HPHD Flashcards
What is a schemata?
group of related information
share same characteristics
Define stereotype
= generalisation made about specific social groups and members of those groups
Define prejudice
attitude and prejudgement based on negative stereotypes
Define discrimination
= behaving differently with people from different groups because of their group membership
What is crystalline intelligence?
experience and long term memory
What is fluid intelligence?
processing speed and short term memory
What is the result of classical conditioning?
Behaviours become linked to unrelated stimuli. Learn by association
How does operant conditioning change behaviour?
Behaviour is reinforced/increases if it is rewarded or a punishment is removed
Behaviour decreases if it is punished or a reward is taken away
How does the social learning theory help us to understand behaviour?
People learn by observation of behaviour and its consequences.
People are motivated to perform behaviours that lead to rewards or that they believe they can do themselves = self-efficacy
If the person observed is of a high status or like the person observing, the behaviour is more likely to be copied by the observer.
Describe the health belief model
Beliefs about health threat
- susceptibility
- severity
Beliefs about health related behaviour
- benefits
- barriers
Cues to action
=> ACTION
What are the limitations of the health belief model?
As humans, is all our behaviour really this rational?
We have habits, conditioned behaviour and can be coerced
We have emotions
Describe the theory of planned behaviour
beliefs and evaluation of outcomes -> attitude towards behaviour
normative beliefs and motivation to comply -> subjective norm
barriers and facilitators of control -> perceived control
=> INTENTION
=> BEHAVIOUR
What are the stages of the stages of change model
Precontemplation = happy with engaging in dangerous behaviour Contemplation = starting to think about changing Preparation = making plans to stop Action = implementing plans Relapse = a natural part! Maintenance = kept plan going for a while!
What is low risk drinking?
People who drink within the Department of Health’s sensible drinking guidelines and hence are at low risk of harmful effects.
What is hazardous drinking?
drinking over the sensible drinking limits, either in terms of regular excessive consumption or less frequent sessions of heavy drinking.
increases the risk of harmful consequences
so far they have avoided significant alcohol related problems.
What is harmful drinking?
drinking at levels above those recommended
clear evidence of some alcohol related harm.
What is moderate dependence?
‘degree’ of dependence
have not reached the stage of ‘relief drinking’ = drinking to avoid physical discomfort from withdrawal symptoms
What is severe dependence?
experienced significant alcohol withdrawal
drinking to stop withdrawal symptoms
What are the four initial questions in the FAST screening tool?
how often do you have more than 8 (men)/6 (women) units or more on one occasion?
How often in the last year have you not been able to remember what happened when drinking the night before?
How often in the last year have you failed to do what was expected because of drinking?
Has a relative/friend/doctor/health worker been concerned about your drinking or advised you to cut down?
What are the five key principles of motivational interviewing?
- express empathy
- avoid argument - encourage the patient to hear themselves say why they want to change
- support self-efficacy
- roll with resistance - delicately challenge the thought processes that underlie the behaviour one wants to change
- develop discrepancy - identify the difference between the current and ideal situation
What is the aim of motivational interviewing?
to help patients identify and change behaviours
What are the steps of motivational interviewing?
- establishing rapport
- setting the agenda
- assessing readiness to change
- sharpening the focus
- identifying ambivalence
- eliciting self-motivating statements
- handling resistance
- shifting the focus
Explain the Transactional model of stress
Demands (life events, daily hassles, chronic stressors)
Resources
=> APPRAISAL
=> STRESS RESPONSE
What is primary appraisal?
demands of a situation are evaluated
What is secondary appraisal?
evaluation of resources and capacity to cope
What is reappraisal?
reconsideration of the situation once they have tried to cope with it
What cognitive distortions can stress lead to?
- Overgeneralisation
- Catastrophizing
- Personalisation = it’s gone wrong because I am a failure
- Rumination = brooding on problems
- Anxiety and depression
- Learned helplessness due to lack of control
- Low motivation and a downward spiral of illness
What are the cognitive symptoms of stress?
memory problems inability to concentrate poor judgement seeing only the negative anxious or racing thoughts constant worrying
What are the emotional symptoms of stress?
moodiness irritability inability to relax feeling overwhelmed sense of loneliness depression
What are the physical symptoms of stress?
aches and pains diarrhoea or constipation nausea chest pain rapid heart beat loss of sex drive frequent colds
What are the behavioural symptoms of stress?
eating more or less sleeping too much or too little isolating yourself procrastinating using alcohol, cigarettes or drugs to relax nervous habits
What are cognitive strategies for managing stress?
cognitive restructuring
hypothesis testing
What are behavioural strategies for managing stress?
skills training
What are emotional strategies for managing stress?
counselling
social support
What are physical strategies for managing stress?
relaxation training
exercise
What are non-cognitive strategies for managing stress?
drugs
What is emotion focused coping?
trying to change the emotion attached to the stress
What is problem focused coping?
change the problem or your resources
reduce demands or expand resources
Define pain
An unpleasant sensory and emotional experience
associated with actual or potential tissue damage or is described in terms of such damage
What is the difference between acute and chronic pain?
Acute pain = short term and only lasts for as long as there is healing.
Chronic pain = for longer than 12 weeks
does not indicate on-going tissue damage.
What is the aim of pain management programmes?
helping a patient to take control of their pain, not about finding a cure
What are the predisposing factors of sexual dysfunction?
experiences which make an individual vulnerable to developing sexual difficulties at a later stage
- Restrictive upbringing,
- inadequate sexual information
- traumatic early sexual experiences
What are the precipitants of sexual dysfunction?
Events or experiences associated with the initial appearance of a dysfunction
- Childbirth,
- infidelity,
- dysfunction in partner,
- depression,
- random failure,
- physical illness.
What are the maintaining factors of sexual dysfunction?
factors which allow the dysfunction to persist
- Performance anxiety,
- guilt,
- poor communication,
- relationship discord,
- restricted foreplay,
- environmental factors.
Describe the main components of psychosexual therapy
- Educative counselling – individual / couple
- Modification of attitudes/beliefs
- Facilitation of communication / assertiveness
- Specific directions for sexual behaviour
Describe the grief model
- Denial
• Refusal to discuss illness/the future - Anger
• Look for someone to blame
• “Why me?” “The doctors don’t know what they’re doing!”
• The patient may search for alternative therapies - Bargaining
• “I’ll do anything, just make me better!” - Depression
• “What’s the point? I can’t go on any longer.” - Acceptance
• “I’m ready to make funeral arrangements”
What characteristics must a patient have to be suitable for CBT?
be keen to be an active participant
be able to engage collaboratively with the therapist
accept a model emphasising thoughts and feelings
be practically seeking a solutions
How does CBT work?
changing maladaptive thoughts, beliefs and behaviour
that it is not the situations itself that upsets us, but the view we take of the situation.
The way we think about something can have a big impact on the emotion experienced from the situation
Why does a secure attachment give the infant psychological security?
shows them that they are worthy of love and care
shows that others will be available to them in times of need.
gives the infant better social competence, peer relations, self-reliance and physical and emotional health.
When is the first social smile?
6 weeks
When can an infant distinguish between strangers and non-strangers?
3 months
At what age are specific attachments formed?
7 to 8 months
The child will miss key people and show distress in their absence. They become wary of strangers picking them up, even when key people are present.
What are the signs in the infant of secure attachment?
Child gets upset when mother leaves
calms down quickly when she returns
explores the environment when she is present
How is secure attachment formed?
mother is quick to respond to physical and emotional needs of the child.
She is sensitive to the child’s signals
the response is rapid, appropriate and emitted consistently.
What are the signs in the infant of avoidant attachment?
Child explores environment
does not respond when mother leaves or returns
How is avoidant attachment formed?
The mother does not respond when child is upset
She tries to stop the child crying
She encourages the child to be independent and explore
What are the signs in the infant of ambivalent attachment?
Child gets upset when mother leaves but can be comforted by a stranger.
When the mother returns, the child will having mixed feelings and may resist contact or appear angry
How is ambivalent attachment formed?
Mother is inconsistent
varies between responding quickly and appropriately and not responding on other occasions.
Child is preoccupied with whether the mother is available before they can use her as a secure base
What are the signs in the infant of disorganised attachment?
shows difficulty when mother returns.
Can rock or freeze.
How is disorganised attachment formed?
mother’s behaviour can be negative, withdrawn or inappropriate.
What are the phases of separation?
Protest
• Child is distressed. They may look for their mother or cling to a substitute.
Despair
• The child shows signs of helplessness.
Detachment
• The child becomes more interested in their surroundings. They may smile and be sociable. However, when the carer returns, the child becomes remote and apathetic.
Why is distress seen on separation in those aged 6 months to 3 years?
lack of ability to keep the image of their carer in mind,
a limited understanding of language
lack in ability to understand abstract concepts
may see separation as a punishment.
State the ages of each stage of childhood cognitive development
Sensorimotor = 0-2 years
Pre-operational = 2-7 years
Concrete operational = 7-12 years
Formal operational = 12+ years
What are the characteristics of the sensorimotor stage?
experience the world through senses develop motor coordination do not think symbolically. body schema develops At around eight months, permanence is understood
What are the characteristics of the pre-operational stage?
- Symbols are used
- Language develops
- Thinking is not logical and the child has a very good imagination
- Egocentricism – difficulty seeing things from other’s point of view and think that everyone experiences the world the way they do.
- Lack concept of conservation – the different glass and water test!
- Can classify things by only a single feature
What are the characteristics of the concrete operational stage?
- Thinking logical, but not yet abstract
- Perspectives of others are understood
- Achieve conservation of number, mass and weight
- Classification by multiple features
What are the characteristics of the formal operational stage?
- Abstract thinking develops
- Thinking becomes multidimensional
- Hypothetic-deductive reasoning
What are the criticisms of the stages of childhood cognitive development?
to focus on what the child can’t do, rather than what they can.
It could be argued that if a child is too young to appreciate a given concept, there is no point in trying to inform them.
This carries a huge risk, as partial information can be damaging and the child will try to make sense of the situation anyway.
It is important to give the child information in a way that is concrete to understand.
What is Vygotsky’s theory of social development?
Cognitive development requires social interaction
Children learn through problem solving that is shared with someone else = collaborative problem solving
Learning occurs in a ‘zone of proximal development’ = the gap between what a child can do by themselves and what they could do with appropriate guidance or collaboration
How is cultural identity defined?
by each person i
n relationship to the group or groups with whom he or she identifies.
Define sexual orientation
what gender a person is attracted to
Define gender identity
someone’s internal perception of their gender
Define gender role
the way the person lives in society and interacts with others
Define transgender
gender identity/expression differs from their birth sex
Define transsexual
a person who feels a consistent and overwhelming desire to transition and fulfil their life as a member of the opposite sex
Define heterosexism
a system of attitudes, bias, and discrimination in favour of opposite-sex sexuality and relationships
Define compliance
the extent to which a patient complies with medical advice.
Define adherence
the extent to which patient behaviour coincides with medical advice
Define concordance
negotiation between patient and doctor over treatment regimes
Why does concordance lead to better adherence?
- Patient has shared ownership of decisions about treatment
- Patient’s beliefs, lifestyles and priorities are taken into account
- Barriers to adherence can be addressed
- It promotes patient trust and satisfaction with care, making adherence more likely
What are direct ways of measuring adherence?
urine or blood test
observation
What are indirect ways of measuring adherence?
pill counts
mechanical or electronic measures of dose
patient self-report
second hand reports
What illness factors influence adherence?
- Adherence is better when patients experience symptoms of their disease
- less serious diseases, patents in objectively poorer health are more likely to be adherent than patients in better health.
- With more serious diseases, patients in poorer health are significantly less likely to be adherent.
What treatment factors influence adherence?
- Preparation: treatment setting, waiting time, time of referral, inconvenience
- Immediate character: complexity of regimen, duration, degree of behaviour change, inconvenience, expense
- Administration: supervision, continuity of care
- Consequences: side effects –social and physical, stigma
How does understanding and recall influence adherence?
- Patient understanding of information and content of consultation and their illness and treatment
- Recall is influence by anxiety, knowledge, importance, primacy/recency effect (remember first and last thing)
How do psychological factors influence adherence?
- Cognitive deficitis and psychological problems impact on compliance
- Social support: more isolated are less likely to adhere
- Social context: homeless less likely to adhere
How do healthcare factors influence adherence?
- Organisational setting: primary v secondary care, inpatient and outpatient services, continuity of care
- The prescriber: their beliefs and attitudes towards the treatment
- Doctor-patient interaction: manner, positive behaviours, good communication, perceived competence
Distinguish between intentional and unintentional adherence
Intentional = arises from beliefs, attitudes and expectations that influence a patient’s motivation
Unintentional = arises from capacity and resource limitations.
What is bad news?
= information that drastically alters a patient’s view of the future for the worse
State the steps of the SPIKES model of breaking bad news?
Setting and listening skills Patient's perception Invitation from the patient Knowledge Empathy Strategy and summary
Describe the Setting and listening skills step of the SPIKES model
Face-to-face Avoid informing relatives first Ensure privacy no interruptions Allow adequate time Find out who the patient wants present Introduction of myself and any colleagues Eyes on same level. Maintain eye contact No physical barriers Active listening skills – silence and repetition
Describe the invitation step of the SPIKES model
Ask how much information they would like me to give about their diagnosis and treatment
Respect the patient when they decline information.
Allow for denial
Offer opportunity for further discussion
Describe the knowledge step of the SPIKES model
Give a warning that you are about to say something that might be shocking
Give information in small chunks
Allow patient time to consider things and ask questions
Check their understanding
Use clear and simple explanations
Incorporate the key terms the patient used
Describe the empathy step of the SPIKES model
Ask how the patient is feeling!
Acknowledge the connection between the news and the emotional response
Validate and normalise the emotion
Listen to the patient’s concerns
Describe the strategy and summary step of the SPIKES model
Summarise the main discussion topics
Check understanding
Discuss strategy and agree on the next step
Give opportunity to ask questions
Offer future availability
If the patient is distressed, offer a member of the healthcare team to remain with them, a close contact to be informed or to be left alone.
