Wednesday, September 30, 2015

The Ole' Thesis

         So here's a little more background info on my thesis. The working title is "The Silent Dimension of a Health Care Narrative: Patient Perceptions of Practitioners' Nonverbal Cues," and I'm really thankful to have settled on a topic that both fascinates me and feels important. Andrew has a true interest as well, which has been great - always nice to live with a vested sounding board. Anyway, here's a little overview taken from my proposal:


         The quality of our health care hinges on the abilities of those providing it. While medical professionals are trained in the instrumental aspects of their field, they overwhelmingly lack communication training, particularly in the nonverbal realm (Roter et al., 2002, Monlineuvo et al., 2011). Yet, chances are, if a patient expresses a strong opinion of their practitioner, that professional is either a very skilled or very unskilled communicator. Beyond patient trust and satisfaction, conventional wisdom would tell us practitioners who put patients at ease have a greater chance of gaining more comprehensive and accurate patient histories, in turn yielding more accurate diagnoses. Satisfied patients are more likely to comply with treatment regimens, more likely to remain with one practitioner, refer other patients, and less likely to initiate malpractice suits (DiMatteo et al., 1980; Montague et al. 2013).

         An estimated 65% of the meaning in a social encounter is communicated non-verbally. Our nonverbal communication (posture, proximity, tone of voice, gestures, eye contact, etc.) often anticipates, substitutes, modifies, emphasizes, or, interestingly - as in the case of the physician who tells a patient she is happy to answer any questions they might have while avoiding their gaze and keeping a hand on the door knob - contradicts verbal communication. Nonverbal cues may be less susceptible to an individual’s censorship than verbal cues and therefore may more reliably indicate what is being communicated (Griffith, Wilson, Langer, & Haist, 2003).

         Patients are often hesitant to verbally express their feelings to their provider, and so the provider’s accurate perception of nonverbal cues may be the only way for him or her to identify patient dissatisfaction or distress and then exhibit the appropriate response (DiMatteo et al., 1980). Also, since the verbal expression of caring and concern is many times uncomfortable or inefficient for the clinician in his or her role, the ability to express emotion through nonverbal cues would be an important aspect of patient trust and rapport as well (Friedman, 1979).

         Modern health care providers are often overbooked and pressed for time. Additionally, the recent electronic health care records mandate is changing the nature and quality of American medical visits, with many patients feeling negatively impacted by physicians who seem preoccupied and use less eye contact. Ultimately, practitioners need to know that positive patient relationships can be established without necessarily compromising efficiency, and may be best achieved through effective nonverbal communication.


         SO. I'm gathering data through focus groups as well as a survey instrument. I'm posting the link to the latter below - the more responses the better!! If you've recently been to see a doctor, dentist, optometrist, nurse practitioner, etc. (really anyone licensed to diagnose and treat), please feel free to fill it out. Or keep it in mind if you have an upcoming appointment! The survey will be up and accepting anonymous responses until the beginning of November. Many of the questions seem redundant, but are taken from two established, validated measures. Anyway, thanks so much for your time!



P.S. On an unrelated, but significant note - the contractions that were just annoying when I started this post are now getting downright uncomfortable. Wondering if this could be the start of a long night...wish us luck!!

Monday, September 21, 2015

Pre-Baby Game

       We're getting close, you guys. At almost 38 weeks, I'm huge...like a house, but with no curb appeal. Being this close to the end makes me equal parts anxious, excited, and terrified. The fear and anxiety result from my desperate desire to complete every single project/task/outing prior to the baby raining down sweetness, sleep deprivation and stringent milk demands on our parade. I just like my joy served a la carte, without a lumpy side of stress lurking on the plate.

       As an insane person, this requires me to clean every baseboard, wall and window, stock up on anything I think we may need in the next 4 months, and drive Andrew batty with odd job requests. Maybe that's normal nesting. But aside from standard baby prep, there is also the "labor" of researching and writing my master's thesis, which I defend early December, and reassure myself daily is not that big of a deal and totally doable with the new baby. I don't know if I'm lying or not.

       Also, we obviously haven't picked out a name for this child yet. Not that we haven't diligently considered every boy name on the planet - we just only like and agree on none of them.

Asher has aided us in the quest. Since coming around to the fact the little sister he'd prayed constantly for would, in fact, be a boy, he's been very vocal about what we should name our new brother. His suggestions became so original and consistent, I started recording them. He gives us a fresh option each day. Sometimes they're surprisingly good; sometimes he misses the mark a bit (see: "Ooeymucho"). 

Here is the lively list of Asher's name suggestions thus far:

Theo
George Robin
Herman
Proopie
Jamal
Cooper
Comnater
Stetson
Maller
Ezra Rhett
Howard
Chris
The Claw
Jethro
Hero
Jazz
Hugo
Link 
Spy Chase
Orlin
Berg
Ooeymucho
Bulletin
Wixy
Carlos
Ja-von
Lucas
Paulo
Sparky
Robert
Maximo

         Can you believe we've had all this naming help and still don't have anything nailed down?! Pahahaha... so Ash man has a liiittle more flare than taste. It's a crime of heredity.

         Another pre-baby development is our new vehicle! When the rattling Nissan Quest with 220,000 miles on it was going to require another repair last week, we finally bit the bullet and something more reliable. Andrew wanted a SUV so badly, but logic (and the realization we won't be cool no matter what we drive) won out and we now have a sweet Honda Odyssey. It was funny to be at the very same dealership where as an excited 17-year-old, I selected a sparkly new Civic coupe to drive to college. Rolling up pregnant with our third child to van shop was a nice little reality check. Time keeps marching, man. 11 years later, that (now impractical) little Civic takes Andrew to work everyday, and makes him afraid of being towed from the hospital doctors lot.  



       Anyway. I never thought a used mini-van would make me feel like a princess, but it's the nicest vehicle we've ever owned and I'm thinking of selling the house and living out of it. Features I love: automatic doors, a DVD player with wireless headphones, heated leather seats (?!), custom weather-tech floor mats, sun roof, blue tooth syncing with our phones, and the list goes on. I am so happy the kids can all sit in the same row, and am excited to look up into that center surveillance mirror (this is a car for parents, people) and see an infant carrier between our two big boys. Heart.

       Last weekend I made a quick trip to Columbus to stay with and see some friends while I could still get around hands free. It was nice to catch up with a lot of people at once (thanks to Super Saturday), and I just kept feeling so grateful to know so many truly good, fun people. I didn't take a lot of pictures, but there was this:

At least one of us knows how to work it. 

I have such a love and admiration for this amazing woman! Melissa is expecting her third girl just as we're expecting our third boy, so obviously there are arranged marriages in the works.

        Then there are my sweet Friel twins. I LOVED getting to work with the youth at church, and can't believe these two are seniors! It makes me feel like a senior too. The kind that qualifies for discounts.

       After a speedy but wonderful Columbus visit, we hit up IKEA in Cincinnati. Let me tell you something - I love that place, but on a Saturday afternoon, it is the pits of hell. We were there for 4 hours getting the last of the furniture and accessories we needed for the house. The boys behaved really well though, and my sweet in-laws came to Louisville and helped us finish off assembly and decor in the basement living area and play room. It is all so functional, homey and cute! One more giant thing crossed off our pre-baby list!

And finally, a note to our new little man:

          We have an ultrasound scheduled at the doctor in a couple days, and I am SO excited to see you. You are by far the most active baby I've ever carried, and I am in constant disbelief at how feisty and strong you are! Your little dance parties last for hours sometimes (ahem, midnight to 3 AM Friday?? You're grounded.), and I am nervous that rather than the low-key third boy I envisioned, you may be our wildest man yet. But be who you are - we'll take you. Your big brothers are anxious to meet and hold you, and I can't wait to see that incredibly special look on your dad's face he only makes as he sees his children for the first time. We'll stay busy so we can be ready whenever you are! Love you so much already.

- Mom

Thursday, September 3, 2015

Preston at 3: A Progress Report

Asher looked forward to his younger brother's birthday. "I'm excited for Preston to turn 3, so he'll know how to share and won't hit me and bite me!" I tried to gently explain that learning and growth were gradual processes, but it didn't quite stick. The morning of Preston's third birthday, a confused Asher walked out of their shared bedroom and exclaimed, "Preston still looks two!"

None the less, the boy is now officially 3 and when asked how old he is, will hold up 3 fingers via the "OK" sign, and say, "Free and a haff!" It's a 6-month lie (innocently inspired by his brother's incessant pronouncement that he's "5-and-a-half!"), but still pretty cute. 

Other cute things about Preston right now: He has a love of small things, and any time he sees a small version of something, for example - a tiny grape amidst those of average-size - shouts, "Aw, mommy look - a SWEET grape!" 

I'm also just low-class enough to mention his cute terminology for doing his big business on the toilet. When he needs to go number 2, he says "Mommy, I need to go squeezes!" or "Look - I went squeezes on the toilet!" Tonight after an especially diminutive bowel movement, he said,  "Aw, look - a SWEET squeeze!" Sorry to make you uncomfortable. Just one of those little things we'll completely forget if I don't record that we want to chuckle about later. :)
Celebrating successful squeezing at the "ice cream shop". There's a Baskin Robbins right next to our house now, and while it's no Jeni's, I still foresee us spending plenty of happy time and calories there.

Preston is one who relies on his naps to maintain human form, which makes 1:00 PM church a trial of our faith. There have been some pretty rough moments. But a couple months ago, we started bringing his tacky Spider Man blanket and travel pillow to church with us. Sometimes it pays to be shameless...the child is now in the routine of conking out for a two hour pew nap like a little homeless person. The sanctity of our Sabbath is saved. 

Though Preston maintains that characteristic of being ready to fight at the slightest provocation, he is happy and affectionate the majority of the time. Really. When he's in an especially good mood, he'll grab your face and just lay one on you, then won't pull away until you sort of pry him off (yes, I've wondered about how this will go in high school; not sure if he'll make me a young grandmother, or never at all :). 

He's also more verbally affectionate lately, which really melts us. Last weekend, he dumped the last of the soap into the tub at once to create, in the words of Asher, "The funnest bath [they'd] ever had!" They had a marvelous time playing, and we heard Preston say again and again, "I love you, Asher. I love 
you, Asher."





Preston's old permascowl has been fading fast, and the former grump has become quite friendly, even to strangers. Instead of snubbing new faces, he now often says, "Hey, wassyo naaame?" When asked his own name, extends a hand to shake and responds, "I'm Pressen Andoo Steah. Nice to meechu!" 

He's also gaining a handle on the ole' aggression. I may be his mother, but since Preston's transformation into troubled toddler, have become his parole officer as well. I long to see him overcome his violent outbursts and regain good citizen status. And while he still has relapses (cut to him hitting a little girl at the Y yesterday, then telling me about it in a disturbingly casual tone), the young man seems well on the path to reform. Angry with Asher amidst a Kinetic Sand dispute last weekend, I saw him rear back, then stop himself, fist trembling mid-punch. Maybe he knew I was watching. But I like to think we're loving the serial killer right out of him. 

He also sings all the time. That's a hallmark sign of a happy child, right? His current favorites include "Ghostbusters," the Spider Man theme song, Sesame Street classics "Rubber Ducky" and "C is for Cookie," as well as more more contemporary selections like Maroon 5's "Love Somebody," and Walk the Moon's "Shut Up and Dance."  I carefully edit this last one when it plays by shouting "COME ON and dance with me!" over the chorus. It's worked like a charm and the boys delight to sing the modified version (although, the crude censorship is not foolproof. Asher recently came to me with squinted eyes and said, "Mom, I think it's actually 'Shum on' and dance with me." Mmm, is that right? ...Oops.)




But even in his happier, less violent form, Preston is still more "boy" than I could have ever prepared for. He loves all things super hero, Buzz Lightyear, and Lightning McQueen. He wants to constantly wrestle and be tickled and chased. The kid is plain rough, and I've informed Andrew Preston may suffer from "high T". There is no cure. Only bedtime.

This child keeps us laughing, guessing, fuming, and melting. We're (almost always) SO happy he's ours.