Developmental Psychology and Mental Health.docx

Developmental Psychology and Mental Health ========================================== Erik Erikson\'s Stages of Psychosocial Development -------------------------------------------------- Erik Erikson\'s theory of psychosocial development is one of the most widely accepted frameworks for understan...

Developmental Psychology and Mental Health ========================================== Erik Erikson\'s Stages of Psychosocial Development -------------------------------------------------- Erik Erikson\'s theory of psychosocial development is one of the most widely accepted frameworks for understanding the challenges and tasks that people face throughout their lives. Erikson believes that successfully navigating these stages results in healthy personality development and a functioning ego. He emphasized that society and culture have a significant impact on personality development. Each of Erikson\'s eight stages represents a psychosocial crisis that must be resolved before an individual can effectively progress to the next stage. Here, we will go over each stage in detail. ### Trust vs. Mistrust (Infancy: 0-1 year) Psychosocial Crisis: Trust vs. Mistrust Successful Outcome: Trust Unsuccessful Outcome: Mistrust During infancy, the primary goal is to form attachments and gain trust in the primary caregiver. This stage is important because it establishes the tone for future emotional development. Infants learn to trust that their fundamental needs, such as food, comfort, and warmth, will be met. As their motor skills improve, they gain confidence in their own bodies. Successful completion of these tasks boosts self-confidence and optimism. Failure, on the other hand, leads to mistrust, suspicion, and interpersonal relationship difficulties. #### Tools for Medical Assistants: - Provide consistent and gentle care. - Ensure that the environment is safe and nurturing. - Educate parents on the importance of responding to their infant's needs promptly. ### Autonomy vs. Shame and Doubt (Early Childhood: 1-3 years) Psychosocial Crisis: Autonomy vs. Shame and Doubt Successful Outcome: Autonomy Unsuccessful Outcome: Shame and Doubt Toddlers start to assert their independence and acquire autonomy. They begin to explore their surroundings and learn new skills, including language. Caregivers who provide firm but supportive guidance to toddlers help them develop self-control and the ability to delay gratification. Success at this stage leads to self-control, confidence, and a sense of autonomy. Failure can cause feelings of shame, doubt, and a loss of self-confidence. #### Tools for Medical Assistants: - Encourage toddlers to try new tasks independently while providing supervision. - Use positive reinforcement to build their confidence. - Communicate with parents about the importance of fostering independence. ### Initiative vs. Guilt (Preschool Age: 3-6 years) Psychosocial Crisis: Initiative vs. Guilt Successful Outcome: Initiative Unsuccessful Outcome: Guilt During the preschool years, children start to initiate activities, make plans, and take on new projects. They have active imaginations and are curious about the world. Adults\' perceptions of their own abilities are shaped by their responses to their initiatives. Encouraging exploration and new experiences promotes initiative. Criticism or restriction can trigger feelings of guilt and inhibition. #### Tools for Medical Assistants: - Encourage creative play and exploration. - Provide opportunities for children to ask questions and express themselves. - Support parents in understanding the balance between guidance and freedom. ### Industry vs. Inferiority (School Age: 6-12 years) Psychosocial Crisis: Industry vs. Inferiority Successful Outcome: Industry Unsuccessful Outcome: Inferiority Recognizing their accomplishments helps school-aged children develop a sense of industry. Positive reinforcement and constructive feedback can help you gain self-confidence. When tasks are completed successfully, people feel competent and trustworthy. Negative responses or a lack of recognition can lead to feelings of inferiority and a loss of motivation. #### Tools for Medical Assistants: - Recognize and praise children's efforts and achievements. - Encourage participation in group activities and responsibilities. - Communicate the importance of supportive feedback to parents and educators. ### Identity vs. Role Confusion (Adolescence: 12-18 years) Psychosocial Crisis: Identity vs. Role Confusion Successful Outcome: Identity Unsuccessful Outcome: Role Confusion Adolescents experiment with various roles, values, and beliefs in order to form their own personal identities. This stage is critical for developing a clear sense of self and direction in life. Success leads to a stable identity and the ability to form committed relationships. Failure can result in role confusion, poor decision-making, and a distorted sense of self. #### Tools for Medical Assistants: - Provide a supportive environment for self-exploration. - Offer guidance and counseling resources. - Encourage adolescents to participate in activities that align with their interests and values. ### Intimacy vs. Isolation (Young Adulthood: 18-40 years) Psychosocial Crisis: Intimacy vs. Isolation Successful Outcome: Intimacy Unsuccessful Outcome: Isolation Young adults want to form intimate relationships and long-term commitments. To achieve intimacy, you must first establish meaningful relationships based on mutual respect and love. Failure to establish these connections may lead to feelings of isolation and loneliness. #### Tools for Medical Assistants: - Facilitate discussions about healthy relationships and emotional well-being. - Provide resources for mental health support and counseling. - Encourage participation in community activities to build social networks. ### Generativity vs. Stagnation (Middle Adulthood: 40-65 years) Psychosocial Crisis: Generativity vs. Stagnation Successful Outcome: Generativity Unsuccessful Outcome: Stagnation During middle adulthood, people focus on contributing to society and guiding the next generation. Success at this stage leads to feelings of productivity and accomplishment. Failure can result in stagnation and self-absorption. #### #### Tools for Medical Assistants: - Encourage involvement in community service and mentoring. - Provide support for balancing career and family responsibilities. - Discuss the importance of lifelong learning and personal growth. ### Ego Integrity vs. Despair (Late Adulthood: 65 years and above) Psychosocial Crisis: Ego Integrity vs. Despair Successful Outcome: Ego Integrity Unsuccessful Outcome: Despair In late adulthood, people reflect on their lives and accomplishments. Achieving ego integrity entails accepting one\'s life and finding meaning in it, which leads to feelings of wisdom and fulfillment. Failure to achieve this leads to despair, regret, and a sense of unrealized potential. #### Tools for Medical Assistants: - Provide opportunities for older adults to share their life stories and experiences. - Support volunteerism and engagement in meaningful activities. - Offer resources for coping with age-related changes and health issues. Understanding Erikson\'s stages of development allows healthcare professionals to better recognize and address the psychosocial challenges that patients face throughout their lives. This knowledge enables more compassionate, effective care that supports each patient\'s path to healthy development and well-being. Prevalent Mental Health Disorders --------------------------------- The significance of mental health is equal to that of physical health in terms of overall well-being. Mental health encompasses an individual\'s cognitive functions, behaviors, and emotional state. Mental health conditions and illnesses can arise from biological factors, such as genetic predispositions, or environmental factors, such as learned behaviors, inadequate coping mechanisms, or traumatic experiences. In many cases, a combination of both factors contributes to the development of these conditions. There exist more than 300 officially acknowledged mental disorders, several of which exhibit similar symptoms. Comprehending the methods of engaging with a patient who is experiencing a mental illness in a compassionate and efficient manner is crucial for medical assistants (as well as all healthcare professionals). This entails demonstrating patience and professionalism in all interactions, establishing trust with the patient, and collaborating with both the patient and healthcare provider to determine the most suitable and effective language and actions for effective communication with each individual patient. The treatment regimen comprises the administration of medications and the implementation of behavior therapies. ### Depression Depression is a psychiatric condition marked by enduring feelings of sadness, diminished interest or enjoyment in previously enjoyable activities, and a variety of physical and cognitive symptoms. It impacts an individual\'s cognition, emotions, and ability to perform daily tasks, and can hinder their functioning in different areas of life. #### Signs & Symptoms: Depression is characterized by enduring feelings of sadness, hopelessness, or worthlessness, alterations in appetite and sleep routines, diminished energy levels, impaired concentration, and contemplation of death or suicide. Depression can also be accompanied by physical manifestations such as headaches, digestive problems, and persistent pain. Depression screening can be performed by utilizing standardized questionnaires like the PHQ-9 (Patient Health Questionnaire-9). These screenings aid healthcare providers in evaluating the intensity of depressive symptoms and deciding on suitable treatment options. #### Treatment: Treatment for depression typically involves a blend of psychotherapy, such as cognitive-behavioral therapy or interpersonal therapy, and medication, such as antidepressants. Implementing lifestyle modifications, such as engaging in consistent physical activity, obtaining sufficient rest, and consuming a nutritious diet, can also yield advantageous outcomes. If the condition becomes extremely serious, it may be necessary to admit the patient to a hospital or enroll them in an intensive outpatient program. ### Anxiety Anxiety disorders are characterized by an excessive and uncontrollable fear or worry that can disrupt daily functioning. These disorders can appear in different forms, such as generalized anxiety disorder, panic disorder, social anxiety disorder, and specific phobias. #### Signs & Symptoms: Anxiety disorders are characterized by enduring and excessive concern, unease, tiredness, trouble focusing, irritability, muscle strain, and disruptions in sleep patterns. Panic attacks, characterized by abrupt and intense episodes of fear or discomfort, are prevalent in certain anxiety disorders. Screening instruments such as the GAD-7, which stands for Generalized Anxiety Disorder 7-item scale, are employed to evaluate symptoms of anxiety and inform decisions regarding treatment. #### Treatment Treatment for anxiety disorders typically involves psychotherapy, specifically cognitive-behavioral therapy (CBT), which assists individuals in recognizing and modifying negative thought patterns and behaviors. Medications such as antidepressants or benzodiazepines may be prescribed to relieve symptoms. Therapeutic interventions can be enhanced by incorporating relaxation techniques, mindfulness practices, and lifestyle modifications. ### ADHD (Attention-Deficit/Hyperactivity Disorder) ADHD is a neurodevelopmental disorder characterized by enduring patterns of inattention, hyperactivity, and impulsivity that hinder functioning or development. It usually commences during childhood and can endure into adulthood. #### Signs & Symptoms: ADHD symptoms encompass challenges in maintaining attention, excessive restlessness or wriggling, impulsivity (acting without forethought), difficulties in task organization, forgetfulness, and excessive verbal communication. These symptoms frequently result in academic and social difficulties for children. ADHD screening entails thorough assessments conducted by healthcare professionals, which encompass evaluating symptoms, developmental background, and functional limitations. Rating scales, such as the ADHD Rating Scale-5 (ADHD-RS-5), are frequently employed to aid in the process of diagnosing and planning treatment for ADHD. #### #### Treatment Treatment for ADHD typically entails a blend of pharmacological interventions, such as stimulants or non-stimulants, and behavioral therapies. Behavioral interventions encompass various approaches such as parent training, classroom accommodations, and cognitive-behavioral strategies. These interventions aim to enhance organization and time management skills. ### Post-Traumatic Stress Disorder (PTSD) PTSD is a psychiatric disorder that is activated by the experience or observation of a distressing event. Common symptoms of this condition may encompass intrusive memories, nightmares, flashbacks, intense emotional distress, avoidance of stimuli related to the traumatic event, and heightened arousal (such as an exaggerated startle response). #### Signs and Symptoms: PTSD symptoms can vary but commonly involve the re-experiencing of the traumatic event through intrusive memories or nightmares, avoidance of reminders of the trauma, negative changes in mood and cognition (such as distorted beliefs about oneself or the world), and alterations in arousal and reactivity (such as irritability and hypervigilance). Screening for Post-Traumatic Stress Disorder (PTSD) entails examining an individual\'s history of traumatic experiences and assessing the existence of PTSD symptoms using standardized tools such as the PTSD Checklist for DSM-5 (PCL-5). Screening facilitates the identification of individuals who may derive advantages from prompt intervention and tailored mental health treatment. #### Treatment Treatment for post-traumatic stress disorder (PTSD) usually consists of psychotherapy, specifically cognitive processing therapy (CPT) or eye movement desensitization and reprocessing (EMDR). These therapies assist individuals in effectively dealing with memories and emotions associated with their traumatic experiences. Prescriptions for medications such as antidepressants and prazosin (used to treat nightmares) may also be provided. Complementary therapies such as supportive therapies, mindfulness practices, and peer support groups can enhance formal treatment. Environmental & Socioeconomic Stressors --------------------------------------- Environmental and socioeconomic stressors refer to a diverse range of difficulties that can have a substantial effect on the mental and physical well-being of individuals. Environmental stressors result from the presence of physical factors in an individual\'s environment, including air pollution, excessive exposure to sunlight, overcrowding, and noise pollution. These factors can trigger physiological stress responses, which can impact various aspects of health, including cardiovascular health and immune function. Moreover, traumatic incidents such as accidents, natural calamities, or incidents of prejudice can result in acute stress reactions and, in certain instances, post-traumatic stress disorder (PTSD), which is characterized by symptoms such as anxiety, insomnia, and intrusive memories. Psychologically, stress can originate from both positive events, referred to as eustress, and encounters with potentially anxiety-provoking situations such as healthcare visits. For instance, even ostensibly favorable occurrences such as holidays or individual accomplishments like completing a college degree can elicit stress reactions. The phenomenon referred to as \"white-coat syndrome\" demonstrates how individuals may experience heightened anxiety and physiological responses, such as increased blood pressure, due to unfamiliar healthcare environments or fear of medical procedures. Effectively managing environmental stressors requires a comprehensive understanding of how perceptions and coping mechanisms impact stress responses. People\'s coping abilities differ depending on their individual experiences and the support systems they have access to. Efficient methods to alleviate environmental stress encompass relaxation techniques, mindfulness practices, and participating in physical activities that foster stress relief. Socioeconomic stressors primarily revolve around financial difficulties and instability. Many people face stress as a result of job instability, increasing debts, unforeseen costs such as medical bills or car repairs, or a decrease in income due to unemployment or retirement. These stressors can result in emotions of despair, unease, and despondency, affecting one\'s overall state of being and worsening pre-existing health conditions. Medical assistants have a vital role in providing support to patients who experience socioeconomic stressors, particularly in relation to the costs of healthcare. It is crucial to engage in these interactions with empathy and sensitivity. Offering transparent details regarding accessible financial aid programs, variable fee structures, or local community assets for healthcare services can help alleviate certain financial hardships. Furthermore, providing support to patients in navigating health insurance choices and comprehending billing statements enables them to make well-informed choices regarding their healthcare. Strategies for Managing Patients Experiencing Environmental and Socioeconomic Stressors: 1. Establish Trust and Rapport: Patients who are facing stress due to environmental or socioeconomic factors may exhibit hesitancy or lack of trust. Allocate sufficient time to establish a positive relationship, engage in attentive listening, and exhibit understanding and compassion in order to foster a nurturing atmosphere. 2. Provide instruction on stress management: Present practical guidance on stress management strategies, including relaxation exercises, mindfulness practices, and making healthy lifestyle choices. Urge patients to integrate these techniques into their daily routines to bolster their resilience against stress. 3. Utilize Support Services: Facilitate the connection between patients and professionals such as social workers, financial counselors, or community organizations that have expertise in dealing with environmental and socioeconomic stressors. These experts can offer extensive assistance customized to specific requirements. 4. Champion Patient Rights: Guarantee that patients are well-informed about their entitlements concerning healthcare accessibility, encompassing possibilities for financial aid, flexible payment scales, and support for equitable treatment in healthcare environments. 5. Promote Transparent Communication: Cultivate a setting that encourages patients to openly express their concerns and seek clarification regarding medical expenses, insurance coverage, and available support. Effective communication can reduce anxiety and empower patients to make well-informed healthcare decisions. Medical assistants can make a substantial impact on patient outcomes and overall well-being by proactively and compassionately addressing environmental and socioeconomic stressors. Communications & Accommodations ------------------------------- When working with all patients, it is beneficial to have a general understanding of therapeutic communication principles. For example, medical assistants can encourage patients to express their emotions by reflecting their statements back to them in a way that encourages further communication. It is also beneficial to make observations and offer recognition for positive changes. These techniques encourage positive communication. Some patients may have unique issues that necessitate specialized treatment methods. The medical assistant plays an important role in developing and maintaining relationships with all members of the health care team. ### Physical Disability The Americans with Disabilities Act requires medical offices and facilities to provide appropriate access for patients using wheelchairs or other assistive devices. These include clearly marked parking spaces, ramps, and accessible restrooms with spacious stalls and handrails. By organizing common areas, medical assistants can help these patients feel at ease and function well in their surroundings. The patients will feel more at ease, making it easier to establish therapeutic relationships with them. They will notice that the office staff has anticipated their needs and facilitated their navigation throughout the office. Many patients with disabilities have reported receiving tactless remarks or being asked inappropriate questions. Only ask questions about their disability during a medical evaluation or history gathering. Instead of asking, \"How did that happen to you?\" ask, \"What can I do to assist you during your visit?\" Being overly solicitous may come across as insincere. Be ready to make any necessary accommodations, but don\'t make assumptions. Ask the patient what they need and respect their response. #### Office Organization Strategies - Ensure adequate gaps between chairs in waiting areas and along walls for safe wheelchair access, maneuverability, and parking. - Do not place area or throw rugs near patients using assistive devices or wheelchairs. - Remove metal or wooden sills in doorways. Replace them with graduated rubber coverings that create a smoother surface for wheels to transition across. - Remove obstacles to wheelchair swiveling. - Position reading materials at a convenient height for wheelchair users. - For patients with walking or balance issues, provide sturdy bars or rails along the walls. - Provide Braille signs and reading materials for patients with vision loss, in addition to large-print materials. When speaking with these patients, use descriptive language and avoid touching unless the patient is verbally alerted. - Offer online appointment scheduling services to patients with hearing loss. Patients may be able to communicate effectively in person but have significant difficulty hearing and understanding speech over the phone, making scheduling difficult. When speaking to the patient, stand directly in front of them, rather than to the side or behind them. Pronounce words clearly so that the individual can see lip movements and hear what is being said. Don\'t shout. Clarity of speech is far more important in facilitating comprehension. If a sign-language interpreter is requested, the office is required by federal law to provide one. - Patients with service animals should not consider them pets. Intervene and educate others that service animals are on duty and should not be distracted. Also, prepare accommodations for any patient requests. Before providing assistance, inquire as to the patient\'s preferred type of accommodations. ### Developmental Delay When working with patients with mental or emotional disabilities, the first step is to figure out how they communicate and how much they understand. Family members and caregivers can help with this, but do not assume the patient is unable to communicate. Always address the patient first. Maintain calm, avoid showing impatience, and speak at a consistent volume. If you do not understand something the patient says, ask for clarification. Advocate for patients and always show them respect and empathy. Make accommodations to meet patients\' needs and ask how you can help during their visit. ### Illness & Diseases Individuals with chronic or terminal illnesses are extremely stressed. Casual, routine opening lines, such as an overly cheerful \"How are you doing today?\" can elicit defensive responses like, \"How do you think I\'m doing? I\'m dying. Even if the patient does not express it, they may think it. Instead, greet these patients warmly and respect their dignity. Always treat them with kindness and care. Provide support and empathy while allowing the patient to set the tone of the conversation. Never say you understand how the patient feels. All feelings are unique to the individual, so expressing them diminishes the person and demonstrates a lack of respect for their individuality. Listen carefully to the patient, maintain eye contact, and always ask how you can assist. Before beginning medical data collection, ask a broad question such as, \"What would you like to talk about today?\" How the patient responds will help set the tone for the rest of the conversation. Ensure that the patient has access to all necessary services, including hospice referrals, meal delivery, and home health assistance. Support groups and community services can also be beneficial, as they provide social experiences and an outlet for dying patients and their families. Defense Mechanisms ------------------ Defense mechanisms are psychological tactics that individuals subconsciously use to shield themselves from anxiety caused by unacceptable thoughts or emotions. Apathy is a mechanism that individuals employ to cope with overwhelming emotions by deliberately avoiding emotional or physical involvement with situations or people. For instance, a student who consistently underperforms in school may display apathy towards their academic obligations, appearing unconcerned about their grades or future prospects. **Compensation** refers to the act of offsetting a perceived deficiency by highlighting a favorable attribute or proficiency in a different domain. For example, an individual who experiences a sense of inadequacy regarding their physical appearance may demonstrate exceptional performance in academic endeavors as a means of compensating for their perceived deficiencies. **Conversion** is a psychological defense mechanism in which emotional distress is manifested as physical symptoms, such as pain or paralysis, even though there is no identifiable medical explanation. As an illustration, an individual who is subjected to severe stress may encounter transient blindness, which subsides once the stressor diminishes. **Denial** is the act of consciously rejecting the acknowledgment of facts or emotions that are excessively distressing to embrace. An instance can be observed when a patient, who has been diagnosed with a grave illness, persists in believing that the doctor must have committed an error, even though there is indisputable medical evidence proving otherwise. **Displacement** is the phenomenon in which emotions are shifted from their initial source to a target that is perceived as less intimidating. For example, an individual who harbors anger towards their superior may vent their frustration on their family members upon returning home. **Dissociation** is a psychological defense mechanism in which an individual intentionally separates themselves from their thoughts, emotions, recollections, or personal sense of self. An illustration of this phenomenon is when an individual who undergoes a traumatic experience deliberately detaches themselves from the recollection of the distressing event as a means of managing the overpowering emotions. **Identification** is the process of imitating the characteristics or behaviors of another person in order to boost one\'s self-esteem or alleviate anxiety. Children who idolize celebrities may emulate their fashion and behavior in order to enhance their self-assurance. **Intellectualization** is a psychological defense mechanism that involves reducing the impact of emotions associated with stressful events by concentrating on the intellectual aspects of the situation. For example, an individual confronted with a terminal illness may prioritize medical investigation and treatment alternatives, disregarding their emotional anguish. **Introjection** refers to the psychological process by which external objects or qualities are internalized and assimilated as part of one\'s own identity. For instance, an individual who consistently receives criticism from others may internalize these critiques and cultivate a severe self-critical inner voice. **Physical avoidance** entails the act of deliberately staying away from situations or individuals that have the potential to trigger feelings of anxiety or distress. For instance, an individual experiencing social anxiety may deliberately abstain from attending parties or gatherings in order to preemptively evade sensations of unease or panic. **Projection** is the act of ascribing one\'s own unacceptable thoughts, feelings, or motives to other people. An example of this phenomenon is when an individual who is deceitful themselves mistakenly perceives others as being deceitful towards them. **Rationalization** is the act of constructing logical explanations or justifications in order to make feelings or behaviors that are considered unacceptable appear more acceptable. For example, an individual who does not pass an examination may justify it by attributing the failure to the challenging nature of the test rather than acknowledging their own lack of preparation. **Reaction formation** is a psychological defense mechanism in which individuals exhibit emotions or behaviors that are contrary to their genuine feelings. For instance, an individual who unconsciously holds negative sentiments towards a coworker may exhibit overtly exaggerated friendliness towards them. **Regression** refers to the act of returning to behaviors or coping mechanisms that are more typical of a previous stage of development. For instance, when an adult encounters a traumatic incident, they may exhibit regressive behaviors such as thumb-sucking or seeking solace in a comfort object, similar to a child. **Repression** refers to the involuntary process of excluding distressing or undesirable thoughts, memories, or emotions from conscious awareness. For instance, an individual who underwent childhood trauma may lack any conscious memory of the incidents that took place. **Sarcasm** is a psychological defense mechanism that involves the use of humor to indirectly express aggression or hostility. For example, an individual who perceives themselves as being treated unfairly or receiving negative feedback may employ sarcasm as a means to conceal their emotional pain or resentment. **Sublimation** is the process of redirecting undesirable impulses or emotions towards activities that are considered socially acceptable. For instance, an individual exhibiting aggressive inclinations may redirect their energy towards engaging in sports or pursuing artistic endeavors. **Suppression** refers to a deliberate attempt to expel undesirable thoughts or emotions from one\'s consciousness. Suppression, in contrast to repression, is a conscious act of intentionally avoiding distressing thoughts. An example of intentional avoidance is refraining from contemplating a demanding forthcoming examination until it becomes absolutely imperative to confront it. **Undoing** is a psychological defense mechanism in which an individual attempts to counteract or compensate for an unacceptable thought, emotion, or behavior by engaging in a different action. For example, an individual who experiences guilt over a hurtful remark may excessively praise the person they offended in order to rectify the perceived harm. **Verbal aggression** is the act of using words to convey anger or frustration towards others. This can encompass derogatory remarks, raised voices, or verbal intimidation as a means of expressing repressed emotions or instilling fear in others. These defense mechanisms offer understanding of how individuals instinctively shield themselves from anxiety and uphold psychological balance when confronted with internal or external sources of stress. Gaining a comprehensive understanding of these mechanisms can assist healthcare professionals in identifying and effectively dealing with the underlying psychological issues present in their patients. +-----------------------+-----------------------+-----------------------+ | Common Defense | | | | Mechanisms | | | +=======================+=======================+=======================+ | Defense Mechanism | Meaning | Example | +-----------------------+-----------------------+-----------------------+ | Apathy | Indifference; lack of | \"I don\'t care what | | | interest, feeling, | she puts in my | | | concern, or emotion | evaluation, it won\'t | | | | change anything.\" | +-----------------------+-----------------------+-----------------------+ | Compensation | Balancing a failure | \"I ate a lot of | | | or inadequacy with an | candy yesterday, but | | | accomplishment | l also ate a big | | | | green salad.\" | +-----------------------+-----------------------+-----------------------+ | Conversion | Transformation of an | "I get a severe | | | anxiety into a | headache every time I | | | physical symptom that | see my ex with his | | | has no cause | new wife.\" | +-----------------------+-----------------------+-----------------------+ | Denial | Avoidance of | "I am healthy and | | | unpleasant or | fit. There is no way | | | anxiety- provoking | I have cancer, so I | | | situations or ideas | don\'t need all those | | | by rejecting them or | tests.\" | | | ignoring their | | | | existence | | +-----------------------+-----------------------+-----------------------+ | Displacement | Redirection of | \"I had enough | | | emotions away from | trouble handling that | | | the original subject | last patient. I | | | or object onto | don\'t need to deal | | | another, | with this | | | less-threatening | malfunctioning copier | | | subject or object | right now.\" | +-----------------------+-----------------------+-----------------------+ | Dissociation | Disconnection of | "I always getting | | | emotional importance | into fights with my | | | from ideas or events | neighbors, which is | | | and | odd because I teach | | | | an online course in | | | compartmentalizing | conflict | | | those emotions in | resolution.\" | | | different parts of | | | | awareness | | +-----------------------+-----------------------+-----------------------+ | Identification | Attribution of | \"I could pass that | | | characteristics of | certification test | | | someone else to | just like she did, | | | oneself or the | and I haven\'t even | | | imitation of another | studied the | | | | material.\" | +-----------------------+-----------------------+-----------------------+ | Intellectualization | Analysis of a | \"He didn\'t break up | | | situation with facts | with me because he | | | and not emotions | didn\'t love me. He | | | | just had too much on | | | | his plate at work at | | | | the time.\" | +-----------------------+-----------------------+-----------------------+ | Introjection | Adoption of the | \"My dad says I | | | thoughts or feelings | should stand up for | | | of others | myself, so I am going | | | | to be more | | | | assertive.\" | +-----------------------+-----------------------+-----------------------+ | Physical Avoidance | Keeping away from any | \"I can\'t go to that | | | person, place, or | hospital because | | | object that evokes | that\'s where my | | | memories of something | father died.\" | | | unpleasant | | +-----------------------+-----------------------+-----------------------+ | Projection | Transference of a | \"She leaves more | | | person\'s unpleasant | charts incomplete | | | ideas and emotions | than I do, so why am | | | onto someone or | I getting this | | | something else | warning?\" | +-----------------------+-----------------------+-----------------------+ | Rationalization | Explanation that | \"My partner drinks | | | makes something | every night to make | | | negative or | himself less anxious | | | unacceptable seem | about work.\" | | | justifiable or | | | | acceptable | | +-----------------------+-----------------------+-----------------------+ | Reaction formation | Belief in and | \"I really hate being | | | expression of the | in the military, but | | | opposite of one\'s | I always sign some | | | true feelings | people up at | | | | recruitment events.\' | +-----------------------+-----------------------+-----------------------+ | Regression | Reversion to an | \"I can\'t do at that | | | earlier, more | paperwork, and you | | | childlike, | can\'t make me.\" | | | developmental | | | | behavior | | +-----------------------+-----------------------+-----------------------+ | Repression | Elimination of | \"They tell me I was | | | unpleasant emotions, | hurt in that robbery, | | | desires, or problems | but I can\'t remember | | | from hate conscious | anything about it.\" | | | mind | | +-----------------------+-----------------------+-----------------------+ | Sarcasm | Use of words that | \"You have a nice | | | have the opposite | office fi you like | | | | working in caves.\" | | | meaning, especially | | | | to be funny, | | | | insulting, or | | | | irritating | | +-----------------------+-----------------------+-----------------------+ | Sublimation | Rechanneling | \"When I was a kid, I | | | unacceptable urges or | used to like to pull | | | drives into something | wings and legs of | | | constructive or | insects I'd catch. | | | | Now I am a biology | | | acceptable | teacher.\" | +-----------------------+-----------------------+-----------------------+ | Suppression | Voluntary blocking of | \"The doctor said I | | | an unpleasant | need more tests, but | | | experience from | I\'m going to take my | | | one\'s awareness | vacation first.\" | +-----------------------+-----------------------+-----------------------+ | Undoing | Cancelling out an | \"I had a big fight | | | unacceptable behavior | with my wife last | | | with a symbolic | night, but I'm going | | | gesture | to buy her some | | | | flowers on my way | | | | home today.\" | +-----------------------+-----------------------+-----------------------+ | Verbal aggression | Verbal attack on a | \"Why would you ask | | | person without | me that when you | | | addressing the | can\'t even control | | | original intent of | your children?\" | | | the conversation | | +-----------------------+-----------------------+-----------------------+ End of Life & Stages of Grief ----------------------------- As individuals grow older and their physiological capabilities and reserves diminish, they typically have a greater inclination to utilize healthcare services. Once individuals reach the age of 60, they often begin contemplating their own mortality. They come to the realization that a significant portion of their life has already passed, prompting them to contemplate the number of remaining \"prime years\" they have. Many individuals have adult children who reside far away and have established their own families and careers. As individuals age, it becomes increasingly challenging for them to sustain employment, upkeep their residence, and engage in activities they find pleasurable, as well as essential daily tasks, depending on their specific health conditions. They express concern that trivial matters, such as failing to purchase a necessary item at the supermarket or misplacing their keys, indicate the onset of dementia. Individuals whose ability to live independently has declined can be susceptible to elder abuse, which may encompass neglect or physical mistreatment, frequently carried out by overwhelmed caregivers or family members responsible for the care of the elderly person. A significant number of elderly individuals experience persistent sorrow as they witness the passing of friends, neighbors, and family members. Additionally, individuals may experience sorrow for themselves, reflecting on their past when they were younger and healthier, as well as lamenting the skills and capabilities they are currently or have already lost. They are exposed to numerous cliches, such as \"Simply focus on the present moment,\" \"Do not concern yourself with future uncertainties,\" and \"Your age is determined by your subjective perception.\" Nevertheless, these clichéd statements provide minimal solace to elderly individuals struggling with the harsh truths of the aging process. Every patient requires assistance when navigating the healthcare system, and older adults present a distinct group due to the numerous difficulties they encounter towards the end of their lives. The tangible obstacles are genuine, and the emotions of sorrow can be overpowering. This gives rise to a significant health issue among older individuals: depression. ### End-of-Life Struggles A significant number of elderly patients suffer from chronic or terminal illnesses, which motivates them to prepare for the end of their lives. Patients should plan for end-of-life care, as well as for funeral, burial, and cremation services. If the individual has a dependent, such as a spouse or partner, they will need to make financial or caregiving arrangements in preparation for their impending death. Additionally, it is necessary for the individual to have advanced directives, a will, and a durable power of attorney for healthcare document readily accessible. These preparations intensify the awareness of the approaching end of life and typically induce a state of anticipatory grief in both the patient and their loved ones. This indicates that they are experiencing the emotions and responses that grief elicits prior to the actual occurrence of the loss. ### The Stages of Grief Similar to the categorization of developmental stages, multiple theorists have delineated the different stages of grief. The most renowned theory is the five stages of grief. Elisabeth Kubler-Ross formulated this definition based on her extensive experience in caring for terminally ill patients. Medical assistants can gain insight into the experiences of grieving patients by being aware of these stages. These stages encompass various losses, such as the death of a loved one, loss of a body part or function, financial loss, loss of home, or any other significant losses that profoundly impact the individual. Individuals vary in their grieving processes. While some individuals may progress through the various stages of grief in a linear and sequential manner, others may experience multiple stages concurrently. Some individuals may choose to bypass one or multiple stages. The duration of the process can vary significantly. There is no universally correct method for experiencing and processing grief. The stages of grief as defined by Kubler-Ross are as follows: #### Denial At this stage, the bereaved individual is unable or unwilling to accept the reality of the loss. They may reject the existence of the illness and decline to engage in discussions about therapeutic interventions. Thought processes are a manifestation of the concept of self-denial. Provide assistance to the individual while avoiding actions that may strengthen their refusal to acknowledge the reality of their situation. Providing the patient with written information about the disease and treatment options, with the provider\'s approval, could be beneficial. #### Anger During this stage, the grieving individual may direct feelings of animosity towards others, including healthcare professionals (due to their inability to remedy or cure the disease). Thought processes are a manifestation of the concept of \"Why am I the one experiencing this?\" Do not interpret the patient\'s anger as a personal attack. Instead, assist them in comprehending that experiencing anger is a predictable reaction to grief. #### Bargaining During this stage, the individual experiencing grief tries to evade the reality of the loss by bargaining, for example, desiring to survive until a specific family event. The patient may also be seeking alternative remedies. They continue to hold onto the desire for their past existence, or existence in general, or at the very least, a delay in the inevitability of death. Thought processes embody the concept of \"Yes, me, but\...\" Pay close attention and provide encouragement to the patient to facilitate the ongoing expression of their emotions. #### Depression At this stage, the individual becomes fully aware of the situation and experiences feelings of sadness, isolation, and powerlessness. For instance, individuals may experience emotions of remorse and self-reproach due to their failure to prioritize their own well-being. They may either openly discuss it or choose to remain silent and not mention it. Thought processes manifest the concept of self-identification as \"Yes, it is I.\" Accompany the patient and refrain from exerting any influence on them to disclose their emotions. Express empathy and comprehension. Seeking referrals for a support group or counseling can be beneficial. #### Acceptance During this phase, the bereaved individual accepts the loss and begins strategizing for moving forward in life, even in the face of the loss or imminent loss. They are eager to endeavor to optimize the situation and develop fresh objectives while relishing novel connections. In the event of impending death, individuals will initiate the process of organizing funeral and burial logistics and may also contact acquaintances and relatives who have been absent from their lives in recent years. While there may still be lingering feelings of depression, there is also the potential for humor and amicable interaction. Thought processes manifest the concept of \"Yes, me, and I am prepared.\" Provide the patient and their family and friends with encouragement, support, and further education during this period.