My notes Block 13

Question 1

What are the stages of grief?

Answer 1

Numbness
Yearning and anger
Disorganisation and despair
Reorganisation

Question 2

What are acute grief reactions?

Answer 2

Somatic or bodily distress
Preoccupation with image of deceased
Guilt relating to the deceased or circumstances of death
Hostile reactions
Inability to function as you can before
Development of traits of deceased in own behaviour

Question 3

What is Wordens task of mourning?

Answer 3

Accept the reality of the loss
Work through the pain of grief
Adjust to an environment where the deceased is missing
Emotionally relocate the deceased and one on with life

Question 4

What does pathological grief consist of?

Answer 4

Extended grief reactions
Major depressive disorder for over 2 months
Mummification and denial
Getting stuck

Question 5

What are the factors affecting grief severity- both obvious and non-obvious?

Answer 5

Obvious:
Closeness of relationship
Meaningfulness of relationship
Nature of relationship prior to death
Expectedness and manner of death
Age and developmental stage of griever

Non-Obvious-
Individual resilience
Attachment and dependency
Religious belief
Social support

Question 6

What are the key components of the impact of religious beliefs on bereavement?

Answer 6

Belief in an afterlife- seeing loved one again
Continued attachment- prayer can still talk to death relative
Defence against fear of personal death
Religious funeral ritual help grief process and recruit social support

Question 7

What are the different types of nurses in palliative care?

Answer 7

District nurses- primary healthcare team, general palliative care, hands on nursing care, community based

Practice nurse- practice based, generic nursing, primary healthcare team

Marie Curie nurse- community based, arranged by a district nurse, specialist, hands on nursing

Macmillan nurse- community or hospital based, specialist, advice and support but not hands on

Question 8

What are the top 3 symptoms in end stage cancer patients?

Answer 8

Fatigue
Pain
Loss of appetite

Question 9

What is the definition of risk?

Answer 9

The probability of an event occurring in a given time period

Question 10

How do you calculate risk ratio?

Answer 10

risk exposed / risk unexposed

Question 11

How do you calculate risk difference?

Answer 11

risk exposed - risk unexposed

Question 12

How do you calculate odds ratio?

Answer 12

Probability of disease occurring in exposed group / probability of disease occurring in unexposed group

Question 13

What is the prevention paradox?

Answer 13

A preventive measure that brings large benefits to the community offers little to each participating individual

Question 14

What is cardiac neurosis?

Answer 14

Heart complaints where no organic cause can be found
Associated with exhaustion an emotional strain
e.g. soldiers heart or irritable heart- characterised by dyspnea, fatigue, tachycardia and chest pain mostly on exertion

Question 15

How do you treat cardiac neurosis?

Answer 15

Physiological assessment
Psychological assessment
Understanding
Education
Psychological support
Some pharmacologic treatment

Question 16

What is decision analysis?

Answer 16

Systematic, explicit quantitive way of making decisions in healthcare that can lead to both enhanced communication about clinical controversies and better decisions.

It-
Assists in understanding of a decision task
Divides devisor task into components
Uses evidence
Uses decision trees to structure task
Suggest the most appropriate decision for that particular situation

Question 17

What are the stages in a decision analysis?

Answer 17

Structure the problem as a decision tree
Assess probability of each choice branch
Assess the utility of each outcome state
Identify the option that maximises expected utility
Possibly conduct a sensitivity analysis to explore effect of varying judgements
Toss up if 2 options have same expected utility

Question 18

What is EQ 5D?

Answer 18

A utility measure- questionnaire for everyone regardless of condition.
It looks at-
Mobility
Looking after oneself
Doing usual activities
Having pain or discomfort
Feeling worried, sad or unhappy

Question 19

What are QALY’s?

Answer 19

Quality adjusted life years.
Can use for population utility measures.
1 year in perfect health = 1 QALY

Question 20

What is a sensitivity analysis?

Answer 20

Needed if numbers in analysis are uncertain

Can show effect different values have on outcome

Question 21

What are the benefits of decision analysis?

Answer 21

Makes all assumption in a decision explicit
Allows examination of decision process
Integrates research evidence into making decisions
Insight gained in process may be more important than actual numbers
Can be used for individual decisions, population level decisions and for cost effectiveness analysis

Question 22

What are the limitations of decision analysis?

Answer 22

Probability estimates require data sets that may not exist
Subjective probability estimates are subject to bias
With utility measures people may be asked to rate health they have never experienced
Different techniques for utility measures will give different results