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49 Cards in this Set

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7 steps to establish a relationship
1.Introduce yourself
2.Initiate discussion
3.state purpose and approx length of discussion
4.Clarify expectations and misconceptions regarding tx
5.listen carefully to pts needs,desires, problems,wants
6.ask pt to help in dental tx
7.say something complimentary
how to initiate discussion w/pt when establishing a relationship
1.be confident,cordial, compassionate

2.become genuinely interested in the pts interests,family,occupation, hobbies, and thoughts
which step of establishing a relationship allows a long term change in the pts tx?
asking the pt to help in defining the tx needs
goal of initial interview
know the pt and their desire about oral health
recognize component parts of initial interview
reasons for seeking tx

chief complaint

pts perception of present dental condition

fear or anxiety about tx

pts expectations

review health hx

clinical exam
purpose of reviewing pts health hx before interviewing pt
1.avoid shock or surprise

2.seek clarification
how to assess pts behavior
1.determine pts readiness to begin tx

2.Id discrepancies between the pts level of info about the extent of tx and possible outcomes

3.Id discripanncies between what you see as your role and the pts role in tx and what the pt sees as your role and his role in tx

see if person is internal or external
old equation model
clinical skill + knowledge

= successful tx
new equation model
clinical skill + knowledge + quality of dr/pt relationship + pts personality = success
T/F

all stress is bad
False

you can have eustress
positive stress
eustress which allows us to reach our peak performance
T/F

goal of stress management should be to ELIMINATE stress
False
T/F

some individuals are geneticaly bound to be hi stress
FALSE
T/F

person can successfully adapt to difficult circumstances if he tries hard enought
FALSE
contrast empathy and sympathy
empathy denotes understanding and acceptance

sympathy is to feel compassions for someone but only those we pity
william harvey (1628)
transitions from physical to emotional stress

"my life is in the hands of people who annoy me"
William Cannon (1932)
Identified the flight or fight response
Hans Selye (1950)
general adaption syndrome

2 types of adaptive nrg:
1.superficial adaptive nrg which is not depletable and can increase w/health and fitness

2.Deep adaptive nrg
Freedman and Rosenman (1959)
Identified the Type A syndrome

Type A personalities are 2x more likely to have a heart attack
number one contributing factor to coronary disease
hostiblity
selye definition of stress
the non specific result of any demand upon the body
katz definition of stress
the psychologic and physiologic response of an individual to any situation that for that person elicits the perception of threat
are people more stressed today? Why?
yes do to cultural factors

v.competive
hi value on material things
achievemnt=self esteem
TV violance
prestige/wealth=happiness
what causes distress?
the interpretation of stressors, not the stressors themselves cause distress
% of illnesses that are stress related
50-80%
consequences of stress
illness

reduce resistance

aggravates existing illness

fosters unhealthy coping

marital discord

family problems

substance abuse

mental disorders

elevated cholesterol/norepi

increase BP

increase heart problems
benefits of aerobic excercise on stress
increase frequency
increase quality of life


liftin weights actually increases testosterone and increases hostility
prolonged distress causes what?
physical illness

low nrg

low self esteem

loss interest in sex

absence of fun

wasted potential

decrease satisfaction in life

joylessness

meaninless
maladaptive rxn to distress
alcohol

drugs

overeating

physical/verbal abuse

overwork

denial

magnificaiotn

martyrdom
methods to manage stress
1.alter the stressor

2.adapt to stressor

3.avoid stressor
ways to strengthen adaptive rxn to distress
medicine

solitude

music

play

massage

hobbies

hydrotherapy

humor

prayer

intamacy

exercise

relaxation
how to help patients tell their story
by attending,listening, probing, and responding w/empathy

encourage clarity

pluses and minuses of discussing the past
patient assessment
discover what the pt perceives

focus on both the pts assessts and the pts deficits
Reluctuctance
misfivings about change,generally passive ambiguity
causes of pt reluctance
lack of trust

lack of knowledge

lack of resources
resistance
fighting coercion, a pts rxn to a power play

may be resentful, abusive,beligerent, or attempt to sabotage tx
unhelpful attitudes toward reluctance and resistance
1.every pt must like me and trust me

2.i can meet every pts needs

3.I am responsible for pt outcomes
Unhelpt fresponses to resistance and reluctance
1.becoming impatient or hostile

2.doing nothing

3.lowering your expectation

4.blaming the pt

5.giving up on the pt and terminating tx
productive approaches to dealing w/reluctance and resistance
1.see some reluctance and resistance as normal

2.see reluctance as avoidance not as a personal issue

3.be realistic and flexible

4.develop a relationship built on mutual respect and allow the pt to participate in tx planning and decision making
challenging pt
an invitation to examine cognitive or external behavior that seems to be harmful to the pt and to change the behavior
how to help pts
1.talk about problems when they are reluctant to do so

2.clarify problem situations in terms of specific experiences,behaviors, and feelings when they are being vague or evasive
3.develop new perspectives when they prefer to cling to distortions
4.express what they wand, develop goals, and consider alternatives
5.search for ways to get what they want in the face of obstacles
6.commit to specific plans instead of taking hit or miss approach
7.persevere in implementing change when they are tempted to give up
goals of challenging-help pts to:
1.see things more clearly
2.gain insight
3.dev. new perspective
4.reconceptualize
what needs challenged w/pt?
1.pts failure to own to problems
2.faulty intretations of experiences,behaviors and feelings
3.failure to identify or understand consequences of behavior
4.hesitancy or unwillingness to act on new perpesctives
pt respones to being challenged-dissonance theory
1.discredit challenger
2.persuade challenger to change his/her views
3.devalue issues
4.shop around
5.agree w/challenger but dont act
gaining perspective through info
do not confuse info w/advise giving

do not use info to push your own values

self disclosure
principles underlying effective challenges
1.keep goal in mind

2.earn right to challenge

3.be tactful and tentative but no apologoletic

4.challenge strengths rather than weaknesses
what does decision-making process involve?
1.gathering info
2.analysis
3.making choice
when not to treat pt
1.pts have hx of failure

2.pts w/malingering or fake illness

3.pts who are chronic non responders

4.pts who are likely to improve on their own

5.relluctant or resistant pts who refuse tx
princples of leverage (helping pts work on right things:
1.begin by tx pain/infection

2.start w/issue the pt sees as important

3.focus on problem for which the benefit outweighs the costs

4. deal w/somethign that if handled will lead to some kind of geneeral improvement