Year Three Flashcards
2 most common causes of death today
- Cancer
2. IHD
Palliative care is…
A philosophy of care that emphasises quality of life
most is provided in primary care with support from specialist practitioners and hospices
How do you know if a patient is at a palliative stage?
Us the “Supportive and Palliative Indicators Tool”
- it indicates if patients are at a stage where supportive and palliative care should begin to take place
- this starts with anticipatory care planning
- then the patient should be placed on the practice’s palliative care register
- the plan for the patient should be sent to the out of hours service
The first steps of palliative care are…
- Anticipatory care planning
- The patient should be placed on the practice’s palliative care register
- The plan for the patient should be sent to the out of hours service
(4. Review regularly)
How to measure the performance status of a palliative care patient?
Palliative Performance Scale
Determined by reading horizontally at each level to find a “best fit” for the patient
Columns closer to the left are a stronger determinant
Scores are given in 10% increments (100% = performance, 0% = dead)
WHO definitions of palliative care
Provides 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 patients illness and in their own bereavement.
Uses a team approach to address the needs of patients and their families, including bereavement counselling if indicated.
Specific members of the Health and Social Care Partnership Team involved in palliative care
Macmillan Nurses,
CLAN,
Marie Curie Nurses,
Religious or Cultural Groups
A “good death” is…
Pain-free death
Open 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
Rules for breaking bad news
Listen Set the Scene Find out what the patient understands Find out how much the patient wants to know Share information using a common language Review and summarise Allow opportunities for questions Agree follow up and support
The stages of adjustment in grief
Shock Anger Denial Bargaining Relief Sadness Fear Guilt Anxiety Distress
(Useful to consider when dealing with bereavement and when a patient is given bad news)
Types of euthanasia
Voluntary Euthanasia – patients request
Non Voluntary Euthanasia – no request
Physician assisted suicide – Physician provides the means and the advice for suicide.
(all types illegal in the UK)
Why do patients request euthanasia?
Unrelieved symptoms
Dread of further suffering
(studies indicate that 60% of patients requesting euthanasia are depressed)
Responses when a patient requests euthanasia
Listen Acknowledge the issue Explore the reasons for the request Explore ways of giving more control to the patient Look for treatable problems Remember spiritual issues Admit powerlessness
Sociology definition
The study of the development, structure and functioning of human society
Applications of sociology to medicine.
Sociology studies…
People’s relationships with healthcare professionals
The way people make sense of illness
The behaviour of healthcare professionals in their workplaces
Characteristics of the medical profession studied by sociology
Systematic theory Authority recognised by its clientele Broader community sanction Code of ethics Professional culture sustained by formal professional sanctions
Give an example of when sociology would be useful in medicine
Health promotion
- promoting healthy behaviour is only possible if we understand how different groups in society operate
The patient in “the sick role”
Exempts ill people from responsibilities
Patient is not responsible for being ill and is regarded as unable to get better without the help of a professional
Patient must seek help from a healthcare professional
- Might bring conflict to doctor-patient relationship if doctor decides who is sick enough
Patient is under a social obligation to get better as soon as possible to be able to take up social responsibilities again
The healthcare professional in “the sick role”
Professional must be objective and not judge patients morally
Professional must put patient’s interests first
He/she must obey a professional code of practice
Professional must have the necessary knowledge and skills to treat patients
Professional has the right to examine patient intimately, prescribe treatment and has wide autonomy in medical practice
How is social class grouped in National Statistics?
Socio-economic Classification (SEC)
- an occupationally based classification with 8 levels
(1 is split into 1.1 and 1.2, 8 = long term unemployed)
Social/socio-economic influences on health?
Gender Ethnicity Physical environment / housing Education Employment Income / social status / financial security Health system Social environment
Influences of gender on health
Men have a higher mortality at every age
Women have a higher morbidity
Women consult more frequently in General Practice settings
How to deal with disparities in health
Identify the potential barriers to the use of health services
Provide Culturally Competent Care
Recognise when we are being culturally incompetent
Incentives: Deprived Area Allowance paid to healthcare professionals working in the most deprived areas
potential barriers to the use of health services
Patient level – language concerns, understanding the system, beliefs
Provider level – understanding of the differences due to ethnicity, provider skills and attitudes
System level – organisation of appointments and referrals
Culturally competent care
Combination of attitudes, skills and knowledge that allows an understanding and therefore better care of patients with a different backgrounds to our own.
Influences of education on health
Those with higher levels of education tend to be healthier than those of similar income who are less well educated
(important to remember the effect that poor health can have on education)
Employment has a positive impact on health as it…
Provides financial security
Provides social contacts
Provides status in society
Provides a purpose in life
(unemployment is associated with increased morbidity and mortality)
