Psyc 314 Final-Textbook

-began as christian monasteries which also housed, poor, orphans, travellers

-18th century began to help only the sick who could contribute to society (mentally ill, disabled, old were not helped)

-eventually upper middle class also got treated

-20th century hospitals gained more positive view

-chief od staff, medical director: manages physicians

-doctors

-nurses: manage ward, care for patients

-allied workers: lab techs, therapists, dieticians

-orderlies: require fewer skills

infection contracted by patient while in hospital

ICN nurses work to prevent these

1. more outpatient procedures

2. more efficient procedures: less haling time

3. more recovery time is spent at home

treating patient as though they are not really present

-allows doctors to disconnect emotionally, intend to avoid awkwardness, so they don't interfere with their work

psychsocial and physical exhaustion from prolonged stress and little personal control

-depersonalizaton: callous, lack of regard for others

-emotional exhaustion: unable to help others psychologically

-perceived inadequacy: low self-efficacy, unable to meet their goals

-thoe who are severely ill and are acting out, may be high maintenance, are usually forgiven due to their condition

-those who are not super sick but may be showing reactance: anger due to loss of freedom and personal control

active: don't complain, stoic, may not ask for medication if they need it

actively seek info, asking for medication, try to change the problem with actions

when believe believe they can't change a situation they will try to regulate their emotions, distraction, social support t

if they are paired with roommates who are also pre surgery they may talk and transfer anxiety

if paired with patient who is post surgery they may have reduced anxiety

--behavioural control: train them to reduce discomfort, speed recovery

-cognitive control: train to recognize and change negative thinking patterns

-informational: control knowledge about procedure

a tube is threaded through vein to the heart and dye is injected to see if there are any cardiac disorders

if procedure has little opportunity to reduce discomfort than cognitive and informational control is best

teaching pregnant women how to give birth without pain medicaiton

avoidance: don't want info, deny fear, do best when little informational control

attention: seek out information, do best with high informaitonal control

-both benefit from repeated exposure to informational control

upset and crying experienced by young children when separated from parents or unfamiliar envionrment

-starts at 9months and peaks at 15 months

that treatment is punishment for being bad

see other people with scars amputations and think it will happen to them

-sense of personal control: feel threatened

-cognitive abilities allow them to become anxious about their illness

-loneliness when separated from school, friends

-more embarrassed by exposing body to strangers

10 scales which asses specific disorders

-pateints usually measured on hysteria, hypochondriacs and depression

-millon beahvoural medicine diagnostic

-psychosocial adjustment to illness scale

if younger than 5 likely don't understand permanence of death, at 8 years they understand dat, school age will know they are dying even if not told

best to be open and honest with child

have more anger, distress and anxiety than older patients

feel it is unjust, senseless,

may worry about their young children

less of shock, have already made financial plans, funeral arrangements, least anxiety if they feel they have lived a satisfying life

developed 5 stage model of acceptance, opened up discussion on death

have higher survival rates, less depression and anxiety

do not resucitate orders, living wills,, help with perceived control

medical and social support for enriched life quality, physical, psychological and social support for patient and families

-folllow up with families after death

arises from tissue damage or pressure

does not appear to have any tissue damage, psychologically induced

chronic pain with no apparent physical cause

temporary, less than three months, generally no lasting anxiety once pain subsides

long lasting, can lead to depression, hopelessness,

1. Chronic Recurrent: benign cause, repeated and intense with periods without pain eg. migraines

2. Chronic-Intractable: discomfort present at all times, no underlying cause, eg. low back pain

3. Chronic-Progressive: increasingly intense, malignant cause e.g. cancer, arthritis

noxious stimuli causes seretoni, histamine and bradykins to be released leading to inflammation and activates nerve endings

signals are carried to brain by norireceptors to spinal cord and then to brain

A-delta: coated with myelin for quick transmission, for sharp pain that commands immediate attention

C-fibres: un coated, for transmitting diffuse, aching, longer pain, won't require immediate attention but can lead to emotional response like depression

pain from internal organs which may be sensed in other parts of the body eg. appendix pain on other side of abdomen

caused by current, past disease or damage to peripheral nerves

-neuraligia: shooting, stabbing pain from previous infection

-causalgia: burning pain from minor stimuli, caused by previous wound

-phantom limb syndrome

body has separate sensory systems for perceiving pain; set of nerves and pathways , area of brain

no separate system for pain, comes from touch receptors, oncce certain threshold is reached the brain perceives it to be pain

for inducing pain in lab, reduced blood flow causes pain, e.g.. tight cuff around arm

for inducing pain in lab, submerging arm in cold water

-gating mechanism in substantia gelatinosa or the spinal cords dorsal horn

-signals enter the gate and activate transmission cells which led to the brain

-pain is perceived once certain level is reached

1. activity in pain fibres: stronger stimuli causes there to be more active fibres

2. activity in other peripheral fibres: a-beta fibres carry non-noxious stimuli sensation and can close the gate (why rubbing area helps)

3. Descending Messages: brainstem and cortex have efferent (moving outward) pathways which can close the gate

physical: injury, too much activity

emotinal: anxiety, depression, tension

mental: focusing on pain, boredom

medication, counter stimulation (a-beta fibres)

relaxation, positive emotions

intene concentration, involvment in life activities

neural network on brain that combines emotional areas, stress regulation systems and cognitive systems

has analgesic effect when electrically stimulated by causing serotonin to activate inhibitory neutrons which release endorphins

opiate like substance produced by the body, endorphin

people which chronic pain may have impaired systems

inhibits opioids ability to work, even if an endogenous opioid

1. facial/audible: groaning, grimace

2. Distorted ambulation/posture

3.negative affect: irritable

4. Avoiding activity, staying home from work

fabricating, exagerating pain behaviours so they can get benefits

trigger release of endogenous opioids and reduce pain

caregiver and patient bring different attitudes, skills and qualities when dealing with pain and they interact with each other continuously to influence experience of pain

dweliing on pain increases it, catastrophizing to gain social support often back fires for people with chronic pain

overt: rest, medication

covert: distraction, prayer, positive thinking

hypochonrdias, depression hysteria

when people don't dwell on pain and engage in activity despite the pain, has good outcome usually

takes into account sensory, evaluative and emotional components

-has big words so no good for kids and esl

EEg: measures evoked potential sin brain

EMG: measures muscle tension, must measure repeatedly over extended period of time

Atuonomic respose: HR, blood pressure

all should be used in addition to self report