MACh.1- Disabilities, developmental delays, defense mechanisms, end of life/stages of grief

What is the Americans with disabilities act? (ADA)

all medical offices must provide accessible environments for patients with disabilities

• marked accessible parking spaces

• wheelchair-accessible entrances or ramps

• bathrooms with large stalls and handrails

General accessibility

• Arrange chairs in the waiting area to allow wheelchair maneuvering space.

• Avoid area rugs or floor mats that can cause tripping or make movement difficult.

• Remove door sills or replace them with smooth, rubber coverings.

• Keep pathways clear of clutter for safe and easy movement.

• Place reading materials within reach of patients using wheelchairs.

• Install handrails along walls for patients with balance or mobility challenges

Patients with vision loss

• Provide Braille signs and large-print reading materials.

• Use clear, descriptive language when giving directions.

• Avoid touching patients without letting them know first.
  

Patients with hearing loss

• Offer online appointment scheduling to reduce phone-related barriers.

• When speaking, face the patient directly so they can read your lips.

• Do not shout

• If a patient requests a sign language interpreter, the office is legally required to provide one.

Patients with service animals

• remind others not to touch, feed, or distract the service animal

• allow the animal to remain with the patient at all times

Communication practices for disabled patients

• ask before assisting them

• avoid personal questions about their disability

• document special accommodations in patients record

When working with patients with developmental delays/ mental disabilities, what should you determine first?

determine how the patient communicates and what level of communication they understand

Defense mechanisms

unconscious coping strategies people use to protect themselves from negative emotions such as guilt, anxiety, fear, and shame

Adaptive defense mechanisms

help the individual adjust and cope as they process stress in a healthy way

Maladaptive defense mechanisms

prevent personal growth and interfere with emotional adjustment or problem-solving

Apathy

Indifference; lack of concern or emotion

Compensation

Balancing a weakness with an achievement

Conversion

Turning anxiety into a physical symptom

Denial

Refusing to accept reality

Displacement

Redirecting emotions to a less-threatening object

Dissociation

Detaching emotions from thoughts or events

Identification

Adopting traits or behaviors of someone else

Intellectualization

Focusing on facts instead of feelings

Introjection

Absorbing the ideas or beliefs of others

Projection

Attributing one’s own faults to others

Rationalization

Justifying unacceptable behavior

Reaction formation

Acting opposite of true feelings

Regression

Reverting to childlike behavior

Repression

Burying painful thoughts in the subconscious

Sublimation

Channeling negative impulses into positive actions

Suppression

Intentionally avoiding unpleasant thoughts

Undoing

Making up for a mistake with a symbolic act

Verbal aggression

Attacking someone verbally instead of addressing the issue

Sarcasm

Using irony or mockery to mask emotions

What are some declines people over 60 may begin to experience?

• physical limitations

• isolation

• fear of cognitive decline like dementia

• loss of independence (vulnerability to elder abuse)

MAs role in elder care

• be alert for signs of depression or elder abuse

• encourage use of support groups, communities, counseling

• helps coordinate referrals to places like hospice or home health care

End of life care preparation

• discussing advance directives, wills, and health care power of attorney

• funeral and burial arrangements

• ensuring loved ones have financial and caregiving support

Anticipatory grief

the process of grieving before a loss actually occurs

• can occur due to conversations regarding end-of-life preparation

5 stages of grief

1. denial

2. anger

3. bargaining

4. depression

5. acceptance

Denial

• patient refuses to believe the loss or illness is real

• provide factual information gently and with provider approval

Anger

• Patient feels anger toward the situation, loved ones, or staff

• MA should not take anger personally and acknowledge it as a normal part of grief

Bargaining

• patient tries to make deals (“If I can live long enough to see my grandchild graduate”)

• MA should Listen without judgment and encourage expression of feelings

Depression

• Sadness and withdrawal occur as reality sets in

• MA should Offer quiet support; avoid forcing conversation; suggest counseling or support group

Acceptance

• patient acknowledges the loss and begins to find peace

• MA should Provide encouragement and respect for their wishes and plans