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Health Psychology Notes Ch. 10

Terms in this set (16)

How the Hospital Evolved

The Roman military had separate barracks for the sick but the first institutions devoted to care were associated with Christian monasteries and were charitable in nature. Orphans and the poor might also find a home there.

On the 18 and 19 centuries these institutions changed in a couple of ways.

1. They restricted admission to the sick and members of the 'worthy poor' and no longer accepted the poor and the handicapped.

2. They became medically specialized with wards for different illnesses.

Prior to the 20 century hospitals had bad reputations giving poor care and making patients worse through the spread of infection.

By the 20 century this perspective changed and people from all social classes went to hospitals for treatment.

Now their role has expanded to include prevention, emergency treatment, rehabilitation and diagnostic testing.

The Organization and Functioning of Hospitals

Most hospitals have a board of trustees appointed from business and professional people in a community. Their role is usually limited to long range planning and fundraising.

Hospital administrators oversee the running of the institution purchasing supplies, paying bills, keeping records, providing services like food and cleaning.

The medical staff is responsible for patient care. It is headed by a chief of staff or medical director. The next level down are the staff or attending physicians. Most of these are not employed by the hospital but work for clinics or are self employed. In return for being allowed to admit their patients to a hospital they must perform certain duties at the hospital.

Teaching hospitals are an exception to this. They employ full fledged physicians whose duties include supervising the work of residents.

Below doctors are nurses who are generally salaried employees of the hospital. They generally spend more time with patients than doctors do.

Below the nurses - but not to far I wouldn't think - are allied health workers physical therapists, respiratory therapists and dietitians.
There are two broad ways of coping with stress: problem focused coping and emotion focused coping.

Problem focused coping attempts to alter the causes of the stress. Emotional focused coping tries to regulate the emotional response to the situation. This is the choice of people who believe they cannot change the medical situation that is causing their stress. The view that there is no medical hope is not always correct.

Cognitive Processes in Coping

Attributing blame is a key cognitive process for the ill. Is someone else responsible? Is it God's will? Am I to blame?

Blaming others and self correlate to poor adjustment but blaming others does make it worse, possibly because these people feel a stronger sense of injustice.

Patients often arrive with or develop feelings of helplessness that the hospital experience can acerbate even if the patient's health is improving.

Being a 'good patient' and the instilled sense of helplessness may make a patient more vulnerable to depression.

Helping Patients Cope

Anesthetized patients who received motivational messages during surgery recover better. This means in a broad way patients understand what they hear while under anesthesia so negative comments made by members of the surgical team are likely to be understood.

Heart patients who received brief counselling sessions for the three weeks of their hospital stay had faster recoveries, fewer complications and less sadness.

Being paired with a roommate who is recovering from the surgery a patient is waiting to undergo will reduce their level of anxiety. This may be because it cuts down on the shared worrying that two patients awaiting the same treatment might experience.
Children are less able to understand what is happening to them than adults. This can be a blessing and a curse in that it can make some kids more frightened than need be and some less frightened than need be.

Hospitalized in the Early Years of Childhood

Toddlers often can adjust easily to the needs of medical treatment as they are often required to sit or stay immobile for longer periods than they like.

Many kids experience separation anxiety, this peaks at 15 months. Prolonged stays in hospitals can cause children to be more anxious at home once they have been discharged.

Very young children do not think logically and some may see their hospital stay as a punishment. They may be easily scared by disfigured patients or people who have experienced amputations.

Hospitalized School Age Children

The idea of illness as a punishment can continue in this age range but children this age have better cognitive development and this allows them to cope with illness better.

Four aspects of hospitalization become more difficult for children as they get older.

1. the older kids get the more self-control they are used to having and hospitalization takes this away

2. their increased cognitive abilities allow them to worry more about their outcomes and treatment

3. being away from friends can cause them to worry about permanent damage to their social lives

4. particularly after puberty, kids are more sensitive about exposing their bodies

Helping Children Cope With Hospitalization

Many children suffer long term fears after being hospitalized. Some hospitals try to prevent this by allowing a parent to bunk in with the sick child.

Other approaches involve pamphlets, films and information as well as puppet shows that demonstrate hospital procedures. These are effective in relieving stress in many children but not for all.

But age, experience and coping styles can affect when the best time to present this information to the child is.
Here are some of the most commonly used tools used in assessing a patient's needs:

Assessing Emotional Adjustment

Many CVD patients suffer from depression and pessimism which predicts slower recovery and poorer outcomes. They may suffer from high anxiety and lower levels of personal control.

Generally two methods are used for assessing emotional adjustment, diagnostic interviews and questionnaires

Many of these interviews are set out or guided by the DSM . Clinicians sometimes apply a less formal interview instead but these time saving measures tend to be less useful.

Two types of questionnaires are used in assessing emotional difficulties. One focuses on a single disorder and the other screens for a range of disorders, the best know is the MMPI.

The MMPI has ten scales that assess specific disorders. Three of these scales are particularly relevant for providing psychological help to medical patients.

1. Hypochondriasis which assesses peoples preoccupation and complaints about their physical health

2. Depression which measures feelings of unhappiness, pessimism and hoplelessness

3. Hysteria which assesses people's tendency to cope with problems through avoidance strategies and developing physical symptoms

Specialized Tests for Medical Patients

There are tests that measure Type A and Type B behavior.

The Millon Behavioral Medicine Diagnostic contains 165 questions that measure coping styles, negative health habits and stress moderators.

The Psychological Adjustment to Illness Scale is another test designed for use with medical patients. It is designed to test seven psychological characteristics of a patients life. The PAIS appears able to measure adjustment problems in patients with kidney disease, hypertension, and cancer.