Teaching videos

The training videos were made by the University of Exeter and ActorFactor with funding from The Higher Education Academy Psychology Network.

The project co-ordinator was Jill Bleiker, who also wrote the accompanying questions.

These pages may be freely used for educational purposes but should not be downloaded or copied without permission. All materials copyright © The University of Exeter 2009 & 2010.

Psychology in patient care

How to use these pages

The ethos of healthcare today puts the patient at the centre of all we do; however all too often patient's experiences can leave them confused, dissatisfied or downright unhappy.

The material here follows Emma, a student radiographer, on her first clinical placement. It is divided into six sessions each containing two short video clips. The first video in each session illustrates the interactions between patients, those accompanying them and a health care professional. The second clip offers the patient's reflections on their experience, with the exception of the final session which ends with Emma's reflections on her time on placement.

Each session contains a common set of suggested questions following a problem-based learning approach suitable for seminars and group discussions. Students can draw on their own learning and experiences to reflect on and identify how they would improve the patient experience.

This can then be used to inform student's own clinical practice. Additionally, some self-test questions and answers are provided, though these can be adapted to meet individual requirements.

An aggressive encounter

Problem-based learning

  1. Summarise the events portrayed in the clip in your own words
  2. What psychological theories, or models of health do you think the clip is aiming to illustrate?
  3. Why is this clip important in patient care?
  4. What do you think is the impact on the patient?
  5. What do you think are the factors that affect a practitioner's skills in communication/patient care?
  6. How might what you have learned from this clip be used to influence and improve your own patient care i.e. is that the way it should be done or would you do it differently and if so how?

Clip-specific questions

Question: What theories of aggression could explain Brian's behaviour in the ultrasound waiting room?

Answer: Social Learning Theory (Bandura 1971), reinforcement (operant conditioning Skinner 1974), Frustration-Aggression (Dollard et al 1939), Berkowitz Cue arousal theory (1966)

Managing aggression

  • Has this shed any new light on your answers to the questions above?

Clip-specific questions

  • Identify some of the verbal and non-verbal cues used by Emma in the second clip which are more effective in managing Brian's aggressive behaviour.

Assumptions

Problem-based learning

  • Summarise the events portrayed in the clip in your own words
  • What psychological theories, or models of health do you think the clip is aiming to illustrate?
  • Why is this clip important in patient care?
  • What do you think is the impact on the patient?
  • What do you think are the factors that affect a practitioner's skills in communication/patient care?
  • How might what you have learned from this clip be used to influence and improve your own patient care i.e. is that the way it should be done or would you do it differently and if so how?

Clip-specific questions

  • What are the three components of the stereotyping behaviour exhibited by the radiographer?
  • How does Goffman (1968) define stigmatisation?
  • What is the toxic end-product of stereotyping?

Answers

  • What are the three components of the stereotyping behaviour exhibited by the radiographer? Answer: Cognitive, Affective, Behavioural (Rosenberg & Hovland 1960)
  • How does Goffman (1968) define stigmatisation? Answer: "Undesired differentness"
  • What is the toxic end-product of stereotyping? Answer: Prejudice

Clifford's reflections

  • Has this shed any new light on your answers to the questions above?

First impressions

Problem-based learning

  • Summarise the events portrayed in the clip in your own words
  • What psychological theories, or models of health do you think the clip is aiming to illustrate?
  • Why is this clip important in patient care?
  • What do you think is the impact on the patient?
  • What do you think are the factors that affect a practitioner's skills in communication/patient care?
  • How might what you have learned from this clip be used to influence and improve your own patient care i.e. is that the way it should be done or would you do it differently and if so how?

Clip-specific questions

  • Which theory of communication would have helped Emma to close the consultation more effectively and leave Mrs Cookson feeling happier?

Mrs Cookson's reflections

  • Has this shed any new light on your answers to the questions above?

Clip-specific questions

Can you explain Mrs Cookson's confusion in her reflections about the wasted appointment for MRI?

Answers

Can you explain Mrs Cookson's confusion in her reflections about the wasted appointment for MRI?
Answer: She could be in a state of cognitive dissonance (Festinger 1956) - the staff are so kind, but she is unhappy at the way she was treated. Boundaries (repeat CXR)

Boundaries

Problem-based learning

  • Summarise the events portrayed in the clip in your own words
  • What psychological theories, or models of health do you think the clip is aiming to illustrate?
  • Why is this clip important in patient care?
  • What do you think is the impact on the patient?
  • What do you think are the factors that affect a practitioner's skills in communication/patient care?
  • How might what you have learned from this clip be used to influence and improve your own patient care i.e. is that the way it should be done or would you do it differently and if so how?

Clip-specific questions

  • Did Emma gain informed consent for the repeat x-ray?
  • What are the issues around age of consent in this example?

Kate's reflections

  • Has this shed any new light on your answers to the questions above?

Answers

  • Did Emma gain informed consent for the repeat x-ray?

Answer: No, Emma did not explain clearly why the repeat was needed and the possible risks or benefits.

  • What are the issues around age of consent in this example?

Answer: Kate is legally a child, but the law allows children aged 16-18 to consent to procedures if the radiographer can be sure he/she understands the procedure (Gillick/Fraser competence)

Problem-based learning

  • Summarise the events portrayed in the clip in your own words
  • What psychological theories, or models of health do you think the clip is aiming to illustrate?
  • Why is this clip important in patient care?
  • What do you think is the impact on the patient?
  • What do you think are the factors that affect a practitioner's skills in communication/patient care?
  • How might what you have learned from this clip be used to influence and improve your own patient care i.e. is that the way it should be done or would you do it differently and if so how?

Clip-specific questions

  • Define stress as experienced by Mandy after her ultrasound scan.
  • Can you identify the 5 components of the therapeutic conversation (Burnard 1987) which would have made Mandy's difficult experience in the ultrasound suite less distressing?

Answers

  • Define stress as experienced by Mandy after her ultrasound scan.

Answer: A perceived discrepancy between the demands of the situation and the resources of the person (Lazarus & Folkman1984b)

  • Can you identify the 5 components of the therapeutic conversation (Burnard 1987) which would have made Mandy's difficult experience in the ultrasound suite less distressing?

Answer: emphasis on the here & now, focus on feelings, empathic understanding, non-prescriptive approach, patient at centre.

Mandy's reflections

Has this shed any new light on your answers to the questions above?

Taking time

Problem-based learning

  • Summarise the events portrayed in the clip in your own words
  • What psychological theories, or models of health do you think the clip is aiming to illustrate?
  • Why is this clip important in patient care?
  • What do you think is the impact on the patient?
  • What do you think are the factors that affect a practitioner's skills in communication/patient care?
  • How might what you have learned from this clip be used to influence and improve your own patient care i.e. is that the way it should be done or would you do it differently and if so how?

Clip-specific questions

After MRI, café, asking about results

  • Mrs Cookson was clearly in some pain or discomfort after her MRI scan. Apart from acute pain, what are the other types of pain as described in Gross & Kinnison (2007)?
  • Did you think Emma handled Mrs Cookson's questions in a professional manner? If not, in what ways could she have improved her professional practice?

Answers to questions

  • Mrs Cookson was clearly in some pain or discomfort after her MRI scan. Apart from acute pain, what are the other types of pain as described in Gross & Kinnison (2007)?

Answer: Acute, Chronic, Psychological, Spiritual. (Howarth 2002, Morrison 1992)

  • Did you think Emma handled Mrs Cookson's questions in a professional manner? If not, in what ways could she have improved her professional practice?

Answer: Emma could have been more helpful about the whereabouts of the café, or even made Mrs Cookson a cup of tea if facilities were available. She should not have referred to Mrs Cookson's notes, then told her she could not give the result of the scan making it seem as though there might be bad news and causing un-necessary anxiety for the patient. Emma's reflections

Emma's reflections on the day

Clip-specific questions

  • Can you outline the key elements in the reflective cycle as outline by Gibbs (1988)?
  • How could Emma resolve the uncertainties in her mind created by the unprofessional behaviour of some of her colleagues and senior staff?

The patient's view

Patient-centred care is at the heart of good clinical practice and, contrary to popular opinion, is more than simple common sense. What better way to understand what matters most to our patients when in hospital or at the doctor's surgery, than by listening to their stories in own words?

These video clips show Vera, a remarkable and courageous lady who has been in and out of the healthcare system many times telling us about her experiences; some exemplary, others less so.

Two of the videos outline an experience which left her feeling distressed and unhappy and two highlight where the actions of the healthcare practitioner made for a more enriching experience.

Each session contains the same common set of suggested questions as in the Psychology for patient care pages as well as some clip-specific self test questions and answers.

Vera describes a visit to her doctor with a problem which, whilst it might appear trivial, was affecting her quality of life.

Problem-based learning

  • Summarise the events portrayed in the clip in your own words
  • What psychological theories, or models of health do you think the clip is aiming to illustrate?
  • Why is this clip important in patient care?
  • What do you think is the impact on the patient?
  • What do you think are the factors that affect a practitioner's skills in communication/patient care?
  • How might what you have learned from this clip be used to influence and improve your own patient care i.e. is that the way it should be done or would you do it differently and if so how?

Clip-specific questions

  • Can you name the model of health which would explain the GP's behaviour towards Vera?
  • Identify some of the non-verbal cues given out by the GP

Answers

  • Can you name the model of health which would explain the GP's behaviour towards Vera?

Answer: Medical Model (patriarchal medicine)

  • Identify some of the non-verbal cues given out by the GP

Answer: posture, eye contact, facial expression

A consultant's ability to emphasise with his patient reassured Vera that her anxieties were justified.

Problem-based learning

  • Summarise the events portrayed in the clip in your own words
  • What psychological theories, or models of health do you think the clip is aiming to illustrate?
  • Why is this clip important in patient care?
  • What do you think is the impact on the patient?
  • What do you think are the factors that affect a practitioner's skills in communication/patient care?
  • How might what you have learned from this clip be used to influence and improve your own patient care i.e. is that the way it should be done or would you do it differently and if so how?

Clip-specific questions

  • What is the name of the theory which would explain the consultant's approach as 'Nurturing Parent'
  • What are the other ego-states outlined in this theory?

Answers to questions

  • What is the name of the theory which would explain the consultant's approach as 'Nurturing Parent'

Answer: Berne's theory of Transactional Analysis (1964)

  • What are the other ego-states outlined in this theory?

Answer: Controlling Parent, Adult, Free Child, Adapted Child

Vera attends the chest clinic where the receptionist's unprofessional behaviour fails to take into account her dignity and self-respect. Compare this with the behaviour of the radiographer in the X-ray room.

Problem-based learning

  • Summarise the events portrayed in the clip in your own words
  • What psychological theories, or models of health do you think the clip is aiming to illustrate?
  • Why is this clip important in patient care?
  • What do you think is the impact on the patient?
  • What do you think are the factors that affect a practitioner's skills in communication/patient care?
  • How might what you have learned from this clip be used to influence and improve your own patient care i.e. is that the way it should be done or would you do it differently and if so how?

Clip-specific questions

  • What is the name of the psychological approach which explores peoples' experiences; in this case Vera's experiences whilst undergoing medical imaging?
  • In terms of the behaviour of the receptionist towards Vera, in what ways was it unprofessional?

Answers

  • Can you name the three theories which attempt to explain Vera's emotions at this time?

Answer: James-Lange, Canon-Bard (in Gross 2005) Cognitive labelling (Schachter 1964)

  • Can you identify the components of grief which Vera may have experienced on learning of her diagnosis?

Answer: Anticipatory grief (Kübler-Ross 1969)-denial, anger, bargaining, depression, acceptance. Assumptions

Vera attends for MRI to find out whether her cancer has returned. She describes her feelings leading up to the scan and the actions the radiographer took to put her at her ease.

Problem-based learning

  • Summarise the events portrayed in the clip in your own words
  • What psychological theories, or models of health do you think the clip is aiming to illustrate?
  • Why is this clip important in patient care?
  • What do you think is the impact on the patient?
  • What do you think are the factors that affect a practitioner's skills in communication/patient care?
  • How might what you have learned from this clip be used to influence and improve your own patient care i.e. is that the way it should be done or would you do it differently and if so how?

Clip-specific questions

  • Can you name the three theories which attempt to explain Vera's emotions at this time?
  • Can you identify the components of grief which Vera may have experienced on learning of her diagnosis?

Answers

  • Can you name the three theories which attempt to explain Vera's emotions at this time?

Answer: James-Lange, Canon-Bard (in Gross 2005) Cognitive labelling (Schachter 1964)

  • Can you identify the components of grief which Vera may have experienced on learning of her diagnosis?

Answer: Anticipatory grief (Kübler-Ross 1969)-denial, anger, bargaining, depression, acceptance. Assumptions