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SH - FoPC > Year 3 > Flashcards

Year 3 Flashcards

1
Q

Who provided palliatiev care

A

MDT

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2
Q

What Scottish government document provides the national action plan for palliative and end of life care?

A

• ‘Living and Dying Well’ - produced in 2008

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3
Q

In Living and Dying Well, what needs of the patient are addressed (6)?

A

physical
practical
functional
social
emotional
spiritual

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4
Q

What is a major benefit of identifying patients who will likely require palliative care?

A

• Allows us to discuss the patient’s wishes with them and try, where possible, to care for them where they want to be treated and, in a way they want to be treated for

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5
Q

Compare the progression of malignancy, organ failure and dementia/frailty

A
  • Malignancy slowly progresses towards a rapid decline
  • Organ failure has a relapsing and remitting course
  • Dementia/frailty has a progressive decline
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6
Q

List 4 common symptoms experienced by palliative care patients.

A
  • Pain is often feared by patients
  • Anxiety
  • Insomnia
  • Nausea
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7
Q

What is SPCIT and when may it be used?

A

Supportive and Palliative Care Indicators Tool:
o it is a guide for doctors to consider their patients who have a life-limiting diagnosis (e.g. cancer), or a progressive chronic condition (e.g. COPD), to assess if they are at a stage where supportive and palliative care should be initiate

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8
Q

What is the first step of a SPCIT?

A

• Anticipatory care planning:
o Carried out with the patient and their carers to decide what they want for their future care

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9
Q

What things are addressed in an ACP (6)?

A
  • Where do they want to be cared for?
  • Do they want to be resuscitated in the event of a cardiac arrest?
  • Do they want to be allowed to die naturally?
  • Who do they want to be informed of their care and any changes in their condition?
  • Are they fully aware of their prognosis?
  • Is their family fully aware of their prognosis?
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10
Q

Once a patient has been diagnosed as at a palliative stage of care, and once an ACP has been carried out, what should you do?

A
  • Place the patient on the practice’s Palliative Care Register
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11
Q

What things should happen once the patient has been placed on the practices palliative care register (3)?

A
  • The plan for the patient should be sent to the out of hours service so that anyone who may be involved in the patient’s care is aware of the patient’s wishes
  • The practice will have regular palliative care meetings to discuss the patients on the palliative care register, with the MDT present to ensure that everyone is aware of the patient’s status
  • The patient will be reviewed regularly
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12
Q

What can be used to evaluate how quickly the situation is changing for the patient and to assess whether their care requires re-evaluation?

A
  • The Palliative Performance Scale
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13
Q

Give 3 benefits of the PPS.

A
  • It is a useful communication tool for describing the patient’s current functional level
  • It may have a value in criteria for workload assessment or other measurements and comparisons
  • It appears to have prognostic value
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14
Q

What are considered to be elements of a ‘good death’ in Western culture (4 main)?

A
  • Pain free
  • Acknowledgement of the imminence of death
  • Death at home surrounded by family and friends
  • An ‘aware’ death, in which personal conflicts and unfinished business are resolved
  • Death as personal growth
  • Death according to personal preference and in a manner that resonates with the person’s individuality
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15
Q

What tool enables the primary care team to provide palliative care at home?

A

The Gold Standards Framework

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16
Q

What are the WHO aims of palliative care (give 4)?

A
  • Provide relief from pain and other distressing symptoms
  • Affirms life and regards dying as a normal process
  • Intends neither to hasten nor postpone death
  • Integrates the psychological and spiritual aspects of patient care
  • Offers a support system to help patients live as actively as possible until death
  • Offers a support system to help the family cope during the patient’s illness and in their own bereavement
  • Uses a team approach to address the needs of patients and their families, including bereavement counselling if indicated
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17
Q

Other than the members of the HSCP previously discussed, who else may also be involved in palliative care?

A
  • Macmillan nurses
  • CLAN
  • Marie Curie nurses
  • Religious or cultural groups
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18
Q

List 4 patient reactions to bad news

A
  • Shock
  • Anger
  • Denial
  • Bargaining
  • Relief
  • Sadness
  • Fear
  • Guilt
  • Anxiety
  • Distress
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19
Q

What do the following 3 terms mean?

  • Voluntary euthanasia
  • Non-voluntary euthanasia
  • Physician assisted suicide.
A
  • Voluntary euthanasia: Patients request
  • Non-voluntary euthanasia: No request from patient
  • Physician assisted suicide: Physician provides the means and the advice for suicide
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20
Q

What is the WHO definition of health inequalities?

A
  • Differences in health status or in the distribution of health determinants between different population groups
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21
Q

What is the key determinant of health inequalities?

A
  • Deprivation
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22
Q

What is sociology?

A
  • The study of the development, structure and functioning of human society
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23
Q

Give 3 examples of ways medical sociology may be applied.

A
  • Studies interactions with those engaged in medical occupations e.g. doctor - patient relationships
  • Studies the way people make sense of illness
  • Studies the behaviour and interactions of health care professionals in their work setting e.g. doctor - nurse relationships
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24
Q

Explain the sick role example comparing the patient and doctor perspectives.

A
  • The sick role patient:
    • Patient feels they are exempt from their daily responsibilities because they are sick
    • Patient must seek help from a healthcare professional
    • Patient is under a social obligation to get better as soon as possible to be able to take up their social responsibilities again
  • The sick role from a healthcare professionals’ perspective:
    • Professionals must be objective and not judge patients morally
    • Professionals must not act out of self-interest and must put patient first
    • They must obey a professional code of practice
    • Professionals must have and maintain the knowledge and skill set to treat the patient
25
Q

What is the inverse care law?

A
  • Those who most need care are least likely to receive it and conversely, those with least need of health care tend to use health services more, and more effectively
26
Q

Give 5 factors that can reduce health inequalities.

A
  • Partnerships across a range of sectors and organisations
  • Evaluate and refine the integration of health and social care
  • Government policies and legislation e.g. smoking ban, keep well campaign
  • Invest more in vulnerable patients
  • Reduction in poverty
  • Social inclusion policies
  • Improved employment opportunities for all
  • Ensuring equal access to education in all areas
  • Housing improvements in deprived areas
27
Q

What is the difference between equality and equity?

A
  • Equality is making a baseline level of healthcare available to everyone (e.g. the NHS)
  • Equity is then giving extra support to those who are more dependent on healthcare (e.g. through third sector organisations)
28
Q

What are the socioeconomic influences on our health (8)?

A
  • Gender:
    • Women more likely to attend GP
  • Housing:
    • Cold homes
  • Financial security
  • Health system:
    • The distribution of GPs across Scotland does not reflect the levels of deprivation
  • Ethnicity:
    • Expectations
    • Traditions
    • Communication barriers
  • Education:
    • Higher education = healthier
    • Increased uptake of screening programmes in educated populations
  • Employment:
    • Income and financial security
    • Social contacts
    • Societal status
    • Purpose
  • Environment:
    • Transport:
      • Expansion of car use (RTAs, pollution)
      • Active travel such as cycling and walking
      • In rural areas infrastructure may present challenges
    • Media:
      • Stereotypes
      • Shapes expectations
      • Stigma
29
Q

Who has higher morbidity/mortality, men or women?

A
  • Men have a higher mortality
  • Women have a higher morbidity
30
Q

List 5 different vulnerable groups and how their healthcare is impacted by their situation.

A
  • The homeless:
    • Reduced life expectancy
    • Increased risk of suicide
    • Increased alcohol and drug misuse
    • More likely to be assaulted
    • Prevalence of infectious diseases such as TB, HIV, HCV
    • Poorer oral health
    • 1/3 of rough sleepers are not registered with a GP
    • Attendance at A+E is 8x higher than that of the general population
  • Learning disability:
    • Lack of accessible transport links
    • May not be identified as LD
    • Staff having little understanding of LD
    • Failure to recognise those with LD are unwell
    • Failure to make correct diagnosis
    • Anxiety or lack of confidence
    • Lack of joint working from different care providers
    • Lack of involvement of carers
    • Inadequate aftercare
  • Refugees:
    • Family integrity
    • Social issues
    • Language barriers
    • Poorly controlled or undiagnosed health conditions
    • Unfamiliarity with healthcare
    • Infectious diseases
    • Exposure to violence
    • PTSD, anxiety, depression
  • Prisoners:
    • Increased prevalence of smoking, drug abuse, alcohol misuse
    • On release they live in deprived areas
    • Increased risk of violence and suicide
  • LGBT:
    • Depression
    • Anxiety
    • Self-harm
    • Lack of understanding
31
Q

Give 4 examples of how global changes affect healthcare.

A
  • Material inequality:
    • The world’s wealthy are getting richer while at least half the world’s population live on less than £1.30/day
  • Population and consumption:
    • The world population is growing
    • More people mean the need for more space, energy, food, and water
    • This is made worse by the fact that people in the developing world aspire to what the developed has by the way of material goods and food
  • Resource depletion:
    • It was estimated in 2005 that we had consumed half of the earth’s extractable reserves of oil and gas and that they are likely to be completely depleted by the end of the 21st century
    • We will be more dependent on alternative sources of energy in the future e.g. nuclear power, shale oil, fracking
  • Climate change:
    • The greenhouse effect has been caused by a change in gas concentrations
    • This impacts on food production due to regional floods and droughts, changes in the environment with regards to incidence of infectious disease e.g. risk of malaria
    • Deaths from heat waves and droughts leads to changes in human migration from affected areas
    • Climate change will affect all countries, but will have the greatest impact on those who have the least access to the world’s resources and who have contributed least to carbon emissions
  • Loss of biodiversity:
    • Increased rate of animal extinction due to habitat destruction and poaching
  • Crisis in healthcare:
    • Crisis in chronic health problems with an increasingly ageing population
    • There are increases in chronic diseases such as diabetes due to rising obesity
    • There is a crisis in the cost of healthcare
32
Q

How will rising sea levels affect healthcare?

A
  • 13 of the worlds 20 largest cities are located on the coast
  • 1/3 of the world’s population live within 60miles of the coast
  • Rising sea levels could lead to a mass migration
33
Q

Give 3 impacts of rising temperatures.

A
  • In the last 150 years, the 12 hottest years on record have occurred in the last 13 years recorded:
    • This leads to heatwaves which can cause excessive deaths
    • This leads to droughts leading to severe food shortages
    • High temperatures also raise the levels of ozone and other pollutants in the air that can exacerbate cardiovascular and respiratory disease
    • 25% of all fossil fuel greenhouse gas emissions can be accounted for by transport. Switching to electrically powered transportation methods will significantly reduce CO2 production - the effect of this will be greatest in India and lowest in Europe
    • Agriculture and food production account for 10-12% of greenhouse gas emissions. 80% of this is from livestock farming. There is an increased demand for animal sourced foods. A reduction in the consumption of animal sourced foods could have benefits for cardiovascular health
34
Q

List 3 simple actions that could be taken to counter the effects of global warming.

A
  • Education of carbon literacy and numeracy
  • Activity modification - modifying human behaviour - being more active
  • Promotion of a plant-based diet
  • Increased use of renewable energy resources
35
Q

What document is used to promote sustainability in the NHS?

A
  • Realistic medicine
36
Q

List 4 actions that can be taken to promote low carbon clinical care and NHS sustainability.

A
  • Substitute harmful chemicals with safer alternatives
  • Reduce and safely dispose of waste
  • Use energy efficiently and switch to renewable energy where possible
  • Reduce water consumption
  • Improve travel strategies
  • Purchase and serve sustainably grown foods
  • Safely manage and dispose of pharmaceuticals
  • The greatest part of carbon emission from NHS England is from purchasing of goods and services - 22% is from the purchase of pharmaceuticals
37
Q

What is the NHS carbon reduction strategy?

What piece of legislation is the strategy based upon?

A
  • Commits the health service to more than an 80% reduction in emissions over the next 30 years
  • Based on national targets set by the Climate Change Act 2008
38
Q

Give 2 benefits to patients that will come from low carbon clinical care.

A
  • Better prevention of conditions
  • Greater responsibility to patients in managing their health
  • Leaner in service design and delivery
  • Use the lowest carbon technologies
39
Q

When was the NHS-social care integration bill passed/initiated?

A
  • Passed in 2014
  • Came into place on the 1st April 2016
40
Q

What 2 aims has the BMA stated following the new 2018 GP contract?

A
  • The BMA will aim to reduce workload and improve recruitment
41
Q

What is the Cambridge dictionary definition of resilience/sustainability?

A
  • Resilience:
    • The ability to “Quickly return to a previous good condition”
  • Sustainability:
    • The ability to be “Able to continue over a period of time”
42
Q

List 4 positive factors and 4 challenges facing resilience and sustainability in your career as a doctor and in your personal life.

A
  • Positive factors:
    • Job security
    • Financial security
    • Stable terms and conditions
    • Respect for professionalism and knowledge
    • Appreciation for being in the role of a doctor
    • Working with a team
    • Ability to develop knowledge and interests
    • Ability to fit work around interests and lifestyle choices
  • Challenges:
    • Considerable and rapid workload
    • Time management
    • Increasingly complex care over time
    • Relentless arrival of mail and blood results, and having enough time to action them diligently
    • Care verse cure for long term conditions
    • Running a business
    • Working in a team
43
Q

The fit note replaced the sick note in April 2010.

What is the purpose of the fit note?

A
  • To facilitate earlier discussion regarding rehabilitation and returning to work
44
Q

Who can write a fit note?

A

Only a doctor

45
Q

What information does the note contain for the employer?

List 4 things the doctor can recommend to the employer regarding the promotion of return to work.

A
  • Things to consider which will promote return to work:
    • Phased return
    • Adjusted hours
    • Adjusted duties
    • Adaptations to the work place
46
Q

List 7 roles of occupational health.

A
  • To ensure the health and well-being of the working population by preventing work-related ill health and providing specialist rehabilitation advice
  • To provide independent, impartial advice to employers and employees on the effects of work on health and the effects of health on work
  • They advise on fitness for work, workplace safety, the prevention of occupational injuries and disease while recommending appropriate adjustments in the workplace to help people stay in work
  • They provide rehabilitation to help people return to work and give advice on alternative suitable work for people with health problems
  • They recommend and implement appropriate policies to maintain a safe and healthy workplace
  • They conduct research into work related health issues
  • Ensure compliance with health and safety regulations including minimising and eliminating workplace hazards
47
Q

What other healthcare professionals may occupational health services work alongside?

A
  • Nurses
  • Ergonomists
  • Hygienists
  • Occupational health advisors
  • Physiotherapists
  • Psychiatrists
  • Therapists
48
Q

List 3 of the positive benefits of work on health.

A
  • Adequate finances which are essential for material well-being and full participation in today’s society
  • Meets psychosocial needs where employment is the norm
  • Central to individual identity, social roles, and social status
  • Employment and socio-economic status are the main drivers of social gradients in physical and mental health and mortality
49
Q

List 4 negative effects of unemployment on health.

A
  • Poorer general health
  • Long-standing illness
  • Poorer mental health
  • Psychological distress
  • Higher medical consultation rates
  • Increased medication consumption
  • Increased hospital admission rates
50
Q

List 3 benefits of re-employment.

A
  • Improved self-esteem
  • Improved general and mental health
  • Reduced psychological distress
51
Q

childrens health is affected by what 4 factors

A
  • Genetics
  • Access
  • Environment
  • Lifestyle
52
Q

What 3 methods are used by the government to achieve health promotion?

A
  • Legislation
  • The provision of preventative services such as immunisation
  • The development of activities to promote and maintain change to a healthier lifestyle
53
Q

define Health promotion

A

An overarching principle/activity which enhances health

54
Q

what are the three components of health promotion

A

disease prevention, health education and health protection

55
Q

define health education

A
  • An activity involving communication with individuals or groups aimed at changing knowledge, beliefs, attitudes and behaviour in a direction which is conductive to improvements in health.
56
Q

define health protection

A
  • Involves collective activities directed at factors which are beyond the control of the individual. Health protection activities tend to be regulations or policies, or voluntary codes of practice aimed at the prevention of ill health or the positive enhancement of well-being.
57
Q

what are the 3 benefits of empowerment

A
  • An ability to resist social pressure
  • An ability to utilise effective coping strategies when faced by an unhealthy environment
  • A heightened consciousness of action
58
Q

use the example of smoking to explain what the cycle of change is, the 4 steps and the 2 outcomes of the action stage

A
  • Precontemplation:
    • Person smokes regularly and has not considered giving it up
  • Contemplation:
    • Person still smokes regularly but has considered giving it up
  • Ready for action:
    • Person still smokes but intends on giving it up and has a plan prepared which will allow them to do so
  • Action:
    • Person attempts to give up smoking using the plan they have prepared
    • The person will then enter maintenance as a non-smoker
    • From this stage 1 of 2 things can continue in maintenance or enter regression:
      • They can maintain a healthier lifestyle and not return to smoking
      • They can regress and start smoking again - they will then feedback in to the cycle of change

SH - FoPC (2 decks)

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