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Chronic illness > Overview and palliative care > Flashcards

Overview and palliative care Flashcards

1
Q

What are the 4 leading chronic illnesses?

A

cardiovascular disease
cancers
chronic respiratory diseases
Diabeties

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2
Q

What are the leading global risk factors for development of chronic illness?

A 
o	Raised blood pressure (13%)
o	Tobacco use (9%)
o	Raised blood glucose (6%)
o	Physical inactivity (6%)
o      Overweight and obesity (5%)
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3
Q

What is chronic disease?

A

Chronic disease refers to the pathophysiology that gives rise to an alteration in a person’s body function and structure.

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4
Q

What is Chronic illness?

A

• Chronic Illness is the ‘irreversible presence, accumulation or latency of disease states or impairments that involve the total human environment for supportive care and self-care maintenance of function and prevention of further disability

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5
Q

Define disability

A

‘multidimensional concept relating to impairment in body structures or function, limitation in activities, restriction in participation and the affected persons environment’.

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6
Q

What are modifiable risk factors?

A

BEHAVIOURAL

Tobacco smoking
Excess alcohol use
Physical inactivity
Poor diet

BIOMEDICAL
Excess weight
High blood pressure
High blood cholesterol

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7
Q

What are broad influences?

A 
MAY OR MAY NOT BE MODIFIABLE 
Socio-environmental factors
Psychosocial factors
Early life factors 
Political factors
NON-MODIFIABLE 
Age
Gender
Indigenous status
Ethnic background
Family history
Genetic make up
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8
Q

What are key components of the acute care model?

A 
Disease-centred
Doctor-centred
Focus on individual
Secondary care emphasis 
Reactive, symptom-driven
Episodic care
Cure focus
Single setting: hospital, specialist centres, general practice
1 : 1 contact through visit by patient
Diagnostic information provided
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9
Q

What are key components of the chronic care model?

A 
Person-centred
Team-centred
Population health approach 
Primary care emphasis
Proactive, planned intervention
Ongoing care
Prevention/management focus
Community setting, collaboration across primary and secondary care
1 : 1 or group contact through visit by patient or health professional, email, phone or web contact
Support for self-management
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10
Q

What are the 5 key principles for caring for someone with a chronic illness?

A
  1. Recognise that chronic illness and/or disability affects all dimensions of personhood: physical, psychosocial, emotional, cognitive and spiritual
  2. Recognise that cultural responses to illness are important when providing care
  3. Provide holistic care by incorporating a team approach to providing care that is relevant to the needs of the person experiencing the chronic illness and their family
  4. Adopt a ‘whole of life’ approach, recognising that risk factors occur across the lifespan and play a significant role in the development of chronic disease
  5. Provide care that is person-centred and inclusive of the family, however the person defines this for themselves
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11
Q

What are the 5 stages of the Prochaska & DeClemente Transtheoretical model?

A 
Pre-contemplation
Contemplation
Preparation
Action
Maintenance
Relapse
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12
Q

Prochaska & DeClemente Transtheoretical model

Explain the Pre-contemplation stage?

A

The person has no intention of making any changes in the next 6 months. While they may lack motivation, they may also lack the knowledge and skills that enable them to change behaviour

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13
Q

Prochaska & DeClemente Transtheoretical model

Explain the Contemplation stage

A

In this stage the person is contemplating change within the next 6 months. Although aware of the benefits of changing behaviour, ambivalence occurs as the person focuses on the barriers and costs that will occur during the change period.

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14
Q

Prochaska & DeClemente Transtheoretical model

Explain the preparation stage

A

Individuals in this stage are preparing to take action within the next month. They generally have a plan and may have already taken some action towards the change.

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15
Q

Prochaska & DeClemente Transtheoretical model

Explain the Action stage

A

The person has made modifications and action is observable and measurable. It is during this stage that ongoing support is essential as relapse is a high risk.

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16
Q

Prochaska & DeClemente Transtheoretical model

Explain the Maintenance stage

A

The changes have been made and the risk of relapse is decreasing. Individuals in this stage feel confident that they continue the new behaviour.

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17
Q

What is motivational interviewing and why is it used?

A
  • Motivational interviewing is based on the premise that most people do not enter into a consultation with a health professional ready and willing to make behaviour changes, thus healthcare professional’s role is to assist the individual to explore and resolve their ambivalence about behaviour change.
  • Motivational interviewing differs from counselling as it is more focused and goal directed. The motivation to change is intrinsic and elicited from the individual are driven by internal needs and goals.
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18
Q

What are the 4 fundamental stages of motivational interviewing?

A

Engaging (express empathy)
Guiding (develop discrepancy)
Evoking (role with resistance)
Planning (support self-efficacy)

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19
Q

Motivational interviewing

What is the clinicians role and responsibilities and what might they say in the ENGAGING (express empathy) stage?

A 
Build a rapport with the person 
Use OARS 
Open ended questions
Affirm 
Reflective listening 
Summarise 
Assess the individual’s stage of change

How are things going?
What do you want to do next?
What are the good things about…. And what are the less good things?

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20
Q

Motivational interviewing

What is the clinicians role and responsibilities and what might they say in the GUIDING (develop discrepancy) stage?

A
  • Explore the values and attitudes held by the individual
  • Identify goals and break into small achievable and measurable steps
  • Encourage the individual to identify the benefits and costs to changing behaviour
  • Allow the individual to form their own argument concerning changing behaviour

How would you like things to be different?
How do you think you could do that?
How can I help you achieve that?
Who is in your life that would support you making these changes?

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21
Q

Motivational interviewing

What is the clinicians role and responsibilities and what might they say in the EVOKING (role with resistance) stage?

A
  • The individual has identified a goal aimed at changing behaviour and is motivated to make the change
  • Use selective eliciting: elicit and selectivity reinforce the individual’s motivational statements, intention to change and ability to change
  • Do not argue
  • Use reflection
  • Summarise
  • Affirm the statements made

It sounds like this is really difficult for you…
What is most important to you now?
So what you are saying is….

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22
Q

Motivational interviewing

What is the clinicians role and responsibilities and what might they say in the PLANNING (self efficacy) stage?

A 
Identify and set goals using SMART criteria 
•	Specific 
•	Measurable 
•	Achievable 
•	Realistic 
•	Timely

How did you manage something like this in the past?
How do you think you could do this?

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23
Q

What are SMART goals

Briefly explain each part

A

S - Specific - goal needs to be specific to the problem

M - measurable - The person needs to be able to determine if they have reached their goal

A - Achievable - The person needs to think that they CAN do this

R - Realistic - The person must be able to expect to attain their goal

T - Timely - The person must have a time frame to achieve their goal

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24
Q

What is self-management?

A

the individual’s ability to manage disease process, the emotional consequences of living with the disease and the changes that occur to daily living as a consequence of the disease.

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25
Q

What skills are essential for facilitating self management support?

A

o Assessing the person’s readiness for change
o Using motivational interviewing techniques
o Assisting the person to set goals and develop a realistic and achievable action plan
o Building self-efficacy

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26
Q

What is self efficacy?

A

♣ Self—efficacy is an individual’s belief that they have the ability to achieve in certain situations. Basically self-efficacy is the ‘I-can’ or ‘I cannot’ belief and reflects an individual’s confidence in performing specific tasks.

27
Q

What are the 4 sources in which self-efficacy can be acquired?

A

¬ Mastery expertise – performing a task successfully
¬ Vicarious expertise – comparing themselves to another person with similar abilities/disabilities and sees the person succeeding.
¬ Social persuasions - positive encouragement or negative comments
¬ Physiological factors - own emotional response to situations

28
Q

What is the illness trajectory?

A

The ‘illness trajectory’ offers a model whereby the goals of the person with a chronic illness and the healthcare provider can be viewed in the context of a long journey. The trajectory is non-linear and people may skip phases or return to previous phases more than once. The trajectory model describes the goals of treatment according to each phase. Each person has a unique experience of the trajectory

29
Q

What are the 8 phases of the illness trajectory?

A 
PRE-TRAJECTORY
TRAJECTORY ONSET
STABLE 
UNSTABLE 
ACUTE
CRISIS
DOWNWARD
DYING
30
Q

In the PRE-TRAJECTORY phase of the illness trajectory, what is the definition and what is the goal of management?

A

Genetic factors or lifestyle behaviours that place and individual or community at risk for the development of a chronic condition

GOAL:
Prevent onset of chronic illness

31
Q

In the TRAJECTORY ONSET phase of the illness trajectory, what is the definition?

A

Appearance of noticeable symptoms, includes period of diagnostic work-up and announcement by biographical limbo as person begins to discover and cope with implications of diagnosis

32
Q

In the STABLE phase of the illness trajectory, what is the definition and what is the goal of management?

A

Illness course and symptoms are under control. Biography and everyday life activities are being managed within limitations of illness. Illness management centres in the home

GOAL:
Maintain stability of illness, biography and everyday life activities.

33
Q

In the UNSTABLE phase of the illness trajectory, what is the definition and what is the goal of management?

A

Period of inability to keep symptoms under control or reactivation of illness. Biographical disruption and difficulty in carrying out everyday life activities. Adjustments being made in regimen with care usually take place at home

GOAL:
Return to stable

34
Q

In the ACUTE phase of the illness trajectory, what is the definition and what is the goal of management?

A

Severe and unrelieved symptoms or the development of illness complications necessitating hospitalisation or bed rest to bring the illness course under control. Biography and everyday life activities temporarily placed on hold or drastically cut back.

GOAL:
Bring illness under control and resume normal biography and everyday life activities/

35
Q

In the CRISISphase of the illness trajectory, what is the definition and what is the goal of management?

A

Critical or life threatening situation requiring emergency treatment or care. Biography and everyday life activities suspended until crisis passes.

GOAL:
Remove life threat

36
Q

In the DOWNWARD phase of the illness trajectory, what is the definition and what is the goal of management?

A

Illness course characterised by rapid or gradual physical decline accompanied by increasing disability or difficulty in controlling symptoms. Requires biographical adjustment and alterations in everyday life activity with each major downward step.

GOAL:
To adapt to increasing disability with each major downward turn.

37
Q

In the DYING phase of the illness trajectory, what is the definition and what is the goal of management?

A

Final days or weeks before death. Characterised by gradual or rapid shutting down of the body processes, biographical disengagement and closure and relinquishment of everyday life interests and activities.

GOAL:
To bring closure, let go and die peacefully.

38
Q

Explain quality of life in reference to Chronic Illness including what psychosocial factors impact quality of life

A

• The approach in chronic illness is not focused on curing but rather maximising a person’s capacity to engage in life or to increase the quality of their life.

good physical health
financial stability
positive family dynamics and cohesiveness
strong social support networks
maintenance of optimal level of cognitive functioning
personal control
prevention of depression

39
Q

How can nurses challenge stigmatisation of chromic illness on a personal level?

A

Being alert to stigmatising processes such as stereotyping, labelling and othering

40
Q

How can nurses challenge stigmatisation of chromic illness on a professional level?

A

working with people in the context recognising and valuing their expertise and resourcefulness; supporting their rights to self-determination and remaining mindful of the risks of social isolation

41
Q

How can nurses challenge stigmatisation of chromic illness on a socio- political level?

A

making visible and challenging stigmatising practices that marginalise and discriminate against people with chronic illness.

42
Q

What are biological and physical factors that affect sexuality of people who suffer from chronic illness?

A

cardiovascular or pulmonary function, fatigue and pain.

43
Q

What is pain?

A

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage

Pain is whatever the experiencing person says it is, existing wherever they say it does

44
Q

What are effective ways of managing chronic pain?

A

education, self-management, knowledge of the condition and effective use of analgesia

45
Q

What are the 7 key principles of rehabilitation?

A

o Individualism of programs to the needs of each client in order to prepare them for life in the real world.
o Mutual participation with health professionals in decision-making and goal setting.
o Outcomes that are meaningful to the client.
o Sharing of information and education that is appropriate, timely and according to the clients wishes.
o Emotional support.
o Family and peer involvement throughout the rehabilitation process.
o Co-ordination and continuity across multiple service sectors.

46
Q

When is palliative care given and what is the goal of palliative care?

A
  • Palliative care is provided for a person with an active, progressive advanced illness, who has little or no prospect of cure and for whom the primary treatment goal is quality of life.
  • The goals of palliative care nursing is promoting quality of life across the illness trajectory through the relief of suffering, including care of the dying and bereavement follow-up.
47
Q

What is palliative care?

A
  • Provides relief from pain and other distressing symptoms
  • Affirms life and regard dying as a normal process
  • Intends neither to hasten nor to postpone death
  • Integrates the psychology and spiritual aspects of patient care
  • Offers a support system to help the family cope during the patient’s illness and their families, including bereavement counselling, if indicated.
  • Uses a team approach to address the needs of patients and their families, including bereavement counselling if necessary
  • Will enhance quality of life, and may also positively influence the course of illness
  • Is applicable early in the course of the illness; in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and include those investigations need to better understand and manage distressing clinical complications
48
Q

What are the principles of the health promotion model in palliative care?

A
  • Building public policies that support dying, death, loss and grief
  • Creating supportive environments (in particular social supports)
  • Strengthening community action
  • Developing personal skills in these areas
  • Re-orientating the health system
49
Q

what is included in the 2008 PCA position statement?

A
  • Dying is a part of life. The care of people at the end of life, their families and carers is the responsibility of the whole community
  • Carers must be recognised as both a key partner in the care team and a recipient of care in accordance with the palliative care service provision model
  • Enabling people’s preferences to receive quality care at the end of life in the setting of their choice is dependent upon ongoing physical, emotional, practical and spiritual support from individual carers and their communities as well as health and professional support
  • The extent and quality of support provided to the carer and the person nearing the end of life is a key determinant of both of their experiences. The whole community should support them.
50
Q

What is the role of a primary carer?

A
  • Providing physical, psychological, emotional, spiritual support
  • Coordinating informal and formal care providers
  • Administering medications
  • Taking patient to various medical appointments
51
Q

Who are primary care providers in reference to palliative care?

A

General practitioners, community and hospital based doctors, nurses and allied health, staff of residential aged care facilities whose substantive work is not in palliative care. Primary care providers in the palliative context can also be other specialist care providers for example, oncologists, general physicians and geriatricians.

52
Q

Who are the specialist palliative care team and what do they do?

A
  • Provide specialist palliative care for patients and their families where assessed needs exceed the resources and/or capability of primary care providers
  • Provides ongoing care to patients with complex, unstable condition not restricted to physical symptoms but including psycho-emotional and spiritual problems
  • Provides education to primary care providers
53
Q

What is symptom control?

A

The relief of symptoms associated with advanced and progressive illness is one of the primary aims of palliative care and without optimal management of symptoms whether they are physical, emotional or existential the patient’s quality of life quickly deteriorates.

54
Q

The Why Framework what is it used for?

A

Need more info

symptom management

55
Q

What are reasons for admittance to an acute care facility?

A
  • Receive treatment for an acute medical or surgical condition
  • Symptom control
  • Respite for carers
  • To die.
56
Q

What are some important things clinicians need to be aware of about working with different cultures who are recieving palliative care

A
  • Communicating in a way that is not clearly understood
  • Isolation of some groups from major treatment centres and the importance of ‘country’ and unwillingness to travel outside of ‘country’ for treatment
  • The desire to die at home amongst family
  • Lack of trust of government agencies
  • Lack of compliance to medication regimens and safe storage issues in some areas
  • The importance of kinship and the position of the patient within their community and its impact on treatment
  • The importance of family and a broader concept of family which includes not only blood relatives but also significant others
57
Q

What needs to be considered about pediatric palliative care?

A
  • Family dynamics and willingness to engage with the team have a profound impact on their willingness to accept palliative care
  • The child’s age and level of understanding dictates the degree to which they are able to participate in the decision making around treatment options and discussions around death and dying
  • The child’s siblings need to be involved in the process of care to the level that they feel comfortable and will require individualised support and education
  • Education and support may need to be directed towards the child’s school and local activity groups in which the child is involved.
  • Family members/friends pose a serious risk for complicated bereavement and will therefore need close follow up after the death of the child
  • Parents struggle to cope with the diagnosis and learn the skills necessary to provide technical; care and negotiate the care system for needed services and information
58
Q

What are barriers to pain control?

A

o Lack of assessment
o Incorrect attitudes or misconceptions by patients, their families or health providers about pain and its management
o Issues related to systems

59
Q

What is bereavement?

A

The experience of the death of a significant person and psychological and emotional adaptations those who had a close relationship with that person make in response to that death.

60
Q

What is grief?

A

a term which describes the sadness that people experience after the death of a loved one. For most people’s grief fluctuates in its intensity and doesn’t require specialised counselling.

61
Q

what are the 3 most common coping strategies people use?

A
  1. Direct approach: confronting the stressor by tackling (energetically fighting), vigilant focusing (obsessional alertness to details) or sensitisers (readily acknowledge emotions of hate, fear)
  2. Avoidance: minimising the threat of seriousness of a situation through minimisation, repression, denial or selective inattention
  3. Non-specific defences: combination of the above approaches
62
Q

What are the positives and negatives of the direct approach?

A

Pos:
Take action
Accurate emotional perception

Neg:
Higher anxiety

63
Q

What are the positives and negatives of the Avoidance approach?

A

Pos:
Break from non-productive worrying
Time to find reasons for hope

Neg:
Problem solving and treatment are delayed
True feeling unknown

Chronic illness (7 decks)

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