My notes Block 13 Flashcards
What are the stages of grief?
Numbness
Yearning and anger
Disorganisation and despair
Reorganisation
What are acute grief reactions?
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
What is Wordens task of mourning?
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
What does pathological grief consist of?
Extended grief reactions
Major depressive disorder for over 2 months
Mummification and denial
Getting stuck
What are the factors affecting grief severity- both obvious and non-obvious?
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
What are the key components of the impact of religious beliefs on bereavement?
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
What are the different types of nurses in palliative care?
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
What are the top 3 symptoms in end stage cancer patients?
Fatigue
Pain
Loss of appetite
What is the definition of risk?
The probability of an event occurring in a given time period
How do you calculate risk ratio?
risk exposed / risk unexposed
How do you calculate risk difference?
risk exposed - risk unexposed
How do you calculate odds ratio?
Probability of disease occurring in exposed group / probability of disease occurring in unexposed group
What is the prevention paradox?
A preventive measure that brings large benefits to the community offers little to each participating individual
What is cardiac neurosis?
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
How do you treat cardiac neurosis?
Physiological assessment Psychological assessment Understanding Education Psychological support Some pharmacologic treatment
What is decision analysis?
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
What are the stages in a decision analysis?
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
What is EQ 5D?
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
What are QALY’s?
Quality adjusted life years.
Can use for population utility measures.
1 year in perfect health = 1 QALY
What is a sensitivity analysis?
Needed if numbers in analysis are uncertain
Can show effect different values have on outcome
What are the benefits of decision analysis?
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
What are the limitations of decision analysis?
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
