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Approach - As by an anthropologist (scholar of human beings, across time and situations) - We can look at the culture (beliefs, customs, language, etc. of a particular society, group, place, or time) of hospitals - And see they have their own set of interaction patterns, rules and...

Approach - As by an anthropologist (scholar of human beings, across time and situations) - We can look at the culture (beliefs, customs, language, etc. of a particular society, group, place, or time) of hospitals - And see they have their own set of interaction patterns, rules and rituals Empathy - Understanding a person from his or her frame of reference rather than one's own - Walking a mile in their shoes Patient - A person receiving or registered to receive medical treatment Patient Categories - Inpatients = (\> 24 hrs) receiving diagnostic/therapeutic procedures that require overnight admission to the hospital for close monitoring - Outpatients = (\< 24 hrs) non-invasive procedures do not require overnight admission, may be done out of hospital - Emergency = unexpected entry to hospital under emergency circumstances - May be admitted for overnight or released in same day Psychological Reactions - Perceived loss of control is a common experience - In Halfens (1995), deference (humble submission) to powerful others rose during a hospital visit for a surgical operation from levels a week before and after the visit Loss of Control - Stack and Martin (2005) showed - Less patient autonomy (i.e., decision-making input in treatment) poorer health outcomes (higher death & lower successful kidney transplant rates) - Psychological reactance (Brehm, 1966) occurs in response to threats to autonomy - Incompliant & defiant behaviors - Miller et al. (2007) -- studied reactance and health promotional messages---be sure to use non-prescriptive language, always imply choice - Reactance is higher in the educated, those who live in autonomous environments (i.e., high SES), men, hostile & quick to anger - E.g., *Conscientious Responders Scale* - "In response to this question, please choose option four, "Agree."' - Learned helplessness (Seligman, 1975) belief nothing can be done to improve a difficult situation Countering Loss of Control - Provision of information (i.e., empowering care) hospital stay patient satisfaction - Reduces uncertainty -...which reduces worry Nurses Make the Culture - Nurses have most direct contact with patients - Therefore, nurses have a big impact on patient hospital experiences Nurses - Enculturated in terms of their practices with patients (therapeutic rituals: medicating and bathing patients) -...and other nurses & healthcare workers (occupational rituals: uniforms, hierarchy, jargon) Nurse Burnout Impact - Leiter et al. (1998) - 700 nurses & 600 patients, across specializations, completed *Maslach Burnout Inventory* and satisfaction with care questionnaires - Strong correlations between nurse burnout & patient rating of nursing care (below), doctors, provision of info, & overall experience - Personal Achievement \>.50 - Emotional exhaustion \> -.50 - Cynicism/Depersonalization \> -.50 - Intention to quit \> -.50 Striking A Balance Between - A total institutional experience, where all autonomy taken from individuals (less satisfaction but care is quick, simple) - Patient-centered experience, in which patient & family are involved in decision making processes (more satisfaction but care is slow, complex) **Psychological Impact of Medical Procedures** Psychology of... - Colonoscopy = test that allows your doctor to look at the inner lining of your large intestine (colon) and rectum - To look for irritated tissues, polyps or cancer - Despite its effectiveness at reducing mortality risk of colorectal cancer (2^nd^ most common cancer killer), it is underutilized - During a colonoscopy, a long, flexible tube (colonoscope) is inserted into the rectum, 30-60 min Barriers - In Denberg et al. (2005), half of 647 referrals for first-time appointments were no shows. Follow-up surveys found: - Cognitive-emotional = women, young, lack of perceived risk, fear of pain, modesty, 40% lack info of alternative screening techniques - Other = scheduling issues, health issues Mammography - a mammogram is an x-ray picture of the breast. Screening mammograms are used to check for breast cancer in women who have no signs or symptoms of the disease - Benefits - Early detection of breast cancer treatment can be started earlier in the course of the disease, possibly before it has spread - Studies show that mammography can help reduce the number of deaths from breast cancer among women \> 40 (especially over 50), but no evidence for \< 40 Error - False-positives (Type I errors) occur when radiologists decide mammograms are abnormal, but no cancer is present (about 10%) - More Type I: - When mammograms are abnormal & women called in for further examination (biopsy=removal of a small piece of tissue for laboratory examination) - 75% of biopsies are benign (=harmless) - Causes unnecessary anxiety & distress? - False-negatives (Type II errors) occur when radiologists decide mammograms are normal, but cancer is present - Lose valuable treatment time Magnetic Resonance Imaging - Is a noninvasive medical device that helps diagnose & treat medical conditions - A powerful magnetic field, radio frequency pulses, & a computer to produce detailed images of virtually all internal body structures - MRI - It's a small loud, hot space (about 60 cm diameter), people get claustrophobic (=fear of confined spaces) - scanned area must be in the middle of the tube - About 10% report feeling uncomfortable & 2% bail - Relax: bring music, friend, close eyes, etc. - Must stay perfectly still for 30 minutes - Any movement causes motion artifacts (blurred images), which negatively affects their diagnostic value **In the Hospital** Emergency - 53% of hospital admissions through emergency (i.e., unplanned), & these stays are longer than planned stays - 29% are discharged same day without diagnosis or treatment, 15% arrive by ambulance - These departments are often hectic, understaffed, which leads to communication issues with patients feel lost in the shuffle - Patients are triaged (prioritized) which leads to distressed (e.g., "I was here before that guy!") Intensive Care - Greatest density of high-tech. equipment (e.g., life support) - Patients & family experience emotional distress during & after their stays - Relocation stress (i.e., separation anxiety) Palliative Care - primary goal is to help patients achieve the best possible quality of life right up until the end of life, also called end-of-life care - Patients whose illnesses are progressive (getting worse despite treatment) & advanced (death is imminent) February 6, 2015:\ Death with Dignity - Supreme Court of Canada legalized euthanasia (physician-assisted suicide) - Eligibility criteria: - patients must be of adult age - mentally competent, capable of giving consent - suffering from a condition which is considered physically or psychologically intolerable - a willing doctor (can't be forced) - "Do No Harm", from the *Hippocratic Oath*, is the foundation of the medical profession - "With regard to healing the sick, I will devise and order for them the best diet, according to my judgment and means; and I will take care that they suffer no hurt or damage." - Prior to this ruling, assisted suicide was illegal & punishable by up to 14 years in prison - Dr. Jack Kervorkian **[Chronic Illness/Disease]** - Health conditions that people live with for 1 year or more and require ongoing medical attention or limit activities of daily live - Range from preventable to unpreventable - DVs: life/death, health, quality of life Smoke Stats - Role in 20% of deaths in USA per year, about 480,000 - CDC, 2023 - A smoker lives 10 years fewer, but quitting by 35 leads to no difference in death rates - Thompson, 2022 Overweight - The fundamental cause of obesity & overweight is an energy imbalance between calories consumed & calories expended CDC Identifies Cause - Many factors can contribute to excess weight gain including eating patterns, physical activity levels, and sleep routines. - Social determinants of health, genetics, and taking certain medications also play a role. Overweight is Major Risk Factor - Cardiovascular diseases - Diabetes 2 - Musculoskeletal disorders - Some cancers Big in Canada - Canadian Community Health Survey (2004) - 36% overweight (BMI [\>] 25) - 23% obese (BMI [\>] 30) - In 2017, 64% of CDNs are overweight The Bad News - It's getting worse, especially for kids - 2004, about 10% are obese - 2020, 14% are obese - Epidemic? An outbreak of a contagious disease that spreads rapidly and widely According to the WHO - Worldwide obesity has nearly doubled since 1980 - In 2008, 35% of adults were overweight (1.4 billion) and 11% were obese Cafeteria Diet Effect - Experimental system for inducing obesity in lab animals - Don't force. Let rats choose among a selection - Remains most effective way to induce obesity - Remains most effective way to induce obesity - This diet rapidly induces weight gain and body fat accumulation in rats allowing for the study of effects of overeating and obesity - In humans, exposure to a variety of foods causes excessive food intake & weight gain - Degree of overeating varies by individual, but nearly everyone overeats 3 Important Environmental Cues - Palatability = the tastier the food, the more we eat - Availability = the bigger the portion, the more we eat - Variety = more variety, the more we eat Role of Dopamine in Pleasure and Addiction - Obese individuals, the scientists have found, have fewer working dopamine receptors than normal-weight subjects **Less Controllable Illness/Disease** Cancer - Is a class of diseases characterized by out-of-control cell growth - There are over 100 different types of cancer - Each is classified by the type of cell that is initially affected or location of cancer Uncontrolled Cell Growth - Cancer harms the body when damaged cells divide uncontrollably to form masses of tissue called tumors - Tumors that stay in one spot and demonstrate limited growth are called benign Tumors - Problem tumors are called malignant - Because they spread throughout the body using the cardiovascular system, called metastasis - Or divide and grow using new blood vessels to feed itself, called angiogenesis Adhesion Properties of Cancer Cells - They can become unstuck at the primary site and travel, then get stuck somewhere else - Only 10% of cancer deaths are caused by the primary site tumors In Canada - 1 in 4 will die from it - 40% women and 45% men will get it Oncology - Is the study and treatment of cancers - Recently oncologists had a boost in their credibility - A genius died Magical Thinking - Potions - Crystals - Mantras - Steve Jobs had a form of cancer that is not usually fatal (\< 10%) - But he chose to undergo "alternative" treatment options before seeking conventional treatments - By the time he went conventional, it was too late Treatment - Radiation -- ionizing radiation damages DNA of exposed cells, leading to cell death; shot in at angles to intersect at tumor and spare surrounding normal tissue - Chemotherapy -- drugs toxic to cells that divide rapidly, cancerous and normal - Surgery -- removal of tumor and surrounding normal tissue - Hormone therapy -- for prostate and breast cancer patients, to block hormone-responsive cancer cells & reduce levels of hormones Living With Cancer - Some look at it like a threat, some like a challenge - Most common forms of suffering: - Physically\--pain and fatigue - Psychologically\--depression and fear Physically - Pain is most common and 90% is treatable - But much of it goes untreated - To not get addicted - Forgetfulness - Belief that pain should be tolerated Psychologically - 10 -- 58% experience depression depending on form of cancer - Fear of pain is common and ironic given that those who fear pain experience more of it compared to those who don't Nathan DeWall - Hypothesis: different forms of pain use same neural mechanisms that register pain - Showed this in a series of studies manipulating Tylenol usage on a social pain questionnaire DV and... -...manipulation of social exclusion by Cyberball on neural activation of physical pain networks - So, it's no surprise that the sensation of physical pain in cancer patients is correlated with their sensation of psychological pain Cancer and Coping Style - Psychological response influenced by coping style - Emotion-focused coping \-- focus on reducing the emotional impact of disease, typically through avoidance - Problem-focused coping \-- focus on addressing stressors, typically through action (e.g., compliance, increasing knowledge) Social Support - Informational, emotional, and practical - E.g., support groups \-- members can provide empathy, knowledge from shared experiences - E.g., education/information \-- attempts to alleviate emotional distress - E.g., transport, housing Medications and Psychotherapy - Antidepressants -- to alleviate depression, but possible interactions with other cancer-related treatment(s) - Psychotherapy -- cognitive-behavioral therapy (CBT) can be used to help patient adopt a problem-focused approach to coping with cancer Psychotherapy - Has been found useful as a method of pain management - Helpful for family caregivers who also experience emotional and physical distress Diabetes - A metabolic disease in which the body can't produce insulin -... Or properly use the insulin it produces Insulin - A hormone produced by the pancreas - Causes cells in the liver, skeletal muscles, and fat tissue to absorb glucose from the blood, where it can be used for energy Too Much, Too Little Blood Sugar **Hyperglycemia (over-eat)** Need for frequent urination - Drowsiness - Nausea - Extreme hunger and/or thirst - Blurred vision **Hypoglycemia (under-eat, over exercise)** - Shaking - Fast heartbeat - Sweating - Anxiety - Dizziness - Extreme hunger - Weakness and tiredness - Irritability **Diabetes** - Leads to high blood sugar levels over time, which can lead to disorders of the circulatory, nervous and immune systems - Affects 4 million Canadians (about 10% of the population) Type I (10% of all cases) - Type I: little to no insulin produced by pancreas - From childhood, genetic component, 15 years off - Monitor blood sugar, inject insulin - More prevalent in First Nations, African, and Hispanic people Type II (90% of all cases) - Type II: an impairment in the way the body regulates and uses sugar (glucose) as a fuel - Develops in adulthood, lifestyle, 10 years off - Monitor blood sugar, watch what they eat - More prevalent in the overweigh with rich diets - Signs and symptoms often develop slowly. In fact, you can be living with type 2 diabetes for years and not know it. - When signs and symptoms are present, they may include: - Increased thirst - Frequent urination - Increased hunger - Unintended weight loss - Fatigue - Blurred vision - Slow-healing sores - Frequent infections - Numbness or tingling in the hands or feet - Areas of darkened skin, usually in the armpits and neck - Increased thirst, frequent urination - Increased hunger - Unintended weight loss - Fatigue - Blurred vision - Slow-healing sores - Frequent infections - Numbness or tingling in the hands or feet **Risk Factors** Weight Fat distribution Inactivity Family history Race and ethnicity Blood lipid levels Age Prediabetes **Prognosis** - There is no cure for diabetes, maybe Ozempic? - - But it is possible to manage (Type I) or reverse the condition (Type II) to where you do not need medication to manage it and your body does not suffer ill effects from having blood sugar levels that are too high **Fear** - Patients who experience negative symptoms experience more fear, and those with more fear, more symptoms - Fears may relate to - Decreased self-efficacy inadequate management (e.g., monitoring, diet) - Possible long-term consequences of disease (e.g., amputation, blindness, stroke) **Depression** - Depression twice as common among diabetics than non-diabetics (about 10%) - May cause difficulty in communicating about emotions and accepting help - Coping: - Ensure a patient adheres to medical advice - Remember, the more that one's lifestyle has to change, the less likely one will adhere - Then deal with psychological issues - Medication and CBT **Cardiovascular Diseases** - One in every 3 deaths in Canada has cardiovascular disease as the underlying cause. - Health psychologists focus on: - Myocardial infarction (heart attack) - Coronary artery bypass graft (bypass surgery) - Angioplasty (surgery to open a blocked artery) Fear and Depression - Anxiety and fear of future attacks leads to cardiac invalidism \-- limiting one's activity more than is necessary - Negatively impacts quality of life, creates unhealthy sedentary lifestyle - Increases risk of future heart attacks - Depression extremely common - Worse for women and people over 65 - Increases risk for future cardiac problems and death **Proactive and Reactive Treatment** - Surgery - Medication -- blood thinners - And... **New Meta-analysis** - Of 305 randomized-controlled trials involving 340,000 individuals Exercise at least as effective as some drugs in reducing the risk of death in stroke and heart-disease patients