HPaHD Flashcards
Give reasons why mortality rates have dropped
Social changes
Improving psychological health
Medical advancements
Describe the biopsychosocial model
Treat holistically Recognises that health is caused by all three factors
Compare the Biomedical and Biopsychosocial Models
BM: Caused by Pathogens, Injuries, Physiological Factors Causes are outside the Patient’s control Treat with interventions BPS: Diverse Causes Individual isn’t a passive victim Treat Holistically Doctor and Patient are both responsible for treatment/care
How can people be diverse?
Health Problems Lifestyles Beliefs Behaviours
What is a Stereotype?
Generalisations made about specific social groups and their members. “Rules of Thumb” Broadly correct but can be erroneous “Social schemata”
Why do we stereotype and why can it be helpful?
We stereotype as the brain stores information in “schematic” which group information together for suitable situations Useful: Saves processing power Allows anticipation and makes things more predictable
Why are stereotypes unhelpful?
They tend to focus on more negative traits Can lead to prejudice Then discrimination We group ourselves into the “in/out” crowd Overlooks individuality
Why should we think about stereotypes?
As we tend to rely on them under stress/pressure Challenge stereotypes by getting to know them
Stereotypes of Aging
Positive: Warm Grandparently Laid Back Negative: Unable to change Incompetent Period of stagnation
Developmental Model of Aging
From psychoanalytical theories Erikson/Freud
Negative view of old age, have life stages
Young adults- Intimacy vs. isolation
Mid-adult life - Generation vs. stagnation
Old-age - Integrity vs. despair
Trait Model (Of Aging and Changing of Personalities)
Personality is defined by Traits
Distribution of traits differ at ages
However traits are stable in individuals throughout time
What is a Health Related Behaviour?
Anything that may promote health or illness eg healthy eating, smoking
Why are Health Related Behaviours important?
As negative behaviours put a large strain in the NHS budget Eg. Smoking, alcohol, blood pressure, cholesterol and obesity
Describe Classical Conditioning
Behaviour can become linked to another unrelated stimuli You can learn by association E.g. Get stressed > have a cigarette Work break > have a cigarette Conditioned behaviour can become a habit/routine
How can we use classical conditioning to change behaviour?
Pair an unpleasant stimuli with behaviour Break the habit by preventing unconscious thoughts e.g. Put an elastic band round a cigarette packet
Describe Operant Conditioning
Behaviour is shaped by consequences It can reinforced by a reward or by taking away a punishment and vice versa
How can we use Operant Conditioning? Why is Operant Conditioning more of a problem?
As unhealthy behaviours tend to give immediate rewards
We can give incentives eg save money for a holiday
Describe the Social Learning Theory
Learn from others actions and their consequences and apply it to themselves Behaviour can be shaped by role models, positively or negatively Behaviour is focused on the goals/outcomes Works well if role model is high status or relatable
Describe the Cognitive Dissonance theory (A Social Cognition Model)
People have preconceptions about health behaviour They feel uncomfortable if this is challenged/shown to be untrue They reduce their discomfort by changing their behaviour
What is the Biomedical Model?
Model defines mind and body as separate entities- Duality Illness is seen as caused by biological and physiological aspects Treated physically Not treating the patient Holistically
Describe the Health Belief Model
People have common sense heliefs and their risk and severity which shape their behaviour Can be changed by a “cue to action”
Describe the Theory of Planned Behaviour
Theory shows you need to understand their intentions to know their actions Takes Attitude to behaviour, subjective norms and percieved control into account. However just because you intend to, doesn’t mean you will
Describe the transtheoretical model
Looks as Stages of Change
Looks at they way people go about changing their behaviours
Cycle goes round, can exit and enter at any stage
Takes relapses into account
1) Precontemplation
2) Contemplation
3) Preparation
4) Action
5) Maintainance
6) Relapse
List some reasons people use substances
Pain relief Boredom, Social Lubricant, Pleasure Forget Worries Anxiety/Depression/Stress Peer Pressure Enhance Creativity etc Spiritual Quest
Levels of Alcohol Risk
Low: abstain or drink within the guidelines Hazardous: drink over limits, avoided consequences so far but have an increased risk Harmful:drink over hazardous level, show some evidence of alcohol related harm
Describe the Difference between Moderate and Severe Dependence
Moderate: Degree of dependence Don’t relief drink Can detox in the community Severe: Chronic alcoholics May have severe and long term problems Experience withdrawal and relief drink May need in-patient detox
Describe treatments of Alcohol Dependence
Medically Assisted Alcohol Withdrawal Supportive: Supplements (Vitamin B and B1) Relapse Prevention: Disulphiram/Medication Therapeutic: Pharmacological, Councilling, Social
Define Coping
The way someone reacts to a potential stressor (Transactional Model)
Describe Emotion Focused Coping
Change the Emotion
Behavioural- talk to friends, drink etc
Cognitive- change how to think about the situations eg denial
Describe Problem Focused Coping
Change the problem
Expand resources- social support, self efficacy, prepare them for the stress
Reduce the demands of stressful situations
What do people with Chronic Illness have to Cope with?
Diagnose Physical Impact Treatment and Hospitalisation Adjustment Socioeconomics
Why is it hard to diagnose depression?
Symptoms can be missed or thought to be due to illness Patient may not disclose them HCP may avoid asking
Describe the Gate Control Theory
Pain is a result of a 2 way communication between the brain and tissue damage, between these are “neural gates” for the message to pass through The more open the gate, the more pain felt Explains why people have different levels of pain control
List some factors which can change the “openness of the gate”
Psychological- thoughts, beliefs, interpretations, expectations, fear Physiological- stimuli, medication, tissue damage Other- Exercise, Distraction
Describe Pain Management Programmes
Aim to improve the physical, psychological, emotional and social aspects to quality of life in people with chronic pain Manage their thoughts and feelings, Improve relaxation, Set Goals, Keep them Active
Problems with talking about sexual diversity
“Normal”-sounds judgmental and is different for everyone as sexuality is so diverse Embarrassing for patient so may not divulge Different levels of understanding Use of Specific Terms
What are the 5 Stages of Grief?
Denial Anger Bargaining Depression Acceptance
What can affect the grieving process? What are some risk factors for chronic grief?
Prior Bereavement Type of Loss- Who, When etc Lack of Support Mental Health If Grief/Ending Grief is Discouraged
What is the physiological response to stress?
Fight or Flight- Short term changes, mainly triggered by NA Increase in O2 availability Conserving energy and preparing for tissue damage
What are the stages of Chronic Stress?
1) Alarm - fight or flight 2) Resistance - up regulation of processes above homeostatic levels 3) Exhaustion - depletion of body’s stores, F or F returns
Define a Stressor
An activity, event or stimuli that causes stress
How to measure Stress?
1) Create a ranking of different Stressors (doesn’t take the individual into account) 2) The transactional model - looks at the demand (stressor) and the resources (coping skills, personality, support) of the individual, then reappraisal, to see their stress response
What is the impact of stress?
Direct physical damage Lower immune system, risk of infection Depressive mood Weight changes Tiredness Low motivation High cortisol
Strategies of Stress Management
Cognitive- find out why it stresses and change the way you react
Behavioural- skills training and time management and assertiveness
Emotional- counselling and social support
Physical- relaxation training, exercise and biofeedback
Non cognitive- drugs
Types of psychotherapeutic therapies
1) Psychodynamic 2) Systemic and Family therapists 3) Humanistic 4) Cognitive Behavioural Therapy
Describe Psychodynamic Therapies
Focuses on childhood/past conflict and relationships Therapist doesn’t talk much to allow transference to occur Good for: interpersonal difficulties and personality problems Requires: interest in self exploration and capacity to tolerate emotional pain
Describe systemic therapy
Also known as family therapy Focus on relationships, address interactions and their meaning
Describe the Humanistic Therapies
Client centred, general counselling Try to help coping Create a positive environment for personal growth Good for: Subclinical Depression, Difficulty with Events, Mild Anxiety
Describe CBT
Relieve symptoms by changing the maladaptive thoughts, beliefs and behaviours. Use classical/operant conditioning for behavioural changing Educate and empower them to be their own therapist for cognitive changes. Challenge negative thoughts and rehearse coping with situations
Describe the CBT Model
1) There is an event/early experience/history
2) This leads to someone’s core beliefs
3) These then lead to underlying beliefs in certain situations
4) There is then a trigger event
This impacts their behaviour, thoughts and emotions, all of which can then add to core beliefs
When do we use CBT?
Depression and Anxiety Sexual dysfunction Eating disorders
Define Attachment Theory and name different Attachment styles
Explains where you get comfort and security. Biologically based to be close to the care giver- proximity seeking and contact maintaining behaviour Secure Avoidant Ambivalent Disorganised
Describe the Stages of Cognitive Development
Sensorimotor Pre operational Concrete operational Formal operational
What are some criticisms of the cognitive development model?
Tends to focus on what they can’t do Development may be more gradual than the stages imply Still need to try and inform child, don’t assume lack of understanding
Describe Social Development
Cognitive development requires social interaction Child is an apprentice and learn through problem solving With help (parent, teacher) they can increase understanding
Give some good ways to interact with children in healthcare
Describe things in concrete terms, no abstracts Use Face Pain rating scales Teddy bear hospital Use puppets, toys to communicate
What is the difference between compliance and adherence?
Compliance- the extent to which a patient complies with medical advice Adherence- the extent that their behaviour coincides with advice, attempt to be more patient centred
What is concordance?
The negotiation between a patient and doctor over treatment Partnership Active participation of patient Respect their priorities and beliefs
What is wrong with non adherence?
Common in chronic illness which leads to hospital admissions Impacts health Financial implications
Types of Non-Compliance
Unintentional- lack capacity or resources to follow treatment Intentional- from beliefs, attitudes, expectations influencing motivation
How to measure adherence
Direct- blood test, observation Indirect- pill counts, mechanical measure of dose, self report Think of pros and cons of each of these
Describe the process of breaking bad news. (Hint, think of the acronym)
SPIKES Setting - face to face, privacy, find out if they want others present Perception - before you tell, ask Invitation - don’t assume they want to know everything Knowledge - give warning, direct them, avoid jargon Empathy - how are you feeling? Validate their response Strategy and summary - agree on next steps
What is bad news?
Any information that will drastically change their view of the future for the worse E.g. Death, terminal prognosis, infertility, antenatal testing
Why is it important to break bad news well?
Good doctor patient relationship It can impact emotional well being It can impact adjustment and coping ability
