BSS Flashcards
Name three features of symptoms which are important for people’s perceptions of their seriousness
- The intensity or severity of the symptom
- The familiarity of the symptom
- The duration and frequency of the symptom
Name 5 social triggers to consultation
Crisis- Family Death Relationships- If can't sleep = angry Sanctioning- "You look ill" Temporising- I'll go on Monday Activities- Interferes with life
The Health Belief Model suggests someone’ beliefs around an illness are based on:
Perceived severity- Perceived susceptibility- Perceived barriers/ costs- Perceived benefits- Cue's to action-
Negative emotion has what link to pain perception?
Negative emotion increases pain perception
Name a psychological factor which contributes to delayed wound healing?
Stress can delay wound healing
What is the difference between sensory info and procedural info?
Procedural info lowers anxiety by reducing fear of unknown
Sensory info lowers anxiety by reducing difference between expected and actual sensation
What is the purpose of cognitive interventions?
Aims to reform cognitions by training positive responses
What are the two types of modelling (copying a person)?
Mastery model- Remain calm and relaxed
Coping model- Learn to cope but still find stressful
What method can be used to help reduce pain in children?
DISTRACTION
Get kids to blow away the pain
Alf hasn’t been in contact with his friends for a while but continues to see on Facebook that they are going out without him. After asking his friends about it, they say it’s because of his frequent toilet trips and smell of urine. What type of stigma is this?
Enacted Stigma
Following his stroke, Stephen feels like his is never going to be able to swallow again properly. Which category of Leventhal’s illness cognitions is this an example of?
Timeline
James has a poor diet. He sees his GP who helps James develop ways to lose weight. As part of his consultation his GP assists James in identifying his own barriers and solutions, increasing his intent to change and self-efficacy. What style of interviewing is this?
Motivational interviewing
What does CAGE stand for?
Cut down (ever felt you should…)
Annoyed (by people commenting on your drinking)
Guilt - felt bad or guilty about your drinking?
E- Eye opener (used it to wake up)
To have capacity to consent to medical treatment you must be able to understand the information, retain the information, weigh the information and what is the last thing?
Communicate (the information/decision
Are NGT’s classed as treatment or basic care?
Medical treatment
Gross negligence can be penalised as what?
Manslaughter
If the patient has no capacity to declare their opinions what must you do?
Act in P’s best interest
Unless evidence to suggest they would not want treatment X- religion/ power of attorney/ advance directive
What is the difference between medical care and basic care?
Basic care MUST always be given
Treatment can be stopped
What are the moral/ legal differences between acts and omissions?
Morally same
Legally different
What is the fight or flight model of stress?
External threats elicit a mainly physiological response.
What is the general adaptation syndrome stress model?
Three phases (alarm, resistance, exhaustion)
What is a problem with the ‘fight or flight’ and ‘general adaptation’ models of stress?
Not much room for psychological components
What is the life events theory?
List of stressful events recently experienced is used to predict stress
What are some problems with the life events theory of stress?
Doesn’t take into account individuals own rating of event
Retrospective analysis can affect
Some life events can interact with each other
Stressors can be short/ long term
What is Lazarus’ transactional model of stress?
Stress response initiated if individual regards a situation as stressful (So individuals’ response more important than event)
What are the three ‘stages’ of Lazarus’ transactional model of stress?
Primary appraisal- Appraises event
Secondary appraisal- Evaluate own capacity to cope
Re-appraisal- After attempt to cope
The individal no longer passively responds to the world but interacts with it. This comes from which model?
Lazarus’ transactional model of stress?
What is stress reactivity?
Changes in physiology due to stress. Very variable between people
What is stress recovery?
Speed of hormone/ physiology returning to normal (varies lots)
What is allostatic load?
The progressive accumulation of stress. Over time the recovery is less and less complete
For agreement to treatment to be legally acceptable it must meet three conditions
Consent must be informed to an adequate standard Patients must be competent to consent to treatment Patients must not be coerced into accepting treatment against their wishes
What is the core statement in the theory of planned behavior?
Strongest predictor of behavior is intentions, affected by (1- Attitude towards behavior, 2- subjective norms, 3- perceived behavior control)
GMC guidance says what about treating when patients behavior is expected to be the cause?
You must not refuse or delay treatment because you believe that patients’ actions have contributed to their condition
What is the first disease concept of addiction?
The first disease concept regarded the substance as the problem and called for the treatment of excessive drinkers
What is the second disease concept of addiction?
This theory no longer saw the substance as the problem but pointed the finger at those individuals who became addicted. Within this perspective, the small minority of those who consumed alcohol to excess were seen as having a problem
What is motivational interviewing?
- Help people understand themselves better + links thoughts and feelings with behaviour
- Gives People strategies to change lifestyle
- Teach people how to manage themselves
What are the 5 main principles of motivational interviewing?
Avoid arguments Express empathy Support self-efficacy Roll with resistance Develop/ explore discrepancy
Name three models of decision making:
Paternalistic- clinician led
Informational- patient led
Shared
What is BresDex?
A decision aid to help in breast cancer decisions
A patient has alcohol-related problems. There is no physical dependency on alcohol. However, there is evidence of moderate levels of psychological and social harm caused by alcohol. The most appropriate place for a General Practitioner to refer the patient would be:
Alcohol Advice Centre
A Px says “I can’t give up smoking. It’s my only pleasure!” In response, the nurse says “I recognise your choice here and when you think you are ready then come and speak to me about how you might go about it”. What, in MI techniques terms, is this an example of?
Rolling with Resistance
In terms of motivational interviewing, what is Rolling with Resistance?
Not confronting the client and avoiding providing resistance, especially in the early stages
In terms of motivational interviewing, what is developing discrepancy?
Show a mis-match between where the client is and where the client wants to be
High pre-operative anxiety is a predictor of what?
Poor post operative outcome
In terms of motivational interviewing, what is supporting self efficacy?
Focus on past success, highlighting skills and strengths to help the patient ‘believe’ they can do it
In terms of motivational interviewing, why is expressing empathy important?
Helps build trust with the client
Allows them to be more open
When a person dies (say from a rare disease) without having joined the organ donor register, is there any way their organs can be tested to help understanding of the disease post death?
No
In England, all donations, whether from living or dead donors, rely on altruism
What is the currently accepted view when deciding on resource allocation between patients with different ages?
Ageism is a term which implies that discrimination on the basis of age is similar to discrimination on the basis of gender
Prior to seeing the doctor, people often go through various stages such as seeking advice from associates, friends and family. This behaviour is referred to as:
The lay referral system
What is enacted stigma?
Discrimination based on stigma
What are the characteristics of problem focused coping?
Seeking information + support
Taking problem solving actions
Identifying rewards of actions
What are some of the characteristics of emotion focused coping?
Emotional discharge Resigned acceptance Affective regulation (emotional regulation of feelings)
What are some of the characteristics of appraisal-focused coping?
Logical analysis
Cognitive avoidance
Cognitive redefinition of problems
What is the definition of dependency?
Shows withdrawal if taken away
What is the definition of addiction?
Need for normal function, drives normal behavior
What is the definition of substance abuse?
Outside social norms
What are the 4 stages of substance addiction?
Initiation
Maintenance
Cessation
Releapse
What are the 4 stages of cessation in addiction?
Pre-contemplation
Contemplation
Action
Maintenance
What is the concept of stress resistance?
Not all individuals respond to stressors in the same way
- Includes coping strategies, social support and personality traits
What is allostatic load?
Stress systems constantly fluctuate
As you respond and recover from stress (allostasis) over time recovery becomes less and less complete
What is a state of allostasis?
The recovering from a stressor
returning to homeostasis
What is instrumental support?
Physical help (buy shopping etc)
Which three groups of people are most likely to visit their GP?
Women
Pre-school children
Adults over 65
What is the difference between morbidity and mortality rates?
Mortality rate = No deaths/ no population (corrected for age and sex as more M die younger)
Morbidity rate= No affected/ no population
What is the difference between objective and subjective measures of functioning?
Subjective: Individuals rate their own health
Objective: Functional questions (eg ADL)
What are unidimensional, multidimensional and composite scales of health measurement?
Uni: Focusses on on health aspect (e.g. mood)
Multi: Assess broad health (e.g. is your health good. bad)
Composite: Combines both
What is the ways of coping (Lazarus and Folkman) questionnaire used to asses?
Coping processes
In the health belief model what is a lack of health motivation?
“Better things to do”- Seen as unimportant
Eldery people are less likely to present in a GP setting because….
They believe their health condition is part of the natural ageing process
The Health Belief Model suggests that the most useful predictor of a patient’s likely adherence to treatment is?
The patient’s beliefs about barriers and benefits of the
treatment
In the theory of planned behavior what is a subjective norm?
An individuals perception about a behavior, influenced by judgement of significant others (spouse, parent, friend)
In the theory of planned behavior what is attitude towards a behavior?
The degree to which performance of a behavior is positively or negatively valued
What has the disease model of addiction been criticised for?
Being inconsistent with evidence that some people can return to ‘normal’ drinking
patterns
- Keeps Px from developing self-control and stigmatizes them
What is the disease model of addiction?
Addiction is a disease with biological/ neurological/ genetic and environmental sources of origin.
Changes in brains mesolimbic pathway
One limitation of the Health Belief Model is…?
It doesn’t account for emotional factors such as fear or denial
“My local gym is really intimidating” is an example of what?
External behavior control factor
In which order to the stages of Levanthals self-regulatory model come?
Interpretation
Coping
Appraisal
What are the steps (in order) of the stages of change model?
Pre-contemplation Contemplation Preparation Action Maintenance
Based on the theory of planned behaviour, an individual’s motivation to comply with others creates their:
Subjective norm
According to the protection motivation theory, which 4 things contribute to an individual’s behavioural intentions?
Perceived severity
Percieved vulnerability
Perceived efficacy of behavior
Perceived self-efficacy
A patient’s perceptions of the possible effects of an illness on their life describes what type of illness cognition?
Consequence
What is the most appropriate way to measure illness cognitions in a clinical environment?
Questionnaires
Shontz (1975) describes three stages people go through following a diagnosis, what are these three stages and what characterizes them?
1) Shock(bewilderment/ detachment)
2) Encounter reaction (loss/ grief/ despair)
3) Retreat (Denial of problems and their implications)
Crisis theory (Moos and Schaefer (1984)) states what?
People in crisis are particularly susceptible to external influences.
What are the 5 changes which affect people in crisis (Moos and Schaefer 1984)?
Identity Role - now passive and dependent Social support - isolation is common Location- hospitalization Future- uncertainty
According to Moos and Schaefer (1984), once confronted with the crisis of an illness, which three processes constitute the coping process?
Cognitive appraisal
Adaptive tasks
Coping skills
Name 3 predictors of compliance according to Ley (1981/89), what is not a predictor?
Understanding/ memory/ satisfaction
NOT: Ease of use
To a social learning perspective, addictive behaviors are learned according to which processes?
Classical conditioning
Operant conditioning
Observational learning
Cognitive processes
Which of the 4 stages of substance use is influenced by self-help?
Cessation
Which of these is a process of relapse?
(a) Subjective norms (b) Societal norms (c) No coping response (d) No cues to action (e) None of the above
c) No coping response
