Chapter 10

Question 1

– Being Hospitalized –

Question 2

How can hospitalization add other negative aspects to a person’s sick-role experience?

Answer 2

• Limits privacy
• Restricts individual’s activity
• Requires a high degree of dependency on others
• Distress - involving interactions between patient and staff

Question 3

“Clear social role” for hospital patients?

Answer 3

They’re typically strangers in the hospital community, unfamiliar with its structure and procedures, dependent for their very lives on the medical staff

Question 4

Most common and pervasive emotion for hospitalized people?

Answer 4

• Anxiety
• Worry about health problems, what the outcomes will be, how the illness will influence their lives…

Question 5

Anxiety - can stem from…

Answer 5

• A lack of information
• Hospitals are busy, and the limited time of staff accounts for their failure to provide informatino that patients needs

Question 6

Depersonalization

Answer 6

Common way practitioners interact with patients; treating them as if they’re either not present or a person (“like a possession someone left behind”)

Question 7

Depersonalization - why?

Answer 7

• Practitioners might want to distance themselves from the fact that the body they’re treating belongs to a thinking and worried person who can observe what’s going on
• Emotional factors - practitioners protect themselves by emotionally distancing, in preparation in case something turns for the worse or dies

Question 8

Burnout

Answer 8

• Workers in emotionally intensive professions (first-responders, healthcare) have the burden of experiencing this day-to-day
• Can lead to burnout: psychosocial and physical exhaustion that results from chronic exposure to high levels of stress and little personal control

Question 9

Workers who suffer burnout tend to experience…

Answer 9

• Low levels of job satisfaction
• High levels of absenteeism, alcohol, drug abuse
• High risk for developing heart disease

Question 10

3 psychosocial components of burnout: 1

Answer 10

• Emotional exhaustion - feeling drained of emotional resources and unable to help others on a psychological level

Question 11

3 psychosocial components of burnout: 2

Answer 11

• Depersonalization - lack of personal regard for others

Question 12

3 psychosocial components of burnout: 3

Answer 12

• Perceived inadequacy of professional accomplishment - feeling low in self-efficacy and of falling short of personal expectations for work performance

Question 13

How can hospitals help healthcare workers avoid or cope with burnout? 1

Answer 13

Hospitals can provide opportunities for workers to mix direct care for patients + other tasks, in their daily activities whenever possible

Question 14

How can hospitals help healthcare workers avoid or cope with burnout? 2

Answer 14

Hospitals can help establish support groups for their healthcare workers, like in stress-management

Question 15

– Sick-Role Behaviour in the Hospital –

Question 16

LORBER: How are patients supposed to behave in the hospital? Pre-existing ideas about how to behave?

Answer 16

• Study done with people who thought they should be active or passive patients
• Those with passive beliefs were less likely to get into conflict with staff than those with active beliefs
• “Good patients” = passive
• “Problem patients” = active

Question 17

LORBER: distinguishing 2 types of problem patients?

Answer 17

1. Individuals who are seriously ill, having severe complications. While showing problem behaviours, staff excuse their behaviour
2. People who are not seriously ill but take up more staff time

Question 18

Problem patients who are not seriously ill may be engaging in…

Answer 18

Reactance - people’s angry responses when they feel controlled or that their freedom is threatened

Question 19

Behaviour of a majority of patients?

Answer 19

• Fortunately, not problem patients
• Many try to be considerate, or are wary of the consequences of being disliked by staff

Question 20

– Emotional Adjustment in the Hospital –

Question 21

How do hospitalized people cope with their emotions?

Answer 21

• Produces enormous stress and anxiety
• Gradually, BUT might also increase over time

Question 22

What does a patient’s ability to adjust to a health problem/emotions in a hospital setting depend on?

Answer 22

Person’s age, gender, perceived characteristics

Question 23

Men tend to be more distressed by _ , women tend to be more distressed by _

Answer 23

Men tend to be more distressed by illnesses that reduce their vigour and physical abilities, women tend to be more distressed by disfigurement - facial injuries, losing a breast

Question 24

– Coping Processes in Hospital Patients –

Question 25

How do hospital patients perceive the stressors they face?

Answer 25

* Perceive the stressors as things they cannot change * In some cases these beliefs are correct, like with paralyzation * In other cases this might not be correct (mostly emotion-focused coping methods)

Question 26

One cognitive process many patients engage in after becoming ill/injured is attributing...

Answer 26

blame; "who's at fault for my condition?"

Question 27

Does the way people attribute blame affect their success in coping with their conditions?

Answer 27

* People who blame themselves might have more intense feelings of guilt, and thus more difficulty adjusting * Blaming someone else might produce feelings of anger; more strongly related to blaming others

Question 28

Another cognitive process that patients engage in involves the assessment of...

Answer 28

* **person control** * **Patients enter the hospital with the expectation of losing some degree of control** - either from the illness itself or the actions of staff * Hospitals can make it seem as though patient's involvement in their treatment process is irrelevant; they're **helpless**

Question 29

Patient's emotional adjustment on health?

Answer 29

* Can impact regardless of illness severity * More likely to die in the hospital if they're depressed than if they're not

Question 30

Helping patients cope: giving verbal suggestions for those going into surgery found fewer complicaions - why is this important? **2**

Answer 30

1. Medical staff often make negative remarks during surgery 2. It may be possible to help surgical patients cope by giving them constructive suggestions while they're anaesthetized

Question 31

An affective way to help people cope is to provide...

Answer 31

Psychological counselling during their stays

Question 32

A circumstance that may help a patient adjust to an illness includes

Answer 32

sharing a room with a person who's recovering from a similar medical procedure

Question 33

Sharing a room with a person who's recovering from a similar medical procedure - **why does this work?**

Answer 33

1. Patients spend more time talking to roommates with a similar surgery status and health problem (opposed to regular roommates) 2. A room of two pre-surgery patients, however, might increase anxiety (sharing information with each other)

Question 34

-- Prepping Patients for Stressful Medical Procedures --

Question 35

People with high preoperative anxiety tend to report...

Answer 35

More pain, stay in the hospital for longer, anxiety/depression, difficult adjustment

Question 36

What can psychologists do to reduce the stress people feel regarding medical procedures?

Answer 36

Enhance patient's sense of control over the situation

Question 37

What can psychologists do to reduce the stress people feel regarding medical procedures? **3 types of control**

Answer 37

1. **Behavioural Control** - being able to reduce discomfort or promote recovery by doing **certain actions** 2. **Cognitive Control** - **knowing how to focus on the benefits**, not the unpleasant effects 3. **Informational Control** - **gaining expectations/knowledge**

Question 38

One medical procedure in which patients can perform useful actions is called an

Answer 38

* **endoscopy**, used in diagnosing ulcers and other disorders * during this process, using methods of informational (describing expectations) and behavioural control (teaching how to breathe and swallow) reduces patients emotional behaviour during the process

Question 39

When faced with stressful medical procedures, some individuals tend to cope by using...

Answer 39

* **avoidance strategies** to minimize the impact of the situation * might deny that a threat exists, supress unpleasant thoughts

Question 40

When faced with stressful medical procedures, some OTHER individuals tend to cope by using...

Answer 40

* attention or "vigilant" strategies, seeking detailed information about the situation

Question 41

Preparation for medical procedures is most effective when...

Answer 41

its content is **matched to the coping needs of the person**

Question 42

Stress in viewing information during a procedure? **Study on avoidance copers...**

Answer 42

Those who viewed an informational tape *once* experienced more anxiety than those who saw it *three* times

Question 43

Stress in viewing information during a procedure? **Study on attention copers...**

Answer 43

Those who watched the irrelevant tape experienced the most anxiety, and those who viewed the informational tape three times has the least anxiety

Question 44

The benefits of of psychological preparations for medical procedures seem to depend on...

Answer 44

**patients coping styles**, and it may be that different preparations are more helpful for people using avoidance strategies than for those using attention strategies

Question 45

-- How Health Psychologists Assist Hospitalized Patients --

Question 46

How do patients develop psychosocial problems?

Answer 46

* From external factors like abuse or alcoholism * Some develop problems because of their illnesses

Question 47

In hospital settings, psychologists do the following: **1**

Answer 47

**Consult with patients' specialists** to provide diagnostic and counselling services

Question 48

In hospital settings, psychologists do the following: **2**

Answer 48

**Assess clients' needs for and provide psychological preparation** to cope with surgery and other stressful procedures

Question 49

In hospital settings, psychologists do the following: **3**

Answer 49

**Help patients adhere to medication and treatment regimens** in the hospital

Question 50

In hospital settings, psychologists do the following: **4**

Answer 50

**Provide behavioural programs for improving clients' self-care skills** and compliance with medical and lifestyle regimens after discharge

Question 51

In hospital settings, psychologists do the following: **5**

Answer 51

Assist in **rehabilitation** processes

Question 52

Initial steps in helping - how is the option of psychological help for patients brought up? Is this always ideal?

Answer 52

* By a physician or nurse who has noticed signs of a psychological, social, or intellectual problem * Not ideal; studies find healthcare workers aren't good at recognizing emotional problems in their clients - they tend to judge that such problems exist if they think the patient has a severe medical illness and is dissatisfied with the present treatment

Question 53

Initial Steps in Helping - after the psychologist receives the request to see a patient?

Answer 53

* **The person who made the request is consulted** and the client's medical record is reviewed * Next step is to **interview the patient and/or relevant family member** to arrive at an impression of what the problem is

Question 54

-- Tests for Psychological Assessment of Medical Patients --

Question 55

Psychologists decide on a set of tests to administer based on...

Answer 55

the type of illness or problem the client seems to have

Question 56

Two psychological characteristics common among people with cardiovascular disease?

Answer 56

* Pessimism - more likely to develop cardiac problems * Depression - slower recovery

Question 57

Psychologists use two approaches in assessing emotional adjustment:

Answer 57

1. **Diagnostic interviews** (based on the DSM, consist of a set of questions, where each question determines the next question to ask) 2. **Questionnaires** (less expensive and time-consuming)

Question 58

2 types of questionnaires are used in assessing emotional difficulties:

Answer 58

1. **Focuses on a single disorder**, such as anxiety or depression 2. Screens clients for a **variety of emotional difficulties**

Question 59

Screens clients for a variety of emotional difficulties - most common type?

Answer 59

* **Minnesota multiphasic personality inventory** * Person responds in a **true-false format to a large number of statements**

Question 60

MMPI - scales that assess specific psychiatric disorders: 3

Answer 60

* Hypochondriasis - assesses people's preoccupation with and complaints about their physical health * Depression - unhappiness, pessimism, hopelessness * Hysteria - assesses people's tendency to cope with problems by using avoidance strategies and developing physical symptoms

Question 61

MMPI - scores reflect what in patients?

Answer 61

1. Individuals with high scores are prone to developing psychophysiological disorders 2. Patients with serious illnesses may fail to comply with treatment regimens because of intense feelings of depression - revealed by scores on depression scale

Question 62

-- Specialized Tests for Medical Patients --

Question 63

The Millon Behavioural Medicine Diagnostic

Answer 63

self-report test to **assess specific psychological factors and decision-making issues** that are known to be relevant for medical patients

Question 64

The Psychosocial Adjustment to Illness Scale

Answer 64

designed **specifically for use with medical patients; to asses seven characteristics of client's life**, each has been associated with adjustment to medical illness

Question 65

-- Promoting Patients' Health and Adjustment --

Question 66

Several psychological approaches can relieve difficulties for patients and their families, involving

Answer 66

group-discussion and cognitive-behavioural therapy

Question 67

Studies have repeatedly identified 3 common system-related factors that predict higher patient satisfaction with healthcare?

Answer 67

1. The quality of the treatment or care received 2. The quality of the interaction with the care providers, including communication 3. A sense of autonomy and informed consent while receiving care

Question 68

What was one of the key factors in a good hospital experience?

Answer 68

* Communication and coordination (especially amongst care providers) * Physical environment (single bed rooms are better for privacy)