HEALTH RELATED CAREERS:Nurses and Physician Assistants, Physical Therapists

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Health Psychology PSY408

LESSON 06

HEALTH RELATED CAREERS

Health-related careers outside of Psychology

The process of providing care for a patient who is suffering from a chronic illness, serious injury or

disability involves a variety of professionals working together with physicians as a team. Each professional

has specific training for a special role in the treatment or rehabilitation process. Most of them have some

education in psychology. We've already seen how health psychologists can play a role. Let's look at some

careers outside of psychology and the training they require in the United States.

Nurses and Physician Assistants

There are two overall categories of nurses registered nurses (RNs) and licensed practical nurses (LPNs).

RNs work in hospitals, community health clinics, physicians' offices, and industrial settings. They assess and

record patients' symptoms and progress, conduct tests, administer medications, assist in rehabilitation,

provide instructions for self-treatment, and instruct patients and their Families in ways to improve or

maintain their health. RNs often deal with mental and emotional aspects of the patient as well. All RNs

throughout the United States must be licensed to practice, have graduated from an approved training

program in nursing, and have passed a national examination. RN training programs vary in structure and

length; college and university programs take 4 or 5 years and lead to a baccalaureate degree.

LPNs work in hospitals, clinics, physicians' offices, and patients' homes. They perform nursing activities

that require less training than those performed by RNs. For example, they take and record temperatures and

blood pressures, administer certain medications, change dressings, assist physicians or RNs, and help

patients with personal hygiene. Like RNs. all LPNs in the United States must be licensed to practice, have

graduated from an approved practical nursing program, and have passed a national examination. Training

programs for LPNs take about a year to complete and are offered through various types of institutions,

such as trade and vocational schools, community and junior colleges, and hospitals.

Physicians' assistants and nurse practitioners usually work closely with medical doctors, performing

routine tasks that physicians ordinarily did in the past, such as examining patients with symptoms that do

not appear serious and explaining treatment details (AANP, 2000; AAPA, 2000). Training involves a

program of about 2 years of study; admission often requires that applicants have a relevant bachelors

degree, such as in nursing, and prior health care experience.

Dietitians

Dietitians study and apply knowledge about food and its effect on the body. They do this in a variety of

settings, such as hospitals, clinics, nursing homes, colleges, and schools. Some dietitians are administrators;

other work directly with patients in assessing nutritional needs, implementing and evaluating dietary plans,

and instructing patients and their families on ways to adhere to needed diets after discharge from the

hospital. Some dietitians work for social service agencies in the community, where they counsel people on

nutritional practices to help maintain health and speed recovery when they are ill.

Becoming a dietitian requires a bachelor's or masters degree specializing in nutrition sciences or institutional

management. To become a Registered Dietitian, the Individual must complete a supervised internship and

pass an exam.

Physical Therapists

Many patients need help in restoring functional movement to parts of their body and relieving pain. If they

have suffered a disabling injury or disease, treatment may be needed to prevent or limit permanent

disability. Physical therapists plan and apply treatment for these goals in rehabilitation (APTA. 2000).

To plan the treatment, physical therapists review the patient's records and perform tests or measure- merits

of muscle strength, motor coordination, endurance, and range of motion of the injured body part.

Health Psychology PSY408

Treatment is designed to increase the strength and function of the injured part and aid in the patient's

adaptation to have reduced physical abilities, which may be quite drastic. People who have suffered severe

strokes are sometimes left partially paralyzed, for instance.

The most universal technique used in physical therapy involves exercise, generally requiring little effort

initially and becoming more and more challenging. Another technique involves electrical stimulation to

move paralyzed muscles or reduce pain. Physical therapists also give instructions for carrying out everyday

tasks, such as tying shoelaces or cooking meals. If the patient needs to use adaptive devices, such as

crutches or prosthesis (replacement limb), the therapist provides training.

All physical therapists throughout the United States must have a degree or certificate from an approved

training program and be licensed by passing an exam. A bachelor's degree has been the minimum

educational requirement to enter the profession, but a master's degree in physical therapy will be the

minimum as of January 2002.

Occupational Therapists

Occupational therapists help physically, mentally, and emotionally disabled individuals gain skills needed for

daily activities in a work setting, at school, in the community, and at home. Their patients are often people

who had these skills at one time, but lost them because of a spinal cord injury or a disease. These

professionals usually specialize in working with a particular age group, such as the elderly, and a type of

disability-- physical, for example. Based on the patient's age and the type and degree of disability, a

program of educational, vocational, and recreational activities is designed and implemented. The program

for a child, for instance, might involve academic tasks and crafts; for an adult, it might involve typing,

driving a vehicle, and using hand and power tools.

Occupational therapists in the United States must have a degree or certificate from an approved training

program and be licensed by passing an exam. Training requires completing a baccalaureate program plus

either a certificate program or a master's degree in occupational therapy.

Social Workers

The field of social work is quite broad. Probably most social workers are employed in mental health

programs, but many others work in hospitals, nursing homes, rehabilitation centers, and public health

programs. When working with people who are physically ill or disabled, social workers help patients and

their families make psychological and social adjustments to the illness and obtain needed community

services, including income maintenance. Thus, social workers may arrange for needed nursing care at home

after a patient leaves the hospital or refer a patient for vocational counseling and occupational therapy if the

illness or disability requires a career change. These professionals are usually called medical social workers.

Training requires a bachelor's degree in a social science field, usually social work, but often a degree in

psychology or sociology is sufficient. Most states mandate some form of licensing or certification. Many

positions require an advanced degree, typically a master's in social work, the MSW degree.

Why is the field of Health Psychology needed?

A number of trends within medicine, psychology, and other health care systems have combined to make the

emergence of health psychology inevitable. It is safe to say that health psychology is one of the most

important developments within the field of psychology in the last 50 years. What factors have led to the

development of health psychology?

Changing Patterns of Illness

The most important factor giving rise to health psychology has been the change in illness patterns that has

occurred in the United States and other technologically advanced societies.

As we discussed in our earlier lecture, until the 20th century, the major causes of illness and death in the

United States were acute disorders--especially tuberculosis, pneumonia, and other infectious diseases.

Acute disorders are short-term medical illnesses, often the result of a viral or bacterial invader and usually

Health Psychology PSY408

amenable to cure. Now, however, chronic illnesses-- especially heart disease, cancer, and diabetes--are the

main contributors to disability and death. Chronic illnesses are slowly developing diseases with which

people live for a long time. Often, chronic illnesses cannot be cured but rather only managed by the patient

and provider working together.

Why have chronic illnesses helped spawn the field of health psychology? First, these are diseases in which

psychological and social factors are implicated as causes. For example, personal health habits such as diet

and smoking are implicated in the development of heart disease and cancer, and sexual activity is critically

important in the likelihood of developing AIDS (acquired immune deficiency syndrome). Consequently,

health psychology has evolved, in part, to explore these causes and develop ways to modify them.

Second, because people may live with chronic diseases for many years, psychological issues arise in

connection with them. Health psychologists help the chronically ill adjust psychologically and socially to

their changing health state.

They help those with chronic illness develop treatment regimens, many of which involve self-care. Chronic

illnesses affect family functioning, including relationships with a partner and / or children, and health

psychologists both explore these changes and help ease the problems in family functioning that may result.

Many people with chronic illnesses use unconventional therapies outside formal medicine. Understanding

what leads people to seek unconventional treatments and evaluating their effectiveness are also issues on

which health psychologists can shed light.

The field of health psychology is changing almost daily because new issues arise that require the input of

psychologists. For example, new technologies now make it possible to identify the genes that contribute to

many disorders. Just in the past five years, genes contributing to many diseases, including breast cancer,

have been uncovered.

How can we help a college student whose mother has just been diagnosed with breast cancer? Now that we

have a better understanding of the genetic causes of breast cancer, we can evaluate the student's own risk

factor of contacting the same disease. We can have different tests that may tell us about the student's risk of

breast cancer. And if the results tell us that she is indeed vulnerable to the same disease, we can design early

prevention plans for her to reduce the risk. We can also enhance her psychological coping abilities so that

her risk is further reduced to a minimum.

Health psychologists also conduct research that identifies the risk factors for a disease, such as a high-fat

diet, and also help people learn to change their diet and stick to their resolution. Helping people make

informed, appropriate decisions is fundamentally a psychological task. Advances in genetic research have

made it possible to identify carriers of illness and to test the fetus for the presence of particular life-

threatening or severely debilitating illnesses. This places some parents in the position of having to decide

whether to abort a pregnancy, a wrenching, difficult decision to make.

Certain treatments that may prolong life have the effect of severely compromising quality of life.

Increasingly, patients are asked their preferences regarding life-sustaining measures, and they may require

counseling in these matters. These are just a few examples of the increasing role that patients play in

fundamental decisions regarding their health and illness and its management and of the help health

psychologists can provide in this process.

Changing patterns of illness have been charted and followed by the field of epidemiology, a discipline

closely related to health psychology in its goals and interests.

Health Psychology PSY408

Expanded Health Care Services

Another set of factors that has contributed to the rise of health psychology relates to the expansion of

health care services. Health care is the largest service industry in the United States, and it is still growing

rapidly. Americans spend more than $1,000 billion annually on health--more than 14 % of their total

income. In recent years, the health care industry has come under increasing scrutiny as we have realized that

massive increases in health care costs have not brought with them improvement in basic indicators of

quality of health.

Moreover, huge disparities exist in the United States, such that some individuals enjoy the very best health

care available in the world and others receive little health care except in emergencies. As of 1994, 37 million

Americans had no health insurance at all, placing basic preventive care and treatment for common illnesses

out of financial reach. These are among the developments that have fueled recent efforts to reform the

health care system to provide all Americans with a basic health care package; similar to what already exists in

most European countries.

Health psychology represents an important perspective on these issues for several reasons. First, because

cost containment is so important, health psychology's main emphasis on prevention--namely, modifying

people risky health behaviors before they ever become ill--has the potential to reduce the number of

dollars devoted to the management of illness. Second, health psychologists have done substantial research

on what makes people satisfied or dissatisfied with their health care. Thus, they can help in the design of

user-friendly health care systems.

Finally, the health care industry employs many millions of individuals in a variety of jobs. Nearly every

individual in the country has direct contact with the health care system as a recipient of services. Thus, its

impact on people is enormous. For all these reasons, then, health has a substantial social and psychological

impact on people, an impact that is addressed by health psychologists.

Increased Medical Acceptance

Another reason for the development of health psychology is the increasing acceptance of health

psychologists within the medical community. Although health psychologists have been employed in health

settings for many years, their value is increasingly recognized by physicians and other health care

professionals. At one time, the role of health psychologists in health care was largely confined to the task of

administering tests and interpreting the test results of individuals who were suspected of being

psychologically disturbed. Like psychiatrists in health settings, psychologists usually saw only the `problem

patients' who were difficult for medical staff to manage or whose physical complaints were believed to be

entirely psychological in origin.

Now, however, caregivers are increasingly recognizing that psychological and social factors are always

important in health and illness. Accordingly, the role of the psychologist in changing patent's health habits

and contributing to treatment is increasingly acknowledged.

Demonstrated Contributions to Health

Health psychology has already demonstrated that it can make substantial contributions to health. Although

these contributions form the substance of later lectures in this course, a few brief examples here can

illustrate this point.

As previously noted, health psychologists have developed a variety of short-term behavioral interventions to

address a wide variety of health-related problems including managing pain, modifying bad health habits,

such as smoking, and managing the side effects or treatment effects associated with a range of chronic

diseases.

Health Psychology PSY408

Techniques that often take a mere few hours to teach often produce years of benefit. Such interventions,

particularly those that target risk factors like diet or smoking, have contributed to the actual decline in the

incidence of some diseases, especially coronary heart disease.

To take another example, psychologists learned many years ago that informing patients fully about the

procedures and sensations involved in unpleasant medical procedures, such as surgery, improves their

adjustment to those procedures. As a consequence of these studies, many hospitals and other treatment

centers now routinely prepare patients for such procedures. Ultimately, if a discipline is to flourish, it must

demonstrate a strong track record, and health psychology has done precisely that.

Methodological Contributions

Health psychologists make important methodological contributions to issues of health and illness. Many of

the issues that arise in medical settings demand rigorous research investigation. Although physicians and

nurses receive some methodological and statistical education, their training may be inadequate to conduct

research on the issues they wish to address unless they make research their specialty. The health

psychologist can be a valuable member of the research team by providing the methodological and statistical

expertise that is the hallmark of good training in psychology.

We will not go into the details of the different research methods used in health psychology. Suffice it to say

at this point that the research training that health psychologists receive in their undergraduate and graduate

school experiences makes them valuable parts of the research teams that attempt to understand how we stay

healthy and why we get ill.

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