FOPC 2nd year Flashcards
(167 cards)
<p>define person-centred care</p>
<p>Person-centered care places <strong>patient </strong>at <strong>center</strong></p>
<p>who decides what person-centered care means</p>
<p>Only the <strong>patient </strong>is in a position to decide this</p>
<p>what makes care patient centered</p>
<p>if it is based on the <strong>principles and values</strong> that define<strong> patient-centeredness</strong></p>
<p>theprinciples and values of patient centered care arebrought togetherby which organisation in what declaration?</p>
<p>International Alliance of Patients’ Organizations (IaPO)</p>
<p>Declaration on Patient- Centered Healthcare.</p>
<p>Name the 5 principles outlined in the Declaration on Patient- Centered Healthcare by the IaPO</p>
<p>1.Respect.</p>
<p>2.Choice and empowerment.</p>
<p>3.Patient involvement in health policy.</p>
<p>4.Access and support.</p>
<p>5.Information.</p>
<p>Long-term conditions now account for what proportion of GP appointments?</p>
<p>50%</p>
<p>long-term conditions are more prevalent in what two groups of people?</p>
<p>older people</p>
<p><strong>deprived </strong>groups</p>
<p>what is equally as important as establishing the causes of a long term illness?</p>
<p>the <strong>consequences </strong>of such long-term illness</p>
<p>define incidence</p>
<p>the number of <strong>new cases </strong>of a disease in a <strong>population </strong>in <strong>a specified period of time</strong></p>
<p>define prevalence</p>
<p>the <strong>number </strong>of people in a <strong>population </strong>with a <strong>specific disease </strong>at a <strong>single point in time </strong>or in a defined period of time (existing cases)</p>
<p>aetiology - name the 2 broadfactors</p>
<p>genetic</p>
<p>environmental</p>
<p>define vulnerability</p>
<p>an individuals <strong>ability/inability</strong>to<strong> resist disease</strong>,<strong> repair</strong> damage and <strong>restore </strong>physiological <strong>homeostasis</strong></p>
<p>describe 3 categories ofnatural historyof diseases</p>
<p>acute onset</p>
<p>gradual onset</p>
<p>relapsing remitting</p>
<p>what 2 things should any treatment aim to cure/allay?</p>
<p>disease</p>
<p>effects of disease</p>
<p>briefly define the burden of treatment</p>
<p><u><strong>patients and caregivers </strong></u>are often put under e<strong>normous demands </strong>by <strong>healthcare systems</strong></p>
<p>give 4 examples of the burden of treatment</p>
<ol> <li><strong>changing behaviour</strong> (of patient) or <strong>policing </strong>behaviour (doctor) of others (i.e. to <strong>adhere </strong>to lifestyle modifications)</li> <li><strong>monitoring +managing</strong> their symptoms at <u><strong>home</strong></u></li> <li><strong>complex treatment regimens</strong> andmultiple drugs (polypharmacy)</li> <li><strong>complex administrative systems -</strong>accessing, navigating + coping with uncoordinated health and social care systems</li></ol>
<p>define the process of biographical disruption</p>
<p>a long term condition leads to a<strong> loss of confidence </strong>in the body</p>
<p>there is thena l<strong>oss of confidence in social interaction </strong>or self-identity</p>
<p>define stigma</p>
<p>a mark of <strong>disgrace associated </strong>with a particular <strong>circumstance</strong>, <strong>quality, or person</strong></p>
<p>outline whystigma might exist for those with achronic illness</p>
<p>having a chronic illness or condition subjects a person to possible <strong>stigmatization </strong>by those <strong>who do not have the illness</strong></p>
<p>what is the biggest decision in coping with the stigma of a condition?</p>
<p>the <strong>decision </strong>about whether to:</p>
<p>1) <strong>disclose </strong>the condition and suffer further stigma</p>
<p>or</p>
<p>2) attempt to <strong>conceal </strong>the condition and pass for normal</p>
<p>the long term condition of a particular individualmayimpact what people/groups of people</p>
<p>patient</p>
<p>family</p>
<p>community</p>
<p>discuss the impact of long term conditions on the individual</p>
<p>can be <strong>negative or positive</strong></p>
<p>negative may be <strong>denial, self-pity, apathy</strong></p>
<p>an individual'slong-term conditioncan impact their family in what 3 broad ways?</p>
<p>financial</p>
<p>emotional</p>
<p>physical</p>
<p>what might happen to an individual that has along term condition with regards totheir community</p>
<p><strong>isolation </strong>of that individual</p>
an observation often made by doctors/nurses who care for people with some long term conditions is “my patient understands their disease better than I do”
what is this concept known as?
the "expert patient"
name 3 conditions that typically creates a lot of these "expert patients"
diabetes mellitus
arthritis
epilepsy
describe the relevance of the "expert patient" in modern care
patient's knowledge/experience has long been untapped
could greatly benefit patient care + quality of life
research/experience shows today’s patients with chronic conditions need not be mere recipients of care
they can become key decision-makers in treatment process
the WHO definition of disability may be split into what 3 categories
- Body and Structure Impairment
- Activity Limitation
- Participation Restrictions
define "body and structure impairment"
abnormalities of structure, organ or system function (organ level)
define "activity limitation"
changed fuctional performance and activity by the individual (personal level)
define "participation restrictions"
disadvantage experienced by the individual as a result of impairments and disabilities
(interaction at a social and environmental level)
describe 4 concepts in the medical model of disability
▪Personal cause e.g. accident whilst drunk
▪Underlying pathology e.g. morbid obesity
▪Individual level intervention e.g. health professionals advise individually
▪Individual change/adjustment e.g. change in behaviour
describe 4 concepts in the social model of disability
▪Societal cause e.g. low wages
▪Conditions relating to housing
▪Social/Political action needed e.g. facilities for disabled
▪Societal attitude change e.g. use of politically correct language.
describe 2 legislations that have been drawn up to support those with a disability
disability discrimation acts 1995 and 2005
equality act 2010
describe 3 roles of a doctor in the care of those with a disability
- assess disability
- co-ordinate MDT care
- intervention with rehabilitation
personal reaction to a disability depends on many factors
give 10 examples
- nature of disability
- information base of individual, ie education, intelligence and access to information
- personality
- coping strategies
- (previous) role of individual – loss of role, change of role
- mood and emotional reaction
- reaction of others around them
- support network of individual
- additional resources available to the individual? e.g. good local self-help group, socio-economic resources
- time to adapt (how long they have had the disability?)
consider 6 possible categories of “benefits” of illness
- social
- familial
- psychological
- financial
- medications
- responsibilities.
outline the concept of the sick role
a concept that concerns the social aspects of becoming ill and the privileges and obligations that come with it
describe 3 ways disability might cause disruption within a family
personal
economic/financial
social
with regard to the epidemiology of disability:
give 9 different causes worldwide
- congenital
- injury
- communicable disease
- non-communicable disease
- drugs-iatrogenic and/or illicit use
- mental Illness
- alcohol
- malnutrition
- obesity
in the uk, what proportion of those with a disability are in employment?
1/3rd
what happens to the prevalence and severity of disability with age?
rises
Wilson and Jungner criteria for screening
testing/examination for a disease - 3 factors
- suitable test or examination.
- test acceptable to population.
- case finding should be continuous (not just a 'once and for all' project as there's limited evidence for single-ocasion screening).
Wilson and Jungner criteria for screening
treatment of disease - 3 factors
- Accepted treatment for patients with recognised disease.
- Facilities for diagnosis and treatment available.
- Agreed policy concerning whom to treat as patients
Wilson and Jungner criteria for screening:
knowledge of the disease - list 3 factors
- condition should be important.
- must be a early symptomatic stage or recognisable latent stage
- natural history should be adequately understood.
what proportion of people consult their GP about their health complaints
20%
what proportion of patients visiting their GP are referred onto secondary care
3%
define disease
symptoms, signs ⇒ diagnosis
(bio-medical perspective)
define illness
ideas, concerns, expectations – experience
patients perspective
what proportion of GP appointments involve no disease
up to 50%
list several medical and non-medical factors which may influence an individuals desire to seek medical attention
Medical factors - new/visible symptoms, increasing severity, duration (e.g long)
Non medical factors – crisis, peer pressure “wife sent me”, patient beliefs, lay refferal, expectations, social class, economic, psychological, environmental, cultural, ethnic, age, gender, GP practice leaflet, NHS website, media: internet, TV, newspaper
who seeks medical attention more often - males or females?
females
give 3 reasons a patient that feels well may not want to accept treatment
- believe themselves to be healthy.
- is physically fit.
- proud not to be using tablets.
define epidemiology
study of how often diseases occur in different groups of people and why
what are the 3 main aims of epidemiology
- description
- explanation
- disease control
regarding epidemiology, define description
to describe the amount and distribution of disease in human populations
regarding epidemiology, define explanation
to elucidate (find out) the natural history and identify aetiological factors
usually by combining epidemiological data with data from other disciplines such as biochemistry, occupational health and genetics
regarding epidemiology, define disease control
data can provide basis for
- preventive measures
- (develop new/modify) public health practices
- therapeutic strategies
to be developed, implemented, monitored and evaluated to help control disease.
epidemiology compares groups (study populations) in order to detect differences.
describe 3 things that may be detected/discovered
- aetiological clues
- scope (capacity) for prevention
- identification of high risk/priority groups in society
in epidemiology, give some examples of different study populations (based on: )
the study population may be defined by:
- age
- sex
- location
(or even be the same group over time)
we then compare how often an event appears in one group with another
data in epidemiology is converted into ratios - what does the numerator consist of?
number of events e.g death / [population at risk]
data in epidemiology is converted into ratios - what does the denominator consist of?
[number of events] / population at risk
minor illnesses (e.g. a cold) typically have a
(high/low) ______ incidence
(high/low) ______ prevalence
high incidence
low prevalence
chronic illnesses (e.g. diabetes) typically have a
(high/low) ______ incidence
(high/low) ______ prevalence
low incidence
high prevalence
incidence is useful for investigating what aspect of a disease?
aetiology of disease
what does the prevalence of a disease tell us?
prevalence tells us something about the amount of disease in a population
define relative risk
Relative risk (RR) =
incidence of disease in exposed group
/
incidence of disease in unexposed group
what is relative risk (RR) a measure of?
the strength of association between a suspected risk factor and the disease
give 10 sources of epidemiological data
- mortality data
- hospital activity statistics
- reproductive health statistics
- cancer statistics
- accident statistics
- general practice morbidity
- health and household surveys
- social security statistics
- drug misuse databases
- expenditure data from NHS
define health literacy
having the knowledge, skills, understanding and confidence to use health information, to be active partners in their care, and to navigate health and social care systems.
why is health literacy relevant?
health literacy is being increasingly recognised as a significant health concern around the world
describe descriptive studies
descriptive studies attempt to describe the amount and distribution of a disease in a given population
describe the advantages and limitations of descriptive studies
limitation
- does not provide definitive conclusions about disease causation,
advantages
- may give clues to possible risk factors and candidate aetiologies.
- usually cheap, quick and give a valuable initial overview of a problem.
what is a cross-sectional study?
in cross-sectional studies, observations are made at a single point in time
what conclusions are drawn from cross-sectional studies?
relationship between diseases and other variables of interest in a defined population.
one strenght of a cross-sectional study
provide results quickly
one negative of a cross-sectional study
usually impossible to infer causation
what is a case control study?
two groups of people are compared:
- Cases - those who have the disease of interest
- Controls - those who do not
how are conclusions drawn from case-controlled studies (process)?
- both groups have exposure to a suspected aetiological factor measured
- amount (of disease?) is compared to identify significant differences
- to give clues as to what factors elevate/reduce risk of disease being studied
what are the results in a case controlled study expressed as?
relative risk (RR)
what is a cohort study?
- baseline data on exposure collected from a group who do not have the disease under study
- group is then followed through time until a sufficient number have developed the disease
- original group is separated into subgroups according to original exposure status and compared to determine incidence of disease according to exposure.
cohort studies allow the calculation of cumulative incidence, allowing for differences in follow up time.
what are trials?
trials are experiments used to test ideas about aetiology or to evaluate interventions
what is the definitive method of assessing any new treatment in medicine?
the “randomised controlled trial”
how is a trial assessing aetiology conducted?
two groups at risk of developing a disease are assembled
- intervention group - alteration made (eg suspected causative factor removed)
- control group - no alteration is made
data on subsequent outcomes (eg disease incidence) are collected from both groups, and the relative risk is calculated.
how is a trial assessing a new treatment conducted?
- intervention group receive new therapy
- control group receive current standard therapy (or placebo)
⇒ treatment outcomes (eg reduction in symptoms) compared in both groups
what is meant by standardisation?
a set of techniques used to remove (or adjust for) the effects of differences in age, gender or other confounding variables, when comparing two or more populations.
what is the standardised mortality ratio (SMR)?
a special kind of standardisation
it is simply a standardised death rate converted into a ratio for easy comparison
the figure for a standard reference population (eg, Scotland) is taken to be 100 and the standardised death rates for the comparison (study) populations (eg, Grampian) are expressed as a proportion of 100. A figure below one hundred means fewer than expected deaths, and above 100 means more. For example, an SMR of 120 means that 20% more deaths occurred than expected in the study population, allowing for differences in the age and sex structure of the standard and study populations and an SMR of 83 means 17% fewer deaths occurred.
describe why the quality of data is an important factor to consider in interpreting results
must ensure data is trustworthy.
explain what 'case defintion' means
the purpose of it is to decide whether an individual has the condition of interest or not.
It is important because not all doctors or investigators mean the same thing when they use medical terms. Differences in incidence of disease over time or in different populations may be artefact, due to differences in case definition, rather than differences in true incidence.
Artefact definition: something observed in a scientific investigation or experiment that is not naturally present but occurs as a result of the preparative or investigative procedure.
describe 'coding and classification'
when data is being collected routinely (eg death certificates), it is normal to convert disease information to a set of codes, to assist in data storage and analysis.
rules are drawn up to dictate how clinical information is converted to a code. If these rules change, it sometimes appears that a disease has become more common, or less common, when in fact it has just been coded under a new heading.
describe 'ascertainment' aka ascertainment bias
Is the data complete - are any subjects missing?
If researchers in one country look harder for cases of a given disease than researchers in any other, it might not be surprising that they come up with higher incidence rates.
Ascertainment bias arises when data for a study or analysis is collected such that some members of the intended population are less/more likely to be included than others
define bias
any trend in the collection, analysis, interpretation, publication or review of data that can lead to conclusions that are systematically different from the truth
name 4 types of bias
- Selection Bias
- Information Bias
- Follow up Bias
- Systematic Error
describe selection bias
Selection bias
Occurs when the study sample is not truly representative of the whole study population about which conclusions are to be drawn.
For example, in a randomised controlled trial of a new drug, subjects should be allocated to the intervention (study) group and control group using a random method. If certain types of people (eg, older, more ill) were deliberately allocated to one of these groups then the results of the trial would reflect these differences, not just the effect of the drug.
describe information bias
Information bias
arises from systematic errors in measuring exposure or disease. For example, in a case control study, a researcher who was aware of whether the patient being interviewed was a 'case' or a 'control' might encourage cases more than controls to think hard about past exposures to the factors of interest. Any differences in exposure would then reflect the enthusiasm of the researcher as well as any true difference in exposure between the two groups.
describe follow up bias
arises when one group of subjects is followed up more diligently than another to measure disease incidence or other relevant outcome.
For example, in cohort studies, subjects sometimes move address or fail to reply to questionnaires sent out by the researchers. If greater attempts are made to trace these missing subjects from the group with greater initial exposure to a factor of interest than from the group with less exposure, the resulting relative risk would be based on a (relative) underestimate of the incidence in the less exposed group compared with the more exposed group.
describe systematic error
tendency for measurements to always fall on one side of the true value.
It may be because the instrument (eg blood pressure machine) is calibrated wrongly, or because of the way a person uses an instrument. This problem may occur with interviews, questionnaires etc, as well as with medical instruments.
what is a confounding factor?
factor associated independently with both the disease and with the exposure under investigation
⇒ distorts relationship between exposure and disease.
(in some cases the confounding factor may be the true causal factor, and not the exposure that is under consideration)
give 3 examples of confounding factors
- age
- sex
- social class
describe 5 ways around confounding factors
- randomisation
- restriction of eligibility criteria to only certain kinds of study subjects
- subjects in different groups can be matched for likely confounding factors.
- results can be stratified (arranged) according to confounding factors.
- results can be adjusted (using multivariate analysis techniques) to take account of suspected confounding factors.
describe 9 factors in the criteria for causality
(It is difficult to prove causation between an exposure and disease. Often the best that can be achieved is to demonstrate a weight of evidence in favour of a causal relationship. A number of criteria have been devised to help investigators assess the available evidence, known as the criteria for causality)
- Strength of association: the larger the association, the more likely that it is causal.
- Consistency: Consistent findings observed by different persons in different places with different samples strengthens the likelihood of an effect.
- Specificity : Causation is likely if there is a very specific population at a specific site and disease with no other likely explanation.
- Temporality: The effect has to occur after the cause
- Biological gradient: Greater exposure should generally lead to greater incidence of the effect
- Biological plausibility: A plausible mechanism between cause and effect is helpful
- Coherence: Coherence between epidemiological and laboratory findings increases the likelihood of an effect.
- Analogy : The effect of similar factors may be considered.
- Experiment: experimental evidence
list the 3 intended aims of sign guidelines
- Help healthcare professionals + patients understand medical evidence and use it to make decisions about healthcare.
- Reduce unwarranted variations in practice + make sure patients get best care available, no matter where they live
- Improve healthcare across Scotland by focusing on patient-important outcomes
What does SIGN stand for and what do they do
- The Scottish Intercollegiate Guidelines Network (SIGN)
- Develop evidence based clinical practice guidelines for the NHS in Scotland.
adefine ageism
stereotyping and discrimination against people just because of their age (not just old!)
what percentage of the world population is expected to be over 60 by 2050?
22%
In the period 2000 to 2050, the number of people aged 80 and older will increase __ fold.
4 fold
By 2050, what percentage of older people will live in low-income and middle-income countries?
80%
what are the biggest killers in the poorest countries?
heart disease, stroke, chronic lung disease.
give 4 reasons for the ageing population in the UK
- baby boom after WWII
- overall mortality rates continue improving (decreases)
- more emphasis on preserving health in old age ⇒ elderly more healthy
- ageing does not (necessarily) cause disease (healthier habits ⇒ live healthier for longer.)
how will healthcare have to change in response to the ageing population? give 4 points.
- More geriatricians + (other care of the elderly professionals) needed
- More facilities for elderly health care needed
- Many long-term conditions (end-stages of which can require as much palliative care as cancer eg DM, CVD) are moving from 2* care to 1* care
- Specific health promotion campaigns aimed at elderly.
what are the social implications associated with the ageing population? list 5.
- elderly dependent on families/carers who are also ageing
- more demand for home carers + nursing home places
- more emphasis on providing social activities for elderly within community
- role of elderly as grandparents (carers of grandchildren) likely to change (as may still be working)
- changed housing demands as more elderly people live alone (single bedroom houses popular with elderly)
what are the economic implications associated with an ageing population? list 5.
- retirement/pension age increases (already)
- finding employment harder for young people (older people required to work longer)
- proportionately less people paying into tax + pension funds ⇒ harder to get adequate return from pension funds.
- some without private pension may find state pension inadequate ⇒ poverty
- rising cost of “free personal care for the elderly” policy (Scotland)
what are the political implications/ factors associated with an ageing population? list 2.
- Decision making/workforce planning must account for ageing population
- Rising ageing population could have power to influence political decision making in relation to their specific concerns
What is the leading cause of death in women in England?
Dementia/Alzheimer's
what is the leading cause of death in men in England?
heart disease
what is increasing alongside life expectancy?
healthy life expectancy
the population is now living longer and spending more years in good health
how is the number of years spent in poor health varying with the number of years spent alive, in the ageing population?
life expectancy increased more than healthy life expectancy, therefore:
number of years lived in poor health has also increased
describe the concept of inequity
life expectancy can vary depending on socioeconomic status
give an example of a third sector organisation that help patients live healthier and better quality lives
'Age Concern'
how is the number of carers changing?
increasing
what proportion of people will be carers at some point in their lives?
3 in 5 people (60%) will be carers at some point
how many people provide over 50 hours of unpaid care per week?
1.4 million
what % of carers were in receipt of disability living allowance as a result of their own disability/ill health?
27% of carers in receipt of Disability Living Allowance due to their own disability/ill health
give 7 examples of work that carers do
- practical help (meals, laundry, shopping)
- keep an eye on person
- keep them company
- take the person out
- help with financial matters
- help deal with care services/benefits
- help with personal care
give some examples of the people carers may care for (i.e. what relations might the carer have to them)
majority of carers care for relatives
- 40% parents/parents-in-law
- 26% spouse/partner.
- Other: disabled children under 18, grandparents, other relative.
1 in 10 care for a friend or neighbour.
what are the proportions of carers that care for one person, two people or more?
83% care for just one person
14% care for two people
3% care for at least three people
discuss the impact that caring has on carers
i) financial (5)
ii) social (2)
iii) health (1)
Financial
- May live in household where no-one is in paid work
- Drop in househould income by £20,000+ p/a
- Cut back on essentials like food and heating
- Financial circumstances affecting their health
- Missing out on financial support due to not getting right information
Social
- Impact on relationships with friends/family
- Many feel society does not think about them at all
Health
- Carers providing round the clock care over 2x more likely to be in bad health than non-carers
define 'multi-morbidity'
“the co-existence of two or more long-term conditions in an individual"
(the norm in primary care patients)
how does multi-morbidity add complexity to management?
preferred treatment for one condition may worsen another
give 5 different options for care for elderly patients that are being discharged from hospital
- Living in own home with support from family
- Living in own home with support from social services
- Sheltered Housing (accomodation for elderly)
- Residential Home
- Nursing Home Care
define 'anticipatory care plans (ACP)'
discussions in which individuals, care providers and relatives make decisions with respect to future aspects of care (health/personal/practical)
when should ACP be done?
any time in life that seems appropriate
continuously
who should do ACP?
anyone with an appropriate relationship to patient
how should ACP be done?
carefully thinking ahead + making plans
write it down
how can ACP be shared?
- KIS (Key Information Summary)
- Other communication mehtods
The electronic Key Information System (KIS) is a communication tool that conveys ACP information from Primary Care to Out of Hours services (111)
give 3 examples of legal ACP
- Welfare power of attorney
- Financial power of attorney
- Guardianship
give up to 8 examples of personal ACP
- advance directive - what actions should be taken if deterioration
- next of kin (closest relative)
- consent to pass on information to relevant others
- preferences + priorities regarding treatment
- who else to consult/inform
- preferred place of death
- religious/cultural beliefs (death)
- current level of support
give up to 9 examples of medical ACP
- Potential problems
- Home care package
- Wishes about DNA CPR
- Scottish Palliative Care Guidelines
- Communication which has occurred with other professionals
- Details of “just-in-case” medicines
- Electronic care summary
- Assessment of capacity/competence
- Current aids and appliances (helps assess current functional level)
give up to 8 reasons for the ageing population that are not due to improved healthcare
- Decrease in birth/fertility rates
- Better housing
- Better water supplies
- Better sanitation/sewerage systems
- Better nutrition
- Better safety/reduction of injury
- Migration (some areas only)
- War/genocide (some areas only)
Define ageing population
Population aging is an increasing median age in the population of a region due to declining fertility rates and/or rising life expectancy.
list 10 members of the primary healthcare team
- GP partners
- GP assistants and other salaried doctors
- GP registrars
- Practice nurses
- Practice managers
- Receptionists
- Community nurses
- Midwives
- Health visitors
- Nurse practitioners
describe the role of the GP partner
- first point of contact for most patients.
- bulk of work = consultations + home visits
- most are independent contractors to NHS (responsible for providing adequate premises to practise from and employing own staff)
- provide complete spectrum of care in community - dealing with problems often with physical, psychological and social components
- help patients take responsibility for their own health.
- work in teams with other professions
describe the role of the practice nurse
Work as one of several or on their own.
May be involved in most aspects of patient care, including:
blood samples, ECGs, wound management (eg leg ulcers), travel health advice + vaccinations, child immunisations, family planning, women’s health (including cervical smears), men’s health screening, sexual health, smoking cessation.
(GP nurses may have direct supervision of healthcare assistants at the practice)
describe the role of the district nurse
Visit people in own homes:
- Direct patient care - Assess healthcare needs ⇒ provide complex care ⇒ monitor quality of care
- Teaching and support role - enable patients to care for themselves or teach family how to care
District nurses help keep hospital admissions lower + ensure patients return home as soon as possible
-
(Note: they are accountable for their own patient caseloads)
describe the role of the midwife
provide care during all stages of pregnancy, labour and early postnatal period.
- Community based - at home, clinics, children's centres, GP surgeries.
- Hospital based - antenatal, labour, postnatal wards, neonatal units.
describe the role of the health visitor
Qualified nurse or midwife working in community with families to give pre-school-age children best possible start in life.
- Visit parents with new babies/young children in own home
- Child + family health services (pregnancy-5 yrs)
- Additional services for vulnerable children/families
- Safeguarding + protecting children
describe the role of a macmillan nurse
specialise in cancer + palliative care
support patients/relatives/carers from diagnosis onwards either in hospital, at home or a local clinic:
Roles include:
pain/symptom control, emotional support, info re cancer treatments/side effects, advising other MDT members (e.g. district nurses), co-ordinated care between hospital and patient's home, advice on other forms of support, including financial help.
describe the term 'allied health professionals' and give 6 examples
Professions distinct from nursing and medicine
- Physiotherapy
- Occupational Therapy
- Dietetics
- Podiatry
- Pharmacy
- Counselling
describe the role of the pharmacist
Expert in medicines
Work in a pharmacy (hospital, community, primary care) to:
- Ensure patients receive maximum benefit from them
- Advise medical + nursing staff on appropriate use
Note: can undertake additional training to be able to prescribe for specific conditions.
describe the role of the dietitcian
Help people make informed choices about food/lifestyle
- Most employed in NHS - (hospital or community)
- Some work in food industry, education, research or freelance
Wide range of responsibilities including:
working with people with special dietary needs, informing general public about nutrition, offering unbiased advice, evaluating and improving treatments, educating patients/clients, other healthcare professionals and community groups.
describe the role of the physiotherapist
Treat people with physical problems caused by illness, accident or ageing.
- See movement as central to health - maximising through health promotion, preventive healthcare, treatment, rehabilitation.
- Appreciate - psychological, cultural, social factors
Core skills: manual therapy, therapeutic exercise, electro-physical modalities.
describe the role of the occupational therapist
Assessment + treatment of physical/psychiatric conditions ⇒
- Prevent disability
- Help overcome effects of disability (physical, psychological, accident)
- Promote independent function in all aspects of daily life.
Work may include:
physical rehabilitation, mental health, learning disability, primary care, paediatrics, environmental adaptation, care management, equipment for daily living
describe the role of a care manager
Help people identify goals + locate specific support services to enhance wellbeing:
- Help find solutions when faced with many choices/challenging decisions
- Advise on social + financial support services (highly trained social workers)
give a few other examples of professions involved in health
Complimentary therapists - acupuncture, homeopathy
Social services - social workers, social care workers
Health promotion - gyms, education
describe 2 political pressures on the PHCT
Reduce cost of treatments.
Provide more treatments closer to where patients live
give 2 examples of the expanding roles of some members of the PHCT
Pharmacist: extended role of in medicines management and minor illness
Nurse: prescribing and triage.
give 2 problems posed by the growing number of ageing patients on the PHCT.
more long term conditions
greater demand for healthcare generally
(both of these are managed largely in primary care)
What was formed as a result of a joint initiative between the Royal Pharmaceutical Society, the British Medical Association, the Royal College of Nursing, the National Pharmaceutical Association and the Royal College of General Practitioners?
The Forum on Teamworking in Primary Healthcare
Outlines recommendations for establishing a successful PHCT.
The recommendations for establishing a successful PHCT are laid out in the 'Forum on Teamworking in Primary Healthcare' - describe up to 14 of these.
- Recognise patient/carer as essential member of PHCT
- Establish common agreed purpose
- Agree set objectives + monitor progress towards them.
- Agree teamworking conditions, including process for resolving conflict
- Members acknowledge skills of team colleagues.
- Importance of communication
- Ensure practice population understands how team works within community
- Select team leader for leadership skills (rather than on status, hierarchy, availability)
- Include in the membership of the team all the relevant professions serving a practice population.
- Promote teamwork
- Evaluate teamworking initiatives on basis of sound evidence
- Ensure sharing of patient information within team complies with current legal requirements.
- Take active steps to facilitate inter-professional collaboration and understanding through joint conferences, education and training initiatives.
- Be aware of other measures involving national organisations, educational measures, research and general guidance which impact on teamworking.
define the 'health and social care team' and explain why it is called this
There is an NHS team around the patient but also carers/social care
Scottish Government recognised need for both to work together so launched a program to integrate Health and Social Care.
The PHCT is often now referred to as the Health and Social Care Team.
describe the 2 primary aims of the new integrated agenda
Reduce:
- Unnecessary admissions
- Delayed discharges.
(Integration makes more effective use of limited resources and improves outcomes for patients)
In 2011, the Scottish Government’s plan to integrate adult health and social care was announced.
what was it called?
THE PUBLIC BODIES (JOINT WORKING) (SCOTLAND) ACT 2014
briefly describe 3 of the key points of the THE PUBLIC BODIES (JOINT WORKING) (SCOTLAND) ACT 2014.
- Created new public organisations (integration authorities) to break down barriers to joint working between NHS boards + local authorities
- Integration of health/social care budgets by NHS boards/local authorities
- Form nationally agreed outcomes and requirement on partnerships to strengthen role of care professionals, along with third and independent sectors, in planning and delivery of services.
describe the demands of the 2014 act on integrated services
The 2014 Act required NHS boards + local authorities to:
- Integrate governance, planning and resourcing of adult social care/primary care, community health and hospital services.
- Jointly submit integration scheme for each area - detailing which functions will be delegated to the integration authority. These schemes are intended to achieve the National Health and Wellbeing Outcomes.
the 2014 act set out a framework for creating the integration authorities.
It allowed NHS boards and local authorities to integrate health and social care services in two ways - name them
- integrated joint board model
- the lead agency model.
describe the 'Integrated Joint Board' (IJB) model
NHS board and local authorities delegate responsibility to IJB:
1) Responsibility for planning/resourcing service provision for adult health and social care services.
2) Budgets - IJB then decides how to use the resources.
list up to 10 professionals the IJB must include
- carer representative
- GP representative
- nurse representative
- secondary medical care practitioner
- service user representative
- staff-side representative
- third sector representative
- officer who is responsible for financial administration
- the Chief Officer
- the Chief Social Worker .
