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Year 2 - LMAP > Health Coaching > Flashcards

Health Coaching Flashcards

1
Q

Describe and explain the smoker’s pathway

A

70% of people who try to stop using meds and support eventually relapse!

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2
Q

How many VBAs lead to one long term quitter?

A

51

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3
Q

what is the health coaching framework to tackle alcohol abuse

A

IBA

  • Identification – find out who’s at risk
  • Brief advice- about cutting down
    • use Motivation interviewing
    • Use Implementation intention (what when how and where)- prompt pt to come up with this
  • Support- Self-help or referral to specialised alcohol service (if audit is more than 20)
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4
Q

what screening tool is used for identification for the IBA framework

A

AUDIT-C

  1. How often do you have drink containing alcohol
  2. How many units of alcohol do you drink on a typical day when you are drinking
  3. How often have you had 6 or more unit- male (8) on a single occasion in the last year
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5
Q

Apart from AUDIT-C what are the other screening tools for alcohol.

Give the features of this!

A

SADQ (Severity of Alcohol Dependence Questionnaire)-

  • checks severity of dependency.
  • used to check whether someone requires assisted alcohol withdrawal and what setting is ideal for it.

CIWA-Ar (Clinical Institute Withdrawal Assessment- Alcohol revised)-

  • checks severity of acute, unplanned alcohol withdrawal (lead to death/seizures).
  • used in A&E and inpatient wards to assess whether a pt with known dependency is experiencing acute withdrawal.
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6
Q

what are the other screening tools for physical activity and Nutrition

what’s the difference between them!

A
  • Physical activity- GPPAQ (General Practice physical activity questionnaire)
  • Nutrition- MUST (Malnutrition Universal Screening tool).

They have varying sensitivity and specificity

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7
Q

what are the demographic differences/inequalities in physical activities

A
  • Men more likely to be active
  • Rich people are more likely to be active
  • Those with a disability and long-term conditions LESS likely to be active
  • Some ethnic groups less likely to be active
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8
Q

What is the framework for Brief intervention for physical activity?

A
  • Ask- ask for permission to discuss it and then screen activity levels using Scot PAS-Q
  • Advice
  • Assist - SIGNPOST
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9
Q

What is the Scot-PASQ screening tools for physical activity?

A
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10
Q

where can you signpost pt with physical activity problems

A
  • NHS
  • Sports England
  • Couch to 5k
  • Parkrun
  • BBC sport

N.B: People who try to exercise need to be checked up at least yearly (prob 6 months) because there are many barriers to participation in physical activity.

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11
Q

what are the contents of a cigarette?

A

It has 4k chemicals and 60 known carcinogens and metabolic poisons!

it contains:

  • Tar
  • Nicotine
  • Butane
  • Naphthalene
  • Ammonia
  • Arsenic
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12
Q

What are the reasons people keep smoking?

A
  • Nicotine addiction
  • Habit
  • Stress
  • Weight control
  • Social
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13
Q

what is the physiology of smoking addiction

i.e. how does nicotine cause addiction

A
  • Nicotine has the highest binding affinity for alpha 4 beta 2 nicotinic receptors. These receptors are mediators of addiction. This occurs in the VTA of the midbrain.
  • Inhaled nicotine reaches these receptors in 7-10 seconds. This then triggers release of dopamine into the nucleus accumbens
  • Regular smoking upregulates the a4b2 receptors by 3-4 times. These receptors are long term.
  • Smoking is a chronic relapsing organic brain disease; not a lifestyle choice.
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14
Q

what are the keys to stopping smoking effectively?

A
  • Good quality support AND
  • Evidence-based treatment- NRT , vareniciline etc
  • Wanting to stop- not very successful alone

This improves quit rate up to 4 times greater than any one alone

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15
Q

Explain the features of NHS stop smoking service

A

They are stop smoking adviser which could be:

  • practice nurses
  • Hospital nurses
  • Healthcare assistants
  • pharmacists.

Standard support regime is: 4-6 face to face appointments over 6-12 weeks

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16
Q

What are the advantages of doctors delivering smoking cessation?

A
  • Smokers know, trust and want help to stop from doctor
  • Tobacco dependence: a med condition responding to medical treatment
  • Doctors are used to tailoring treatment (independent prescribers)
  • Cessation advice can be more effective from doctors than counsellors and nurses.
17
Q

What are the licensed pharmacotherapy for smoking cessation?

A
  • Varenicline- most effective
  • NRT : 2nd more effective especially with 2 or more of them
  • Bupropion

you should tell the pt that all 3 options are available to be used:

18
Q

why should 3 of the meds be considered for smoking cessation?

A
  • It allows pt to choose
  • If quit attempt fails, they know there are other options
  • Different meds work differently for different people
19
Q

what are the different forms of NRT

A
  • Skin patches
  • Inhalator
  • Oral spray
  • Oral film
  • Gum
  • Lozenges
  • Mini Lozenges
  • nasal spray
20
Q

what is the treatment regimen for NRT?

A
  • The NRT is slowly tapered off
  • Treatment lasts 8-12 weeks – use combination therapy
  • Spray enters the blood stream quickly
  • Use enough for long enough.
21
Q

What is the pharmacology of buproprion

A
  • Non-nicotinic- used to be antidepressant
  • Maintains higher level of dopamine and noradrenergic activity

Therefore has side effects

22
Q

what is Varenicline pharmacology?

A
  • Partial nicotine agonist
  • Partial stimulating: this relieves craving and withdrawal symptoms
  • Partial blocking: reduces reward and risk of relapse
23
Q

what is the realtiy check statistics for smoking cessation

A

20-30% long term quit rate with support and treatment

3-5% long term quit rate with willpower alone

2 or 3 quit attempts with support and treatment for 50% smokers to stop long term

Smoking cessation with support is very cost-effective as it has a very low number needed to treat

24
Q

what are the features of E-cigarettes

A
  • As effective as NRT
  • Very popular
  • 95% safer than smoking in short term
  • Long term impacts not known
  • Half of users also smoke
  • Controversial and many misconceptions
25
Q

How long does it take nicotine to leave the body

A
  • Nicotine takes 24-48 hrs to leave the body
26
Q

Why is smoking considered an organic relapsing disease?

A
  • Nicotine receptors take 8-12 weeks to downregulate but it DOES NOT DISAPPEAR.
  • Hence an addict is always and addict physiologically speaking
27
Q

what is the OARS framework for motivational interview

A

O- Open Questions:

A - Affirmations: Positive statements to highlight strength and abilities of pts.

R- Reflective listening: Reflect on what the pt said to you and repeat it back to them in a meaningful way. it can be para-verbal or non verbal communication.

S- Summaries: this convey to the pt they have being listened to and also checks your understanding.

28
Q

what is the spirit of Motivational Interview

A

Compassion: The healthcare practitioner acts from a desire to support the patient’s wellbeing  

Acceptance: The healthcare practitioner takes a respectful, non-judgemental approach, and values and affirms the patient’s autonomy and worth. 

Partnership: The healthcare practitioner works in partnership with the patient, recognising that the patient is resourceful and an ‘expert’ in their own situation.  

Evocation:  The healthcare practitioner helps a patient to identify their own perspectives and motivation for change. 

29
Q

What are the 3 coaching principles for effective collaborations?

A
  • The patients assumed resourcefulness
  • Relationship based on mutual trust and respect
  • Coaching is about change and action.
30
Q

What are some important areas to consider when clarifying expectations:

A
  • Practicability
  • Approach to confidentiality
  • Expectations of the roles of practitioner and patient
  • Boundaries of the work
  • Keeping a record
31
Q

What are the 4 processes of Motivational Interviewing?

A

Engaging – build connection and rapport

Focusing – Helping the pt to identify a health behaviour related goal that they can focus on during the coaching interaction

Evoking- supporting pts to explore their situation further which can lead to development of insights. There’s change-talk during this process

Planning – supporting pts to identify possible options, opportunities and resources available to help achieve their goal. You guys can come up with a plan of action

32
Q

How does MI practitioners carry out “rolling with resistance”?

A
  • expressing empathy
  • emphasising the patient’s autonomy
  • avoiding arguing and advice-giving
33
Q

outline the statistics that show the health burden of chronic diseases- which can be modified by health coaching

A

70% of deaths globally are due to 5 major causes: CVD, stroke, cancer, chronic lung disease and diabetes.

Many long-term health conditions are associated with modifiable risk factors such as smoking, poor diet, lack of exercise and excessive alcohol consumption.

About 80% of heart disease and stroke is preventable. Also about 30-50% of cancers are preventable (WHO).

34
Q

What range of fields has influenced health coaching principles and approaches?

A
  • Motivational interviewing (MI)- heaviest one
  • Psychological therapies,
  • The positive psychology movement
  • Sports coaching and executive coaching
35
Q

Who developed Motivational Interviewing and state it’s general features

A

William Miller and Stephen Rollnick.

This is a collaborative, person-centred form of guiding to elicit and strengthen motivation to change.

it has the heaviest influence on health coaching

36
Q

what conditions may present issues with assuming patient’s resourcefulness?

A

Capacity-

Drug or alcohol intoxication

Year 2 - LMAP (5 decks)

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