RESUMO
This article reviews the data related to psychosocial adjustment of young ICD recipients, postulates theories to explain potential adjustment difficulties to ICD therapy experienced by younger recipients, and suggests clinical management techniques for addressing the unique psychosocial concerns of young ICD recipients. Studies of young ICD recipients suggest that a wide range of psychosocial adjustment issues are prominent in the post-ICD implantation period and that the issues may be different from older ICD recipients. The disability-stress-coping model and the transactional-stress-coping model are postulated as explanations for the unique adjustment concerns of children and adolescents with ICDs. Social comparison theory is also applied to the concerns of young adults with ICDs such that they often lack same age peers to compare experiences with cardiac difficulties. Brief, clinic-based interventions by health care providers, like a screening and referral heuristic and an "ICD Buddy" system, are suggested to increase effective coping and decrease social isolation for young ICD recipients.
Assuntos
Adaptação Psicológica , Desfibriladores Implantáveis/psicologia , Ajustamento Social , Adolescente , Adulto , Fatores Etários , Criança , HumanosRESUMO
METHODS: This article incorporates known findings from the psychological literature regarding health behaviors and adjustment to cardiac illness with identified psychosocial needs of implantable cardioverter defibrillator (ICD) patients. An emphasis is placed on healthcare providers' unique ability to facilitate adjustment during routine patient contacts. RESULTS: Seven principles of supportive communication are presented to enhance healthcare providers' awareness of the psychosocial needs of ICD patients. A table of "quotes" representing each principle is provided to show how each form of supportive communication may be delivered to optimize health outcomes for ICD patients. CONCLUSIONS: Brief, routine communication between healthcare providers and ICD patients about psychosocial issues can facilitate patient adjustment. Although not sufficient to meet the needs of all ICD patients, supportive communication bolsters problem-solving and coping strategies of most ICD patients. For patients with more severe psychological adjustment difficulties, supportive communication may lead to better identification of patients who would benefit from referrals to mental health professionals.
Assuntos
Comunicação , Desfibriladores Implantáveis/psicologia , Apoio Social , Taquicardia/terapia , Humanos , Educação de Pacientes como Assunto , Relações Médico-Paciente , Qualidade de Vida , Autoeficácia , Taquicardia/psicologiaRESUMO
BACKGROUND: Previous research indicates that patients exiting a 12-week cardiac rehabilitation program (CRP) have difficulty maintaining an adequate exercise program. Thus, the authors' purpose was to determine if a home-based exercise program would enable patients to maintain/improve their blood lipids, body composition, and functional capacity after exiting the CRP. METHODS: Thirty-one patients exiting an initial 12-week CRP were assigned randomly to the home-based (HB) intervention or the standard care (SC) condition. After one home visit, the HB participants (n = 16) were contacted by telephone every other week by CRP staff and completed and returned weekly exercise logs. The SC participants (n = 15) had no contact with the CRP other than to schedule follow-up tests. A third group (n = 17), randomly selected from patients that elected to remain in the center-based CRP (CB) for the same duration, also were examined. All groups underwent exercise testing, fasting blood lipid analysis, and body composition assessment before starting CRP (0M), after 3 months (3M) in a standard CRP, and after 9 months (12M) in either HB, SC, or CB condition (12 months after starting CRP). RESULTS: Analysis of variance indicated that there were significant increases in metabolic equivalents and high-density lipoprotein, in all three groups, over time. However, analysis of covariance revealed no significant differences between the HB, SC, and CB groups at 12M for any variable. CONCLUSIONS: These data indicate that the HB program was as effective as the CB program at improving/maintaining functional capacity, blood lipids, and body weight/composition. The similar success of the SC group is likely due to their prior experience in CRP and knowledge of follow-up testing. Home-based maintenance program could be offered as a low-cost alternative to CB programs.
Assuntos
Composição Corporal , Doença das Coronárias/fisiopatologia , Doença das Coronárias/reabilitação , Terapia por Exercício/métodos , Serviços Hospitalares de Assistência Domiciliar , Lipídeos/sangue , Autocuidado , Idoso , Análise de Variância , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Doença das Coronárias/sangue , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Triglicerídeos/sangueRESUMO
Managing workplace conflict is one of the most important, stressful, and time-consuming tasks faced by today's medical leaders. Poorly managed workplace conflict can alienate patients, demoralize staff, increase turnover, damage relationships with valued referral sources and third party carriers concerned about patient satisfaction, and lead medical practices to costly "corporate divorces." Physician executives cannot solve the problems caused by disruptive doctors simply by bolstering their own conflict management skills or by policing offenders. The larger contexts within which inappropriate workplace behavior occurs must also be assessed and addressed. The true leadership challenge is to intervene in ways that help to foster a "culture" of appropriate interpersonal dynamics throughout your organization. This requires learning to think and to intervene systematically.
Assuntos
Conflito Psicológico , Liderança , Corpo Clínico Hospitalar/psicologia , Negociação/métodos , Humanos , Moral , Satisfação do Paciente , Diretores Médicos , Relações Médico-Enfermeiro , Estresse Psicológico/prevenção & controle , Estados Unidos , Local de TrabalhoRESUMO
Managing workplace conflict is one of the most important, stressful, and time-consuming tasks faced by today's physician leaders. In Part 1 of this article series, the authors describe how to assess an organization's interpersonal dynamics. True change comes from interventions that help an organization to become a positive interpersonal culture, one that fosters cooperation and collaboration. Part 2 offers seven steps to solving the disruptive physician problem: (1) provide protection to complainants; (2) listen, empathize, and avoid communication triangles; (3) confront offenders with data, authority, and compassion; (4) if needed, get outside help; (5) offer workplace training and experiences that foster positive relationships; (6) follow-up; and (7) practice what you preach. The self-assessment and intervention guidelines discussed in this series of articles can help physician executive move beyond struggling with episodes of conflict to shaping stress-resilient medical organizations.
Assuntos
Conflito Psicológico , Negociação , Gestão de Recursos Humanos/métodos , Diretores Médicos , Comunicação , Comportamento Cooperativo , Humanos , Relações Interpessoais , Relações Interprofissionais , Cultura Organizacional , Estados UnidosAssuntos
Esgotamento Profissional , Pessoal de Saúde/psicologia , Apoio Social , Adaptação Psicológica , Saúde da Família , Feminino , Humanos , Capacitação em Serviço/organização & administração , Relações Interpessoais , Relações Interprofissionais , Masculino , Inovação Organizacional , Política Organizacional , Estados Unidos , Mulheres Trabalhadoras/psicologiaRESUMO
Family challenges, depression, and age-related developmental and psychological issues must be considered when structuring interventions for elder cardiopulmonary patients. Elderly patients tend to have difficulty coping when they face novel, unpredictable circumstances and are left to flounder in suspenseful anticipation. Furthermore, if support is not forthcoming during such times--or if they are treated in ways that strip them of control rather than in ways that bolster their sense of control--elderly patients are at great risk of quickly developing a passive, learned helplessness that can significantly complicate their rehabilitation. The overall well-being of elderly cardiopulmonary patients is affected by more than the actions of health-care providers. Poverty, pension and health-care plans, institutionalization, concomitant diseases, family issues, and other factors have a profound and, frequently, an overriding effect on the functional status of the elderly population. However, it is also true that the provision of spirit-enhancing care can make a tremendous difference in quality of life for elderly patients, independent of factors such as residential circumstance or health status. The most valued and valuable sources of social support for elderly patients come from family, church, and health-care providers. Our interventions either enhance or diminish an elderly patient's sense of autonomy and control. Our task-driven health-care system, replete with its growing emphasis on brevity of treatments and cost-effectiveness, can create a style and pace of delivering care that demoralizes an elderly patient. The results can be devastating: "When the spirit is broken, one has no will to marshall coping skills". But health-care providers who are attuned to the psychosocial issues relevant to the later life stages can make a profound difference in enhancing both rehabilitation and quality of life for elderly cardiopulmonary patients and their loved ones.
Assuntos
Cardiopatias/reabilitação , Pneumopatias/reabilitação , Idoso , Idoso de 80 Anos ou mais , Feminino , Geriatria , Cardiopatias/psicologia , Humanos , Pneumopatias/psicologia , Masculino , Avaliação de Resultados em Cuidados de Saúde , Relações Médico-Paciente , Qualidade de VidaRESUMO
One of the most difficult aspects of physician leadership is addressing angry colleagues. The first article in this series called attention to the problems that come with the Type A coping styles of many physicians and outlined strategies for managing oneself. Part 2 provides specific strategies that can be helpful in managing others' anger-generating behaviors and anger reactions. There are eight practical communication guidelines recommended by experts in the field for managing anger in others. They include: Strike while the "iron is warm." Match, then lead. Stay in your own zone. De-escalate the other's angry reactions. Do something different. Be assertive, not aggressive. Use effective negotiation tactics. Operationalize the problem.
Assuntos
Ira , Gestão de Recursos Humanos , Médicos/psicologia , Comunicação , Guias como Assunto , Humanos , Relações Interprofissionais , Liderança , Negociação , Estados UnidosRESUMO
Angry physicians create problems--for the people they treat and work with, for their administrators, and for their loved ones. Addressing negative emotions is one of the most prevalent organizational and personal challenges facing physician leaders. Solving this problem starts with taking an honest look at the factors and processes that shape physicians' coping patterns. Learning effective emotional management skills is underscored by a simple fact: Emotions are contagious. The Type A behavior pattern (TYABP) refers to an aggressive coping mode. Cross-cultural research suggests that, compared to the general population, physicians show elevated scores on TYABP measures, and that women physicians are at particular risk of developing TYABP. In Part 2 of this series, interpersonal anger management strategies will be presented.
Assuntos
Ira , Corpo Clínico Hospitalar/psicologia , Médicos/psicologia , Adaptação Psicológica , Ansiedade/epidemiologia , Comportamento , Depressão/epidemiologia , Emoções , Feminino , Humanos , Masculino , Personalidade/classificação , Psicologia Industrial , Estados Unidos/epidemiologiaRESUMO
This paper reviews the literature concerning the penile prosthesis. Included are discussions of the historical development of the penile prosthesis, characteristics of patients treated with prosthetic implantation, assessment techniques utilized in patient selection, and the relative outcome and complication rates for the two major types of prostheses. Recommendations regarding future research and practice are presented throughout.
Assuntos
Disfunção Erétil/terapia , Pênis , Próteses e Implantes , Disfunção Erétil/etiologia , Humanos , Masculino , Pênis/cirurgia , Próteses e Implantes/história , Desenho de PróteseAssuntos
Diabetes Mellitus , Disfunção Erétil/terapia , Próteses e Implantes , Adulto , Complicações do Diabetes , Disfunção Erétil/etiologia , Disfunção Erétil/fisiopatologia , Disfunção Erétil/psicologia , Humanos , Masculino , Terapia Conjugal , Pessoa de Meia-Idade , Planejamento de Assistência ao Paciente , Desenho de PróteseRESUMO
This study investigated the impact of group systematic desensitization (SD) on varied aspects of sexual functioning in primary and secondary nonorgasmic women. After serving as their own controls, 22 women (eight primary, 14 secondary) received 15 sessions of group SD using four common hierarchies of sexual scenes. The measures were administered to each subject and her regular sex partner at each of the testing periods. Significant positive treatment effects were found on measures of general and specific sexual adjustment and in extracoital orgasmic frequency. Treatment also enhanced sexual communication among subjects and their partners, increased the females' acceptance of their mates as being satisfactory sexual partners, and increased the females' self-acceptance as sexual beings. All but one of the treatment effects (degree of pleasure experienced during extracoital stimulation) were maintained at the 6-week follow-up. Secondary subjects reported significantly greater pleasure from coital and extracoital stimulation and significantly increased frequency of orgasm in response to extracoital stimulation than primary subjects. Primary and secondary subjects did not differ in their evaluation of the experiment. The need for controlled comparative treatment investigations is stressed.
Assuntos
Terapia Comportamental/métodos , Dessensibilização Psicológica/métodos , Orgasmo , Psicoterapia de Grupo/métodos , Disfunções Sexuais Fisiológicas/terapia , Adulto , Ansiedade/terapia , Feminino , Humanos , Masculino , Casamento , Testes Psicológicos , Educação Sexual , Comportamento SexualAssuntos
Psicoterapia , Disfunções Sexuais Fisiológicas/terapia , Dessensibilização Psicológica , Estudos de Avaliação como Assunto , Extinção Psicológica , Feminino , Humanos , Hipnose , Masculino , Terapia Conjugal , Métodos , Contração Muscular , Psicoterapia de Grupo , Projetos de Pesquisa , Educação Sexual , Disfunções Sexuais Fisiológicas/tratamento farmacológicoRESUMO
This study investigated the impact of self-monitoring on smoking patterns of internal and external smokers. Eighty-nine Ss charted their smoking behavior (number of cigarettes per day) on a daily basis for 4 consecutive weeks, after which personality measures were administered. Self-monitoring produced wide changes in reported cigarette consumption, although this procedure did not change significantly smoking behavior for the entire sample. Ss were divided arbitrarily into three categories: Ss who increased 20 cigarettes or more, Ss who decreased 20 cigarettes or more, and Ss who increased or decreased up to 19 cigarettes. Negative affect traits, locus of control, and self-concept variables did not differentiate increasers, decreasers, or maintainers. Ss who increased consumption reported greater reinforcement value from solitary related as opposed to socially oriented functions than the decreasers and the maintainers. Future studies should explore the meaningfulness of an intervention designed to improve the smoker's social interactions.
Assuntos
Terapia Comportamental , Autoimagem , Autoavaliação (Psicologia) , Fumar , Adulto , Afeto , Feminino , Humanos , Controle Interno-Externo , Relações Interpessoais , Masculino , Pessoa de Meia-Idade , Personalidade , Reforço Psicológico , Comportamento SocialRESUMO
This study investigated whether six women who previously had received 15 sessions of group systematic desensitization (SD) for their sexual anxiety would report additional treatment gains from participation in a sexual-enhancement workshop with their partners. After group SD six couples participated in six, 1 1/2 hour weekly group sessions. The women reported a significant increase in marital adjustment and a significant decrease in sexual anxiety. A significant decrease was found in the women's sexual nonresponsiveness as perceived by their partners. Future studies should (1) contrast the effects of group SD with women alone versus couple group treatment, (2) determine which treatment components are most influential for defined subject types, and (3) obtain data on men's sexual functioning.
Assuntos
Ansiedade/terapia , Terapia Comportamental , Dessensibilização Psicológica , Terapia Conjugal , Disfunções Sexuais Psicogênicas/terapia , Estudos de Avaliação como Assunto , Fantasia , Feminino , Humanos , Masculino , Psicoterapia de Grupo , Psicoterapia Múltipla , AutoestimulaçãoRESUMO
This study assessed the impact of structured and unstructured leader roles on measures of outcome for Ss who differed on the pretest dimension "locus of control." On the basis of their pretest locus of control scores, Ss were assigned to a structured or an unstructured marathon group. The treatment in the two 16-hour -arathons consisted of a defined series of exercises; the only difference between the two groups was the degree of leader control over member participation. As predicted, internal Ss in the unstructured group rated the leader and the group more psoitively than did external Ss, while the reverse responsivity occured in the structured group. Significant Locus of Control X Treatment interactions indicated that internal and external Ss reflected differential shifts in general anxiety, general depression, and locus of control as a function of treatment. The relationship between changes in self-actualization and locus of control and changes in conflict-handling styles and negative affects differed as a function of locus of control and treatment condition. The overall results coupled with prior findings tentatively support the appropriateness of an unstructured leader role for internal scores and a structured leader role for external scorers.