pps revision 2 Flashcards
what is an informal carer? Describe the potential social and psychological costs of undertaking the role of informal carer.
Unpaid or trained people and are not obliged to help out but will choose to out of personal obligations.
Caring can impose a heavy financial, physical and psychological strain on carers.
Carers typically experience reduced independence and a reduction in their social participation as a consequence of their role.
Carers themselves may experience a loss of personal autonomy in relation to their increased dependence on others for support in their caring role.
Caring relationships between partners / family members are normally reciprocal, but relationship tensions can arise from the increasing dependency of the recipient of care in the relationship.
Individuals who have become physically dependent on their partner may well feel frustration and anger with their physical condition which they cannot express to their carer; although this may be possible with a formal / professional career.
There is frequently a constant, unrelenting dependency on the carer
what is the difference between sex and gender
Lecturer: if a question was to come up on this topic it 100% would include the difference between sex and gender.
Sex: sex is relating only to biological facts. Used strictly only to do with the biological.
Gender: social and cultural perceptions associated with ‘sex’ differences - socially constructed as ‘masculine’ and ‘feminine’.
• Provide examples of the ways in which gender difference is socially constructed
- Starts from birth name, colours
- Told men are stronger and therefore…
- A girl may be physically stronger and enjoy rugby but then woman aren’t expected to that or girls may not want to play netball but that is all that is available to them.
- Boys would find it hard to say they don’t like sports because of the gender norm that men should be sporty
Explain the concept of transcendence
The concept of transcendence is utilised to signify the ways in which socially constructed gender identities can result in a negation or distortion of biology.
Culturally, girls are frequently portrayed as physically weaker than boys even though at an early developmental stage they may well be taller and stronger than their male peers.
This socially constructed gender difference is reinforced through the traditional encouragement of boys, but not girls, to engage in strenuous physical exercise.
This difference can and does have a long-term effect on health of both groups.
in a study High ‘masculinity’ scores were associated with reported better overall health, and conversely, high ‘femininity’ scores with poorer health, for both men and women. (in this gender and femininity/masculinity are separate entities.
what 3 things need to be present for someone to be diagnosed as having a learning disability?
- Impaired cognitive functioning
- Limitations of learning, adaptive behavior and skills
- Early onset (before adulthood) with lasting effect on development
what are some resonable adjustments that can be in healthcare for people with a learning disability
- Good quality multi-disciplinary working
- Holistic person-centred care
- Regular proactive reviews of health condition, needs and risk assessments
- Well-coordinated care
- Good communication with families
- Good quality end-of-life care
- Reasonable adjustments to care
- Full and accurate record keeping
what are the differences between mild, moderate, severe and profound learning difficulties?
mild 85% of LD population • Some learning difficulties in school • Can generally learn to read, write and do basic maths may struggle to: • Understand written instructions • Keep appointments • Grasp the purpose of procedures • Stick to treatment regimes • Understand consent procedures these patients may be branded as difficult instead of having LD
moderate
10% of LD population
• Marked developmental delays in childhood
• May be able to learn basic reading and writing
• Most can learn to develop
– some degree of independence in self-care
– adequate communication skills
• Adults will need varying degrees of support or supervision to live and work in the community
severe
5% of LD population
• Probably unable to read or write
• May learn self-help skills and routines
• Some verbal skills, but may need augmented communication aids
• Need supervision and support in all daily activities and living environment
profound 1% of LD population • Need intensive support in: – Self care – Continence – Mobility – Communication • May have medical conditions that require ongoing therapy or nursing care
Case 1: Angela is 87 years old. She is in A+E following a fall. She is frail but is striving to maintain her independence. A colleague describes her as ‘quite feisty’. You would like to admit her for a few days, partly to ensure she has somewhere safe to go home to. She, however, is adamant that she wants to go home, even though she lives alone and knows she will struggle to cope. She probably has the capacity to make this decision.
n What should you do? How does this make you feel?
My notes:
- Asses the patient’s capacity fully by doing some cognitive tests.
- Fully explain to her why you want her to stay and the risks of her not staying if she chooses to go home so she can make an informed decision.
- Try to build rapport by showing that you have her best interests at heart and be very patient with her and listen to her worries.
- Understand her concerns about why she doesn’t want to stay in hospital if there is something you can change to make her happy to stay. Maybe she’s had negative experiences or has some prior commitments she wants to attend to.
- Think about adaptions that can be made in her home to make it safer e.g., lifts, get someone to help remove clatter, lighting stair cases, having a career that helps her out
- I would feel worried and upset that she doesn’t feel comfortable to stay at the hospital
!!!!!!!Legal requirement to respect autonomy !!!!!!
what is Judicious Paternalism
Paternalism is the interference with the liberty or autonomy of another person, with the intent of promoting good or preventing harm to that person.
- Autonomy can only have meaning if it is informed
- Autonomy may not be valued as highly by patients (esp. the elderly?) as by ethicists and doctors
- Emotions, confusion, pain and distress can compromise decision-making so that it is not fully autonomous
- Autonomous decision making can result in poor and preventable outcomes
what is the criteria for capacity:
• For the purposes of the Act, a person is unable to make a decision for himself if he is unable to:
o understand the information relevant to the decision
o retain that information
o use or weigh that information as part of the process of making the decision, or
o communicate his decision
• The fact that a person is able to retain the information relevant to a decision for a short period only does not prevent him/her from being regarded as able to make the decision. As long as they can retain capacity for enough time to understand, retain and make an informed decision on the information then it is fine.
- Capacity may change over time and patients may be capacitous at some times and for some choices but not others.
- Be wary of placing too much emphasis on previous assessments
What happens when a patient lacks capacity?
• Is there a valid Lasting Power of Attorney?
A lasting power of attorney (LPA) is a way of giving someone you trust, your attorney, the legal authority to make decisions on your behalf if you lose the mental capacity to do so in the future, or if you no longer want to make decisions for yourself.
• Is there a valid Advance Decision?
• If no LPA or AD, treat in patient’s best interests
• Is there anyone who can advocate for the patient? Family?
• Document all assessments and rationale for conclusion/decisions
what is a QUALY?
QUALY- quality-adjusted life year - The quality-adjusted life year or quality-adjusted life-year is a generic measure of disease burden, including both the quality and the quantity of life lived. It is used in economic evaluation to assess the value of medical interventions. One QALY equates to one year in perfect health. QALY scores range from 1 to 0.
Name some ways in which the human rights of elderly people can be breached
• There is growing recognition that elderly people in care homes are vulnerable. Their rights can be breached in a number of ways:
o Leaving someone in soiled sheets
o Not giving patients enough to drink
o Leaving food when the person needs help to eat
o Using excessive force to restrain someone
o Privacy breaches, e.g. changing a person in an open area
o Disregard for autonomy (e.g. ignoring wishes of a patient with dementia)
what things do you need to take into consideration when having a consultation with another doctor/ collegue
Give the absolute same care, information and treatment to someone who’s from a medical background and those not for example don’t use medical jargon either way
IF you’ve had a consultation with another doctor and then someone comes to you saying they’re worried about them do not say anything about the consultation or even that that ever happened due to confidentiality.
Consult with their own gp if your family member is sick
what are ways that you can communicate risk effectively
- If invited for screening; explain difference between ‘screening’ and ‘diagnostic’ test
- Avoid using terms ‘positive’ and ‘negative’
- Avoid using descriptive (or ‘qualitative’) terms only
- Signpost you will be providing numerical data; check numeracy
- Use natural frequencies with consistent denominators
- !!!Use absolute risks or actual numbers, rather than relative risk!!!!
- Always provide a reference group
- Percentages can be helpful when comparing two probabilities
- Present both positive and negative framing
- Invite questions (at different stages during the consultation)
- Offer written and/or graphical information or online resource
