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ESA 4 Rev > ASBHDS > Flashcards

ASBHDS Flashcards

1
Q

What is the sociological theory on chronic illness?

A 
Illness work
Everyday life work
Emotional work
Identity work
Biographical work
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2
Q

What is illness work?

A

The work up to diagnosis and following diagnosis to manage physical manifestation of illness.
How an individuals self-conception changes as a result of living with their condition.

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3
Q

What is everyday life work?

A

Actions and processes involved in managing the condition and its impact.
The daily tasks to keep household going.

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4
Q

Give 4 examples of illness work.

A

Multiple tests
Uncertainty - diagnosis without clear explanation
Managing symptoms
Emotional impact

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5
Q

Give 3 examples of everyday life work.

A
  • Decisions about mobilisation of resources
  • Balancing demands and maintaining independence
  • Disguising or minimising symptoms
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6
Q

What is identity work?

A

Establish and maintain an acceptable identity.

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7
Q

Give 3 examples of identity work?

A
  • Managing actual and imagined reactions of others
  • Presentation of yourself to avoid stigma e.g. walking without aid even though painful
  • Avoiding sharing some information about illness as fear of being treated differently
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8
Q

What is emotional work?

A

Work to protect others emotional well-being that made lead to a changed role for the person living with chronic disease.

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9
Q

Give 3 examples of emotional work.

A
  • Demonstrate ability to remain active by taking part in activities as if not ill e.g. run 5k
  • Withdrawal from social groups
  • Dependence on close others e.g. spouse
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10
Q

What is biographical work?

A

The interaction between body and identity from the continual or occasional reconstruction of their life.

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11
Q

What is biographical disruption?

A

Chronic illness leads to loss of confidence in body, leading to loss of confidence in social interaction/self-identity.

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12
Q

Give 2 examples of biographical work.

A
  • Patient tries to re-construct life before diagnosis - e.g. past friendship groups
  • Period of uncertainty as loss of previous ‘taken-for-granted’ life
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13
Q

What is the effect of lay referral?

A 
Delays people seeking help
When, how and why people see a doctor
Use of alternative medicines 
Use of health services and medication
Your role as a doctor in their health
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14
Q

What is scarcity?

A

Need outstrips resources, prioritisation inevitable.

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15
Q

What is efficiency?

A

Getting the most out of limited resources

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16
Q

What is equity?

A

Extent to which distribution of resources is fair

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17
Q

What is utility?

A

The value that an individual places on a health state

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18
Q

Why are QALYS useful?

A
  • Evaluate cost-effectiveness
  • Combine survival + QoL
    Compare different uses of resources
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19
Q

What are some problems with QALYs?

A

Do not distribute resources according to need, but according to benefits gained per cost
Disadvantage common conditions
Technical problems with calculations
Do not assess impact on carers or family

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20
Q

Why is it important to measure health?

A 
Indicate need for healthcare
Target resources where needed
Assess effectiveness of interventions
Evaluate quality of health services
Monitor patients' progress
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21
Q

What are the advantages of measuring PROMS?

A

Aim of many conditions is manage not cure
Patient-centred care
Attention to iatrogenic effects of care
Biomedical testes one part of picture

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22
Q

What is HRQoL, what does it take into account?

A

Multidimensional test
Physical function, symptoms, global judgements of health, psychological well being, social wellbeing, personal constructs, satisfaction with care

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23
Q

Give 5 advantages of generic instruments.

A
  • Used for broad range of health issues
  • Used it no specific instrument
  • Comparisons across treatment groups
  • Detect positive/negative effects of intervention
  • Assess health of populations
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24
Q

Give 4 disadvantages of generic instruments.

A

Less detailed
Loss of relevance - too general
Less sensitive to changes that occur as a result of intervention
Less acceptable to patients

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25
Q

What is the social learning theory?

A
  • Behaviour is goal-directed
  • People motivated to perform behaviours that:
  • are valued/lead to rewards
  • they believe they can enact
    Learn from observing others - peers, family, media, celebs
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26
Q

What is an advantage of social learning theory?

A

Peer modelling and education

Celebs in health promotion campaigns

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27
Q

What is the health belief model?

A

Health-related behaviour depends on:
Beliefs about threat - perceived susceptibility and severity
Beliefs about health-related behaviour - perceived benefits and barriers
Cues to action

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28
Q

What are the beliefs about threat in the health belief model?

A

Perceived susceptibility - their chance of getting infection

Percieved severity - how serious, consequences of getting infection

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29
Q

What are the beliefs about health-related behaviour in the health belief model?

A

Perceived benefits - how effective intervention is at reducing risk
Barriers - psychological effect, cost

30
Q

What are cues to action in the health-related behaviour model?

A

Reminders

How-to information

31
Q

What are the limitations of the health belief model?

A

Assumes rational/cognitive decision making based on weighing up pros and cons
Doesn’t incorporate emotional influences

32
Q

What are the 3 components of the theory of planned behaviour?

A

Attitude towards behaviour - belief about outcomes
Subjective norm - comply to norm
Percieved control - barriers and facilitators

33
Q

What is the issue with the theory of planned behaviour, how can this be improved?

A

Intention behaviour gap - good predictor of intentions but poor predictor of behaviours
Improve by concrete plans of action - what i will do, when and where.

34
Q

What are the 5 stages of change?

A 
PCPAM
Precontemplation
Contemplation
Preparation
Action
Maintenance
35
Q

What happens in the precontemplation stage?

A

Not considered change - e.g. do not think need to lose weight

36
Q

What happens in the contemplation stage?

A

Thinking about change e.g. maybe i should lose weight

37
Q

What happens in the preparation stage?

A

Take action in near future e.g. i will start exercising regularly

38
Q

What happens in the action stage?

A

Make attempts

39
Q

What is the prevention paradox?

A

Interventions that make a difference at population level might not have much effect on individual.

40
Q

What is the artefact explanation for inequalities?

A

Due to the way statistics are collected, problems particularly with measurement of social class.

41
Q

What is the social selection explanation of inequalities?

A

Direct causation from health to social position - sick people move down hierarchy and healthy move up.

42
Q

What is the behavioural-cultural explanation of inequalities?

A

Ill health is due to peoples choices, decisions, knowledge and goals.

  • Disadvantaged background - engage in more health-damaging behaviours
  • Advantaged background - health-promoting behaviours
43
Q

What is the materialist explanation of inequalities?

A

Arise from differential access to material resources

  • Lack of choice in exposure to adverse conditions
  • Low income, unemployment, poor housing
44
Q

Give 4 examples of primary prevention strategies.

A
  1. Immunisation
  2. Prevent contact with environmental risk factors
  3. Precautions
  4. Reduce risk of health-related behaviours
45
Q

What is secondary prevention?

A

Detect and treat diseases at an early stage to prevent progression and complications.

46
Q

Give 2 examples of secondary prevention.

A

Screening for cancer

Blood pressure treatment and monitoring

47
Q

What is tertiary prevention?

A

Minimise the effects of established disease.

48
Q

What is sensitivity?

A

proportion of people who have the disease who the test correctly identifies as positive.

49
Q

What is specificity?

A

proportion of people without the disease who test negative.

50
Q

What is positive predictive value?

A

Probability that someone who has tested positive actually has the disease.

51
Q

What is a factor in positive predictive value?

A

Prevalence of disease

52
Q

What is negative predictive value?

A

Proportion of people who are negative who do not have the disease.

53
Q

Give 5 reasons for non-adherence.

A 
Forgetting
Fear of ADRs
No longer feeling unwell
Concern about safety or effectiveness
Confusion about directions
54
Q

What is concordance?

A

Patient and doctor working together on prescribing agreed treatment.

55
Q

What is the benefit of concordance?

A

Patient empowered as feelings discussed and respected.

Greater likelihood of adherence as patient played a role in process.

56
Q

What is adherence?

A

The extent to which a persons’ behaviour corresponds with agreed recommendations from a healthcare provider.

57
Q

What is the impact of stereotypes and stigma in clinical settings?

A

Diagnosing symptoms - symptoms missed due to attributes linked to an illness
Patient disclosure - patient reluctant to disclose symptoms in order to avoid stigma and being judged
Healthcare professionals approach - capacity/ time constraints.

58
Q

What is an adverse event?

A

injury caused by medical management and that prolongs hospitalisation, produces disability or both

59
Q

What is a preventable adverse event?

A

An adverse event that could be prevented given the current state of medical knowledge.

60
Q

Give 6 things that could make health delivery safer?

A 
Avoid reliance on memory
Make things visible
Review and simplify process
Checklists
Standardise common processes and procedures
61
Q

What is first order problem solving?

A

Doing what it takes to continue patient care task, no more or less.

  • meets immediate needs
  • minimises time away from patient care
62
Q

Where do first order problem solvers seek help?

A

Ask for help from people socially close rather than best equipped to help

  • Preserve reputation
  • Minimise difficult encounters
63
Q

What is second order problem solving?

A

Forward thinking about how to adapt a system in order to prevent problem recurring.
- reduce likelihood of error recurring and causing harm

64
Q

What are active failures?

A

Acts leading directly to patient being harmed - slips, lapses, mistakes and violations
Sharp-end

65
Q

What are latent conditions?

A

Predisposing conditions which increase likelihood of active failures

66
Q

Give 4 examples of latent conditions?

A 
Poor training
Lack of checks built into process
Too few staff
Time pressures
Fatigue
Poor supervision
67
Q

What is the swiss cheese model?

A

Some hols due to active failures, some due to latent conditions. The more layers/defences then the less likely an active failure will be the result.

68
Q

What is systems approach?

A

Identifying underlying latent factors - not about blame (root cause analysis)

69
Q

What are 3 ways that systems approach can be applied?

A

5 whys
Fishbone diagram
Timelines

70
Q

What system can be applied when seeking continual assessment?

A

Plan, Do, Study, Act - what changes are we going to make based on findings?

71
Q

Give 4 barriers to speaking up.

A

Hierarchal relationships
No certainty that will lead to improvements
Provoke hostility and reduce quality of working relationships
Difficult to assess if something is really a problem

ESA 4 Rev (16 decks)

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