Flashcards in Legal, moral & ethical responsibilities of patient care Deck (63):
Define health literacy and patient education.
Health literacy - the individual’s cognitive and social skills that determine the ability to access, understand and use health information in a way that will promote their health.
Patient education - any set of planned educational activities/organised learning experiences that intend to improve (or enable change of) patient’s health behaviours and/or health status. This is to slow deterioration of a disease, or to maintain/improve health outcomes.
Articulate the rights of the patient to refuse interventions.
This is autonomy.
Give an example of a legal aspect/acts relating to care. (3)
Disability discrimination act 2005
Equality Act 2010
International development (gender inequality) Act 2014
What is stated in the Disability discrimination act 2005? (3)
It is unlawful to discriminate against a disabled person
It is unlawful to subject a disabled person to harassment
It is unlawful for a public authority to discriminate against a disabled person in carrying out its functions.
What do service providers have to do under the Equality Act 2010?
Make reasonable adjustments.
e.g. reduce the inequalities of outcome which result from socio-economic disadvantage
What do service providers have to do under the International development (gender inequality) Act 2014?
Duty to have regard to gender inequality
e.g. reducing inequality between persons of different gender
e.g. taking into account any gender-related differences in the needs of those affected by the disaster or emergency
What is the GMC?
What is its chief responsibility?
General medical council - official register of doctors within the United Kingdom.
‘To protect, promote and maintain the health and safety of the public’ by controlling entry to the register
What is the disciplinary responsibility of the GMC?
What about standards?
Suspending or removing members when necessary. Sets the standards for medical schools in the UK.
What other organisations are there for the legal responsibilities of care? (2)
What did the Royal College of Physicians publish in 2016?
Keeping medicine brilliant 2016
Health and social care act 2012 - what themes are discussed in this? (9)
Quality and safety
Primary care – patient access, expand GP workforce
Seven day services
Mental health & learning disabilities
Public health funding cut
How is healthcare regulated? (6)
Care Quality Commission
Department of Health
Health watch dogs
What do the CQC do to regulate healthcare?
Carry out unannounced audits
What act are the moral aspects of patient care built on? What does this state?
Human Rights Act 1998
Treat with dignity and respect, not neglect or abuse patients
There is a direct link between erosion of human rights and...?
What is the strongest predictor of health status intrinsic quality of well-being?
How is literacy associated with health outcomes?
Lower levels of literacy associated with worse health outcomes
What is bioethics?
Applied ethics (medical ethics)
The study of the moral, social and political problems that directly or indirectly affect human well-being.
What does normative ethics cover? (5)
Duties and obligations
Context and relationships
i.e. the things you need to follow to provide excellent care for your patients.
What are the four principles of ethics?
What is meant by autonomy?
What does it underpin? (5)
Deliberated enabled self-rule – the right of a person to have an opinion, make choices, and take actions based on personal values. Respects the right of self-determination & non-interference.
Capacity for deliberation
What is meant by non-maleficence?
Do no harm – practices & legislation relating to duty of care, negligence and malpractice are based on this. Requires us to justify actions that cause harm & failure to do so is considered negligent.
What is meant by beneficence?
Actions designed to positively benefit the well-being of others, imposes a moral obligation to provide clients with net benefit and minimal harm.
What is meant by justice?
Fair and equitable distribution of benefits, burdens and duties among and between members of society. Fair and equitable – fairness, comparative justice, distributive justice, & compensatory justice.
What are some of the ethical issues in medicine? (7)
Care of self vs care for others
Responsibility and privilege
Autonomy and integrity
What did Foucault state about the meeting place between patient and doctor?
Some truth is shared here. Two sets of values, beliefs and expectations.
Individuals with chronic diseases who also have lower literacy levels have _____ health outcomes and _____ __ ______ healthcare advice.
Struggle to follow
People with MSK conditions are encouraged to be active partners in their health care and to adopt a range of...?
Active involvement in self-management generally leads to...?
Better health outcomes in chronic diseases
Poor and vulnerable bear unequal burden of...
People with osteoarthritis are disproportionately represented in...?
Why might this be?
Lower socioeconomic positions - more likely to work in manual/hard labour, causing wear and tear of their joints.
Access, delivery and impact of healthcare is...?
What is patient education?
A central strategy to increase knowledge and understanding so as to enhance self-management skills, and become more confident in managing their condition.
Education interventions are less effective for...?
People with lower health literacy
People with lower literacy significantly more ________ and _________.
Why is this?
Anxious & depressed
Poor reading leads to poor knowledge which associates with more anxiety and depression.
Arthritis Self Help Course at 4 and 12 months - what did it show?
For what group of patients was this finding not statistically significant?
An increase in self-efficacy (modest)
African American participants
Compare the results of using plain English leaflets and educators analysed by univariate and multivariate analysis.
What does multivariate take into account?
Increase in univariate
Not maintained in multivariate analysis
Socio-economic status, gender etc.
What can be concluded from these studies about the effect of patient education for people with lower literacy?
Only moderate level evidence is demonstrated for the effectiveness of patient education for people with lower literacy.
Why are patients with lower levels of literacy under-represented in clinical models/research?
Difficulty recruiting participants i.e. those with low literacy didn’t even attend clinics.
What are the three models of evidence/research for health literacy?
What does the biomedical model focus on?
Individual clinical and behaviour change and compliance
What does the public health model focus on?
Individual behaviour change and supportive environments
What does the social science model focus on?
Empowerment and context
Why must patient education be tailored to different populations?
In order to reduce disparity
Name some potential confounders in trials about lower levels of literacy. (4)
Define disease. Why is this problematic already?
Any deviation from or interruption of the NORMAL structure or function of any body part, organ, or system that is manifested by a characteristic set of symptoms and signs and whose aetiology, pathology, and prognosis may be known or unknown.
It is already categorising into normal/not normal.
A patient’s interpretation of their disease, the feelings that accompany it, and the life events it turns into.
What are the advantages of labels? (2)
What are the disadvantages? (2)
It is a way of communicating/ a shared language that is efficient and effective and enables us to distinguish between things. It simplifies things/reduces complexity.
BUT it can turn patients into objects (objectification), i.e. they become the label. They also involve value judgements (e.g. bad/good) that are usually binaries about what is socially normal/acceptable or not.
What does deviance imply?
Some degree of negative evaluation
Give some examples of labels that can be stigmatising. (8)
Race, gender, age, disability, class, income, illness, nationality.
Why is illness considered a form of deviance?
It disrupts social systems as the sick person cannot contribute. A person is viewed as deviant in relation to general social norms e.g. not working.
What is stigma?
A powerful discrediting and tainting label that radically changes the way individuals view themselves and are viewed as persons.
Stigma may lead to a _______ identity.
What is meant by identity?
Who we think we are and who others think we are
What is courtesy stigma?
Stigma that affects those associated with the stigmatised person.
Stigma is associated with... (3)
Perceived blemishes of the body
Perceived blemishes of character
Belonging to a group seen as bad or inferior
What is enacted stigma?
Discrimination because of a condition
Person or group is stigmatised
Dramatises difference, causes suffering
What is felt stigma? What is it also known as?
The fear that discrimination might occur. This influences patients’ behaviour as the person seeks to limit possibilities for stigma to occur. They feel fear, guilt and shame and may view themselves as socially incompetent.
What types of diseases are associated with high levels of stigma? (4)
Person with disease is seen as responsible for having the illness
Disease is progressive and incurable
Disease not well understood by the public
Symptoms cannot be concealed
How long does stigma last?
It may increase/decrease over time for a particular condition
It may be associated with a temporary episode of illness (but the effect may be long-term), or associated with the effects of treatment.
Why is HIV stigmatised? (6)
Life threatening condition
Perceived as contagious and threatening
Lack of understanding
Associated with specific behaviours or lifestyles
Viewed as the responsibility of the individual
Irresponsible and biased media reporting
Stigma affects... (6)
Medically unexplained symptoms
Engagement with health care e.g. screening
Experience of health care
Adherence to treatment
Quality of life
How can we limit stigma? (4)
Don’t ‘blame the victim’
Consider people’s fears and anxieties
Educate the public
See the person as an individual, not an illness