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49 Cards in this Set
- Front
- Back
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7 steps to establish a relationship
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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 |
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how to initiate discussion w/pt when establishing a relationship
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1.be confident,cordial, compassionate
2.become genuinely interested in the pts interests,family,occupation, hobbies, and thoughts |
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which step of establishing a relationship allows a long term change in the pts tx?
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asking the pt to help in defining the tx needs
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goal of initial interview
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know the pt and their desire about oral health
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recognize component parts of initial interview
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reasons for seeking tx
chief complaint pts perception of present dental condition fear or anxiety about tx pts expectations review health hx clinical exam |
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purpose of reviewing pts health hx before interviewing pt
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1.avoid shock or surprise
2.seek clarification |
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how to assess pts behavior
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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 |
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old equation model
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clinical skill + knowledge
= successful tx |
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new equation model
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clinical skill + knowledge + quality of dr/pt relationship + pts personality = success
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T/F
all stress is bad |
False
you can have eustress |
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positive stress
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eustress which allows us to reach our peak performance
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T/F
goal of stress management should be to ELIMINATE stress |
False
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T/F
some individuals are geneticaly bound to be hi stress |
FALSE
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T/F
person can successfully adapt to difficult circumstances if he tries hard enought |
FALSE
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contrast empathy and sympathy
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empathy denotes understanding and acceptance
sympathy is to feel compassions for someone but only those we pity |
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william harvey (1628)
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transitions from physical to emotional stress
"my life is in the hands of people who annoy me" |
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William Cannon (1932)
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Identified the flight or fight response
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Hans Selye (1950)
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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 |
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Freedman and Rosenman (1959)
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Identified the Type A syndrome
Type A personalities are 2x more likely to have a heart attack |
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number one contributing factor to coronary disease
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hostiblity
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selye definition of stress
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the non specific result of any demand upon the body
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katz definition of stress
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the psychologic and physiologic response of an individual to any situation that for that person elicits the perception of threat
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are people more stressed today? Why?
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yes do to cultural factors
v.competive hi value on material things achievemnt=self esteem TV violance prestige/wealth=happiness |
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what causes distress?
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the interpretation of stressors, not the stressors themselves cause distress
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% of illnesses that are stress related
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50-80%
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consequences of stress
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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 |
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benefits of aerobic excercise on stress
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increase frequency
increase quality of life liftin weights actually increases testosterone and increases hostility |
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prolonged distress causes what?
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physical illness
low nrg low self esteem loss interest in sex absence of fun wasted potential decrease satisfaction in life joylessness meaninless |
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maladaptive rxn to distress
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alcohol
drugs overeating physical/verbal abuse overwork denial magnificaiotn martyrdom |
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methods to manage stress
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1.alter the stressor
2.adapt to stressor 3.avoid stressor |
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ways to strengthen adaptive rxn to distress
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medicine
solitude music play massage hobbies hydrotherapy humor prayer intamacy exercise relaxation |
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how to help patients tell their story
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by attending,listening, probing, and responding w/empathy
encourage clarity pluses and minuses of discussing the past |
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patient assessment
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discover what the pt perceives
focus on both the pts assessts and the pts deficits |
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Reluctuctance
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misfivings about change,generally passive ambiguity
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causes of pt reluctance
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lack of trust
lack of knowledge lack of resources |
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resistance
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fighting coercion, a pts rxn to a power play
may be resentful, abusive,beligerent, or attempt to sabotage tx |
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unhelpful attitudes toward reluctance and resistance
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1.every pt must like me and trust me
2.i can meet every pts needs 3.I am responsible for pt outcomes |
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Unhelpt fresponses to resistance and reluctance
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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 |
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productive approaches to dealing w/reluctance and resistance
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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 |
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challenging pt
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an invitation to examine cognitive or external behavior that seems to be harmful to the pt and to change the behavior
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how to help pts
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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 |
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goals of challenging-help pts to:
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1.see things more clearly
2.gain insight 3.dev. new perspective 4.reconceptualize |
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what needs challenged w/pt?
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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 |
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pt respones to being challenged-dissonance theory
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1.discredit challenger
2.persuade challenger to change his/her views 3.devalue issues 4.shop around 5.agree w/challenger but dont act |
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gaining perspective through info
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do not confuse info w/advise giving
do not use info to push your own values self disclosure |
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principles underlying effective challenges
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1.keep goal in mind
2.earn right to challenge 3.be tactful and tentative but no apologoletic 4.challenge strengths rather than weaknesses |
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what does decision-making process involve?
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1.gathering info
2.analysis 3.making choice |
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when not to treat pt
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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 |
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princples of leverage (helping pts work on right things:
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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 |
