Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
112 Cards in this Set
- Front
- Back
|
3 Objectives of Psychosocial Approach
|
Emphasizes the impact of the sociocultural context on human development and behavior
Emphasizes the interaction between the individual and his/her social environment which makes demands or exerts pressures in the form of social expectations, norms and values Considers family, neighborhood or community and the culture |
|
|
4 Elements of Psychosocial Dynamics
|
The individual and his/her belief system
The family as a system The community as a context The culture as the wider context |
|
|
Core Beliefs
|
most deeply held internal messages
|
|
|
Values
|
those concepts held about everyday living, behavior and institutions
|
|
|
Attitudes
|
those perspectives which come out of our core beliefs and values
|
|
|
6 Examples of Core Beliefs
|
The world
Nature of self Nature of others The purpose of life Nature of God What is family |
|
|
7 Examples of Values
|
Work
Education Conduct of relations with others Emotions Honesty Religion Prejudice and discrimination |
|
|
4 Examples of Attitude
|
TV
Abortion Welfare Politics |
|
|
4 Characteristics of Functional Families
|
Display consistent caring and love for its members
Display mutual respect for each other’s boundaries and roles Tend to communicate their problems openly May tend to follow treatment regimens or let their provider know why not |
|
|
6 Characteristics of Dysfunctional Families
|
Tend not to display consistent caring and love for their members
Tend not to display mutual respect for the boundaries and roles of their members Members may tend to be poor communicators Members may tend to be noted for manipulative behaviors Members may tend to be non-compliant with treatment regimens May appear normal |
|
|
9 Causes of Dysfunctional Families
|
Poverty
Low education Poor self-esteem Isolation Inadequate communication skills Chemical/behavioral addictions Abuse Rigid control Maintain a “family secret rule” |
|
|
9 Modern Family Patterns
|
Nuclear family
Multigenerational extended family Single parent family with grandparents Single parent family Multigenerational family group Blended Family Same gender couple with children Two single persons living together without children Several single persons of either/both genders living together |
|
|
Culture
|
a collection of beliefs, values, ideals, and customs handed down in history and commonly accepted either by a society or a large group within that society (a subculture)
|
|
|
Norms
|
rules of behavior generally accepted in a culture or subculture
|
|
|
Ethnic Groups
|
groups that exist on the basis of sentiments that bind individuals into solidarity on some cultural basis
|
|
|
Race
|
a classification for a group with distinct observable biological features such as skin color, hair texture and eyelid shape
|
|
|
Prejudice
|
attitude which arises when visual differences are assigned negative cultural meanings by the dominant culture
|
|
|
6 Roots of American Culture
|
Judeo-Christian
Puritanical Western European Dominant white majority Multi-ethnic Multi-racial |
|
|
3 Effects of Culture on Patient-Provider Interactions
|
Language difficulties
Nonverbal communication Attitudes toward health care |
|
|
2 Examples of Language Difficulties
|
Understanding pitch, rhythm, inflection
Taboo subjects |
|
|
3 Examples of Nonverbal Communication
|
Eye contact
Smiling (Japanese, Korean) Spacing |
|
|
4 Examples of Attitudes toward Health Care
|
Home remedies
Magical remedies Fear Hostility toward the provider |
|
|
4 Reasons for Limited Access to Health Care
|
Low income
Lack of community health services High cost of health insurance Absence of “culturally competent providers” |
|
|
6 Areas of Excess Death Rates Due to Limited Access to Health Care
|
Cancer
Cardiovascular disease and stroke Chemical dependency Diabetes Homicide and accidental injuries Infant mortality |
|
|
Patients are individuals exhibiting much variability due to:
|
Separation/assimilation into dominant white culture
Level of education Level of or previous contact with health care |
|
|
4 American Subcultures
|
Hispanics
African-Americans (Blacks) Native Americans Asian American and Pacific Islanders |
|
|
Problems for Hispanic Americans
|
Dropping out of school
Alcoholism Drug Abuse HIV/AIDS Problem of Illegals |
|
|
6 Attributes of Hispanic Americans
|
Assimilation by second generation
Family and extended family very important Unit decisions Does not question the authority of older generation Reluctance to disagree Machismo |
|
|
"The American Dilemma"
|
The contradiction between American ideals and racist practices
(Cf., African Americans) |
|
|
7 African American Common Health Problems
|
HIV/AIDS (51% = African Americans)
Hypertension Neonatal complications Substance abuse/alcoholism Diabetes Cardiovascular disease and stroke Stress |
|
|
4 Problems of Differing Values for African Americans
|
Ancestral healing practices
Strong sense of communalism Powerful kinship ties Problem of Extended Family in Decision Making |
|
|
5 Native American Common Health Problems
|
Alcoholism
Diabetes Hypertension Cardiovascular disease Obesity |
|
|
4 Problems of Differing Values for Native Americans
|
Suspicion and distrust of a system engaged in ethnic cleansing
Societal sharing Holistic concept of health which integrates traditional spiritual beliefs with mind and body Cure includes restoration of balance and harmony |
|
|
5 Health Beliefs of Native Americans
|
Medicine defined as everything being alive and including natural elements
Medicine = healing = healing is everywhere Harmony allows for acceptance of living in balance in one’s world Relation is being connected to one’s world Vision is honoring one’s nature, life’s gifts, and one’s purpose. |
|
|
Problems of Communication for Native Americans
|
Traditional, or marginal, or middle class, or pan-Indian
Possible discomfort with Western medicine |
|
|
Problems of Time for Native Americans
|
Fluid sense of time out of step with those of the American culture
|
|
|
5 Largest Groups of Asian Americans
|
Japanese
Chinese Filipino Korean East Indian |
|
|
6 Groups of Southeast Asians
|
Vietnam
Cambodia Laos Thailand Malaysia Singapore |
|
|
5 Groups of Pacific Islanders
|
Indonesians
Filipinos Hawaiians Samoans Micronesians |
|
|
5 Problems of Differing Values for Asian Americans and PIs
|
Collectivist orientation – personal identity defined as a member of the family, group or society
Interdependence and reliance on the group Tao = harmony and equilibrium in relations with others Karma = performance in previous lives determines one’s fate Suppression of inner needs and emotions |
|
|
4 Problems of Communication for Asian Americans and PIs
|
Silent communication (bad luck to talk about illness and death)
Taboo subjects Whole family needs to be involved in health decisions Decision may be abdicated to health provider seen as wise and benevolent |
|
|
7 Problems in Rural Areas
|
Higher infant mortality rates
Higher maternal deaths Increasing incidence of HIV infections in women and children Excessive death rates from violence High frequency of adolescent pregnancy High incidence of TB High incidence of deaths from injuries |
|
|
9 Problems with Differing Values for Rural Areas
|
Manual work over academic learning
Traditionalism Strong identification with the land and the home place Traditional gender based family roles Familism (reliance on kinship ties) Neighborliness and friendships Xenophobia Rugged individualism Fatalism |
|
|
7 Problems of Communication for Rural Areas
|
Reluctance to ask for help
Reluctance to admit to any health problems Desultory, evasive, or ambiguous answers on interview Ambiguous names/terms for health problems Inadequate understanding of body functions/anatomy Body shyness Poor awareness and self observation |
|
|
4 Theorists of Human Development
|
Sigmund Freud
Erik Erikson Jean Piaget Lawrence Kohl |
|
|
2 Commonalities Between the 4 Theorists of Human Development
|
All examined measurement of emotional, cognitive, social and moral development
All held a common concept that there are sequential developmental tasks at each stage that are building blocks for the subsequent stage |
|
|
Sigmund Freud
|
A psychodynamic model of personality development
Human development driven by libido (biologically based sex drives) Divided into 5 stages |
|
|
Sigmund Freud's 5 Stages of Human Development
|
Infancy = oral and anal stage
Early childhood = phallic stage including an aggressive drive and anal retentive and passive-aggressive behavior Early childhood = phallic stage (Oedipus complex and Electra complex) Mid-late childhood = latency stage Adolescence = genital stage |
|
|
Important Concept of Freud's Theory
|
psychological conflicts and trauma which are not resolved at each stage become the determinants of the motivations and behaviors throughout the life span
|
|
|
Erik Erikson's Theory of Human Development
|
psychological conflicts and trauma which are not resolved at each stage become the determinants of the motivations and behaviors throughout the life span
|
|
|
Erik Erikson's 7 Stages of Life
|
Infancy = Trust vs Mistrust
Toddler = Autonomy vs Shame Early childhood = Initiative vs Guilt Mid-late childhood = Industry vs Inferiority Adolescence = Identity vs Role Confusion Early adulthood = Intimacy vs Isolation Middle adulthood = Generativity vs Stagnation Late adulthood = Ego Integrity vs Despair |
|
|
Jean Piaget's Theory of Human Development
|
Ability to process information = intelligence
Intelligence is adaptive, arising out of interaction with the psychosocial environment Four stages (of increasing complexity) |
|
|
Jean Piaget's 4 Stages of Human Development
|
Sensorimotor = reality and objects exist only through the infant’s sensory experience
Preoperational = child develops the ability to represent things in the mind Concrete operational = child develops the ability to sort and classify objects Formal operational = ability to think conceptually and abstractly and use formal logic |
|
|
Important Concept of Piaget's Theories
|
Only those who receive sufficient physical, social and intellectual stimulation and nurture will develop the cognitive structure necessary to reach the final stage
|
|
|
Lawrence Kohlberg's Theory of Human Development
|
Model of moral development
Six stages |
|
|
Lawrence Kohlberg's 6 Stages of Human Development
|
Pre-conventional morality = acts in obedience to superior force of parents
Stage One -To avoid punishment Stage Two -To attain rewards Conventional morality = motivation to be good Stage Three – To gain social approval Stage Four – To conform to rules and uphold order Post-conventional morality (some people never reach this level) Stage Five = Morality of Individual Ethics, Tolerance Stage Six = Morality of universal ethical principles |
|
|
Life Course Model
|
Specific phases or stages defined by events/psychological circumstances
Characterized by tasks or challenges Normative Non-normative (unexpected) Family as context |
|
|
Family as Context
|
No specific family constellation or living arrangement is inherently functional or dysfunctional for the personal growth/development of its members
Functional families adapt to changes in a healthy way Dysfunctional families have difficulty accommodating change |
|
|
Formation of a couple --Tasks
|
Need to blend two sets of family values and traditions
Need to reach agreement on how to divide family chores, manage money, establish a mutually satisfying sexual relationship, and find balance between togetherness and privacy Need to cope with disillusions regarding the other Need to decide which faith to follow Need to find ways to achieve agreement/compromise and resolve conflict |
|
|
4 Couple's Difficulties
|
Idealistic childlike expectations
Disillusionment Resentment Power struggles |
|
|
Parenting – Tasks
|
Reorganizing family division of labor
Adjusting intimacy time Finding energy/love to support one another Renegotiating boundaries with extended families |
|
|
Parenting Difficulties
|
Pregnancy may exacerbate unresolved issues
Pregnancy may threaten a partner’s primacy Domestic violence Overwhelmed mothers Depression Unreasonable fears |
|
|
Preschool to Middle School Tasks
|
Guiding growing independence of the child/children
Setting appropriate limits Socializing the child into family beliefs/values Adjusting to evolving demands of the child and changing parental role |
|
|
Preschool to Middle School Difficulties
|
Emerge when parents lack knowledge about the changing phases of child development
Emerge when parents have their own unresolved issues with dependency Emerge when parents resist the child’s natural process of individuation and try to keep the child dependent Emerge when parents attempt to rigidly control the child’s peer contacts Emerge when children begin to express values different from the norms practiced at home |
|
|
Adolescent Tasks
|
Acquiring autonomy
Coping with everyday life situations Dealing with pubertal physical development Finding reference values Establishing a stable relationship with friends Establishing an intimate relationship Successfully completing one’s school career Preparing for integration into a work setting Achieving economic independence Preparing for the responsibility of having one’s own family |
|
|
Adolescent Difficulties
|
Frayed parent relations
Lack of guidance Issues of sexual behavior substance abuse identity formation gender orientation |
|
|
College/Extended Adolescent Tasks
|
Dealing with family separation
Adapting to living with others Adopting mutually acceptable behaviors with others Arriving at mutually satisfying levels of commitment, emotional nurture, and sexual activity within a romantic relationship Polishing communication, decision-making, and social skills for careers and life |
|
|
College/Extended Adolescent Difficulties
|
Engaging in unhealthy behaviors
Substance abuse Feelings of isolation and alienation High levels of anxiety and stress |
|
|
Adult Tasks and Challenges
|
Occurs in multiple dimensions over long period of time
Divided into 5 broad spheres of activity Family Work/career Social relationships Health Spirituality |
|
|
Elements Effecting Life Model
|
The level of competency in one area is likely to affect fulfillment in others
Sequence is neither uniform nor age graded Factors affecting management of tasks include Individual genetic predispositions (Intelligence, Temperament, Physical health) Core values and beliefs from family and subculture Cohort – generation or group Events, cultural fashions, or patterns of current times Normative and non-normative events Socioeconomic status – lower status leading to Advanced state of health problems Emotional problems Higher incidence of child abuse and domestic violence |
|
|
Career Tasks
|
Find balance between career demands and family life/obligations/responsibilities
Find time for leisure, personal, social and spiritual growth Midlife crisis Crisis of values Disillusionment with life patterns Disenchanted by stress load Crisis of identity |
|
|
Life Course Model 5 Disruptions by Unexpected Events
|
Issues with children/grandchildren
Sudden death of spouse/family members Divorce Job disruptions Health problems |
|
|
5 Life Course Model Stages
|
Preschool to Middle School
Adolescent College/Extended Adolescent Coupling Parenting |
|
|
Basic Counseling and Communication Skills
|
Communication is the key to Understanding
Communication is complex as it occurs on different levels Litigation – often due to patients feeling rushed, receiving no explanations, feeling ignored, or having insufficient time spent on their care |
|
|
Factors Affecting Patient Communication
|
Patient’s
psychosocial issues cultural beliefs language barriers Provider’s beliefs values stress/fatigue levels inner conflicts |
|
|
Communication Channels
|
Verbal communication – what a person says
30-35% of social meaning Nonverbal communication Visual form = facial expression, gestures, posture, and appearance Kinesthetic form = eye contact and distance maintained Auditory form (paralanguage)= pitch of voice, voice tone, volume, rhythm, inflections and hesitations |
|
|
Factors Influencing Output
|
Immediate situation
Psychosocial issues Cultural factors |
|
|
Which is more accurant, verbal or nonverbal accuracy?
|
Nonverbal is often more accurate because it is unintentional and uncensored
|
|
|
Non-verbal Leakage
|
signifies rejection, disagreement or ambivalence
Respiratory avoidance response (frequent throat clearing) Nose rub |
|
|
4 Communication Tasks
|
Engage
Empathize Educate Enlist |
|
|
2 Biomedical Tasks
|
Find it
Fix it |
|
|
5 Barriers to Engagement
|
Medical terms/terminology
Patient’s impaired ability to listen or focus Patient’s preoccupation with emotions Patient’s ambivalence and anxiety Provider’s memories, feelings, or associations and sensitivities |
|
|
9 Assists to Engagement
|
Provider thinks back to similar situation
“Universalizing” = Provider acknowledges patient’s feelings Provider extends a “warm welcome” Patient is comfortable Provider uses good (but not overpowering) eye contact Provider “listens” “listens” “listens” attentively and without interruption Provider is curious about the patient Provider seeks some common linkage in Experience, Background, Identity, Acquaintances Provider elicits patient’s agenda--complaints |
|
|
Empathy
|
Is an active concern and curiosity about the patient that lets the provider see and hear the patient
Is the provider’s ability to see things as the patient sees them from his/her perspective Is the provider’s ability to understand the patient’s emotions Allows a safe psychological space to be created Assures the patient that the provider is paying attention to them |
|
|
11 Ways to Express Empathy
|
Don’t listen and write at the same time
Remain silent (for more than 10 seconds) Practice patience Acknowledge the patient’s feelings, values and thoughts Don’t ignore anger Communicate your understanding of the patient’s reason for being angry, sad, upset, etc. Observe thought processes Use open-ended questions Use reflective listening to refocus rambling Don’t make early judgments as to whether the patient is Manageable, Treatable, Likable If the patient is reluctant/indirect about a health condition, respond indirectly with positive remarks about other persons with the condition |
|
|
Educate
|
Two-way street = provider educates the patient and the patient has information the provider needs (?self diagnosis)
|
|
|
5 Characteristics of Education
|
Assesses patient’s understanding
Assesses patient’s response to the health challenge Illustrates the patient’s concerns, fears or dismissals Provides clues towards patient’s willingness to change habits and to follow a treatment plan Illustrates patient’s internal reality map |
|
|
Imparts information but also creates understanding
|
Actively involved patients remember more and understand more
Enlists patient’s cooperation and responsibility for treatment adherence |
|
|
7 Things the Patient Wants to Know
|
What has happened to me?
Why has this happened to me? What is going to happen to me? short/long term What are you doing to me? Why are you doing this to me? Will it hurt/harm me? When/how will you know what this means? |
|
|
Important Question to Ask When Educating the Patient
|
Will you tell me what you understand at this point?
|
|
|
Two parts to enlisting the patient’s participation
|
Decision making
Encouraging adherence |
|
|
3 Aspects to Decision Making
|
Solicit patient suggestions about treatment
Respect patient suggestions Solicit joint discussion of the issues in treatment and come to agreement |
|
|
6 Aspects to Encouraging Adherance
|
Keep the regimen simple
Write it down Give specifics about the benefits and timetable Assure that the patient knows potential side effects Discuss obstacles to carrying out the treatment Get feedback |
|
|
Maintaining Professionalism
|
Expressing emotion appropriately is OK
Maintain clear role boundaries Phenomena of “transference” and “counter transference” |
|
|
Phenomena of “transference” and “counter transference”
|
Feelings from our past triggered by someone and our projection of those feelings on them
Can be positive or negative Occur frequently Happen on an unconscious level Often propel provider into inappropriate intimacy with a patient |
|
|
Counter transference
|
projection from provider to patient
|
|
|
Transference
|
projection from patient to provider
|
|
|
How to manage transference and counter transference
|
Acknowledge they are normal and common
Bring transference and counter transference into conscious awareness |
|
|
How to bring transference and counter transference into conscious awareness
|
Examining one’s own feelings--overworked, undervalued
Bring issue into open with the patient If romantic/sexual feelings involved, inform a colleague and speak to the patient immediately: Remember and say “Against professional ethics” Never be alone with the patient Refer patient to a colleague Avoid dual relationships |
|
|
Termination Issues
|
Occur when an established professional relationship between a patient and a health care provider comes to an end due to departure of either or a change in insurance coverage.
|
|
|
4 Steps to Termination of Patient/Provider Relationship
|
Notifying patients is an ethical requirement
If temporary, arrange backup coverage If permanent, refer patients to colleagues Transfer medical records to the practice location of new providers |
|
|
Processing Social Information
|
A patient’s anxiety, fear or anger can lead a provider to an adverse evaluation of the patient’s like-ability, manageability or treatability and thus interfere with appropriate treatment.
A provider’s prejudices similarly can create a barrier which can cloud professional judgment and interfere with appropriate treatment. |
|
|
3 Things Social Psychology Explains
|
Human beings form impressions of others, often subconsciously and fairly quickly after meeting for the first time
People seek certainty about how to relate to the other person This process is based on the most fundamental level of instinctual survival |
|
|
What Snap Judgements Are Based On
|
gender, race, ethnicity, religion, age, socioeconomic status, gender orientation, physical and mental disabilities, physical fitness and/or appearance
|
|
|
Results of Snap Judgements
|
We automatically categorize and stereotype others
We group ourselves and others as either “belonging” or “not belonging” (to the in-group) We give negative names Judgments and prejudices translated into actions denying out-groups of rights and privileges is called discrimination |
|
|
Discrimination in Health Care
|
Health care providers are expected to provide care and “to do no harm”
Care without reservation is assumed Providers have a special responsibility to be aware of their own human tendencies |
|
|
Examples of Racial and Ethnic Prejudices in Healthcare
|
1999 lung cancer report finding that African-American patients were less likely than White patients to get surgery for early stages of lung cancer
Tuskegee study Women having criteria for heart surgery receive it less frequently than men |
|
|
Homophobia and Heterosexism in Healthcare
|
Special health care needs ignored in literature and in practice
Inappropriate, inaccurate stereotyping Messages that homosexuality is abnormal, sick, and perverted Studies indicate that health care professionals are less tolerant of GLBT patients |
|
|
Age, mental illness and other prejudices in Healthcare
|
Infantilizing the elderly
Unflattering labels Stigmas Blaming smokers and other addicts for their illnesses Failing to assess for depression in the elderly or obese |
|
|
What can be done?
|
Seek contact and interaction with minority target groups
Address prejudice and discrimination in the workplace Be proactive to assure an open and accepting work environment |
|
|
How to be proactive to assure an open and accepting work environment
|
Clearly written office policies
Strict and consistent implementation Exemplary role model |
|
|
How HC Providers can overcome homophobia/heterosexism
|
Health care providers can educate themselves on the etiology of gender orientation and develop understanding
HC providers can learn to use non-heterosexist language in health care delivery (sexual histories, health discussions) HC providers can allow partners of GLBT patients to have family privileges |
