objectives 2.1 psychological concepts overview 2.2 resource portfolio 2.3theories of aging 2.4 role...

OBJECTIVES2.1 PSYCHOLOGICAL CONCEPTS OVERVIEW

2.2 RESOURCE PORTFOLIO2.3THEORIES OF AGING

2.4 ROLE THEORY 2 .5 PRACTICAL RESEARCH

Unit 2: Psychological Implications of the Cooperative Care Relationship

Psychological Implications of the Cooperative Care Relationship

The cooperative care relationship (the dynamic interaction between the patient and the proxy) is an association in constant flux due to the characteristics of changing roles, the natural aging process and the way these two influences interact.

Home | Overview | Portfolio| Aging Theory| Role Theory| Research

After completing this unit of instruction, you will have acquired knowledge of psychological issues that arise as part of the natural aging process, as those issues are experienced by the patient and their proxy. That knowledge will be practically applied in a later module. You will also create a reference tool which will be added to your resource portfolio.

Key Takeaway

The cooperative care relationship is fraught with ever changing interpersonal dynamics that affect health care outcomes. Understanding the theoretical foundations for patient and proxy behaviors and perspectives is a critical component in proactively facilitating positive outcomes. By using your theoretical knowledge to analyze the behaviors and perspectives unique to the cooperative care teams with which you interact, you can promote patient quality of life and cooperative care team satisfaction.


Customizing Instruction

There are three ways to customize the instructional materials to meet your needs. You can choose to utilize these options to expand on the activity or omit them at will.

The three customizable options include:

Definitions – clarification of newly introduced and uncommon terms is provided at your discretion. Defined terms are bolded and underlined indicating this is hyperlinked text. Simply click on the text for the definition.

ADDITIONAL INFORMATION, EXAMPLES & TIPS – additional helpful information, a practical example of the theoretical concept or a useful tip is available when the hyperlinked text is CAPITALIZED, BOLDED AND UNDERLINED .

Resources for further inquiry are linked to italicized underlined text. These resources are pertinent to the concepts but expand beyond what is necessary knowledge for the current context.

When you see hyperlinked text, there’s

more information!


OBJECTIVES

2.1 PSYCHOLOGICAL CONCEPTS OVERVIEW

2.1 RESOURCE PORTFOLIO2.3 THEORIES OF AGING

2.4 ROLE THEORY 2 .5 PRACTICAL RESEARCH


2.1 Psychological Implications of the Cooperative Care Relationship Overview

The interpersonal dynamics of the cooperative care relationship is created and manipulated by complex psychological factors that can be explained by theories of aging and role theories. These same theories, when proactively applied to unique situations, can act as behavioral tools which facilitate a highly functional relationship between the patient and proxy where conflict is minimized and successful health care and social outcomes are maximized.


Remember to look for

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2.1 Psychological Implications of the Cooperative Care Relationship Overview


There are two separate theoretical schools of thought that provide tools for explaining the psychological and psychosocial dynamics that exist within the cooperative care relationship.

The second set of theoretical concepts is Role Theory. There are five recognized concepts that assist in describing roles. They are Role Confusion Role Conflict Role Strain Role Distance Role Embracement.

The first set of theoretical concepts is Aging Theory. Three psychosocial aging theories are relevant and useful for explaining and modifying behaviors within the cooperative care team . They are Activity Theory Disengagement Theory Continuity Theory.

Remember to look for

hyperlinked text!


2.2 RESOURCE PORTFOLIO2.3 THEORIES OF AGING

2.4 ROLE THEORY2.5 PRACTICAL RESEARCH


2.2 Resource Portfolio

PURPOSE

The purpose of the resource portfolio is twofold. 1. Provide an organized format

for compiling the information and tools you identify as valuable for personal future use.

2. Create a location for storing, manipulating and retrieving that information for future use.


Sample

PROCEDUREFollow this procedure for creating the individual artifacts to include in your portfolio.

1. Choose between the digital and paper based portfolio options. 2. As you progress through the instructional activities use the

template (either digital or paper) to compile notes, resources and tools you find valuable for future reference.

3. After completing this module of instruction, store the completed artifact in your portfolio.

4. You will create a new artifact during each module.



TEMPLATE & STORAGE



Digital Template & Storage Retrieve the

Aging Theories template Role Theory template Practical experience template

Storage options include Your Google Drive Google Apps iPad, iPod or iPhone App Your computer

Paper based Template & Storage Retrieve the

Aging Theories template Role Theory template Practical experience template

Storage options include A paper file folder Your computer Have your artifacts

bound in book formThe digital options are

recommended for ease of access and reuse.


2 .2 RESOURCE PORTFOLIO

2.3 THEORIES OF AGING2.4 ROLE THEORY

2.5 PRACTICAL RESEARCH


There are three main Theories of Aging that provide tools for explaining the psychosocial, as opposed to BIOLOGICAL, dynamics that exist within the cooperative care relationship.They are ACTIVITY THEORY, Disengagement Theory and Continuity Theory.

Activity Theory views aging as a positive process. It asserts people believe maintenance of personal relationships and physical/social activities is critical for quality of life and self-actualization. HINDRANCES TO QUALITY OF LIFE can result from outside stimuli such as lack of economic resources, lack of health care resources, lack of accessibility to peers and lack of desire to pursue activities.

An equilibrium of relationships, activities, etc. is created during middle age and continues as the individual ages. DEVELOPMENTAL ROLES that are naturally lost, such as retiring from a job, are substituted with new roles, such as volunteer work.

Older adults who share this mindset will pursue participating in social relationships and maintain high activity levels.

2.3 Theories of Aging


Disengagement Theory views aging as a negative process. It asserts the most advantageous course of action for the aging person and society as a whole, is for people to withdraw from society as they age. BIOLOGIST PETER MEDAWAR DEVELOPED A SIMILAR THEORY.

Disengagement beliefs and behaviors can be cued by situational or environmental factors. Aging adults who experience difficulty accessing the tools for maintaining social relationships may see withdrawing from society as their only option. Aging adults who are not included in activities by younger members of society may begin to believe they have no value or are unwanted.

Older adults who share this mindset will neglect social relationships and avoid organized activities.



Continuity Theory is a modification and elaboration of Activity Theory. It states aging individuals will adapt to whatever situation in which they find themselves in order to maintain equilibrium.

Continuity Theory recognizes aging individuals’ SCAFFOLDING BEHAVIOR of connecting new situations, events, people and so on with characteristics of known situations, events, people, etc. to maintain internal balance.

Older adults who share this mindset may review their lives and reminisce as they seek to assign meaning to their lives and share the value of their experiences with others. Reminiscing may also function as a part of the continuity scaffolding process.



There are many widely recognized stereotypes associated with the natural aging process. These stereotypes are recognized by individuals of all ages and they can be negative or positive. In general, when aging stereotypes are negatively stated there is also a way to give the idea a positive spin. Consistently restating negative stereotypes with the positive alternative assists in TRANSFORMING THE NEGATIVE BELIEF into one with positive connotations.



Negative Stereotype Older individuals offer nothing to society.



Corresponding Positive StereotypeOlder individuals provide society with valuable perspectives and

skills.Negative Stereotype Older individuals are in poor health.

Corresponding Positive StereotypeOlder individuals can access services and tools that minimize health

related issues.Negative Stereotype Older individuals are cranky and anti-social.

Corresponding Positive StereotypeOlder individuals may need extra patience to maximize participation in

social activities due to issues such as hearing loss or restricted mobility.

Negative Stereotype Older individuals are slow and forgetful.



Negative Stereotype Older individuals drain society of resources.

Corresponding Positive StereotypeOlder individuals have a wealth of life experience to share.

Negative StereotypeOlder individuals are incapable of understanding new technology.

Corresponding Positive StereotypeOlder individuals are curious about new technologies and like to

reminisce about the advent of previous technologies.

Corresponding Positive StereotypeOlder individuals have a vast library of information and experience

to consult which takes time.


2 .2 RESOURCE PORTFOLIO2.3 THEORIES OF AGING

2.4 ROLE THEORY2.5 PRACTICAL RESEARCH


2.4 Role Theory

Role Theory is a predictive theory. Having information about the expectations for a particular role allows us to predict how a person will behave within that role.Roles help people identify their personal responsibilities, goals and appropriate behavior for a particular situation.People fulfill many roles at any given point in their lifetime. Furthermore, these roles can change based on external circumstances, personal choice and other factors.ROLES AND BEHAVIORS ARE CLOSELY LINKED. The role a person enacts affects their behavior. Conversely, the behavior reflects the characteristics associated with the role.Roles can be fluid. PEOPLE SHIFT BETWEEN ROLES, or even combine roles, based on choice or need.


2.4 Role Theory

Role ConfusionThe individual cannot identify the appropriate role to enact or the roles of the role are unknown to them.


Within Role Theory there re several recognized concepts that assist in describing, analyzing and responding to role related behavior.

Role ConflictThe individual experiences frustration, anger or related emotions as a result of multiple roles that are incongruent or experiences competition between roles.Role StrainThe individual experiences stress created by obligations related to a particular role. They may be unable to adequately fulfill the obligation(s).

Example The patient cannot decide if it is

appropriate to assume a more passive role while the proxy assumes

the role of decision maker.

Example The healthcare proxy who is the

stay-at-home mother of 4 may have a hard tim fulfilling her

responsibilities to the patient since she is expected to be involved in her

children’s school activities.

Example The mother from the previous

example may be physically unable to devote the amount of time to follow

up on health care issues that the patient feels is necessary so

interpersonal dysfunction develops.

2.4 Role Theory


Role DistanceThe individual displays overt behaviors or utilizes internal coping mechanisms as a way of mentally separating themselves from an unpleasant or unwelcomed role. Some role distance occurrences are based completely on the current adult developmental life stage.Role EmbracementThe individual thoroughly embraces the rules and behaviors of the role.

Example A patient that feels a health care proxy has been thrust upon them may make unkind jokes about the proxy or refuse

to acknowledge the proxy’s presence at health care events. The situation of

having a proxy is a result of the patient’s current advanced developmental life

stage.

There are three prerequisites:1. Personally expressed devotion to the

role2. Demonstration of abilities necessary

for executing responsibilities of the role

3. Observable physical and mental engagement in the role

2.4 Role Theory


Successful role embracement can be taught to the cooperative care team. It is an interactive 5 step process that ensures both the patient and the proxy agree on the specific components of the role in question.

Before beginning the process the cooperative care team must identify the specific roles in which they participate. Then the process is completed for each role.

2.4 Role Theory


1. Identify each person’s perception of the role

2. Identify role expectations3. Identify skills necessary for the role. If applicable, identify the process for learning

the skill.

4. Identify demands created by the role.

5. Identify the role’s priority status (high, medium, low). The priority status may

change in relation to other roles; identify priority within different contexts.

2.4 Role Theory


The list of roles is endless based on context, the individuals involved and numerous other factors. The ways people title roles is also ambiguous.

Common examples of functional roles include driver and schedule keeper. Health care related roles include proxy/decision maker, peer consultant, and medical care recipient.

Cooperative care team members can assign negative connotations to roles in much the same way they can with their perceptions of aging. You can modify negative attitudes by restate the connotations in a positive way.

Negative Role ConnotationOne role takes precedence over another role.

Positive Role ConnotationShared responsibility makes the team stronger.

Negative Role ConnotationOne team member’s roles are more important or valuable than the other team members roles.

Positive Role ConnotationMutual respect for each roles promotes high quality

decisions and actions.


2 .2 RESOURCE PORTFOLIO2.3 THEORIES OF AGING

2.4 ROLE THEORY

2.5 PRACTICAL RESEARCH


2.5 Practical Research

In this section, you will use a worksheet

work through a process in which you identify a past experience involving a cooperative care team that either did not produce an optimal result or did produced a significantly successful result for the patient,

analyze this experience using your theoretical knowledge to detect useful techniques,

include this information as an artifact in your portfolio.

This technique can be repeated with as many scenarios as you deem appropriate. It is also a useful technique to employ after a particularly positive or negative cooperative care team interaction to identify useable techniques.


2.5 Practical Research

Home | Overview | Steps | Applicability | Use | Exercise

1. State the main topic of the interaction.2. Identify secondary topics.3. Eliminate any secondary topics that are not

relevant.4. Identify each participant’s perspective on the topic.5. For each participant list the behaviors, techniques

and any other significant factors associated with their involvement in the interaction.

6. Eliminate behaviors, techniques and factors that are not significant to the final outcome.

7. Of the elements that are left, identify those that significantly shaped the outcome of the interaction.

If the element is negative, what

could you potentially do to

neutralize or redirect the situation.

If the element is positive, how can

you use it to facilitate positive cooperative care interactions in

the future.

THE ENDR E F E R E N C E S , D E F I N I T I O N S , R E S O U R C E S , F O R M S

A N D E X T R A S F O L LO W T H I S S L I D E


References

2.3 Theories of Aging http://en.wikipedia.org/wiki/Activity_theory_(aging) http://www.cliffsnotes.com/sciences/psychology/development-psychology/psychosocial-

development-age-65/theories-of-aging

Aging by Design How new thinking on aging will change your life by Theodore C. Goldsmith 2011, Azinet Press, MD. ttp://www.azinet.com/aging/aging_by_design.pdf

http://www.ncbi.nlm.nih.gov/pubmed/19035823

2.4 Role Theory http://en.wikibooks.org/wiki/Sociological_Theory/Role_Theory http://socrates.berkeley.edu/~kihlstrm/images/APAHypnosis07/Sarbin.jpg

Graphics artifact template http://www.scotland.gov.uk/Publications/2003/12/18513/28937 APP template

http://www.forbes.com/sites/tomiogeron/2012/03/06/edmodo-launches-third-party-platform-for-education-apps/

Older couple photo By DavidYork71 at en.wikipedia (Transferred from en.wikipedia) [Attribution or CC-BY-2.5 (http://creativecommons.org/licenses/by/2.5)], from Wikimedia Commons

http://en.wikipedia.org/wiki/Activity_theory_(aging)

http://www.cliffsnotes.com/sciences/psychology/development-psychology/psychosocial-development-age-65/theories-of-aging

http://www.cliffsnotes.com/sciences/psychology/development-psychology/psychosocial-development-age-65/theories-of-aging

http://www.azinet.com/aging/aging_by_design.pdf

http://www.azinet.com/aging/aging_by_design.pdf



http://en.wikibooks.org/wiki/Sociological_Theory/Role_Theory

http://socrates.berkeley.edu/~kihlstrm/images/APAHypnosis07/Sarbin.jpg

http://www.scotland.gov.uk/Publications/2003/12/18513/28937

http://www.scotland.gov.uk/Publications/2003/12/18513/28937




Definition

Cooperative Care RelationshipThe interpersonal relationship between the patient and health care proxy. This relationship includes all the social aspects of interaction, health care related functions, and the manner with which the cooperative care team interacts with health care professionals.


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Definition

Cooperative Care TeamThe patient and their health care proxy working together as a team. In some cases there may be additional individual(s) who fulfill active roles in addition to the proxy.


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Definition

PsychosocialThe behavioral interaction of social influences and cognitive processes


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Definition

Natural Aging ProcessThe human body undergoes a specific biological development processes beginning at birth, progressing throughout the life span and ending with death. This biological process is separate from psychosocial implications. However, the observable changes associated with the aging process have influenced stereotypes of aging in both positive and negative ways.


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Definition

RoleA generally recognized set of social rules that shape behavior within a human occupation.

Individuals fulfill multiple roles. For example, mother, police officer, librarian and neighbor are all roles.


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Examples, Information & Tips

Activity Theory is also known as Implicit Theory of AgingNormal Theory of Aging Lay Theory of AgingActivity Theory was originally developed by Robert Havighurst in the early 1960’s as a rebuttal to Disengagement Theory.


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http://en.wikipedia.org/wiki/Robert_J._Havighurst


There are also biological theories of aging including Programmed Aging Theory and Non-programmed Aging Theory that revolve around the idea of whether the human body is designed to deteriorate with age. Only psychosocial theories apply in the context of understanding the cooperative care relationship.


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Diffuse Benefit The idea that inequalities can be neutralized by sharing resources and responsibilities.

The concept of Diffuse Benefit can be applied to obstacles that develop in response to demands created by the cooperative care relationship.


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Erik Erikson’s Theory of Human Development details developmental stages humans pass through from birth to death. He notes that aging adults have a tendency to strive toward “ego integrity” which is the process of maintaining self-esteem and self-worth. Likewise, they tend to avoid despair by shunning the idea of life as increasingly finite.


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http://www.simplypsychology.org/Erik-Erikson.html


Biologist Peter Medawar proposed the idea that each species, humans included, only needs a particular lifespan. People whose behavior aligns with disengagement theory may also share this view. If they believe they have reached the end of the ‘needed’ years they may demonstrate an unpleasant affect and/or behavior.

Austrian biologist August Weismann proposed the Programmed Death Theory in the 1880’s. The theory claimed the death of older animals benefited younger animals by freeing up resources for their use.


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http://www.programmed-aging.org/theories/medawar_hypothesis.html

http://www.programmed-aging.org/theories/weismann_programmed_death.html


Cognitive processes slow as part of the developmental processes the brain passes through as age advances. The Scaffolding Theory of Aging and Cognition (STAC) provides a mechanism for assisting aging adults in maintaining cognitive functioning.


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STAC asserts the natural loss of brain structure and function resulting from the aging process can be counteracted by generating new neural structures to assume the functions of the lost structures.




When the patient or proxy asserts a stereotype with a negative connotation, work it into the conversation restated in a positive way. For example, if the proxy said, “Albert is cranky and anti-social like all old men.” You can redirect that negative opinion with a response that validates the proxy’s input but redirects their attention to a positive outlook. “I realize Albert avoids social interaction, but it is difficult for him to participate in conversation due to hearing loss. You can help him feel more comfortable by looking directly at him when you speak and avoiding areas with lots of background noise.”


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Roles can be fluid.For example, the proxy fulfills their role as proxy while participating in health care related situations with the patient but can choose to shift to fulfill the role of peer, or possibly confidant, if they go to a coffee shop after leaving the medical office.


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Roles create observable behaviors which can be useful for interpreting patient and proxy beliefs and motivations, as well as identifying problems for conflict resolution.

Cognitive Role Theory is the discipline that specifically examines the relationship between roles and resulting behavior.


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http://books.google.com/books?id=n14-2xhMz2cC&dq=%22Structural+Role+Theory%22+definition&source=gbs_navlinks_s

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objectives 2.1 psychological concepts overview 2.2 resource portfolio 2.3theories of aging 2.4 role...

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