Chapter 9
What factors impact adherence as being one of the results of poor-patient-provider communication?
1. Communication 2. Treatment regimen 3.Creative non adherence
What can be done to prepare children for medical intervention?
1. Conscious sedation 2. Distraction for managing pain and discomfort 3.Exposing children to modeling film 4.Coping skills preparation
What can reduce non adherence?
1. Health care institution interventions 2.Presentation of treatment interventions 3. Skills training 4.Probing for barriers
What does holistic health movement and health care entail?
1. Health is a positive state to be actively achieved . 2. Western medicine incorporating Eastern approaches.
What are the reasons malpractice suits have exploded over the past decades?
1. Increases in technical complexity 2. Administrative complexity 3. Incompetence and negliglence 4.Poor communication
What are some provider behaviors that contribute to faulty communication?
1. Not listening 2. Use of jargon 3. Baby talk 4. Non person treatment 5. Stereotypes of patients
What are some patient contributions that lead to faulty communication?
1. Patient characteristics 2. Patient knowledge 3. Patient attitude toward symptoms
What are some of the impacts of hospitalization on the patient?
1. Patients arrive at the hospital with anxiety. 2. Patients are given a road map of procedures they can expect.
What is the structure of health care delivery system?
1. Private, fee-for-service care 2. Health Maintanance Organizations (HMOs) 3. Preferred-Provider Organiztions (PPOs)
One of the interactive aspects of the communication problem is when a patient doesn't return. What are reasons why that occurs?
1. The treatment may have led to a cure. 2.The patient may have died . 3. The patient may have gotten worse and gone elsewhere.
What are changes of role of psychologist in the hospital setting?
1.Increasing number 2.Expanding role
What are some examples of nurses as providers?
1.Nurse-practicioners 2.Nurse midwives 3.Clinical nurse specialists 4.Nurse anesthetists
Diagnostic-Related Group (DRG)
A classification scheme that determined the nature and length of treatment for particular disorders.
Nurse midwives
A registered nurse w/ additional training as a midwife who delivers infants, provides prenatal and postpartum care, newborn care, and some routine care (as gynecological exams) of women
Nurse Anesthetic
A registered nurse who has completed two years of additional training in anesthesia and is qualified to serve as an anesthetist under the supervision of a physician.
The hospitalized child can develop anxiety and what else can occur ?
A warm, nurturant relationship with a caregiver can offset some of the adverse effects of hospitalization for children.
Core
Administration of the hospital
Clinical nurse specialist
Advanced practice registered nurses that diagnose and treat illness in their area of expertise. (Area of specialty: patients and their families, nurse management, and administration.)
Nurses as providers
Advanced-practice nurses.
What companies are examples of an HMO?
Aetna Blue Cross Blue Shield Association CIGNA Kaiser Permanente
Providers always receive feedback. (True/False)
False. Correct Statement: Providers rarely receive feedback.
There is no evidence that quality of care has eroded. (True/False)
False. Correct statement: There is some evidence that quality of care has erroded.
DRGs only have positive effects on care. (True/False)
False. Correct statement: DRGs have positive and negative effects on care .
Occupational segregation in the hospital is low. (True/ False)
False. Correct statement: Occupational segregation in the hospital is high.
Greater emotional contact between patient and provider is under what?
Holistic health movement and health care.
Hospital patients show problematic psychological symptoms as an impact of what?
Impact of hospitalization on the patient.
When teaching providers how to communicate to improve patient-provider communication there is "patient-centered communication", what is it ?
It improves patient-provider dialogue.
What does measuring adherence to treatment regimens do ?
It yields unreliable and artificially high estimates.
A PA has to work under the supervision of who ?
Licensed doctor (an MD) or osteopathic physician (a DO).
What is a single payer health care?
Medicare
How many people are admitted yearly to nearly 6,000 hospitals in the U.S.?
More than 37 million people.
Who has more authority NP or RN?
NP
What is one of NPs advantages in 20 states here in the U.S.?
NPs do not have to work under the supervision of a doctor, they have "full practice authority".
What is one of the results of poor-patient-provider communication?
Nonadherance to treatment regimens.
Nurse practitioners
Nurse Practitioners are advanced practiced registered nurses [APRNs]. NPs can prescribe medication, examine patients, diagnose illnesses, and provide treatment, much like physicians do.
Care
Nursing staff
Nonadherence
Patients do not adopt the behaviors and treatments that providers recommend.
Patient consumerism
Patients have a desire to be involved in decisions that affect their health.
Hospital workers are likely to break rules designed to control infection, especially who though?
Physicians
Cure
Physicians responsibility
What is one of the changes in the philosophy of health care delivery?
Physicians role is changing
Physician's Assistant
Practice medicine on teams with physicians, surgeons, and other healthcare workers. They examine, diagnose, treat patients, and prescribe medication.
Patient dissatisfaction in managed care
Provider not always overly concerned with patient satisfaction.
Nonverbal communication skills and practice of communication skills are part of training for providers or patient?
Providers
Nosocomial infection
Results from exposure to disease in the hospital setting.
In teaching patients how to communicate, what is one of the training skills?
Teaching patients skills for eliciting information from physicians.
Judging quality of care
The manner in which care is delivered used as the criteria.
In order to convince a patient to follow a treatment plan, what is required from the patient?
The patient has to cooperate.
What depends on the health program?
The structure of the hospital
Point-of-service plan (POS)
These are plans that are administered by insurance companies or HMOs, that let members go to doctors and hospitals out of the network-for a price.
Memember with POS usually need what to see a network specialist?
They need a referral.
Moderately feaful patients in the Landmark study - Janis (1958) showed?
They were able to develop realistic expectations of what post-surgery would be.
In the Landmark study - Janis (1958), fearful patients showed what ?
They were too absorbed with their pre-operative fears to process prepartory information adequately.
Patients must assume more responsibility . (True/False)
True
Patients often have considerable expertise about their health problem. (True/False)
True
Thinking up one's own question or perceiving that physicians are open to questions improves communication during office visits. (True/False)
True
PPOs
When a network of affiliated practintioners have agreed to charge provider who first sees the patient determines what is wrong and the recommends specialist to follow up with treatment.
The treatment may have failed, but the patient got better anyway is what interactive aspect of the communication problem?
When a patient doesnt return.
Private, fee-for-service- care
When individuals pay directly on a visit-by-visit basis.
HMOs
When individuals receive their health care through a pre-paid financing and delivery system.
What percentage of patients do not heed their physicians advice?
[estimate ranges] 15%-93%
