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How Learned Helplessness Can Impact Patient Satisfaction Nursing Essay

Ever since To Err is Individual did patients really begin to care about the quality of treatment they received of their physicians, private hospitals, and healthcare organizations. However, medical care organizations experienced already recognized the value of patient satisfaction several years previously. Many organizations began calculating patient satisfaction as a way to evaluate the perceptions of how their patients viewed their experience while under their attention. There are numerous facets to calculating patient satisfaction but to time the concept of learned helplessness has not been incorporated into the mix. Discovered helplessness is a happening taking place in many places in our society. It influences how we work, connect to others, conduct our business, and utilize our thoughts and views on medical. When experience with uncontrollable incidents leads to the expectation that future happenings may also be uncontrollable, disruption in motivation, feeling, and learning might occur. That phenomenon has been called learned helplessness (Cemalcilar 2003). Armed with an improved understanding with how learned helplessness is important in patient satisfaction healthcare configurations will be better in a position to alleviate this discomforting sensation and therefore should increase patient satisfaction scores. This paper acts as a vehicle to investigate the concept of learned helplessness combined with an assessment of patient satisfaction and provide instruction for research to further our knowledge of the relationship between your two.

Literature review:

Learned helplessness came into being by accident in 1965 by Martin Seligman and his team while studying the partnership between fear and learning. Seligman noticed an unexpected patterns while investigating Pavlov's theory on stimulus and response. Seligman didn't match the bell with food but compensated the dog with a small impact while restraining the dog to keep it from jogging away. The researcher thought that the dog would experience dread after reading the bell and would make an effort to try to escape or display some other type of action. After this your dog was put into a package with two compartments divided by a minimal enough fence that the dog could see the other area and avoid if the dog so desired. With their amazement, following the bell was sounded your dog didn't make an effort to run away but instead just laid or sat on the one aspect of the pack. The research workers repeated the test but instead of sounding the bell they gave the dog a small distress. As was the case with the bell the dog decided to stick to its initial side of the box. The test was repeated with your dog that acquired never been subject to any of the previous experiments so when given the impact the dog required journey and jumped over the tiny fence to escape. What was chose was that the first dog, while being restrained, learned that looking to get from the distress was pointless and the dog got no control over its future and was therefore helpless. Some analysts have contended that your dog just thought he had been punished for some act of wrongdoing or that the end of the pain from the shock was indeed the pay back. However, this behavior has been used in a number of situations which is explained here in an effort to learn more about this sensation.

Learned helplessness has harmful effects on children. They create a lack of self-confidence in challenging duties which bring about deterioration of shows (Dweck, Davidson, Nelson, & Enna, 1978). These children do not develop good problem fixing strategies and can suffer from lack of attention and feel that all of their work are fruitless. Children such as this are often organised back a level in an effort to bolster their public and academics skills. In the end, they get a note that they are worthless and hopeless (Berger, 1983). These children may be inadequately ready to take on new learnings and perform unusual tasks. Failure become synonymous in these children's vocabulary and repeated efforts may do little to change their view. In Erikson's view, he suggests that children with few successes can be inferior which leads them to truly have a low self-esteem (Berger, 1983). Most discovered helpless students give up trying to gain esteem through their educational performance so they decide on other opportinity for recognition. They could become the class clown, bully or tease. When they commence adolescent years they try to gain respect through antisocial conducts (Berger, 1983). With learned helpless children, competence is nearly entirely demolished. They lose self-confidence within themselves because they experience failures, leading them to trust they can be failures. They could feel competent about something at first but if they fail for the reason that activity they don't bother to try it again for fear of inability. Autonomy is also faint in a learned helpless student's life. They feel as if they have no control over their environment because no matter how hard they attempted in the past, they never been successful. For relatedness, discovered helpless students feel as if they don't really belong because they believe that they don't relate to the environment. This is why they end up being the class clown, bully or tease in order to get their recognition. These results can include becoming an antisocial person throughout their adolescent years or prior. These three factors are all detrimental to an individual's expansion and development inside our communal world today. There were a few scales conducted and assessed trying to utilize this construct in a number of situations. The majority of these studies used discovered helplessness as a secondary construct in describing either complaint patterns (Lee and Soberon-Ferrer 1999) and measuring the partnership between empowerment and learned helplessness (Campbell and Martinko 1998). The study showed that there have been many differences between empowerment and learned helplessness. Another review was conducted in a hospital environment with a reported trustworthiness of 0. 85. It acquired a positive marriage with Beck's hopelessness range (r=. 252) and a poor correlation with Rosenberg's Self-Esteem range (r=-. 622) (Quinless 1988).

Another way it make a difference people is through different thoughts such as pessimism, futility, risk aversion, unhappiness, and self-esteem. It's been identified in people as a state of which the buyer cannot control their future or outcomes and therefore relinquish control over a certain situation.

What research currently has been conducted to study patient habit with learned helplessness? Raps et. al (1982) discovered that the longer a patients length of stay was the worse the individual performed on cognitive jobs that index discovered helplessness. First, they motivated this because of a perceived lack of control by the individual. Second, increased hospitalization resulted not only in increased deficits but also in increased vulnerability to similar deficits produced by minimal amounts of uncontrollable noise, recommending that the procedure root the deficits in the no-noise conditions is learned helplessness made by hospitalization. Third, increased hospitalization disrupted performance at the problem-solving responsibilities, however, not at the verbal intelligence test-replicating the previous results from laboratory studies of learned helplessness and suggesting that the deficits of our own subjects were not an over-all deterioration but instead a more specific difficulty with new learning (Raps et al. 1982). Fourth, increased hospitalization produced increased depressive symptoms that covaried with poor performance both across and within conditions. This structure advises again that perceptions of helplessness triggered the experienced deficits, since melancholy involves a diminished sense of efficiency (Raps et al. 1982).

Faulkner (2001) set out to research the relevance of learned helplessness and discovered mastery ideas in the individual development of dependence and self-reliance in old hospitalized people. Faulkner's experiment shows how an exposure to uncontrollable or disempowering circumstances probably places patients at risk of developing learned helplessness. This problem has the potential to retard self-care performance in the absence of supervision, route, or dynamic personal assistance thus making patients based mostly (Faulkner 2001). Moreover, this dependence might not exactly continue to be specific to the task within which LH was induced, but may generalize to have an impact on patient performance in alternative activities. To date the accepted size to utilize when measuring discovered helplessness is the LHS range developed by Quinless and McDermott-Nelson.

A conceptual classification is necessary so as to further explore this trend. Learned helpless can be identified by a state when a person believes that they can not control their own future and the life span experiences which happen to them. This meaning incorporates the key elements found throughout the study: loss of control, despair, low self-esteem, pessimism, and beat.

Learned helplessness can contain the potential for explaining some variance in patient satisfaction ratings. In order to further explore the way the two are interrelated, a study into patient satisfaction must be used.

Patient satisfaction:

With the potency of medical care being increasingly assessed according to economic as well as specialized medical criteria, the addition of patients' viewpoints in assessments of services has gained increased prominence within the last 25 years (Sitzia & Wood 1997). As healthcare costs come under scrutiny, so consumers in the Western world have become more critical of the health care provided, managing and claiming privileges as active individuals in the planning and analysis of health services (Sitzia & Solid wood 1997). An increase in interpersonal romance interest sparked the development for a need to understand the patient-physician marriage which gave climb to patient satisfaction measurement. Consumer advocate organizations like the National Consumer Council produced Patients' protection under the law, which affected the climb of consumerism in healthcare. The term patient's rights became the rallying cry for Patients to have significantly more control and say about the care and attention that was expanded to them. What then decides what patient satisfaction is? Linder-Pelz (1982) approached a meaning of patient satisfaction through five social-psychological parameters proposed as possible determinants of patient satisfaction with health care. These are specified as: Occurrences-the event which actually takes place, as well as perhaps moreover, the individual's conception of what happened; value--evaluation, in terms of good or bad, of attribute or an aspect of a healthcare come across; expectations--beliefs about the probability of certain capabilities being associated with an event or thing, and the identified probable outcome of this association; interpersonal comparisons--an individual's rating of the health care encounter by looking at it with all such encounters recognized to or experienced by her or him; and entitlement--an individual's idea that s/he has proper, accepted grounds for seeking or professing a particular final result. Ware et al. (1983) provides more definitive taxonomy with eight sizes: social manner--features of the way in which providers interact privately with patients (e. g. admiration, matter, friendliness, courtesy); technical quality of care--competence of providers and adherence to high criteria of medical diagnosis and treatment (e. g. thoroughness, accuracy and reliability, unnecessary hazards, making flaws); accessibility/convenience--factors involved with arranging to get medical care (e. g. longing times, ease of reaching specialist); finances--factors involved with paying for medical services; efficacy/outcomes of care--the results of services provided (e. g. advancements in or maintenance of health); continuity of care--constancy in service provider or location of health care; physical environment--features of setting up in which treatment is delivered (e. g. quality of signs and directions, orderly facilities and equipment, pleasantness of atmosphere); and availability--presence of medical care resources (e. g. enough medical facilities and providers). CMS has mandated the HCAHPS measures of patient perception of quality of treatment as a disorder of Medicare contribution (Griffith & White 2007). CMS (Medicare) states "the provider shall perform beneficiary satisfaction surveys and make the results available upon request and/or listed on the Internet website (if applicable). The provider shall file and review on the quarterly basis a share of beneficiaries content with services. " These research include questions that are divided into five teams: Your health care from nurses, Your health care from Doctors, A healthcare facility environment, Your encounters in the Hospital, When you still left a healthcare facility, Overall score of a healthcare facility, and Demographic questions. These questions must be incorporated into commercial patient satisfaction studies and publicly reported. In some instances referring doctors may act as agents because of their patients and are concerned with clinical benefits, patient satisfaction and cost. This is important because if they are not satisfied with the patient's responses, they may divert their patients in other places.

However there are some concerns for those that don't buy into patient satisfaction scores. These fall in to the category of social-psychological artifacts. LeVois et al. (1981) says that "Social desirability response bias" argues that patients may report greater satisfaction than they actually feel because they believe positive comments are more acceptable to survey administrators. In the same way, "ingratiating response bias" occurs when patients use the satisfaction review to ingratiate themselves with experts or medical personnel, particularly if there are any reservations above the anonymity of respondents (Sitzia & Hardwood 1997). Why then analyze patient satisfaction?

Typically patient satisfaction surveys are after the assistance have been rendered and the patient has left the hospital or medical professionals office. A lot of the surveys use a 5 point Likert scale with 5 indicating excellent or highly satisfied and 1 being poor or highly dissatisfied. Most managers think that getting typically 4s is great or good enough and trying to achieve a 5 rating is too costly or frustrating. This is not the situation. Many managers also think that they should concentrate on unsatisfied customers but research has shown that no subject how much time, work, and money they invest, there will always be a small ratio of patients that are dissatisfied. Professionals should then concentrate on moving those four evaluations to fives. With regards to customer devotion, "excellent" has some other interpretation from the other rating categories (Otani et al. 2009). Highly satisfied customers are the ones that are faithful and return for his or her next come across or recommend others to the same doctor or center. This usually consists of about 75% of the medical doctors business so it is crucial that they keep this group happy and highly satisfied. Within an emerging competitive market such as professional medical, managers should concentrate on achieving excellent rankings to tell apart their firm from others (Otani et al. 2009). Patients that are merely satisfied will seek attention elsewhere to check out other providers. Despite the fact that the expense of switching hospitals is quite high, patients have significantly more alternatives now than they do in past eras. What are various other reasons to highly satisfy these patients? Satisfied patients have a tendency to comply with prescribed medical treatments (Ford, Bach & Fottler 1997). Because of a rise in long-term conditions, it is more very important that patients follow the procedure process prescribed. This may reduce amount of remains and lower readmission rates thus minimizing costs. Also, it reduces switching. When a patient changes doctors, she or he may be asked to retake tests, which escalates the patient's costs and may hurt the individual (Otani et al 2009). Another factor is patient satisfaction is now considered a key part of the healthcare quality improvement initiative (Shortell and Kaluzny 2000). Many handled care and attention organizations use patient satisfaction data to ascertain reimbursement rates to healthcare providers, and many leading companies won't deal with health plans that do not need a patient satisfaction review. Providers with positive patient satisfaction survey results may get more financial incentives than providers with poor patient satisfaction review results (Kongstvedt 2001). In addition a 1 standard deviation point increase in the quality of pt/physician interaction equals a 35% lower chance of a patient complaint for the principal care physician, and a 50% lower potential for a patient grievance for a specialist (Saxton et al. 2008). Saxton (2008) also accounts a one standard deviation decrease in patient satisfaction equals a five percent increase in the medical doctors risk management. In comparison to doctors in top satisfaction ratings: Doctors in middle 1/3 of results got malpractice lawsuit rates 26% higher while Doctors in bottom 1/3 of results acquired malpractice lawsuit rates of 110% higher. Matching to Saxton (2008) the most notable five patient priorities are: Response to concerns/problems during stay, Level to which hospital staff tackled patient's emotional needs, Staff effort to add patient in decisions about their treatment, How well the nurses retained the patient enlightened, and Promptness in responding to the decision button by the patient. One issue not investigated carefully is the billing activities of a healthcare facility or caregiver. Richard Clarke, HFMA CEO and Chief executive has explained "the best good care, and great customer support provided through the patient's hospital come across can be destroyed quickly by perplexing, complicated, or inappropriate billing later on" (Swayne et al. 2008). According to Swayne (2008, the top five hospital monthly bill features that irritate customers the most are: confusion in what the patient's insurance company has paid, misunderstandings about the balance the patient owes the hospital once the insurance provider pays its show, use of medical terminology that the individual does not understand, sending a monthly bill to the individual before the insurance provider has processed the patient's says, and inability to ascertain exactly what services a healthcare facility has provided and what the individual is being charged for the service. Follow-on activities are also another area that the physician or caregiver can transform patient satisfaction results. Many providers feel that after the patient has gone out the door the experience ends there. After an individual has been seen by a physician or is giving a healthcare facility after surgery, there's a likely need for further services: a kid with an ear canal infection has to return in 10 times for another check-up to ensure the problem is no longer present; after hip surgery an individual might need to be relocated to a rehabilitation facility to figure out how to walk again (Swayne 2008). Many of these additional services are value adding service activities. All of these factors play a role in discovered helplessness as the patient may become annoyed by not having an excellent experience throughout the visit or after the visit.

Proposed study:

This paper shall utilize the current learned helplessness level (LHS) and apply it to see how it moderates patient satisfaction results.

Method of analysis:

The suggested model because of this study is:

Patient Satisfaction Scores

Internal Express of patient

Patient Experience

Learned helplessness

Learned helplessness

This research was steady with the often used S-O-R paradigm. This paradigm assumes that surroundings contain stimuli (Ss) that cause changes to people's inner or organismic claims (Os), which cause strategy or avoidance replies (Rs) (Mehrabian and Russell 1974). It really is predicted that higher levels of discovered helplessness will adversely impact patient satisfaction scores. The region most anticipated are those constant with loss of control in gratifying the needs of the patient, like treatment from the nurses, care and attention from the doctor especially in information showing, and billing issues from either the hospital or the insurance provider. The build will be viewed as a moderator. "In general conditions, a moderator is a qualitative (e. g. , intimacy, race, category) or quantitative (e. g. , level of reward) adjustable that affects the course and/or durability of the relationship between an independent or predictor adjustable and a based mostly or criterion adjustable. Specifically inside a correlational analysis framework, a moderator is a 3rd variable that influences the zero-order relationship between two other parameters. . . . Within the more familiar examination of variance (ANOVA) terms, a basic moderator effect can be symbolized as an discussion between a focal indie variable and one factor that specifies the appropriate conditions because of its operation. " (Baron & Kenny 1986).

Data collection:

Data collection will be the most challenging facet of this study. It is important to gather abundant data that will either support or disprove the theory that discovered helplessness decreases patient satisfaction ratings. A large enough sample is usually to be gathered in order to fully display this phenomenons functionality. The LHS will be distributed along with the chosen hospitals patient satisfaction study and patients will be asked to complete them. It might be necessary to delay the syndication of the study therefore the patient has ample a chance to be contacted or experience discovered helplessness form billing conditions that may come up. After a sufficient number of studies have been returned to the writer, statistical regression methods will be employed to assess statistical relevance as it relates to discovered helplessness and patient satisfaction ratings. Different factors can be cross-tabulated to see if there are any generalized results on the ratings like age, race, financial, and educational positions. Model fit could be assessed using SEM or other solutions to ensure proper allocation and model analysis.


As explained before data collection will be difficult in accomplishing this study. Hospitals may be reluctant to allow a researcher, in addition to the organization, access to their patients and their satisfaction data. This reluctance could be over a variety of factors including patient privateness, fear of incorrect ratings released to the general public, and an over-all distrust for educational research. It may be necessary to execute this review as a jv so the medical center may study from this review as well as the researcher. Another restriction is patient recall. That is always one factor since consumer recall plays a role in remembering perceptions, actions, and behaviours that occurred in the hospital or caregivers office. Since billing can be an issue with discovered helplessness, the hold off in presenting the research may affect memory space recall. The last limitation may be that of the build being researched itself. Since there may be little research on learned helplessness as it pertains to patient satisfaction or patient experience it might be difficult to determine how strong a score on the LHS size must be to totally realize an effect on patient satisfaction.


This newspaper has specified the construct of discovered helplessness and exactly how it probably could connect to patient satisfaction ratings. Patient satisfaction scores are of the upmost importance to hospitals and caregivers as it impacts their quality rankings, their allocation from CMS, and their reputation in general. While this project is a significant undertaking, the author feels that it is worthy of such time and effort as patients and caregivers seek to help expand understand the individual experience in medical settings. This newspaper has discussed a plan of action even though this project must be further looked into, it lays the necessary framework for a study worth journal submission. Future research could fully implicate different ways that discovered helplessness is developed in different professional medical settings allowing for richer evaluation into how patients react to different perceived benefits. Hospitals and caregivers can use information from this research to redesign their patient satisfaction surveys to allow them to accumulate richer data and utilize this to improve satisfaction ratings which ultimately impact the bottom brand. In this modern of health care reform, it is critical that healthcare firm strive in every effort to raise the bar of patient results, not only physical final results but mental outcomes as well.

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