case 4 - bss Flashcards

1
Q

what is patient centred care

A

patients and their priorities have central importance
Responsive to patients’ preferences, needs and values - use these to guide clinical decisions
Holistic care similar
Care for patient as a whole
Considers all aspects of a patients life
Includes physical, psychological, social and spiritual affects of illness

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2
Q

why does patient centred care matter

A

aid understanding of clinical problems
Improve relationship between healthcare professionals and patients
Increase concordance
Increase satisfaction from patients and from healthcare providers
Increasingly patient experience is used to develop services and measure outcomes
Increased job satisfaction

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3
Q

what is the biographical disruption

A

long term conditions can disrupt normality and individuals begin to re examine their expectations of self, daily life and future

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4
Q

what is the definition of palliative care

A

an approach that improves the quality of life of patients and their families facing the problems associated with life threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.

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5
Q

what does palliative care involve

A

careful and continual assessment of symptoms
concept of total pain
the family as the unit of care
active total care
listening
questioning

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6
Q

what is the essence of palliative care

A

‘ You matter to the last moment of your life and we will do all that we can, not only to help you die peacefully, but to live until you die’

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7
Q

who should get palliative care

A

traditionally aimed at patients with incurable cancer

although more recently, patients with any life limiting diagnosis

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8
Q

what is the definition of consent

A

permission for something to happen or agreement to do something

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9
Q

what has to happen for consent to be valid

A

it must be voluntary and informed, and the person consenting must have the capacity to make the decision

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10
Q

what is the definition of voluntary

A

Voluntary: the decision to either consent or not to consent to treatment must be made by the person themselves, and must not be influenced by pressure for medical staff, friends or family. ‘Freely given’ is a common term here.

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11
Q

what is the definition of informed

A

Informed: the person must be given all the information in terms of what the treatment involves, including the benefits and risks, whether there are reasonable alternative treatments, and what will happen if treatment doesn’t go ahead.

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12
Q

what is the definition of capacity

A

Capacity: the person must be capable of giving consent, which means they understand the information given to them and they can use it to make an informed decision.

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13
Q

why is consent important

A

out of respect for autonomy
Without it you are likely to commit an offence:
Information disclosure - data protection, GDPR
Bodily contact - battery, manslaughter etc
f you gain it inadequately, just like any there facet of medial practice, you may be found to have acted negligently

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14
Q

what kind of actions might require consent

A

anything a person may rightfully require you to otherwise refrain from

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15
Q

what form may consent take

A

implicit, explicit, verbal or written

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16
Q

what information is needed for informed consent

A

this is the part of the law continuously evolving
Highly indicative of a shift in society’s relationship with its doctors
This evolution has not yet finished

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17
Q

what is the interpretation of the law we now use

A

law as laid out by ‘Montgomery vs Lanarkshire’

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18
Q

what does the Montgomery framework do

A

puts the reasonable patient as the standard

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19
Q

as per GMC guidance, what does this framework mean for us

A

take time to ask your patients what they need to know
Answer truthfully and to the extent of their wishes
Add on anything else they need to know
Remember to cover alternatives, including doing nothing. You aren’t a salesperson - you are a guide

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20
Q

what happens if you fail to get informed consent

A

You/your trust may get sued. Failure to meet the (evolving) standard will lead you open to a charge of negligence

Professional censure. You may also have to answer to the GMC they feel your incompetence makes you unfit to practice.

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21
Q

what is the health and illness continuum

A

illness onset –> illness adaption -> illness outcomes

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22
Q

what is included in illness onset

A

beliefs and behaviours

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23
Q

what is included in illness adaption

A

help seeking, coping, social support

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24
Q

what is included in illness outcomes

A

quality of life and behaviours

25
Q

what is an example of the susceptibility health belief

A

i may have cancer

26
Q

what is an example of the cost health belief

A

i need to be at home to look after my partner

27
Q

what is an example of the benefits health beliefs

A

i might not feel as tired and have more energy

28
Q

what is an example of the cue to action health belief

A

physical symptoms

29
Q

what are the psychological consequences of ill health

A

lowered mood
increased anxiety
feelings of hopelessness

30
Q

what are the potential behaviour changes

A

reducing alcohol
taking medicines

31
Q

what do life stressors and behaviour change relate to

A

these two relate to adaption which is:
difficulty coping and adaption

32
Q

what is the outcome part of the health belief

A

quality of life
disease free interval
prognosis

33
Q

what is a stressor

A

something in our external environment

34
Q

what is the stress

A

the response to the stressor

35
Q

what is distress

A

stress that is harmful and damaging

36
Q

what is eustress

A

stress that is positive and beneficial

37
Q

what is the primary appraisal in Lazarus and Folkman’s model of coping

A

how stressful is the situation

38
Q

what is the secondary appraisal in Lazurus and Folkman’s model of coping

A

how capable am i of coping with this thing

39
Q

what is stress the imbalance between

A

demands and resources

40
Q

what happens when stress activates the sympathetic nervous system

A

adrenaline and noradrenaline are released

41
Q

what happens when adrenaline and noradrenaline are released

A

changes in blood pressure, heart rate, sweating, pupil dilation, immune function

42
Q

what is the activation of adrenaline and noradrenaline more likely to be involved in

A

acute stress

43
Q

what is released in HPA activation

A

cortisol is release

44
Q

what does this cortisol release lead to

A

changes in management of carbohydrate stores, inflammation, immune function

45
Q

what does this cortisol release involve in

A

chronic stress

46
Q

what are stress behavioural changes

A

smoking
Drinking alcohol
Eating
Exercise
Accidents

47
Q

what is the direct pathway between stress and illness

A

physiology

48
Q

what is the indirect pathway between stress and illness

A

behaviour

49
Q

what are the physiological moderators of stress-illness

A

stress reactivity, stress recovery, allostatic load, stress resistance

50
Q

what are the psychological moderators of stress illness

A

health behaviours, coping strategies, social support, personality, actual or perceived control

51
Q

what are the psychosocial risk factors for cancer

A

demographic
health behaviours

52
Q

what are the psychological responses to cancer

A

anxiety
Depression
Body image
Coping strategies
Problem focused
Avoidant strategies

53
Q

what is authenticity

A

understand what is important in their life

54
Q

what is autonomy

A

perceived freedom to live life in line with values

55
Q

what is acceptance

A

peaceful and joyful experiences and greater connection to others

56
Q

what is the cognitive adaptive theory for the process of searching for meaning

A

searching for causality and to understand the implications. improved self knowledge, self change, process of reprioritisation

57
Q

what is the cognitive adaptive theory for the process of searching for mastery

A

the sense of mastery is achieved by thinking the illness is controllable. mastery is achieved through psychological techniques or behavioural techniques

58
Q

what is the cognitive adaptive theory for the process of self enhancement

A

comparing yourself to others to improve self esteem - ‘at least ive only had cancer once’, it could have been worse etc

59
Q

what are the psychological interventions

A

cognitive behaviour therapy - CBT
Acceptance and commitment therapy - ACT
Mindfullness