Ch 10: In the Hospital

In 18th and 19th centuries, hospitals became more specialized in 2 ways:

1. they began to restrict admissions to people who were both sick and judged to be members of the "worthy poor"—that is, those who could make contributions to society

2. became more medically specialized (grouped those who had similar illness)

What are the wide variety of functions of hospitals?

-provide services to inpatients and outpatients to cure disease and repair injury, prevent illness, conduct diagnostic tests, and aid people's rehabilitation and life situations after being discharged

-also involved in conducting research and teaching current and future medical personnel

Administrators

mainly in charge of the day-to-day business of the institution, such as purchasing equipment and supplies, keeping records, and providing food and maintenance services

Medical Staff

responsible for patient care

Physician

medical director or chief of staff

Nosocomial Infection

an infection a patient contracts while in the hospital setting (5% each year; 1.7 million)

Prospective-Payment System

health problems are classified into "diagnostic-related groups," and the fee a hospital receives for treating a person with a particular health problem is predetermined

What changes have influences the length patients stay in hospitals?

1. people are having more procedures done on an outpatient basis

2. medical procedures are becoming increasingly efficient

3. patients are being released at earlier stages of recovery, so larger part of recovery is spent at home while receiving care as outpatients

Depersonalization

treating the person as if he or she were either not present or not a person; helps practitioners feel less attached and emotionally affected

Burnout

a state of psychosocial and physical exhaustion that results from chronic exposure to high levels of stress and little personal control

What are the 3 psychosocial components of burnout?

1. Emotional exhaustion—feeling drained of emotional resources and unable to help others on a psychological level.

2. Depersonalization—a lack of personal regard for others, as shown by treating people as objects, having little concern for and sensitivity to their needs, and developing callous attitudes toward them.

3. Perceived inadequacy of professional accomplishment—feeling low in self‐efficacy and of falling short of personal expectations for work performance

How can health care workers avoid or cope with burnout?

1. health care workers can spend off‐work time in low‐effort, social activities to recover from their stress

2. hospitals can provide opportunities for workers to mix direct care for patients and other tasks in their daily activities whenever possible

3. hospitals can help establish support groups for their health care workers to train them in stress‐management and coping methods

Reactance

people's angry responses when they feel controlled or that their freedom is threatened

Why is adjustment so difficult when patients blame someone else?

may be that these people feel an added sense of injustice if the person they blame did not suffer severe consequences too (i can't walk now but he can)

Why did the type of roommate affect patients' adjustment?

1. when patients have multiple roommates, they spend more time talking to roommates with a similar surgery status and health problem than to other roommates

2. having pre surgery patients share a room may increase the anxiety of both individuals by some form of "emotional contagion"

Behavioral Control

being able to reduce discomfort or promote recovery during or after the medical procedure by performing certain actions, such as special breathing or coughing exercises

Cognitive Control

knowing how to focus on the benefits of the medical procedure and not its unpleasant aspects

Informational Control

gaining knowledge about the events and/or sensations to expect during or after the medical procedure

When these procedures offer little opportunity for the person to take helpful action,

psychological preparation to promote informational and cognitive control may be especially effective

When patients will undergo procedures in which they can take direct action to facilitate the process and reduce their own discomfort

preparation should usually include approaches to enhance behavioral control

Lamaze Training

in which the mother learns how to participate in childbirth and receives minimal medication

Seperation Distress

refers to young children's normal reaction of being upset and crying when they are separated from their parents, particularly in unfamiliar surroundings

What 4 aspects of hospitalization seem to become increasingly difficult for children as they get older?

1. personal control

2. think about and worry about the outcomes of their illness or treatment

3. feelings of loneliness, boredom, and concern about losing friends or status in their social group

4. become embarrassed by exposing bodies to strangers or needing help with private activities

Minnesota Multiphasic Personality Inventory

a questionnaire to assess emotional problems; This test has the person respond in a true‐false format to a large number of statements, such as, "I would rather win than lose a game" and "I am worried about sex matters."

What 3 scales are especially relevant in the MMPI?

1. Hypochondriasis, which assesses people's preoccupation with, and complaints about, their physical health.

2. Depression, which measures people's feelings of unhappiness, pessimism, and hopelessness.

3. Hysteria, which assesses people's tendency to cope with problems by using avoidance strategies and developing physical symptoms.

Millon Behavioral Health Inventory (MBHI)

a self‐report test that was developed to assess specific psychosocial factors and decision‐making issues that are known to be relevant for medical patients

Psychosocial Adjustment to Illness Scale (PAIS)

A test of several psychosocial aspects of a patient's life that are related to adjustment to medical illness

Hospice Care

involves a medical and social support system to provide an enriched quality of life—through physical, psychosocial, and spiritual care—for terminally ill people and their families