We are moving through our interviews at this time, running approximately 15 minutes behind schedule due to initial technical difficulties. Thank you for your patience, applicants!
Susan R. Redmond-Vaught, Ph.D
Director, WKPIC
January 01 2016
January 01 2016
Friday Factoids: Underplaying Tobacco as a Health Issue
As an ex-smoker I understand the struggles involved in quitting. I used to joke that the messages I received to quit sounded like the nagging, wordless voice of the Charlie Brown teacher. I think that in order for any of us to change a behavior, addictive or not, we need to have an “Ah-Ha” moment.
I began working in the medical field at a young age as a respiratory therapist. I saw the effects of smoking on others, but I rationalized this by looking at how much older they were than me. Some of them were in fact in their 40’s, but in my early 20’s this seemed pretty far off. My perspective changed though. I saw patients tracheostomies beg to be taken outside the hospital to smoke. I worked with people who were very severe asthmatics who would fight with staff over being able to remove supplemental oxygen so that they could smoke. I saw burn victims who had caught a bed on fire. I worked with COPD patients who became burn victims while smoking at home on oxygen. Unfortunately for me, it took this high level of exposure to negative outcomes in order to make changes.
Every smoker or tobacco user knows that it is something they “shouldn’t” be doing. Clinical staff tends to look at smoking as a minor problem when a patient presents with high levels of substance abuse or other behaviors that threaten health and wellbeing. Despite knowing how much tobacco use will cost someone in the long run, I feel like clinicians and patients have a greater sense of complacency with this particular issue. As psychologists, we tend to shy away from the diagnosis of Nicotine Use Disorder even when it seems severe. I have often times not addressed a patient’s smoking for different reasons. If it was a substance abusing patient, I feared that smoking cessation would increase relapse risk. Research hasn’t supported this idea. I really worried that adding smoking cessation goals to patients’ care plans would prove to be too much for them.
As clinicians we have a duty to help our patients, especially when they are engaging in behaviors that have a high likelihood to result in death and disability. In my opinion, we need to take just as strong a stand on tobacco use as any other substance of abuse that is resulting in damage to our patients. Since smoking is a slower more gradual killer, it tends to get overlooked. Sometimes “over compassion” and not wanting to add additional “stress” to a patient keeps clinicians from pursuing smoking cessation/education more aggressively. I think patients need to see a strong tobacco free stance from all healthcare personnel. We ourselves should strongly consider quitting if we are smokers. Having our own stories of what led us to quit and how we did it will only help our patients.
Kentucky Department of Public Health supports an online program offering education and individual coaching: https://www.quitnowkentucky.org/
References:
Knudsen, H., Studts, C., & Studts, J. (2012). The Implementation of Smoking Cessation Counseling in Substance Abuse Treatment. Journal Of Behavioral Health Services & Research, 39(1), 28-41. doi:10.1007/s11414-011-9246-y
Rain Blohm, MS
WKPIC Doctoral Intern
January 01 2016
Friday Factoids Catch-Up: Being with A Life Until The End
I am experiencing the impending death of an elderly family member, our matriarch, my Granny. Thankfully, she will be able to pass on in peace. Our family knew what she wanted the end of her life to look like. We had very much agreed with her wishes.
Despite whatever differences our family may have on other fronts, we are a unified front for her now. We are sure about our decisions for her. When a doctor had come in and suggested she be transferred to a large medical center for very aggressive treatment we were able to smile and nod in understanding. Her kidneys have failed as a part of the dying process and her doctor wants to help by “fixing” this. Most of the people in the small community my Granny lived in knew her well and this doctor is no exception. He wants to do everything his training in the healing arts has given him to stop death. It is his imperative. When we were able to talk with him and describe what we knew were her wishes, he understood, but seemed defeated somehow.
I have worked in intensive care unit settings as a respiratory therapist prior to becoming a doctoral intern in psychology. I have assisted in brain death determinations on patients a day old to 104 years old. I have been a part of ethics committees questioning the continuation of aggressive treatment via life support. I have been in situations where a very few medical staff, usually three of us, an MD, RN, and RT, remove life support alone because a dying person’s family has fractured and no one can emotionally or physically attend the death. I have seen and heard reactions to death by medical staff despite the denial that they are affected. Broken professionals are leading broken families at times and creating poor outcomes for dying patients.
What is a “poor outcome” in death? The medical community most certainly identifies death itself as a “poor outcome.” Aggressive treatment is used too often with dying patients and this is something I personally identify as a poor outcome. The message that there is still hope is easier to deliver than there is no hope. I disagree with the idea that there is no hope in the dying process itself, if it is recognized. There have been great strides made in awareness of death and dying, but too many still die in pain and with modern medicine trying valiantly to “save” them. Why? Most medical staff in intensive care units know they do not want the same measure of treatment they provide to others every day. This should provide a better guide in the care administered in these settings. The more I practiced in medical settings initiating and maintaining life support, the more times I administered care I would personally never want. This happened to most all I worked alongside regardless of religion, culture, or creed.
I hope at some point to be able to help other families and medical teams in providing a death like my Granny’s for others–where there is a sense of calm and not a flurry of anxious activity meant to avoid what cannot be avoided. Our family and her medical team are sitting with her calmly. There is no push to “save” a life when the proper course is to simply be with a life until its end.
Rain Blohm, MS
WKPIC Doctoral Intern
January 01 2016
Friday Factoids Catch-Up: Exposure to Violence
Unfortunately, exposure to acts of violence has become all too common. Adults as well as children can be affected by the media information streaming into our homes after yet another act of terrorism or violence scrolls across our electric windows to the world. I think that we underestimate the impact of our exposure as a whole to these events via media.
The information age has resulted in real time coverage of some violent events as they unfold. As a survivor of trauma, observing the public reaction to media when these events occur has become of interest to me. I observe a response that looks like a unique group form of the “fight or flight” response. I am concerned about how the long term effects of these frequent exposures and responses might manifest. We know very little about how the public as a group reacts to repeated exposure to violence.
I do not think that the same physiological intensity comes into play with violent media exposure because we identify the event as not an IMMEDIATE threat. However, we are more frequently exposed to violent events through the media. Learning about an event can produce traumatic stress. The immediate reaction to many media stories seems to be one of interest or curiosity in the event. We want to gather all the facts we can about the event that has caught out attention. I feel it is a part of why our attention is quickly drawn into seeing violent events on screen. It is important to our survival to be able to quickly identify danger in our environment. The computer screen provides an element of separation from the event, which is a part of why I think we become less likely to have the same strong physiological response as if we were a part of the actual event.
Watching the violent media event seems to induce enough of a fear response for people to want to fight. Our fight response is not fulfilled by just watching the media event but wants to “do” something. This may turn into positive “fights” like advocacy for the event victims or donations to charities. An example of this was demonstrated after the 9/11 attacks. Donations flowed into the Red Cross and other charitable organizations related to this tragedy. People lined up for blocks to donate blood to ensure resources would be available for those injured during the attack. Other times it seems our fight reactions bring out some of our less desirable traits as human beings. Prejudice against Muslims and those assumed to be of Middle Eastern origin developed and continues to increase. Retaliatory attacks and acts of war were carried out in a very tangible example of fighting. Those answering the 9/11 fight response were not at ground zero but exposed by media and information given to them.
I think the flight response takes its own form in our reactions to at large violence as well. At one time it was simple to turn off the TV and not have yourself or children exposed to unfolding violent events. This is not realistic in our current world of instant information availability. If we know we cannot win a fight, we will try to escape. I think that we do not truly appreciate the effect of the current lack of this ability to escape from violent events. A dripping faucet will eventually fill a bathtub, but not as quickly as a sudden opening of the faucet. A drip is more difficult to notice at first and I think constant drips of fear from violent events cannot be escaped in the information age. When an animal or a human cannot escape, they adapt to the threat. This again seems to be able to take both positive and negative forms on our human group as a whole. Adaptation to violence by being appropriately vigilant and not hypervigilant can prove helpful. Children and adults seem comforted by the presence of an emergency plan even if it is never used. Many emergency plans for dealing with violence have been put into place with the increase in mass shootings and terroristic acts. Changes in airport security may be another example of adaptation. I think in some of the more negative manifestations adaptation in this situation could prove to decrease our empathy for those involved in the tragedies we see unfolding. We accept the higher levels and more frequent violent events as a part of our modern society, in other words we just blindly accept that the violence is here. That it cannot be changed. Apathy may produce depression in an individual but in the group it seems to create dangerous stagnation.
I think that as a group we could do more to limit the real time coverage of violent events to help stem the “drips” that come into our tub constantly without notice. Unfortunately our inaction to decrease this flow seems apathetic. Making a stronger push for our positive fighting mechanisms that we have in fact demonstrated could help us develop solutions to unwanted violent media exposure.
Rain Blohm, MS
WKPIC Doctoral Intern
January 01 2016
Surviving Match: Personal Stories
Like many students, I found the APPIC process daunting, but worth it in the end. I experienced an early elation at receiving interviews. I am a returning adult pursuing a second career, and I was unsure how that might play out in the eyes of those reviewing my applications. I am quite sure there have been older graduate students, but I encountered only younger applicants during my interviews. I have more life and work experience than my younger counterparts, but this does not always seem to compete with the solid accomplishments that many of my counterparts had already made very early in their careers.
I found that the APPIC process caused me to look at the lingering doubt I had in myself being able to finish my doctoral program. I was excited that I received the interviews, but also dismayed by fellow students in my program who I felt were just as qualified as myself receiving none. I felt like I knew even less about what to expect on interviews if students who I thought were well qualified had not received interviews.
The logistics of what I was about to embark on quickly became a reality. I found a phone app that helped me organize travel itineraries and hoped for the best with the January weather. There were several hitches along the way, but the worst actually happened traveling to my WKPIC interview. I was delayed in Chicago due to poor weather conditions and had missed an interview. I was placed on another flight and thought I was underway until there was a loud thump as the plane backed up. The plane began moving back toward the gate and that was when the entire plane of delayed and tired passengers let out a collective groan. We soon found out that our plane had backed up into a truck, and once it was determined that no one was hurt, jokes and laughter abounded. The accident was actually considered a plane crash and we all remained on the flight until an investigator dismissed us. I pretty much stepped off my flight from Chicago to Nashville, into my rental car and drove to Hopkinsville (thank you GPS). I had already called WKPIC while sitting on my “crashed” plane to alert the interviewers I might be running a bit late.
I of course made it to my interview and was even on time within 5 minutes. I had taken the idea of finding a good fit to heart, and at this point tried to interview sites as well as having them interview me. I feel like one of my stronger interviews was at WKPIC because in part, I was literally too tired to be anxious. I was drawn to WKPIC because they treated applicants so well during the interview process. One of the psychologists complimented me on an answer to an interview question. I actually still carry that compliment with me. Current interns smile and laugh that WKPIC definitely fed us better than other sites. I noticed a group of psychologists who seemed to enjoy being with one another. I saw a culture of acknowledgement, dignity and respect during my interview. My thought during ranking was that if I was acknowledged and respected in an interview, this was likely part of the culture at WKPIC. I have certainly found that culture to hold true as an intern.
Rain Blohm, MS
WKPIC Doctoral Intern