from substance abuse before and after birth

maturation theory principles

-growth and development occur in orderly stages & sequence
-individual genetic timetable affects rate of maturation

psychodynamics theory principles

-behavior is controlled by unconscious urges
-three components are id, eco, and superego

psychosocial theory principles

-personality develops in 8 stages throughout a lifetime
-development in influenced through interactions with family, friends, and culture

cognitive theory principles

-qualitative changes in the way children think
-the child is considered an active learner going through stages

behaviorist theory principles

-learning is gradual and continuous
-development is a sequence of specific conditional behaviors
-main emphasis is on the environment, not heredity
-observable behaviors are considered most important

ecological theory principles

-balance between nature and nurture
-child is placed in the middle of the concentric factors which all influence the child
-emphasis is placed both on environment and heredity

information processing theory principles

-we all have an innate learning ability
-children are born with specialized information processing abilities that enable them to figure out structure of development

classical conditioning

-First visit: Neutral stimulus → unconditioned → response
-Second visit: conditioned stimulus → unconditioned stimulus → response
-Generalization - pain's association between hospital visits and GPR dentistry or Oral Surgery (e.g., carry over in waiting rooms, reception areas, waiting pts...)
-Discrimination - a different type of "pain free" or more "painless" environment helps pts to differentiate from other offices/experiences.
-Key is to try to make the first visit diff then other harmful visits.

operant conditioning

-Theory to explain complex behaviors based on unconscious determinants
-A consequence of a behavior is itself a stimulus that can affect future responses (a response becomes a future stimulus)
-The behavior is strengthened by its consequence
-The consequence itself is the "reinforcer"

types of operant conditioning

negative reinforcer & positive reinforcer

learning from imitation

learning via observation of family members, doctors, dentists

learning vicariously

learning from others

cognitive behavioral therapy (CBT)

addresses thought patterns and beliefs that impact an individual's behavior; environment can impact what we believe, think, feel, and behave

rational-emotive behavior therapy (REBT) model

-strives for a more directive & efficient approach than traditional psychotherapy
-uses A-B-C-D-E model

cognitive therapy model

-negative view of reality creates depression
-ex. Beck Depression Inventory

individual psychology model

unique and private beliefs and strategies (one's lifestyle) that each individual creates in childhood

dialectical behavior therapy model

-developed to treat people with Borderline Personality Disorder (BPD)
-pertains to concepts of stress tolerance, acceptance, mindful awareness to help regulate emotions

DSM clinical definition of anxiety

excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance)

DSM symptoms of anxiety

1. Restlessness or feeling keyed up or on edge
2. Being easily fatigued
3. Difficulty concentrating or mind going blank
4. Irritability
5. Muscle tension
6. Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)

DSM clinical definition of depression

depressed mood and/or loss of interest or pleasure in life activities for at least 2 weeks and at least 5 of the following symptoms that cause clinically significant impairment in social, work, or other important areas of functioning almost everyday

DSM symptoms of depression

1. Depressed mood most of the day
2. Diminished interest or pleasure in all or most activities
3. Significant unintentional weight loss or gain
4. Insomnia or sleeping too much
5. Agitation or psychomotor retardation noticed by other
6. Fatigue or loss of energy
7. Feelings of worthlessness or excessive guilt
8. Diminished ability to think or concentrate, or indecisiveness
9. Recurrent thoughts of death

binge drinking SAMSHA definition

drinking 5 or more alcoholic drinks for males & 4 for females on the same occasion on at least 1 day in the past 30 days

heavy drinking SAMSHA definition

binge drinking on 5 or more days in the past month; heavy alcohol use

definition of mental health disorder

syndrome characterized by clinically significant disturbance in an individual's cognition, emotion, regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes during mental function

according to DSM, what is meant by SUD

mild, moderate, or severe to indicate the level of severity, which is determined by the number of criteria (2 or 11 of the DSM symptoms within 12 months)

when is the CAGE approach most effective?

when questions are embedded in a benign component of the medical history, such as review of health habits

CAGE approach

“Have you ever felt you should CUT DOWN on…?”

“Have people ANNOYED you by criticizing…?”

“Have you ever felt bad or GUILTY about…?”

“Have you ever thought about… as soon as you first woke up?”

EYE OPENER

stages of MI

pre-contemplation, contemplation, preparation, action, maintenance, relapse

pre-contemplation stage of MI

not considering change, feeling no control, believes seriousness doesn't apply, denial

contemplation stage of MI

weighing benefits/costs of changing, may not be confident or know how to change

preparation stage of MI

experimenting with small changes & making plans

action stage of MI

having a definitive plan, negotiating terms/goals

maintenance stage of MI

practicing/maintaining new behavior over time

relapse stage of MI

normal change process

ways to engage with patients during the stages of MI

have discrepancy, express empathy, amplify ambivalence, roll with resistance, support self-efficacy, make a referral to a specialist

F in FRAMES model

feedback

R in FRAMES model

responsibility

A in FRAMES model

advice

M in FRAMES model

menu options

E in FRAMES model

empathy

S in FRAMES model

self efficacy

what is the PDM?

prescription drug monitoring used to promote appropriate drug use of controlled substances for their left medical purpose, while deterring misuse, abuse, and diversion of these substances

why should dentists utilize PDM?

to prevent risk of misuse of opioids in their patients

what is meant by 'giving discrepancy' when using MI?

clarify important goals of the patient, explore consequences of patient's current behaviors, look at current problem and figure out what the future goal should be

ADA code of ethics principles

patient autonomy, non-maleficence, beneficence, justice, veracity

patient autonomy ADA principle

self-governance, duty to respect patient's rights to self-determination and confidentiality

non-maleficence ADA principle

do no harm

beneficence ADA principle

do good, promote welfare of patient

justice ADA principle

fairness, treat all people fairly

veracity ADA principle

truthfulness

why is patient confidentiality required?

dentist-patient tryst to exist; there may be consequences in not maintaining this

situations in which confidentiality may be violated

reporting of certain communicable diseases is required, when patient says they are going to hurt someone else, child abuse

confidentiality in adolescents

still an obligation to maintain confidentiality BUT we should encourage communication between adolescent and their caregiver/parent

in Indiana, what must you receive in order to release confidential Information?

written consent from patient

defintion on informed consent

process of communication between a clinician and patient that results in the patient's authorization or agreement to undergo a specific intervention; document is obtained as evidence to document legal and ethical responsibilities

general principles of informed consent

choice, free will, influence, respect, communication

elements of informed consent

-Purpose of treatment and what it involves
-Effects and consequences of treatment
-Risks, limitations, and possible side effects
-Alternatives and how they compare
-Cost

definition of capacity

an assessment of the patient's abilities to form rational decisions specifically their ability to understand, appreciate, and manipulate information and form rational decisions

factors that affect capacity & understanding

age of patient, severity of need or pain, education level, language, health literacy, cognitive capacity

standards for assessing decision-making capacity

-ability to make a choice and voice a decision
-ability to understand relevant information
-ability to appreciate the situation and likely consequences
-ability to manipulate information rationally

definition of competency

legally-determined state surrounding an individual's mental ability and cognitive capabilities

T/F: guardian assigned to make decisions on someone's behalf if they are found incompetent just because pt has mental disorder or impairment DOES NOT equal lack of competence

true

persons authorized to consent for treatment in order of priority

judicially appointed guardian, spouse, child(adult), adult sibling

persons authorized to consent for minors

judicially appointed guardian, parent, adult sibling of minor, grandparent of minor

cases when minors are authorized to consent

emancipated, at least 14 years of age; living apart from parents, has been married, 16yo, pregnant, in labor, postpartum for 60 days, authorized to consent to health care by any other statute

consent during emergency dental treatment

consent should be sought for, but if not obtained, treatment should be in best interest of patient, immediately necessary, consistent with any reasonable person in that situation would prefer

standards for decision-making by surrogates

substituted judgement, respect for persons narrative, best-interest standard

ethical advantages of using social media in dentistry

speed of communication with patients and colleagues, clinical purposes, useful during epidemics

ethical disadvantages of using social media in dentistry

patient varying digital literacy, potential HIPAA violations