Chapter 9: The World of Health Care

Factors that Influence Perception of Symptoms

1. Mood/Personality: Worse mood increases the likelihood of perceiving symptoms

2. Stress: Increases the accuracy of someone noticing symptoms

3. Gender: Women seek health care more frequently but may delay longer in seeking that care. Men attribute minor symptoms to major problems more frequently.

4. Age: Older adults seek care more frequently and are more likely to notice symptoms. Younger people are also concerned about stigma and delayed care.

5. Environment: Environments that lack stimulation result in an increased likelihood of noticing symptoms and paying attention to your internal state.

Interpreting Symptoms

1. Education and Health Literacy

2. Expectations about Health

3. Attentional Resources

4. Prior Experience

5. Cultural Factors

6. Lay Referral System

7. Internet

Lay-Referral System

An informal network of non-practitioners who offer their own interpretations long before any medical treatment is sought
i.e., Friends and Family

Cyberchondria

Excessive and repeated health-related information searching on the internet

Seeking Help

Depends on:
1. Type of symptom: More likely to seek help if symptoms are: new, unexpected, painful, disruptive, highly visible or affects highly valued parts of the body.

Delaying Medical Care

1. Appraisal Delay: The time it takes for a person to decide that a symptom is a sign of illness

2. Illness Delay: The time between recognizing one is ill and deciding to seek medical care

3. Behavioural Delay: The time that elapses between the decision to seek medical care and acting on this decision by making an appointment

4. Medical Delay: The interval between making an appointment and first receiving medical care

The Hospital

1. Professionals use high-tech language

2. Asks personal questions

3. People dress and act differently

4. Procedures may seem to be ritualistic, unknown 5.Loss of control over one's health and well-being

5. You are not feeling well

Type of Patients

Outpatients: Do not stay overnight, seen in office, clinic or ambulatory care facility

Inpatient: Admitted for at least overnight

Day Care Patients: More involved simple procedure, but patient does not stay overnight

Emergency Patients: Length of stay depends on severity

Loss of Control

Total Institution: The hospital takes control of virtually every aspect of a patient's life (49% preferred the shared approach)


Learned Helplessness: Empowering vs Disempowering care

Reactance

Behaving counter to recommendations in response to feeling that one has lost perosnal control over health behaviours; the non-compliant behaviours and attitudes of patients who perceive hospital rules and regimens to be unacceptable challenges to their freedom

Learned Helplessness

1. Empowering Care: Patient care that yields independence and results in learned mastery

2. Disempowering Care: Patient care that yields dependence and results in learned helplessness

Coping Style & Loss of Control

Patients are less stressed when given an amount of information consistent with their coping style

1. Monitors: Seek Info

2. Blunters: Avoid info

Depersonalization

Taking away someone's sense of individuality; Results from: 1.Lack of information 2. Impersonal interactions 3. Hospital clothing 4. Being referred to by illness - not by name 5. Lack of privacy

Dehumanization

The tendency to see people as object or body parts rather than human beings

Patient-Centred Care

An approach in which patients and families become active members of the treatment team

1. Making rooms more homelike

2. Provide more personalized care and increase health education

Better satisfaction and healing

Emergency Room

1. Common point of entry for patients

2. Patients often in a state of distress

3. Treatment needs are pressing, but so are those of other around them

Admission Procedure is Key

1. Triage: Sorting patients to determine priority of needs and treatment location

2. Psychological concerns drop in priority

Recovering From Surgery

Patients in recovery must cope with:

1. Varying degrees of incapacitation

2. Unfamiliar Body sensations

3. Painful or uncomfortable instructions

4. Uncertainty about rate of recovery

Pre-operative information is one way to help patients through postoperative times -> Psychoeducational care

Patient-Controlled Analgesia (PCA_

Analgesic administration that is independently controlled by the patient. Depression device allows practitioners to set dosages.

Lock-Out Interval: Time period between allowable doses

1. PCA patients tend to use less analgesia and recover more quickly. Prior patient education and positive staff attitudes can positively affect PCA use.

Pain Management

One of the most important factors in determining a patient's satisfactory recovery from surgery, affects mood, which affects length of stay.

Challenges in Pain Management

1. Issue of control: Patients may not like being dependent on other people to relieve their pain.

2. Ascertaining correct dosages

Intensive-Care Unit

1. Lowest nurse-to-patient ratio in hospital

Three stages:

1. Incommunication Phase: Unconscious or barely conscious, memories for experience are poor

2. Readaptation Stage: Dealing with dependence on machines, sense a struggle to recover

3. Reflection Stage: Attempt to piece together the details of the experience

ICU Communication

Communication is key for patient's experience in the ICU, but;

1. Inhibited because patients in ICU tend to be unresponsive or unconscious

2. Inhibited by ventilation

3. Post-intensive care syndrome

ICU Family Communication

1. Expertise Model: A model in which the physician and the intensive care team are assumed to be best informed and most objective, and therefore best equipped to make end-of-life decisions

2. Negotiated Model: A decision making model that allows decision making to be shared among practitioners, family and patient.

Discharge

Considerations:

1. Social problems, support, dependency on others due to medical conditions

2. Additional expenses (equipment, in-home nursing care_

3. Elderly tend to have > stays & more complication discharges

4. Length planning - should involve patient

Palliative Care

Care intended to maintain quality of life as best as possible for a patient in advanced stages of an illness. The focus is the control of pain and other symptoms as opposed to the cure of the illness.

1. Progressive illness: continue to worse in spite of treatment

2. Advanced progressive illness: Death is imminent

Issues in Palliative Care

1. Pain Management

2. Learn to deal with euthanasia, ethical debates

3. Mixed management model for care: Preparing patients for death while providing life-sustaining treatments

Psychological Impact of Colonoscopy

1. Colorectal Cancer: Second leading cause of cancer-related death in Canada

2. Can reduce 10-year mortality by 16.7%

3. Cost-benefit analysis from the health belief model -Possibility test will yield worrying results -Procedure is painful and anxiety producing -Pain rates higher for women

Psychological Impact of Mammography

1. Moderately invasive

2. Psychologically distressing

3. Benefit of reduced mortality

4. High rates of false-positive (1-14%)

5. Women with false positives are more likely to attend regular screening

Physicians

1. Canada saw a 4% increase in physicians since 2000

2. 2019 Survey: 71% of general practitioners and 75% of specialists are either satisfied or very satisfied with their professional lives

Physician Coping

Often cope by distancing themselves from patients, though this makes it harder to appear compassionate

Physicians and Stress

38% of Canadian Physicians described their practice as very or extremely stressful

1. Task of communication bad news adds stress

2. Many patients want to be "fit in" right away

3. Male or female physicians experience stress differently (more role strain for females)

4. Burnout - emotional exhaustion, perceived ineffectiveness, cynicism, dissatisfaction with relations with co-workers

Uncertainty as a Source of Stress

Medicine is NOT a precise science

1. Diagnoses can be uncertain and prognoses are even more uncertain. Patients underestimate how uncertain medicine really is and do not always understand probability.

2. General and family physicians experience greater uncertainty than specialists.

Physician Impairment

A state in which stress-related symptoms interfere with the physicians ability to perform his or her job

1. Substance abuse (prescription drugs)

2. Physicians are often reluctant to seek treatment because of the implications for their licensing

Gender Issues in Medical Practice

The Femination of Medicine

1997: 25% of all physicians were female
2018: 43%
2018: 56% of medical students

QC 2018: More female than male physicians

Nurses

Nurses must stay up-to-date on medical knowledge

1. Roles are expanding

2. Nurses must balance care with cure

Advance Practice Nursing: The role of a nurse working within a speciality area where superior clinical skills and judgement are acquired through a combination of experience and education

Compassion Fatigue

A lack of energy among health care professionals, particularly nurses who are constantly working in an environment in which suffering is common.

1. Can affect patient safety

2. Susceptible to burnout

New Nurses

Sources of stress include:

1. Reality Shock: Reaction to the discrepancy between training and actual work

2. Learning the system, long hours

3. Having to sacrifice care for higher volume

Experienced Nurses

1. Volume of work (must multitask)

2. Long hours

Nurses Dealing w/ Stress

1. Personal Factors: Including pers. characteristics and coping strategies

2. Social Factors: Elements of a nurse's social network

3. Taking care of selves before patients

Job Strain Model

A high strain job has high demands and low control -> reduce nurses strain by enhancing their sense of control

Physiotherapists

Psychological Components involve:

1. Goal Setting: Physiotherapist and Patient

2. Adherence: Up to patient 3: Behavioural Interventions: External and Self-Reinforcement 4: Cognitive Interventions: Efficacy Beliefs, Attributions