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"layman defined" reaction to perceived alteration in health physical and social meaning
illness
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"professional defined" diagnosis as basis of medical practice and therapy
disease
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activity by person who sees self as healthy to prevent or detect disease in early stage before symptoms
health behavior
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activity of person who sees self as ill for purpose of getting well
sick role behavior
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"a state of complete emotional, physical, mental, and social well being and not just the absence of disease or infirmity"
definition of HEALTH by the World Health Organization (WHO)
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view to help professional understand why and under what conditions people take preventative health actions (behaviors)
health belief model
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List Maslow's Hierarchy of Human Needs according to which needs must be met first (bottom of pyramid): love and beloning, self actualizing, safety and security, physiologic, self-esteem
physiologic... safety and security... love and belonging... self-esteem... self-actualizing
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What are Erik Erikson's 8 stages?
- 1. infancy - 0 to 1
- 2. toddler - 1 to 3
- 3. preschool - 4 to 5
- 4. school age - 6 to 12
- 5. adolescence - 13 to 20
- 6. young adult - 20 to 40
- 7. middle years - 41 to 64
- 8. later adults - 65 to older
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trust vs mistrust (erikson's 8 stages)
INFANCY (0-1 yr)
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autonomy (independence) vs shame & doubt (erikson's 8 stages)
TODDLER (1-3 year)
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initiative vs guilt (erikson's 8 stages)
PRESCHOOL (4-5 yr)
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industry vs inferiority (erikson's 8 stages)
SCHOOL AGE (6-12 yr)
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identity vs role confusion (erikson's 8 stages)
adolescence (13-20)
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intimacy vs isolation (erikson's 8 stages)
young adult (21-40)
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generativity vs stagnation (erikson's 8 stages)
middle years (41-64)
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integrity vs dispair
later adults (65-)
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mostly unconscious mental process that lessen anxienty
defense mechanisms: denial, projection, repression, regression, displacement, reaction formation, rationalization
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defense mechanism: failure to recognize threat event
denial
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defense mechanism: attribut to other's one's negative trait
projection
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defense mechanism: dismissing anxiety producing thoughts from awareness
repression
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defense mechanism: return to earlier pattern of behavior
regression
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defense mechanism: redirect feelings about one person to another
displacement
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defense mechanism: substitute opposite wishes for true wishes
reaction formation
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defense mechanism: substitute socially accepted reason for real reason
rationalization
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How do you cope with defense mechanisms?
Goal is to develop more CONSCIOUS coping skills to handle life issues (versus unconscious mental processes = defense mechanism). Examples include talking, relaxation methods, excercise and to balance work and play.
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pharmacy-patient relationship: 4 communication attending behaviors
- 1. eye contact
- 2. attentive body language
- 3. vocal qualities
- 4. verbal tracking
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what does practicing good behavior lead to?
- 1. encourages people to talk
- 2. demonstrates that you're interested, that you care
- 3. establishes rapport
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open ended vs. close ended questions: which is better and why?
- open ended questions are preferred because if you practice good questions:
- 1. brings out specifics about the patient
- 2. effectively diagnoses a patient's concern
- 3. guides the manner in which a client talks about an issue
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avoid WHY questions and go for HOW & COULD
- WHAT - leads to facts
- HOW - leads to feelings or process (good)
- WHY - leads to reasons (can make someone defensive!)
- COULD - considered maximally open (good)
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Correct Communication - Listening Accurately is...
- 1. encouraging
- 2. paraphrasing
- 3. summarizing (esp in the end of counseling session)
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What does practicing good listening lead to?
- 1. communicates interest/caring
- 2. clarifies for the patient what they said
- 3. checks your accuracy
- 4. communicates to the patient that they have been heard
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What are the two observational skills we need to develop?
- 1. non-verbal behavior - something they're not saying, so pay attention
- 2. patient discrepancies - try to notice/catch them
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What are the principles for good therapeutic communication?
- 1. know patients have inner resources and strengths
- 2. practice non judgmental listening
- 3. repeat what you heard
- 4. accept the patient where they are
- 5. avoid using your personal value system
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What are the characteristics of a professional?
- 1. genuine feeling of warmth for person being helped
- 2. empathetic understanding of patient's internal frame of reference
- 3. ability to be human and real in the relationship
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definition: professional borrows the patient's feeling to fully understand them BUT always are aware of own separateness
empathy
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definition: professional loses separate identity and takes in patient's feelings or circumstances
sympathy
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empathy vs sympathy? why?
empathy... because important to keep separateness or we might break boundaries... main thing is that we still NEED to be able to do what we need to do
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caring concept: caring FOR or caring ABOUT? caregiver expresses concern by taking charge of another's life, not the proper professional relationship
caring FOR
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caring concept: caring FOR or caring ABOUT? caregiver meets patient as a complete person and exhibits respect for that person's abilities
caring ABOUT
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What are the 6 barriers to communication?
- 1. interrupting
- 2. belittling
- 3. moralizing
- 4. lack of privacy
- 5. impairments
- 6. time constraints
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definition family term: family to which a person is born
family of origin
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definition family term: new family created by 2 partners
nuclear family
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definition of blended family
common
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extended family
family network
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family rules (3)
culture, health, discipline
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family boundary
- rules for separateness
- -codependent relationship = disfunctional
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family characteristic: scapegoat?
blame a family member
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how should communication in a family be like?
open, clear, direct NOT closed, indirect and confusing
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What is the ideal size for a working group?
6-10 is the best for effective work
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What are group norms?
- GROUP: behaviors expected of group members, people know how class graded, know expected dress, behaviors
- GROUP SPECIFIC: risk taking, humor, anger
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cohesiveness: need cohesion "glue" to make group work
- - value group holds for members & member investment, "glue"
- - cohesiveness enhances commitment
- - care of and care from group favors cohesion
- - the more you put into group, the more you get out of it
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what factors favor cohesiveness?
- 1. group tasks are within member expertise
- 2. leader points out group accomplishments
- 3. leader models empathy and gives feedback
- 4. leader allows group tension at some point to reach goals
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characteristics of a group leader
leader facilitates all phases of group development
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definition: WHAT group does or dicusses
group content
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definition: HOW group works
group process
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what are the group phases?
- 1. initiating
- 2. working
- 3. termination
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what happens at the initiation group phase of development?
- - anxiety felt
- - need acceptance and trust
- - establish group goals, power & control, testing
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what happens at working phase of group development?
- - work on group goals
- - out of conflict norms and agreement come, sharing, emotional growth
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what happens at termination phase of group development?
summarize feelings about goals and accomplishments, and that you'll miss group members
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type of group membership: meet for time frame and no new members
closed
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type of group membership: anyone can join at any time such as on a hospital unit group
open
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type of group membership: everyone has the same problem like diabetes
homogenous
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type of group membership: different diagnoses, ages all meet together
heterogenous
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YALOM is a group theorist
- - make people feel good about a group by imparting info and instilling hope
- - curative factors such as universality, catharsis (talk about concerns), instill hope and improving communication
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Hans Selye and Stress Theory
- - developed the "general adaptation syndrome" GAS
- - ALARM: caused by physiological response, body defense by adrenal cortex
- - then leads to (1) resistance and recovery OR (2) exhaustion - toxic substance or stress overwhelms defenses
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family function in stress
affection, security & acceptance, satisfaction & purpose, continuing relationships, socialization, sense of right & wrong
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what should pharmacist do in response to patient ANXIETY? can be mild, moderate, sever or panic
- 1. recognize anxiety and search for cause, show cal and care
- 2. teach stress reduction techniques
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what should pharmacist do in response to patient DENIAL? patient has denial bec of fear and anxiety, to avoid intolerable feelings. adaptive if it helps them get through trauma but maladaptive it if prevents them from accepting the problem and need for treatment.
- - pharmacist should be gentle and have an indirect approach
- - comment on observed condition
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what should pharmacist do in response to patient being DEMANDING? excessive need for dependency, entitlement attitude and fears abandonment
pharmacist should set limits in a caring and supportive manner... should anticipate care needs
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what should pharmacist do in response to a patient being CONTROLLING? rigid, needs lots of control, thinks rather than feels, driven to achieve
- - give control over schedule and treatment
- - provide detailed teaching
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what should pharmacist do in response to patient MANIPULATION? through flattery, self pity, for self gain, lying, threats to harm, takes advantage
confront behavior with clear limits
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what should pharmacist do in response to patient being SUSPICIOUS? questions caregivers intentions, complains about care and feels vulnerable/fearful
recognize beliefs and feelings but offer no challange
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what should pharmacist do in response to patient ANGER?
- - calm appearance, speak softly and provide neutral comments
- - listen, show respect
- - don't make promises you can't keep
- - talk about anger management
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what should pharmacist do in response to patient DEPRESSION?
- - provide safe environment and LISTEN
- - encourage self-worth and life equality
- - share concerns with team
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what's the difference between informal and formal support systems?
- - informal: family members, friends, coworkers, neighbors, spiritual center
- - formal: hospital, clinics, health care professionals, community agencies, home care agencies, professional counselors/therapies
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what's the difference between support groups versus self-help?
- - support groups are led by care professionals whose goals are for new knowledge and skills, encouragement, feedback on behavior and normalization of the experience
- - self help groups are controlled and directed by individual members whose goals are self reliance, hope and improved moral
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conclusion of albrecht and havinghurst on aging? activity of youth and middle years
- - elderly with more activities are happiest
- - not just any activity, but those they engaged in during the younger or middle years or substitute activities to replace ones you can no longer do
- - society disengages from elders
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