Diversity, Dying, Bad News, Flashcards
How can culture effect presentation to health services?
- Stigma around mental health in community and religion e.g. evil
- the treatment and management may not be accepted in a culture so wont present till an emergency
- johava
- sexual orientation
- not in culture to ask for help admit to pain
- confidentiality family members in the consultation. Abuse?
What is cultural identify/diversity?
Is a very broad, dynamic process, hard to assign
Association of american medical colleges: grouping depends on individual, identity based on heritage and individual circumstances and choices, based on many factors e.g. sexual orientation, country, socioecomonic. Influences how patients and healthcare professionals perceive health and illness and interact with each other.
Give examples reasons of why organisation and delivery of healthcare needs to take into account diversity
- The diversity if the populations is increasing
- staff may change care according to who they are looking after
- differential outcomes
- legal framework
- ## challenge so dont fall back on sterotype
What are the three main patterns of dying outlined by clark and seymour? Why is it significant in bereavement of individuals?
Gradual death- slow decline in ability and health
Catastrophic death- through sudden and unexpected events
Premature death- in children and adults through accidents or illness
The pattern will effect how people deal with death, but it is important to realise that each death is different even with same underlying cause
What are the 5 stage grief model of adjusting to the idea of dying
Denial- +ve- coping mechanism (should respect- written info) -ve barrier to good care if continues
Anger - why me? Who is to blame? Alternatives?- hard to manage
Bargaining- life savings for cure? Religion important here
Depression- why should i bother? I missed my love one why should i carry on
Acceptance- ready to phase up to it, will be okay, funeral arrangement
What are the Stages to bereavement/ the grieving process?
Loss
Griefing- denial, anger, bargaining, depression,acceptance
Mourning
What are some the symptoms often experienced after bereavement?
Physical- shortness of breath, fatigue, reduced immune
Behavioural- insomnia, crying, irritability
Emotional- depression, anxiety, anger, guilt
Cognitive- lack of concentration, memory loss, hallucination
CBT little use unless high risk of developing depression
What are some of the risk factors for chronic grief after bereavement?
Prior deaths Mental health Type of loss (violent, young) Lack of social support Stress from other crisis (divorce) Ending grief/ expressing grief discouraged
What is the difference between grief, mourning and bereavement?
Grief- normal process of reacting to loss
Bereavement- period of loss during which grief is experienced and mourning occurs
Mourning is process after grief in which people adapt to loss
What are the aims of palliative care? Can you name an initiative that had been implemented in hospitals to try to achieve these aims? Since most people tend to die in hospital rather than home.
Improves quality of care, management of emotional and physical symptoms, maximising quality if life
Liverpool care pathway
Why is important to break bad news
When might you not do it?
Maintains trust Reduces uncertainty Prevents unrealistic expectations Allow appropriate adjustment Promotes open communication
In some cultures it seen as cruel or dangerous it is a family decision to tell the individual or not. You should consult a senior on this situation
What are the implications to patient if bad news is not delivered well?
Damage to the doctor patient relationship
Emotional well being of the patient e.g. distress/depression
Influences how the individual will cope and adjust
What are blocking behaviours? Why might they be used by doctors?
Breaking bad news can be difficult-> worried about reactions, being blamed, lack of confidence, sense of failure, time, own grief
Blocking behaviours reduce the efficacy of the process of breaking bad news. Changing subject, focusing on physical aspects, asking leading/closed/ multiple questions, giving information/advice before concerns have been addressed
What is the SPIKES model and give examples of good practice for each step
S- etting and listening skills: face to face, own room
P-atients perception: what do they already know?
I-nvitation from patient to give info: how much do you want to know?
K-nowledge: warning shot, small chunks avoid jargon
E-mpathy: how are you feeling, listening to patient concerns
S-tragegy and summary. Check understanding, document, safe, discuss strategy and agree in next step. Check someone with with the,
