Week 1 - Client Centered Care Flashcards
How do we analyze cues?
- Organize and link the recognized cues to the client’s
clinical presentation - What client conditions are consistent with the cues?
- Are there cues that support or contraindicate a
condition? - Why is a cue/cues concerning?
- What other information helps establish the significance
of a cue or set of cues?
Phases of the Clinical Judgement Model
1) Recognize Cues
2) Analyze Cues
3)Prioritize Hypotheses
4) Generate Solutions
5) Take Action
6) Evaluate Outcomes
How do you prioritize a hypotheses?
- Evaluate and rank hypotheses or conditions according to priority (urgency, likelihood, risk, difficulty, time, etc.)
- Which explanations are most/least likely?
- Which explanations are the most serious?
What is involved in “Generating Solutions”
- Identify expected outcomes and use hypotheses to
create interventions for the expected outcomes - What are the desirable outcomes? What interventions can achieve those outcomes? What should be avoided?
- Focus on goals and multiple potential interventions
How to “Take Action”
- Implement the solution(s) that addresses the
priorities - Which intervention or combination of interventions is most appropriate?
- How should the intervention(s) be accomplished (performed, requested, administered, communicated, taught, documented, etc.)?
How to “Evaluate Outcomes”
- Compare observed outcomes to expected outcomes
- What signs point to improving/declining/unchanged status?
- Were the interventions effective?
- Would other interventions have been more effective?
Characteristics of an Acute Illness
- rapid onset
- Short duration
- Usually Self limiting
- Usually Responds well to treatment
- Complications infrequent
- Person returns to previous level of functioning
Characteristics of a Chronic Illness
- Prolonged
- Does not resolve spontaneously
- Rarely cured completely
- Permanent impairments/deviations from normal
- Irreversible pathological damage
- Residual disability, rehab
- Need for long-term, medical management
What are the 3 factors contributing to chronic illness?
1) Individual
2) Communities
3) Phsychosocial Dimensions
What are the 3 Individual Factors Contributing to Chronic Illness
1) Background risk factors: non-modifiable
○ such as age, sex, level of education genetic composition
○ things that can NOT be changed
2) Behavioural risk factors: behavioural/modifiable
○ such as tobacco use, unhealthy diet, physical inactivity
○ can be changed
3) Intermediate risk factors
○ such as elevated blood lipids, diabetes, high bP, and overweight/obesity
○ Be aware of background risk factors bec they could be the cause of an intermediate factor
○ Not illness themselves, but cause chronic illness
Which 4 community factors contribute to Chronic Illness?
1) Social and economic conditions (poverty, employment, and family composition)
2) Environment (climate, air pollution)
3) Culture, practice, norms, values
4) Urbanization - influences housing and access to products
Psychosocial Contributors to Mental Illness
- Illness behaviour = ways in which one responds to physical symptoms
- Self-efficacy - belief that one can manage their health challenge
- Health-related resilience - personality resource that buffers stress and allows people to experience a high degree of stress without falling in
○ Allows us to manage stress and cope
○ Requires control, commitment, challenge
Why is fatigue a critical symptom?
- Subjective, unpleasant symptoms which incorporates total body feelings ranging form tiredness to exhaustion, creating an unrelenting overall condition which interferes with individuals ability to function at normal capacity
- One of the most distressing symptoms people w chronic illness experience
- Both the symptom and outcome of a condition
- Ex. For women with a cardiac disease, they often feel unusually tired for weeks prior (which is a normal thing they don’t think is an indication of heart disease)
How does stigma influence patient care?
- Labelled, set apart due to diagnosis or treatment
- Older personally and chronically ill people are negatively viewed
- Caring for these groups is seen as less rewarding in terms of recovery, treatment, and economics
- Can influence how care is provided, cause an unequal power dynamic
- Can create unwillingness of patients to disclose information
What is the caregiver burden?
- Living with chronic illness affects the individuals and those in patients immediate social network
- Families and others have to provide complex and long term care required by those with chronic illnesses
- > 9 million Canadians (25%) provide care to people with long-term health conditions
- Caregiver burden: level of multifaceted strain perceived by the caregiver from providing care to a family member or loved one over time
What is Quality of Life defined by:
○ good living standard
○ robust health
○ a sustainable environment
○ vital communities
○ an educated populace, balanced time use
○ high levels of democratic participation in leisure and culture
What factors influence Quality of life:
- Refers to subjective evaluations of positive and negative aspects of life
- “broad concept affected in complex way by physical health, psychological state, personal beliefs, social relationships, and their relationship to the environment”
- QOL is a primary outcome measure in evaluating treatment for many conditions
- Influenced by multiple factors:
○ Financial status
○ Employment
○ Housing
○ Spirituality
○ Social support network
○ Health
Dimensions of Quality of Life
- Health
- Work
- Financial Material wellbeing
- Belonging
- Personal Safety
- Quality of environment
- Emotional wellbeing
- Social Relationships
What is Health Related Quality of Life
- HRQOL: how health influences and is influenced by overall QOL
Individuals:
- perceptions of physical and mental health status and variables that are associated with health status, such as health conditions, functional ability, social support, and socioeconomic status
Community
- resources, conditions, polices and practices, that influence a populations health perceptions and functional status
What are the 3 levels of patient response to health care recommendations:
3 levels of patient response to health care recommendations:
1) Compliance
- reflects coercion of the patient to engage in recommendations
2) Adherence
- implies conformity of the patient to the recommendations
3) Self-care
- implies a therapeutic alliance between the patient & the provider
4 tasks related to coping with chronic illness
1) Processing emotions
2) Adjusting to the changes to self & because of the illness
3) Integrating illness into daily life
4) Determining meaning of the illness to identify tasks &
skills to promote personal growth & satisfaction
Why is self-management important to health?
- Foundation for optimizing health outcomes for people
living with chronic illness - Successful self-management is related to better overall
physical & psychological health outcomes - Patients role in managing their illness optimizes quality of life
What patients with chronic illness want from the healthcare system?
- diagnosis and its implications
- available treatments and their consequences
- potential impact on patients future
- continuity of care and ready to access it
- coordination of care (with specialists)
- infrastructure improvement (scheduling, wait times, prompt care)
- ways to cope with symptoms
ways to adjust to disease consequences (uncertainty, anger, loneliness, sleep disorders, memory less, exercise needs, nocturia, sexual dysfunction)
What are characteristics of effective communication?
- Open and honest communication
- Ongoing and early conversations
- Communicating about treatment goals
- Balancing hope & reality in communicating bad news
- Taking cues from the patient about how much information
they can process at one time - Communication & active listening
- Health is more than absence of disease
- Understand what quality of life means to our patients
- Build on strengths
- Advocacy- public policy
