Behavioural Sciences

Behavioral Sciences deal with the Study of human behaviour,

using principles of psychology, Sociology & Anthropoly in condition Of health & disease.

Psychology: It contributes to the study of human mind and the role played
by its various functions such as emotions, thoughts, cognition, motivations, perceptions and intelligence in maintaining health or causing disease & how the development of personality takes place.

Sociology: deals with relation of Socio Status (Society, Family): It Helps the
doctor to understand the influence of society & its various units and how they can change to cause disease.

Medical Anthropology deals with evolutionary, cultural history, racial

classification, geographical distribution of human races, and effects of health issues and signs.

Bio-Psycho-Social Model
Presented by George Engel 1970
Provides a comprehensive clinical approach towards the practice of holistic medicine. Which leads to wards doctor patient relationship.

Biological:
Structural, biochemical, molecular

Psychological
Provides an insight into the role of persn.

Human health/ Disease/illness

Social Factors

Bio-Psycho-Social Model
Biological Component

Potential cause functioning of the body

Psychological Component Potential Psychological Cause emotional turmoil, death of important relation, self control, negative thinking etc. Social Component (Influence of Society & Its components)
Socio economical Status, Culture, Technology, religion Role of family, gender issues, social classes, housing, employment. Medical Anthropology: Geographical dist, cult hist, Hum Rac

Health Problem

Bio-Psycho-Social Model
NPIs

To deal with the health problem with Nonpharmalogical Interventions NPI a) Communication Skills b) Counseling c) Informational Care NPIs are extremely important to avoid medicine over dose.

Bio-Psycho-Social Model
Bad News:
Any new that adversely effects an individuals view of his/her own future. e.g Cancer diagnosis, death of a loved one How to disclose?

Breaking The Bad News

Creating an Environment:
a) Exclusivity b) Involvement of significant other c) Comfortable seating arrangement d) Active listening and use of communication e) Avoid time constraints

Breaking The Bad News

Knowing the patients perception:
Before you tell ask the patient. Read the patient expectation. Obtaining overt permission/invitation: Not all the patients want to know all about their illness. Symptoms of disease, causes of death etc etc.

Breaking The Bad News

Use proper language/ knowledge:
    Important phrase I am sorry to have to tell you. Avoid Scientific terms and use patients language (Panjabi, Urdu) Give information's in small bits and clarify person is following your speech Response to the emotions of the person.

Breaking The Bad News

Show your empathy: To reassure that you understand the human side of medical issue. Summarize: Before discussion ends give opportunity to voice any concern or questions. Give a plan of action:

Breaking The Bad News

Individualized Disclosure Model:
People are different it takes time to absorb and adjust to bad news. Rate of disclosure is tailored according to the desire of patients. Its time consuming but strengthen doctor patient relationship. Full Disclosure Model: Give full information to every patient as soon as it is known. Negative emotional consequences that appear, advantage promotion of trust.

Breaking The Bad News

Paternalistic Disclosure Model:
The information of illness is the right of doctor & he should deliver the information in sugar coating to minimize pain. (obsolete now)

Non Disclosure Model:

The patient needs protection from the terrible realities of terminal illness. Use of deception undermining of trust Less compliance of patient It is easier and less time consuming (Rejected by doctor & patients relatives.

Approach To The Cultural Issues

Culture:
Culture is the outcome of the man-made part our environment. Its always dynamic process so evolving Principle of right & wrong actions Rules and laws which govern the acceptable and unacceptable behaviours: Abortion, Intake of alcohol, Euthanasia

Subculture:
Culture within a Culture with distinctive set standard & behaviour patterns.

Approach To The Cultural Issues

Beliefs: These are considered / accepted as important truth with shared meaning of Culture. Political believes. Religious believes.

Approach To The Cultural Issues

Values: Aspects of Culture that are held in high regards. Equal rights of all & People should be treated with respect and dignity are representative of values. Ethical / Moral Values. Social Values, Aesthetic values

Approach To The Cultural Issues

Social Culture:
Placing of people in social strata like: Wealth, education, inheritance etc. Roles: Expectation or demands from a person: Demand being a doctor and a father may differ and create substantial psychological stress.

Approach To The Cultural Issues

Family:
Family is important and integral partner in the assessment & the therapeutic process. Out of which one or two person call the shots when making a decision.

Childhood: The process promoting & supporting the

physical, emotional, social & Intellectual development of a child from infancy to adulthood. (Need role model).

Guidelines For Parents

Physical Development: Provide physical safety, shelter, clothes, nourishment, protect form danger, health care, develop health habits. Intellectual Development: Provide atmosphere of peace, justice, with out fear, threat & abuse. Provide and Support school related learning. Moral & Spiritual development. Create an ethics & value based system to the child to learn adopt beliefs, culture & customs.

Guidelines For Parents

Emotional development: Give a child sense of being loved, being needed, welcomed, show empathy & compassion to younger and older, weaker & sicker. Promote caring for others, helping grandparents etc.

Guidelines For Health Professionals

Avoid Cultural & Social Bias, prejudices(An adverse judgment or opinion) & ethnocentrism. (Belief in the superiority of one's own ethnic group). Remember Physicians cant solve cultural problems on the behalf of patients. Be ready to accept diversity of behaviour. Accept your culture-related mistakes to avoid confrontation.

Death & Die:

If suddenly informed to patient about a fatal disease what will be the response: a) Denial/ depression b) anger towards family. This situation demands tolerance from caregiver. In our society death is believed to be Allah ki Marzi. Norms of Iddat, sog etc, provides psychological relief to the person.

rd 3

Lecture

Psychological Disorders Attributes to Social Beliefs. a) Evil Eye b) Spiritual illness c) Beliefs in dum, darood, dhaga Social Support with Patient. Treatment Adherence: Siana, a neighbor or a Wiseman. Stigma: , Infertility, congenital deformity,

Sick Roles: Being excused from various obligations & duties after initial illness settled. There always under lying anxiety, role confusion & Personality vulnerability associated with it.

Guidelines For The Delivery Of Culturally Relevant Care & Cultural Sensitivity

Accept & be aware of cultural Differences Collect data about patients culture Adapt to his care plans Remove own biases & attitude Interact directly Respect the norms, values & beliefs

Influence Of Sociocultural Factors On The Therapeutics Beliefs about Taseer & use of injections affect the Compliance of the patient to therapy. The doctor needs to learn to convert these factors to the benefits of the patient.
Understanding of human behaviour specially related to biomedical Sciences

Crisis Intervention/ Disaster Management: Crisis: Time of disorganization characterized by trial & error, disequilibrium & attempts to reduce the feeling of discomfort. The crisis @ community level is associated with disaster.

Types of Crisis: Developmental: These are common to all & occur in

response to stressful periods e.g. marriage, divorce, schooling

Situational: Personalized & occur in response to a natural or

man made disaster e.g. War, earthquake, murder etc. Communication skills are very important during crisis.

Things To remember Regarding Disaster

 Disasters affect surgical/medical & psychological aspects of a person.  Associated psychological responses mostly are normal.  Women & children are most vulnerable groups.  To prevent long term morbidity, early support by trained people is needed.  Besides medical needs, Psychosocial needs like foods, shelter & Security should also be addressed.  Socioeconomic support, early return to homes & active participation in social activities support the recovery of traumatized individuals the best.

 Psychiatric trauma should be dealt with NPIs rather than medicines.  The rescue recovery professionals should also be provided adequate support, rest, appreciation & patronage.  1/3rd of the affected people will develop post-traumatic conditions like flashbacks, anxiety, depression etc.  Secondary disaster affects like malnutrition, infection, epidemics, further deaths etc should be avoided by adopting appropriate measures.

Rights & Responsibilities Of Patients

Rights: Informed Consent. With draw consent at any time. Refused experimental or research treatment. Obtain a second opinion Have a necessary details about the illness & its treatment. Leave the hospital at any time but if the patient leaves without the hospital consent he is liable for any damage. Be treated with care Request medical files from the doctor.

Ask to stay with children at all the times except medically contraindicated.  Inform the staff if he or she wants to see a visitor or not. Responsibilities:  Know his/her medical history  Comply with treatment  Inform the doctor if already under treatment form another professional.  No such conduct that can harm the well-being of the other patient or staff.

Health Belief Model: Psychosocial Model that attempt to

explain & predict health behaviors, by focusing on attitude and beliefs of individuals.  Person feels that a negative health condition i.e. lung cancer can be avoided.  has a positive expectation that by taking a recommended action, he/she will avoid a negative health condition i.e. avoid smoke will prevent lung cancer.  Beliefs that he/she can successfully take a recommended health action i.e. the habit of smoking can be changed.

Explanatory Model Of Illness:

The Notions about an episode of sickness & their treatment that are employed by all those engaged in the clinical process.  Etiology  Time & mode of onset of symptoms  Pathophysiology  Course of Sickness  Treatment

Psychosocial Aspects Of Disease:  Stress due to illness.  Change of role. Most of the time sick is assigned a passive role.  Financial loss.  Loss of self esteem.  Fear of being handicapped.  Uncertain prognosis.

Stress of Hospitalization:
      

Loss of privacy. Loss of autonomy. (independence) Separation from dear ones. Need of seeking approval of the doctor. The issue of handing over his health matters to a group of total strangers. Threat of the social dysfunction of the family. Unsatisfactory information.

Psychosocial Issues In Special Hospital Settings

 Fear of procedures  Powerlessness  Sleep deprivation  Interventions  Redesigning of ICU  Improve psychosocial care of Patients