In the Hospital

early institutions

• ancient greek temples

• roman military

• religious orders

ancient greek temples

temples dedicated to healing gods, hoping for healing; combined religion and medical care

roman military

roman army est facilities to treat injured and sick soldiers; helped develop more organized medical care

religious orders

monks, nuns, other religious groups cared for the sick, poor, and vulnerable; religious institutions often prodivded shelter, food, treatment

early hospitals

closely connected with religion, charity, and military rather than modern scientific methods

18-19 century

hospitals began changing; increasingly focused on specific groups of patients and particular diseases

disease specific wards

early step toward specialized medical departments in modern hospitals

many people did not want to receive services at wards

poor sanitation and hygiene, overcrowding, high risk of infection; hospitals still not looked at as place to recover safely

germ theory

scientists est microorganisms cause many diseases

antiseptic techniques

methods were developed to reduce contaiminatio during surgery

anesthesia

patients could undergo surgery with much less pain

growth in hospitals

1873-1909; advancements and better care → more utilization

roles dictated by presenting problem

different patients require diff specialists depending on their symptoms, diagnosis, and treatment needs

• procedures known and roles performed

coordinated care

care coordinated in a team

• requires different specialties

coordinated care may seem fragmented or uncoordinated if

communication between professionals is poor, professionals are giving conflicting info, etc

health hazards

healthcare workers may be exposed to harmful substances while performing their duties; hazards can cause infections, irritations, breathing problems, other injuries

chemicals

disinfectants, cleaning products, sterilizing agents, certain meds

microorganisms

bacteria, ciruses, fungi, other infectious agents

regulations are established

created to protect healthcare workers, patients, and visitors from preventable harm

• safe handling of chemicals, proper disposal, PPE, hand hygiene, safety training

infection control procedures

practices used to prevent the spread of infectious diseases

• washing hands, gloves, masks, sterilizing, sharps containers, isolation procedures

physicians are least likely to comply

some studies show physicians were observed to have lower compliance with certain safety procedures compared to other healthcare workers

• does NOT mean all physicians fail to follow safety rules

• compliance varies among ind, facilities, situations

infection control nurses (ICN)

more likely to correct people of equal or lower status

• may be related to hierarchy and power differences in healthcare workplaces

behavioral interventions can increase compliance

• encourage people to follow safety rules consistently

• reminders, education, feedback, role modeling, accountability, safety culture

costs are very high

expenses include paying for services and resources like doctors, nurses, other healthcare workers, medical equip, tech, meds, supplies, labs, buildings/electricity, maintenance, emergency services, 24/7 care

goal is to control costs

while still providing safe, high quality patient care

efforts to regulate price include

setting payment rules for certain healthcare services, monitoring hospital charges and spending, changing how hospitals are reimbursed by insurance

medicare

U.S federal health insurance program that primarily covers people 65 years as older as well as some younger people with disabilities or specific medical conditions. Uniform across states. Not income based. Provided limited long-term care

medicaid

Jointly funded program by federal and state governments for low-income individuals, families, children, pregnant women, elderly and people with disabilities. Run individually by each state within federal guidelines (rules vary by state). Based on income and asset limits. Provides comprehensive long-term care.

changes to hospital procedures

to manage expenses and operate more efficiently, hospitals changed how and where they delivered care

• more outpatient

• procedures more efficient

• less time in hospital

outpatient procedure

does not require patient to stay overnight in hospital, avoids cost of overnight bed, extended care, depends on condition and procedures

procedures more efficient

For example: better scheduling of operating rooms, standardized procedures and checklists, more advanced technology, reduced duplication of tests

less time in hospital

But patients are discharged only when medically cleared

inpatient

patient is formally admitted to a hospital and stays at least for one night or longer for treatment, monitoring, or recovery

medical

treat illnesses not requiring surgery

surgical

care for patients before and after surgery

intensive care unit (ICU)

care for critically ill patients who need continuous monitoring and advanced medical support

outpatient and ambulatory care

patients return home the same day as receiving care

oncology

cancer

psychiatric

serious mental health illness

neonatal ICU (NICU)

for newborns who are premature, critically ill, need extra medical support, need help breathing, temp regulation, specialized feeding

rehab/recovery units

help patients regain strength, mvmt, independence, daily living skills

patient’s journey in hospital

admission → diagnostic tests → procedures → surgery → recovery → discharge → follow up

social role of being a patient

• dependent on medical staff for care and survival

• unfamiliar with hospital structure, procedures, terminology

• anxiety (most common), depression, helplessness

• varies with diagnosis

• issues with lack of info

• depersonalization

• loss of control, self efficacy issues

• body image concerns

caregiver burnout

psych and physical exhaustion that results from chronic exposure to high levels of stress with little personal control

psychosocial components of burnout

• emotional exhaustion

• depersonalization

• perceived inadequacy of professional accomplishment

more time spent in direct care

more burnout

nurses low on depersonalization

they spend a lot of time providing direct, personal patient care

doctors low on sense of accomplishment

heavy workloads, long hours, high responsibility, admin work, limited time to connect

unfamiliar environment that requires adjustment

• lack of privacy

• strict rules and time schedules

• restricted activities

• little control

• dependency on other

medical staff have similar beliefs about how to behave in hospital

• good patient is cooperative, uncomplaining

• problem patient is uncooperative, overemotional, dependent

staff “forgiveness” of behavior associated with

severity of illness

people react emotionally to hospitalization

• anxiety high at admission and prior to operation

• function of age, gender, illness

problem focused patient coping

seeking info, planning

emotion focused patient coping

relaxation, reframing

avoidant patient coping

short term relief, potential risks

social support patient coping

visitors, peer interaction

positive comments by staff

linked to quicker recovery

psych counseling

• improves recovery

• improves adjustment to illness/condition

• decreases related anxiety and depression

roommates

• less anxiety

• but may exacerbate anxiety

psych prep of surgery

enhance sense of control

• behavioral (ex: special breathing)

• cognitive control (ex: focusing on benefits)

• informational control (ex: gaining knowledge)

  • must be clear, straightforward, discussed

reduces anxiety and tension

nonsurgical psych prep

may not be painful but weird

• cognitive and info control reduces anxiety

• can reduce physical reactions (ex: gagging during endoscopy)

work with psych problems that lead to/result from disease

• correct (change) factors that produce disease

• help cope with illness

• provide counseling to reduce depression and pessimism

additional activities of health psychologists

• consulting with patients’ specialists and treatment team

• assessing client’s needs

• helping with adherence

• developing behavioral programs

• assisting with rehab

minnesota multiphasic personality inventory (MMPI)

test personality characteristics associated with psychological disorders

• lengthy to administer, measures other traits that might not be relevant

• specific scales relevant to health

  • hypochondriasis

  • depression

  • hysteria- tendency to use avoidance strategies

million behavioral health inventory

specific psychosocial factors and decision making issues relevant to patients (coping style, negative habits, etc)

psychological adjustment to illness scale

7 psychosocial characteristics of life associated with adjustment to illness (healthcare orientation, domestic environment, family relationships)