(DD13-14) Patient Management PDF

Preview

Summary

####### BSArrange the following steps of the educational process in correct order.1. expressing needs stimulating motivation recognizing needs evaluating results reinforcing learning setting goals acting to achieve goals 1 copyright © 2013-201 4 - Dental DecksPATIENT MANAGEMENT####### BSIdentify eac...

Description

BS Arrange th e f ollowing step s of th e educationa l process in correct order.

1. expressing needs 2. stimulating motivation 3. recognizing needs 4. evaluating results 5. reinforcing learning 6. setting goals 7. acting to achieve goals

1 co pyrig ht ©

- Dent al Decks

PATIENT MANAGEMENT

BS Identify each of th e f ollowing statement s that ar e tru e concerning need s and learning.

needs are drivin g forces that promp t a perso n t o act the process of learnin g is continuous learning occurs a s a person attempts t o satisfy needs

expressing needs helps t o pinpoin t the m for th e patien t an d dentis t recording educational needs ca n be as importan t as recordin g

needs

all of th e abov e statements are true

2 co pyr ig ht © 2013-2014- Dent a l Decks

PATIENT MANAGEMENT

3,1,2,6,7,5,4 4 Although each learning situation will not follow these steps in exact sequence, most situa- • settin g goals tions will include all of these seven steps in • short-range or long-range guides to acsome form: tivity • must be meaningful , attractive & at• recognizing needs tainable • expressing needs 5 • stimulating motivation • actin g to achieve goals • setting goals • activity is needed for learning • acting to achieve goals • must be directed at specific goals • reinforcing learning 6 • evaluating results • reinforcin g learning • review & repetition aid in learnin g re tention • recognizin g needs 7 • dentist recognizes educational needs as treat• evaluatin g results ment needs are determined • ai d i n judgin g what patient has learned • dentist helps patien t recognize needs • aid in determinin g how effective Step 2 dentist's teaching has been • expressin g needs • can help clarify or redefine goals • dentist records educational needs • dentist helps patien t state needs 3 • stimulatin g motivation • motivation arouses & maintains interest • dentist may appeal to inner needs or use artificial stimuli

all of the abov e statements are true Needs & Learning • needs & goal s may provide motivation • motivation arouses & maintains interest • motivation ma y be artificial or builtin • patients rarely learn without motivation • learnin g is continuous an d occurs when a person attempts to satisfy needs • motivation stimulates a person to act on needs • motivation is a fundamental par t of every learning situation

& attained • goals shoul d be attractive & attainable in order to be meaningful • goal-directed activity is necessary for learning

Assessment of behavior • in order to change behavior , assessment of the behavior is needed • how to assess behavior - identify problem - consider motivation - consider readiness - consider willingness to change - consider ability to change - collect baseline data - reassess behavior after memtation

BS Most researchers believ e tha t changes in behavior ar e a prerequisit e to changes in attitude. Behavior can be define d as a determined , purposefu l unit of activity.

• bot h statements are true • bot h statements are false • th e firs t statemen t is true , th e secon d is false • th e firs t statemen t is false, th e secon d is true

3 copyright 0

Dental Decks

PATIENT MANAGEMENT

BS The principa l nonverba l cue that two or mor e persons can use to regulat e ver bal communication is:

• posture • facial expression • eye contact • gestures • proximity

4 copyright

PATIENT MANAGEMENT

- Dental Decks

• bot h statement s are true Be h avi or • changes in behavior ar e a prerequisite to changes i n attitude • be h avi or is defined as a determined, purposeful un i t of activity - determined the assumption tha t th e behavior is lawful & ha s determinants - purposeful the assumption tha t the behavior i s goal-oriented, tha t i t seeks to achieve positiv e an d reduce negativ e need or motivated states - un i t o f activity what a person does that can be reported or describe d as discrete elements

Be h avi or e xample s • a c o m m o n be h avi or for a de n ti s t is to obse r ve that a problem exists (e.g., tooth decay) • a com m on behavior for a patient is to avoid th e dentist even though a need exists & treatment i s required both of the abov e examples mee t the criteria of being "determined, purposeful units of human activity " Behavior m anagem ent • as described by the ADA , tech niques or therapie s used to alter or control the actions of a patient wh o is receiving dental treatment; examples or anxiety relief techniques • th e means by whic h the dental health team effectivel y an d efficiently performs treatment for the patient, and , a t th e same time , instills a attitude

• eye contact Communication • th e process by which information i s exchanged betwee n 2 or more persons • communication is essential in the dentist-patient relationship • acceptable verbal & non-verbal communication varies with sex, ethnicity an d culture of th e patient • communication is both verba l & non-verbal; also includes listening Verbal communication • involves use of language • choice of words i s important • delivery of speech is important (fast vs. slow, loud vs. soft) Non-verbal communication • involves use of body language • conveyed by eye contact, posture , body movement, hand gestures & expressions Empathy & Rappor t • empathy (is th e ability to experience the feelings of another person a mutual sense of trust and openness between individuals

Listening • receiving & understanding messages • a good listener shows attention & interest • listening techniques include • paraphrasing (repeating in own •

(identifying the underlying reason) for dis• preparation (allowing cussion & eliminating distractions) Eye contact • is th e principl e non-verba l cue used to regulate verba l communication • when listenin g to a patient, a dentist should maintai n eye contact • a dentist should engage the patient's eyes as often as is comfortable for both parties Facilitative skills • facilitative skills make communication easier and help to develop trust • include encouraging patien t questions, to reanswering questions, quests & communicating with warmth

BS Which term describes a behavioral response that operates by the simple process of association of one stimulus with another?

• operant conditioning • classical conditioning • observational learning

5 co pyrig ht ©

- Dent al Decks

PATIENT MANAGEMENT

BS Which type of aggression is an act of hostility unnecessary for self-protection or preservation that is directed towar d an external object or person?

• destructive aggression • inward aggression • constructive aggression

6 copyright

PATIENT MANAGEMENT

- Dental Decks

• classical conditioning Classical conditioning • a stimulus leads to a response • a.k.a. pavlovian or responden t condi tioning • a process of behavior modification by which a subject comes to respon d i n a desired manner to a previously neutral stimulus that has been repeatedly presented alon g with an unconditioned stimulus that elicits the desired response Operant conditioning • process of behavior modification in which the likelihood of a specific behavior is increased or decreased through positive or negative reinforcement each time th e behavior is exhibited, so that the comes to associate th e pleasure or displeasure of the reinforcement with the behavior • four types: positive reinforcement, negative reinforcement, punishment & extinction

Observational learning • or modeling, is a type of learning that occurs as a function of observing, retaining and replicatin g behavior executed by others i n a social context • two phases: acquisition of the behavior & performance of the behavior Example Classical conditioning • before conditioning, a painful injection (unconditioned stimulus) would elicit a fear reaction (unconditioned response) • during conditioning, the dentist with syringe (neutral stimulus) is linked with the painful injection and elicits a fear reaction • after conditioning, the dentist with a syringe (conditioned stimulus) will encourage a fear reaction (conditioned response)

• destructive a g g r e s s i o n Destructive aggression • act of hostility • unnecessary for self-protectio n or preservation • directed towar d externa l objec t or person Constructive aggression • act of • i n response to a threatenin g action • for purpose of self-protection and preservation aggression • destructive behavior directed against oneself

Aggressive personality • personality wit h behavior patterns characterized by irritability, tantrums, destructiveness or vio lence in response to frustration • aggressiv e personalities are individ whose overall "style" of inter acting involves considerable, persistent, maladaptive aggression expressed in a variety of ways and in a wide range of circumstances characteristics include the following: - seek a superior position in any relationship or encounter - abhor submission - self-advancing at expense of others - have disdain for truth - lack internal "brakes"

BS Match th e type of question on the left to the correct example on the r ight.

direct probing laundry list open-ended leading facilitating

2. 3. 4. 5. 6.

You're not afraid of needles, are you? How are you doing wit h brushing & you? Is it easier to hold the brush this way? What else did you notice about your gums? Is the pain sharp, dull, or throbbing?

7 Decks

PATIENT MANAGEMENT

BS Which one of th e followin g types of patients is usually considered to be the most difficult?

• the "know-it-all" patient • the anxious patient • the shy patient the talkative patient • the stubborn patient

co pyrig ht

PATIENT MANAGEMENT

- Dent al Decks

4,5,6,2,1,3 #

Ty pe

Exam ple

4 direct question

Is it easier to hold the brush way? direct questions asked for a specific bit of

5 probing question

What else did yo u notic e abou t your probing questions ask for more specific information that the Patient offers spontaneously

question

or throbbing? list Is the pain sharp, laundry list questions give the patient a list of choices

2 open-ended How are you doing wit h brushing & flossing? open-ended questions request information i n the patient's q uestion own words and specify a content area

X

1 leading question

You're not afraid of needles, ar e you? leading questions entice a patient to answer in a specific way; leading questions should not be used with patients

3 facilitating question

How are you? facilitating questions encourage the patient to say more without specifying an area or topic

C o m m u n i c a t i o n h i n ts • ask questions/never presume • carefully inquire/never interrogate • be specific/avoid bein g vagu e or abstract • provid e information & educate/instead of givin g advice • provid e accurat e information/fully discuss concern s & offer support • exhibi t i s an essential componen t o f dentist-patient relationships • exhibi t confidence , car e & warmth

• the anxious patient Anxious patient • is the mos t difficult patien t to manage in dentistry • anxiety is define d as unpleasan t nega tive emotiona l stat e without identifiable cause • anxiety is th e feeling of apprehension, uneasiness, agitation or uncertainty resulting from the anticipation of a threat of dange r whose source is unknown • most anxious patients have had a traumatic experience in a healthcar e setting • anxiety causes patients to avoi d dental treatment & interferes with treatment • anxiety may cause problems with pain Indicators of - patient is emotional, talks a lot, talks fast - patient is not listening & does not follow instructions increase in body movement & muscle tension psychological - increase in hear t rate, respiration, sweating & dry mouth

Management of th e anxious patient • be friendly • be calm & patient • build trust; use empathy & respect • create a relaxing environment • make th e patien t feel welcome • convey a sincere concern for patient's well-being • explain procedures before doin g them • encourag e th e patien t to ask questions • use understandable words • pay attention to wha t the patien t is saying and how it is said • forewarn patien t about possible pain • watch a patient's eye s & eyebrows to see if th e patien t is feeling pain • give patien t contro l by givin g option to "raise your hand if feel anything" • provide mora l suppor t during proce dure • use headphones or TV as a distraction (the of dis• use tress scale) to assess the level of pat ient anxiety throughout treatment; ask the patien t to rate their leve l of anxiety from 0 (none) to 10 (highest level)

BS Which type of parent has an excessively demandin g attitude?

• neglectful parent • overprotective parent • manipulative parent • hostile parent

copyright

- Dental Decks

PATIENT MANAGEMENT

pain) occurs.

statements

true

statements are false false true 10 right ©

• m anipulative parent Man i pulati ve p a r e n t • is demanding • demands usually star t with appoint me nt times • may tr y t o provid e diagnosis and di rect th e cours e of treatment Ove r pr ote cti ve p a r e n t • insists on remainin g wit h chil d in operatory regardless of situatio n or age of child • usually has a child wh o is shy, docile and manageable • by pointin g ou t th e lack of appre hension of the chil d an d the importance of establishing a one-on-one relationship betwee n the dentis t and child, this wil l usually satisf y most overprotective parents

Hostile p a r e n t • questions th e necessity of treatment • questions stem fro m distrus t and not curiosity Neglectful p a r e n t • fails to kee p appointments • misses recal l visits • does no t overse e ora l hygiene of child th e un coope r ati v e child • may be described as stubbor n or spoiled & is usuall y a chil d with defiant behavior • may be hostil e or angry ; with this child, th e dentis t mus t try t o iden tify the underlyin g source of these emotions

• b oth s t a t e m e n t s are true Dental fear • refers to the fear of dentistry and receiving dental care • i s defined as an unpleasan t mental, emotional or physiologi c sensation derived from a specific dental-re lated stimulus • elements common to all fears - fear of unknown - fear of injury - fear of loss of control - fear of helplessness & dependency • understanding th e above elements of fear allows for effective planning for the treatmen t of fearful & anxious patients • when evaluatin g a patient's dental fear, take note of wha t th e patient says and how the patient behave s & appears while in the dental office Dental anxiety • is defined as a non-specifi c uneasiness, apprehension or negative thoughts about what may happe n durin g a dental appointment • patients who ar e fearful or anxious avoid dental appointments

Stress • i s defined as th e body's reaction to a change tha t requires a physical , men tal or emotiona l adjustmen t or response • stress can be caused by physical, emotional or psychological influences Stress, anxiety, & fear • of stress, fear & anxiety — stress is associated with a response is the body' s response to danger is a feeling of uneasiness in response to imminen t danger is a feeling of uneasiness when no danger is present • th e interaction of the intensity of an emotional response with threat appraisal determines the behavior that will follow — whether to show up to a dental appointment, submi t to an injection, accept th e need for extraction etc.

BS A 32-year-old woman visits th e dental office for a routine dental cleaning. The dental hygienist discovers that the patien t has not been following th e home care program that was recommended six months ago. The hygienist believes that the problem is not a skills deficiency but a managemen t deficiency instead. What is th e best course of action for th e hygienist?

• accept that the patient might never change her habits • provide the patient wit h a pamphlet on periodontal disease • collaborate wit h the dentist to determine the course of action • go over brushing & flossing techniques

11 co pyrig ht

2013-2014- Dent al Decks

PATIENT MANAGEMENT

BS Behavior shaping is also called:

• aversive conditioning • successive approximation • restraining • hypnodontics

12 co pyrig ht

- Dent al Decks

• collaborat e wit h th e dentist t o determin e course of action Motivating the patient • reviewing home car e instructions will not solve th e problem, since this i s not a skills deficiency; a plan must be determined to motivate this patient • if the patien t knows what to do, and how to do it, members of the dental team must collaborate and fin d a way to motivate the patient to embrace the recommended home car e regimen Stages of change model (no admission of 1problem ) 2 - contemplation & change) 3 - preparation (getting ready to change) 4 - action / willpower (changing behavior) 5 - maintenance (maintain behavior change) 6 - relapse (abandon change)

Motivating patients • use good communication techniques • express empathy and engage the patient • identify the patient's curren t oral hygiene status and the agre e on achievable goals for improvement • avoid arguing; gently challenge the thought that underlies the behavior • support self-efficacy; encourage the patient to believe that they can change the behavior and the y will achieve their desired goals • develop a partnership with the patient • consult your patient & elicit their views , the patien t will feel that their voice is heard & their needs are considered • ultimately, the patient must believe that the decision to follow a particular course of action is theirs

successive approximation Behavior shaping • a.k.a. successive approximation • shaping is used whe n an existing behavior needs to be changed into a more appropriate or new behavior • th e strategy involves use of reinforce ment of successive approximations of a desired behavior • immediate positive reinforcement includes verbal praise and nonverbal indications of approval • each approximate desired behavior that is demonstrated i s reinforced, while behaviors that are not approximation s of the desired behavior ar e not reinforced • examples of behavior shaping methods and modeling include

Aversive conditioning • using a punishmen t or something u pleasant to stop an unwante d behavior • like all forms of punishment, i t may work but is less effective than reinforcement an example is the HOME technique (Hand-Over-Mouth) Hypnodontics • th e application of hypnosis and controlled suggestion i n dentistry Restraining • a dental restraint is defined as any form of restriction of movement by a patient in the dental environment • a dental restrain t includes the following characteristics : - short duration - limits movement of head & body - prevents injury to the patient and/or dental staff during the procedure - provides physical control to allow dental staff to complete treatment - is usually well tolerated by patient • an example is papoose

BS Which one of the following is a conceptual framework that describes a person's health behavior as an expression of his or her health beliefs?

• health maintenance model • health role model • health belief model • leading circle model

13 copyright ©

- Dental Decks

PATIENT MANAGEMENT

BS Behavior...