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)
Effects of media on health
Shapes and stereotypes our views
Shapes our expectations
(e.g. recent change in attitudes to mental health)
WHO definition of health inequalities
The differences in health status or in the distribution of health determinants between different population groups
Barriers thatstoppeople with a learning disability from getting good quality healthcare:
A lack of accessible transport links.
Patients not being identified as having a learning disability.
Staff having little understanding about learning disability.
Failure to recognise that a person with a learning disability is unwell.
Failure to make a correct diagnosis.
Anxiety or a lack of confidence for people with a learning disability.
Lack of joint working from different care providers.
Not enough involvement allowed from carers.
Inadequate aftercare or follow-up care.
Vulnerable groups at risk of not receiving good quality healthcare
The homeless Learning disabilities Refugees Prisoners LGBT
The inverse care law states that…
those who most need medical 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
Factors that can reduce health inequalities
Effective partnership across a range of sectors and organisations e.g. to promote health, improve patient education about health
Evaluate and refine integration of health and social care
Government policies and legislation e.g. smoking ban, Keep Well campaign
Time to invest in the more vulnerable patient groups
Improve access to health and social care services and professionals
Reduction in poverty
Social inclusion policies
Improved employment opportunities for all
Ensuring equal access to education in all areas
Improved housing in deprived areas
Role of voluntary sector organisations in reducing health inequalities
Provide a means of engaging effectively with communities and individuals
Deliver a range of services which may help to reduce health inequalities, including:
– Promoting healthy living to groups of people who may not use mainstream services
– Supporting people to access relevant services NHS Health Scotland
Benefits of Volunteering
Gain confidence Make a difference Meet people Be part of a community Learn new skills Take on a challenge Have fun
Mild to moderate mental health conditions include…
depression generalised anxiety disorder panic disorder social anxiety disorder obsessive compulsive disorder post-traumatic stress disorder
These can affect 15-25% of the general population at any one time
Ways in which medical schools can promote wellbeing among their students
Delivering group learning exercises focusing on how to deal with stress
Providing and promoting online resources and sessions. e.g on advice on healthy lifestyles,
Providing sessions on mindfulness, meditation, physical exercise and yoga etc…
The personal strengths underpinning resilience
High frustration tolerance Self acceptance Self belief Humour Perspective Curiosity Adaptability Meaning
Behaviours supporting resilience
Building / having support networks – positive relationships
Reflective ability
Assertiveness
Avoiding procrastination
Developing goals – realistic plans and ability / motivation to follow them through
Time management
Work – life balance
Sources of burnout
PERSONAL:
- Perfectionism, denial, avoidance, micromanaging, unwilling to seek help
- Being too conscientious
PROFESSIONAL
- Culture of invulnerability
- Culture of presenteeism
- Blame culture / silence
SYSTEMIC
- Overwork, shiftwork, lack of oversight
- Chaotic work environments
- Lack of teamwork, fractured training
How might stress or burnout present in medical students
Repeatedly failing or nearly failing Handing in work late Poor attendance Absence due to illness Behavioural issues Fitness to practice issues Lack of engagement with the course Poor communication with staff, peers and patients
After receiving a complaint, resilience may lead to…
Reflection
Improvement
Returning wiser and better
Factors aiding resilience
Intellectual interest Self awareness and self reflection Time management and work life balance Continuing professional development Support including team working Mentors
An occupational and environmental history is…
a chronological list of all the patient’s employment with the intention of determining whether work has caused ill health, exacerbated an existing health problem or has ill health had an impact on the patient’s capacity to work.
Aspects of an occupational history
A description of the present and previous jobs
Identifying any exposure to chemicals or other hazards Did the symptoms improve when not exposed / not at work
Determine the duration and intensity of exposure
Is personal protection used What maintenance is in place for the protection measures?
Do others suffer similar symptoms?
Are there known environmental hazards in use?
Any hobbies, pets, worked overseas, moonlighting?
The purpose of the fit note
to facilitate earlier discussion about returning to work and about rehabilitation.
Includes items of consideration for employers when signing a patient’s return to work such as to include a phased return, adjusted hours, adaptations to the work place and/or amendments of duties.
Advice only, is not binding on the employer
Required if the patient has been off for >7 consecutive days
The fit note must be signed by…
A doctor
Roles of occupational health
Deal with patients who are off for longer periods of time or with more complex needs (than can be dealt with a fit note)
support and help people stay in work and live full and healthy lives.
ensure the health and well being of the working population by preventing work-related ill health and providing specialist rehabilitation advice.
provide independent, impartial advice to employers and employees on the effects of work on health and the effects of health on work.
Possible suggestions that can be made by a fit note
Phased return to work
Altered hours
Amended duties
Workplace adaptation
Sustainability definition
The ability to be able to continue over a period of time
Strategies for Low Carbon Clinical Care and NHS Sustainability
Prioritise Environmental Health
Substitute harmful chemicals with safer alternatives. Reduce and safely dispose of waste
Use energy efficiently and switch to renewable energy. Reduce water consumption
Improve travel strategies
Purchase and serve sustainably grown food
Safely manage and dispose of pharmaceuticals
Adopt greener building design and construction. Purchase safer more sustainable products
Reduce the need for travel (25% of emissions) e.g. with one-stop-clinics
What would low Carbon Clinical Care look like?
Be better at preventing conditions
Give greater responsibility to patients in managing their health.
Be leaner in service design and delivery
Use the lowest carbon technologies
Proposed new definition of health
‘resilience, adaptation and self management in the face of physical, social and emotional challenges’
Health promotion is…
Any planned activity designed to enhance health or prevent disease.
Can target environment, access and lifestyle
Theories of health promotion
Educational - e.g. providing info on smoking Socioeconomic - e.g. redistributing income Psychological
Health promotion definition
an overarching principle/activity which enhances health and includes disease prevention, health education and health protection. It may be planned or opportunistic.
Health education definition
an activity involving communication with individuals or groups aimed at changing knowledge, beliefs, attitudes and behaviour in a direction which is conducive to improvements in health.
Health protection definition
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.
empowerment
the generation of power in those individuals and groups which previously considered themselves to be unable to control situations nor act on the basis of their choices.
Benefits of empowerment
An ability to resist social pressure.
An ability to utilise effective coping strategies when faced by an unhealthy environment.
A heightened consciousness of action.
Types of health promotion in primary care (and examples)
Planned – Posters, Chronic disease clinics, vaccinations
Opportunistic – Advice within surgery, smoking, diet, taking BP
Types of government level health promotion (and examples)
Legislation – Legal age limits, Smoking ban, Health and safety, Clean air act, Highway code
Economic – Tax on cigarettes and alcohol
Education – Health Education Board Scotland (HEBS)
Primary prevention
Measures taken to prevent onset of illness or injury
Reduces probability, severity
e.g. smoking cessation
Secondary Prevention
“Detection of a disease at an early (preclinical) stage in order to cure, prevent, or lessen symptomatology”
Occurs between when a disease becomes detectable and when it becomes symptomatic
Wilson’s criteria for screening
Knowledge of disease– important, natural history understood, pre-symptomatic stage
Knowledge of test – easy, acceptable, cost effective, sensitive and specific
Treatment – acceptable, cost effective, better if early
Tertiary Prevention
“measures to limit distress or disability caused by disease”
The role of parenting in lifelong health
Habits and lifestyles established in adolescence
Smoking is more than twice as likely if your parents smoke
Neglect and abuse recur.
Goals of “realistic medicine”
Build a personalised approach to care
Change our style to shared decision-making
Reduce unnecessary variation in practice and outcomes
Reduce harm and waste
Manage risk better
Become improvers and innovators
