Introduction to Professional Practice

Culture

" The beliefs and attitudes about something that people in a particular group or organisation share". - " What people believe, how they act and interact, and the way they live, culture is the specific traits, beliefs passed on through the generations of families".

where did health literacy come from?

"Attributed case for school health education with the intention that pupils would not only be educated in the customary curriculum subjects but might become as literate in health as they were. For example, in history and science

Essentially, partnerships with consumers exist when:

- Consumers are treated with dignity and respect - Information is shared with consumers - Participation and collaboration in health care processes are encouraged and supported to the extent that consumers choose.

Measuring Health Literacy:

- Health Literacy has been assessed through measuring reading ability, comprehension and word recognition skills - 3 key tools used with patients ➢ Rapid estimate of adult literacy in medicine ➢ Test of functional health literacy in adults ➢ Newest vital sign New Health literacy Surveys - Health literacy survey - Europe - Health literacy management tool, Australia and Thailand

Lower health literacy associated with:

- Inadequate knowledge about health and health care system - Increased hospitalization - Poor access and utilization of health services People with lower health literacy 1.5 - 3 times more likely to experience to poor health event.

Why the recent re-emergence of health literacy?

- Previous tools failed, confusing, missing key elements of common definitions - Public Health and Health promotion still do not meet the needs those with low literacy - New national/ international survey. Health education, prevention and disease management programs continue to fail to engage and improve outcomes for people who are most at risk and are disadvantaged.

Control of chronic Disease

- Self management - Carer and family - Community

What is health literacy?

- The degree to which people are able to access, understand, appraise and communicate information to engage with the demands of different health contexts in order to prepare and maintain good health across life course. - An individuals overall capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions - The capacity of an individual to obtain, interpret and understand basic health information and services in ways that are health enhancing - Health literacy represents the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health - Health literacy is the ability to make sound health decisions in the context of everyday life, at home, in the community, at the workplace, the healthcare system, the market place and the political arena

Why partner with consumers?

- There is good evidence that patient centered approaches to care can lead to improvements in safety, quality and cost effectiveness, as well as improvements in patient and staff satisfaction - The way to ensure that care is patient centered is to work in partnership with consumers

4 categories of action for Clinical Reasoning Cycle

- clinical skills - clinical knowledge - problem solving reflect

Structured concepualisation process

1. Brain storming session 2. Sorting and rating of statements 3. Multivariate analysis 4. Interpretation of maps

Domains

1. Receptivity to health improvements 2. Understanding health information 3. Support with utilizing health care 4. Economic barriers to care 5. Accessing GP health care services 6. Communication with doctors 7. Seeking a second opinion 8. Using health information

How can we reduce the burden due to chronic disease?

1. Set policy directions - Whole of government 2. Set new legislation to minimize individuals and communities exposure to risk factor settings - E.g. smoking, limit junk food in schools, limit advertising, ban trans fat acids 3. Surveillance, screening - With reporting to key stake holders 4. Ensure universal access to diagnosis and treatment 5. Strengthen individuals and communities - General education of population - Reduce risk factors in individuals 6. Plan for and develop an appropriate work place - Build communities of practice 7. Develop, import, adapt and engage in strategic implementations of a set of essential interventions - Through improved service delivery and reduce inequity - Generate intervention strategies and programs with the community 8. Support the community engagement and ownership of the problem - Social marketing 9. Continuously evaluate, adapt, improve health programs

health literacy

An individual`s overall capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.

APA 6 BOOK

Benesch, S. (2001). Critical english for academic purposes: theory, politics, and practice. Mahwah, NJ: lawrence Erlbaum.

APA 6 WORLD WIDE WEB

Centre for bioethics, (2009). Ethics and pharmaceutical marketing. Retreived from https://www.ahc.umn.edu/bioethics/research/pharm/home.html

Functional literacy

Consent forms, medicine labels, pamphlets.

Alzheimer`s

Definition Alzheimer's is a type of dementia that causes problems with memory, thinking and behaviour

Peer Review

Evaluate the quality of other work within people in the same line of work, by doing this, they aim to ensure the work is rigorous, coherent, uses past research and adds to what we already know.

Peer review

Evaluating the quality of another worker with in the same field, by downing this, they aim to ensure work is rigorous, coherent, uses past research and adds to what we already know

APA 6 GOVERNMENT PUBLICATION

External reference group. (2004). Evaluating of knowledge and innovation reforms consultation report (DEST) no. 7164.HERCO4A). Canberra Australia: Department of Education, Science and Training.

Prevalence of low health literacy

Grade 4-6 may need low literacy materials, may not be able to read prescription labels Grade 7-8, May struggle with most currently available patient education materials High School should be able to read most patient education materials

Team Work

Helps develop interpersonal skills, developing sense of self esteem, learn effectively

Targets for measurement to capture health literacy from the patient`s perspective

Individual abilities: 1. Understanding health information 2. Accessing GP health care services 3. Communication with health professionals 4. Proactive about seeking further care/ second opinion 5. Using health information Broader Factors: 6. Economic barriers to care 7. Social support with utilizing health care 8. Receptivity to improving`s ones health

Clinical Reasoning cycle

Is a cognitive and metacognitive process that involves elements of critical thinking. it is a cognitive process that manifests into an action.

Good literature

La Trobe Library and Google scholar

Why is there new re-emergence of health?

Many reasons: - Lack of tailoring of interventions to local settings - Programs are not ongoing over time - Lack of consideration of health literacy

Conceptual Literacy

Skills to seek out, comprehend and evualting information

Health literacy subsequently acquired a more limited technical meaning:

The currency patients need to negotiate a complex health care system, e.g. ability to read and comprehend prescription bottles, appointment slips and other essential health related materials required to successfully function as a patient.

Bad literature

Wikipedia, Blogs and opinion pieces

APA 6 JOURNAL ARTICLE

Woodward, J. D. (1997). Biometrics: Privacy`s foe or privacy`s friend? proceeding of the IEEE, 85, 1480-1492. Retrieved from https://ieeexplore.ieee.org/xpl/recentissue.jsd?punumber=5

Learning Styles The Adult learner: Adult learning theory is based on the understanding that adults are - ➢ Autonomous and self directed ➢ Have accumulated a foundation of life experiences and knowledge ➢ Goal and relevancy orientated ➢ Practical ➢ Need to be shown respect Clinical reasoning cycle: Clinical reasoning is a cognitive and metacognitive process that involces elements of critical thinking. It is a cognitive process that manifests into an action. There are four categories of action: clinical skills

clinical knowledge, problem solving and reflect. The seven learning styles: - Visual - Aural (sound and music) - Physical - Logical - Social - Solitary (work alone) Team Work Working in teams benefits us through: - Helps develop interpersonal skills - Developing sense of self esteem - Develop skills early as possible - Learn effectively from each other Effective teams - Combined group effort of all members - Clear goals - Focused on learning - Mutual trust and support - Open communication - Democratic processes Searching literature Good: - La Trobe library - Google Scholar Bad: - Wikipedia - Blogs - Opinion pieces Evidence Based Practice / Quality of Evidence Evidence Based/informed - We use evidence for a variety of reasons: ➢ Identify health issues ➢ Determine magnitude of a health issue ➢ Identify causes of a health issue ➢ Guide us in addressing a health issue ➢ Evaluating whether the way in which we addressed the issue was effective So, what is evidence? - Good quality - Useful - Relevant - Credible - Appropriate APA 6: BOOK: SINGLE AUTHOR In-text referencing - Direct quote (page number(s) must be included - Benesch (2001) stated that English for academic purposes (EAP) was "more rhetorical in focus" (p. 6). - Paraphrasing or summarising (use of page number(s) encouraged) - Benesch (2001) described the function of the rhetorical-grammatical process chart (pp. 6-7) Reference List - Author, A. A. (Year). Title of work. Location: Publisher. - Benesch, S. (2001). Critical English for academic purposes: Theory, politics, and practice. Mahwah, NJ: Lawrence Erlbaum. APA 6: GOVERNMENT PUBLICATION: GOVERNMENT REPORT (PRINT/ONLINE) In-text referencing - Direct quote (page number(s) must be included) - It has been recognised that, "the IAS has benefited from the arrangement" (External Reference Group, 2004, p. 33). - Paraphrasing or summarising (use of page number(s) encouraged) - The External Reference Group (2004) has also taken this viewpoint (p. 13). Reference List Print - Author, A. A. or Corporate Author. (Year). Title of work (Report No. xxx). Location: Publisher. - External Reference Group. (2004). Evaluation of knowledge and innovation reforms consultation report (DEST No. 7164.HERC04A). Canberra, Australia: Department of Education, Science and Training. Online - Author, A. A. or Corporate Author. (Year). Title of work. Retrieved from http://xxxxxxxxxxxxxxxxxxxx - Department of Families, Housing, Community Services and Indigenous Affairs. (2009). Growing up in Australia: The longitudinal study of Australian children: 2008-09 annual report. Retrieved from http://www.fahcsia.gov.au/sites/default/files/documents/lsac_ar_08-09.pdf - APA 6: JOURNAL ARTICLE: ARTICLE (1 AUTHOR) - In-text referencing - Direct quote (page number(s) must be included) - Studies have found that "the overall size of the biometrics industry remains relatively small" (Woodward, 1997, p. 1482). - Paraphrasing or summarising (use of page number(s) encouraged) - Woodward (1997) found that the studies were well funded (p. 1482). - Or - The studies were well funded (Woodward, 1997, p. 1482). - Reference List - With DOI - Author, A. A. (Year). Title of article. Title of Journal, Volume, pp-pp. doi:xx.xxxxxxxxxx - Woodward, J. D. (1997). Biometrics: Privacy's foe or privacy's friend? Proceedings of the IEEE, 85, 1480-1492. doi:10.1109/5.628723 - Without DOI - Author, A. A. (Year). Title of article. Title of Journal, Volume, pp-pp. Retrieved from http://xxxxxxxxxxxxxxxxxxxx - Woodward, J. D. (1997). Biometrics: Privacy's foe or privacy's friend? Proceedings of the IEEE, 85, 1480-1492. Retrieved from http://ieeexplore.ieee.org/xpl/RecentIssue.jsp?punumber=5 APA 6: WORLD WIDE WEB: WEBPAGE In-text referencing - Direct quote (page number(s) must be included) - The Center for Bioethics (2009) noted that increasingly "American patients have been transformed into health care consumers" (para. 2). - Paraphrasing or summarising (use of page number(s) encouraged) - A forthcoming book will address these issues (Center for Bioethics, 2009, para. 3). Reference List - Author, A. A. or Corporate Author. (Year). Title of webpage. Retrieved from http://xxxxxxxxxxxxxxxxxxxx - Center for Bioethics. (2009). Ethics and pharmaceutical marketing. Retrieved from http://www.ahc.umn.edu/bioethics/research/pharm/home.html Key things to remember with quality of evidence? - Is it Authorities or non-Authorities evidence? - Who has written it - Is there a Reference list - What have people said about them - What systems do they use Authorities Non-Authorities - Journal Article - Web pages - Government publication - Wikipedia - Blogs - Websites Patient/ client focused care Partnering with consumers is about healthcare organisations

what is evidence

good quality, useful, relevant, credible, appropriate

Reasons for use of evidence

identify health issues, guide us in addressing them, evaluate whether it was effective or not

The adult learner

is based on the understanding that adults are: - self directed - be shown respect - practical

health care providers and policy makers actively working with consumers to ensure that health information

systems and services meet their needs. Essentially, partnerships with consumers exist when: - Consumers are treated with dignity and respect - Information is shared with consumers - Participation and collaboration in health care processes are encouraged and supported to the extent that consumers choose. Why partner with consumers? - There is good evidence that patient centered approaches to care can lead to improvements in safety, quality and cost effectiveness, as well as improvements in patient and staff satisfaction - The way to ensure that care is patient centered is to work in partnership with consumers JNB foundation - Covered a clear gap - Raised a couple million dollars - Being told many things - Need to make it clear for the patient Brain Acquired brain injury Refers to any damage to the brain that occurred after birth, common cause of ABI include accidents, strakes, lack of oxygen, and degenerative neurological disease. Each person who experiences is different. The brain is important when it comes to whom we are, what we feel, and how we control our bodies, so there are a lot of things that can change when our brains are injured, impacts on memory, concentrating on things, and become hard to talk to people and control your emotions. - 73% of victims of social violence are males, with the highest occurrences in the 15-34% year old range. Consumer Participation The process of involving health consumers in decision making about health service, planning, policy development, setting priorities and quality issues in the delivery of health services. Consumers involved in health care planning and delivery of services: - How to recognize the good and bad professionals - Community consumer - Increase in chronic illness - Difficult to navigate - If consumers plan and come with their own goals they are more likely to succeed - Consumers need to be involved from the beginning - Effective consumer participation requires leadership, funding and support Consumer participation initiatives should also: - Involve a range of different consumers - Provide support and encouragement for consumers to participate - Establish and maintain commitment High degree of consumer involvement: - Consumer representatives involved in service planning committees - Consumer representatives attend staff meetings - Consumer representative involved in staff recruitment - Consumer representative involved in staff performance appraisal Population Health The study of population health is focused on understanding health and disease in community and on improving health and well being through priority health approaches addressing the disparities in health status between social groups. Three categorisations of priority areas for health interventions: Priority population groups There are several groups in Australia with worse health than the general population due to a range of environmental and socio economic factors, for instance, people living in rural and remote areas may experience difficulties accessing health services and this could have a direct impact on their health. Priority population groups: - Indigenous people - People in rural and remote areas - Socioeconomically disadvantaged people - Veterans - Prisoners - Overseas born people Priority age groups There are several age groups that are more vulnerable to illness and disease than others. For instance, babies, immune systems are not fully developed to combat foreign organism's Priority age groups: - Mothers and babies - Children - Young people - Older people Disease Priorities Disease priorities focus on those areas that contribute most to the burden of illness and injury in the community, particularly if the burden can be significantly reduced. This provides a framework for managing health interventions in the community. Health Promotion What is health promotion? A process of enabling people to increase control over (the determinants of health), and (in turn) to improve, their health. Holistic approach to positively maintaining and improving the health and wellbeing individuals communities and whole populations. The insidious nature of 'Complete physical, mental and social wellbeing Why health promotion? - Way to address Australia`s priorities - Chronic disease is increasing and is now a priority world wide - Persistence, emergence and re-emergence of infectious disease - Increase in life expectancy - Changing economic, cultural and political circumstances Key Aspects: Health promotion is: - Multi-level - Multi- Sectorial - Multi- Disciplinary activity - Visionary - Concerned with equality and justice - Environmental protection Foundations for understanding health promotion Population Health - Improving health of populations through interventions that have the potential to affect everyone - How do we know what the issues are that affect everyone - How do we know what the issues are that communities/populations? - Epidemiology: ➢ Basic demographic information ➢ Health status of communities ➢ Determinants of health in the community - Epidemiological questions for understanding how to improve health ➢ Identification ➢ Magnitude and distribution ➢ Analysis ➢ Action and Evaluation Ottawa charter - Was developed at the first international conference on health promotion in 1986 - Sees individuals as having responsibility for their own health, but also a collective concern for the health of others - Societal responsibility to create conditions that enable people to take control of their own health - Recognises factors that are required for good health - Definition of health promotion - Identifies 3 broad principles to guide health promotion activity: ➢ Advocate ➢ Mediate ➢ Enable - Provides 5 action areas in which health promotion can be undertaken: ➢ Build health public Policy ➢ Create Supportive environments ➢ Strengthen community action ➢ Develop personal skills ➢ Reorient health services Build health public policy - Engaging policy makers in the health and other sectors on how policy can impact directly and indirectly on people`s health Create supportive environments - Working with stakeholders to create contexts in which people can live healthy lives - may be the social, natural, economic and built environments Strengthen community action - Involving, enabling and ultimately empowering the community to determine, lead and implement actions relating to their health and wellbeing Develop personal skills - Increasing ability and capacity to maintain and improve health throughout life by supporting personal and social skill development within a variety of settings Re orient health services - Planning services and programs, creating policies and providing training , opportunities that support a wellness approach to health Effectiveness - Use a combination of action areas - Investment in building health public policy is a key action are - Supportive environments need to be created at all levels - Personal skills development must be combined with other action areas to be effective - No action area can be successful on its own Summary - Health promotion defined - Foundations for understanding health promotion ➢ Determinants of health ➢ Population health ➢ Ottawa charter Best practice approaches to health promotion - Evidence - Equity - Enablement/empowerment - Collaboration Enablement/ Empowerment - Enablement is used in the Ottawa charter definition of health promotion - At basis of community enablement is empowerment - Empowerment, People Acquiring a degree of power and control over the change process they are involved in However this approach: - Can take a longer time to achieve goals. Is this equitable? - What is important a timely response or an enabled response? - As health professionals, do we really hand over power to the community? Working Collaboratively - The influences on our health lie outside of the health sector - Engaging with other sectors is necessary to address determinants of health and wellbeing Factors inhibiting collaboration - Current political environment - Confusion over roles - Health system language Factors promoting collaboration - Shared belief in purpose - Capacity to collaborate - Agreed outcomes form collaboration Contemporary health promotion - Based on evidence and grounded in relevant theory - Increasingly used as a population health approach - Increased focus on prevention - Health promotion is gaining traction nationally - more money available but more outcomes expected Contemporary health promotion issues - Global health issues on our doorstep ➢ Chronic disease ➢ Economic insecurity ➢ Environmental damage ➢ Ageing ➢ Re-emergence of infectious disease e.g. measles Health Equity Equity - What is it? - Recogising diversity and disadvantage - Directing resources towards those most in need - Based on principles of social justice Improving Equity Much of equity in health relates to distribution of opportunities for wellbeing - Way of improving equity can be guided by the Ottawa charter and often involve the social determinants of health - The WHO has made 3 recommendations on ways to reduce health inequality: ➢ Improve daily living conditions ➢ Tackle inequitable distribution of power, money, resources ➢ Measure and understand the problem and assess the impact of action Access to Health care/ Health Equity Responding to issues of healthcare equality - Access to medical staff - Lots of Grants are given out to work in rural areas - Aboriginal and rural work force - Access to financial incentives - Extended practice - More services increases greater access Equitable healthcare for consumers living in rural and remote regions when compared to those living in urban areas - Less services equals less choices - Services will only be a generalised - Key things that are missing in rural areas, a lot more occupational and car accidents in rural areas, and further away from services and health care - Poorer access to cancer treatments - Less access to good food - Lower income to good food and services - Cultural issues within health practices - Confidentiality Rural and remote population look comparison with urban Australia - Higher social Determinants of health - Lower income - Low levels to education - Lower levels to economic opportunities - Lack of highly professional groups - The more remote the more Aboriginal patients - Social pressure - Australia living in the city is that you have made it - Higher educated people in urban areas Challenges working in healthcare in rural and remote areas - Lack of Anonymity - Cultural issues - Mandatory reporting requirements - Distance management and support Benefits of working in health in rural and remote areas - Extended practice - Can create your own style - New and different things - Be create - New technologies - Developing competencies - The client may help and support you - Create better relationships with the patients - Create a great lifestyle - More affordable Health inequalities - Unemployment - Transport - Early life experiences - Social exclusion - Poverty - Stress - Food quality - Social support ➢ Planning policy and health ➢ Bad environment reflects on self worth and you don't feel worth while ➢ Local development strategies, for a healthy sustainable strategy ➢ Poor infrastructure Communication with different types of clients Effective communication 1. Listen First (what is empathy) 2. Breathe (Stress, speech, tense) 3. Say I (think this or that) 4. Judgment and blame and denial responsibility 5. Separate facts from opinions 6. Aware of emotions (Feelings) 7. Beware of needs and values 8. Ask for what you want 9. Body language 10. Taking account of individual differences and cultural diverse Body Language - Arms crossed shows defensive - Legs crossed - Leaning shows Boredom Emotions - Divide between you and the patient Communication with people with disabilities - They can communicate - Non-verbal gestures - Day to day behaviours - Hard to interpret for people who don't know them - Complex health care needs high level of support - No voice about decisions - No ways on commenting on the services they receive - Difficult consultation - Storying telling helps to connect and feel involved - Consistently - Need access to a wide range of services - Communication Passport journal for a patient, Families and health care professionals all document in the book and to effectively communicate with a patient, benefit in planning services - Music for communication to express feelings Communicating through a interpreter - When you don't speak the same language can create a huge barrier - Secondary interpreter is a commonly used tool in the health care field Tips: 1. Speak directly to the patient, using words such as you 2. Face the patient, make eye contact (Interpreter to the side of you) 3. The interpreter will interpret will do it in the first person 4. Speak slowly and pause regularly, so the interpreter has time to interpret 5. Everything is interpreter even if it is not important, so no one gets left out Communicating with people with a mental illness - People are with a mental illness may be seeing, hearing or feeling something that is very real to them - Help peers remember - There are vulnerable Helping people who hallucinate - These sensations are very real - Most hallucinations can be stopped or minised with mediation - Some people live with their hallucinations quite well - Some people are bothered by them, but can function in society - Some people respond to their internal stimuli without realizing it Tips for health care works: - We speak slowly and calming - Help them gain self control - Stay calm - Never get angry at the patient - Self care Helping angry people 1. Take a deep breathe and center 2. Face the person directly 3. Open your posture 4. Cover your solar plexus 5. Use good eye contact 6. Watch for the end When a person is calm, we ask them to let us know right away if they feel upset again. To help a person during anger, we are: - Very centered in compassion and a very good listener for just a few moments - Focused on the person, not the story - Aware that anger is self limiting - Respectful and willing to stay with this person as s/he calms him or herself down. Therapeutic communication Therapeutic communication is interpersonal exchange, using verbal and non-verbal messages, that culminates in someone`s being helped to over come stress, anxiety, fear, or other emotional experiences that cause distress. It is also communication that expresses support, provides information and feedback, corrects distortions, and provides hope. Effective therapeutic communication Being empathic - Allows connection with patients Creating a trusting relationship - Helps acceptance of medical advice and opinions Therapeutic use of questions/questioning - Helps in collecting information and establishing medical history Therapeutic us of silences - Can have cultural implications, conveys active listening Effective therapeutic communication The impact of self - disclosure - Should be used with caution, within guidelines Giving advice - Can be given directly or indirectly. Requires rationale Reflection and interpretation - The process of paraphrasing and restating both the felling and words of the speaker. Allows client or patient to hear their own thoughts. Therapeutic communication with a Schizophrenia patient - Voicing Doubt - Making observation - Present reality - Offering self - Building trust - Giving a broad opening Therapeutic communication with a bipolar patient Depressive Phase - Giving broad openings - Making observation - Attempting to translate into feelings - Integrating the existence of an external source of power - Probing for an answer - Restating - Offering self Manic Phase - Voicing doubt - Presenting reality - Active listening ➢ Sit Squarely facing client ➢ Open posture ➢ Lean forward ➢ Establish eye contact ➢ Relaxed - Accepting and Restating Health care Delivery Teams Collaborative practice - Aging population - Health work force - Chronic disease - Shift from cue oriented to holistic approach - Informed educated clients patients and consumers Interprofessional Practice - Inconsistent use of terminology - Two or more professions working together as a team with a common purpose, commitment and mutual respect - Main element is one of collaboration between professionals and other workers Collaborative practice - when multiple health workers from different professional backgrounds provide comprehensive services by working with patients, their families, cares to deliver the highest quality of care across settings. Benefits: Consumers/patients - Reducing confusion - Better orientation of care - Only have to tell your story once Health professions - Level of satisfaction - New level of skills - Higher commitment Health care Organisation - If you have happy staff and patients you have a happy organisation - Longer length in staff (financial benefit) Government - Economics Multidisciplinary teams A team of professionals including representatives of different disciplines who coordinated the contributions of each profession which are not considered to overlap, in order to improve patient care - Centre is the patient and health professionals may be OT, social worker, nurse, Physio, GP, speech path. Boundaries: - GP deals with the referral - Occasional case conference for an opportunity - Create confusion for patients - Interdisciplinary teams (interprofessional teams) A group of health cares professionals from diverse fields who work in a coordinated fashion toward a common goal for the patient. Transdisplinary team - A team composed of members of a number of different professions cooperating across disciplines to improve patient care through practice and research. - Early childhood intervention - Roles of individuals team members blurred - Team members take on roles of other professionals in the team - requires up skilling and training - Encourages exchange of information, knowledge and skills ➢ A child with a speech disorder in a rural area, Possibly have to teach a family member on training if it needs to happen on a daily basis. Summary - Interprofessional practice is common feature of the health and human services work place. - Collaborative practice may be a better way of conceptualizing interprofessional practice - Benefits of collaborative interprofessional practice for clients/ consumers/ patients, their families, cares, professionals, organisations and government. - Three collaborative team models commonly observed in health and human service practice - Multi, Trans, Inter Clinical Decision making/ Reasoning Critical reasoning and thinking are processes that we use in our everyday lives to problem solve. Clinical Reasoning enables health professionals to diagnosis the strengths and needs of people in their care. In order to plan and implement therapies that help each person to attain and maintain and promote their individual optimal bio psychosocial functioning. Elements of Clinical Reasoning - Interpretation of data - Meaning of data - Identify and draw conclusions - Planning of individised care (culture to be considered) Clinical reasoning is the thinking that underpins health professionals decision making. Important things to consider: - Keep an open mind - Be aware of your own biases - Do not rush through the process - This is an ongoing process - Identify your own learning needs - Build your own knowledge base that continues to build - Patient understanding - Cultural awareness Clinical Reasoning Cycle Phase 1:Consider the patient situation ̶ Describe the facts, context, objects or people Phase 2: Collection of Cues/information ̶ Review current information(analyse data to come to an understanding) ̶ Gather new information(subjective/objective data) ̶ Recall knowledge(physiology/pathophysiology etc) Phase 3: Process information ̶ Interpret (analyse the data to come to an understanding to come to an understanding, abnormal/ normal, what does it mean?) ̶ Discriminate (relevant from irrelevant, narrow down information to what is important) ̶ Relate (discover patterns, cluster the cues, discover relationships in them) ̶ Infer (make deductions, logical interpretation of the data) ̶ Match (previous experience) ̶ Predict (an outcome) Phase 4: Identify the problem or issue ̶ Synthesize facts to make a definitive diagnosis Phase 5: Establish goals ̶ Describe what you want to happen, a desired outcome, timeframe Phase 6: Take action ̶ Select a course of action between different alternatives available Phase 7: Evaluate ̶ The effectiveness of the outcomes and actions Phase 8: Reflect ̶ What have you learnt from this process/ what would you have done differently? Eight Phases of the clinical Reasoning Cycle Models of health / Health care systems The Australian Health Care System Models of health care Welfare state model - Health is social right for all citizens - Free to all, regardless of income - Tax funded health care - E.g. national heath service (NHS) in UK. Market Model - Individual pay for health care - Individuals rights to freedom of choice take precedence over government intervention - E.g. USA, (Obama care reforms - shifting us to welfare state model) Australia = Public welfare and private market Medicare - Compulsory, universal, health insurance scheme - Equal access for all Australians - Financed through taxation, the Medicare levy, if you earn more then you pay Public Hospital Funding - Hospitals managed by state and territory government - 40-50% of costs covered by commonwealth government, states and territories provide the balance Direct payment to primary care services - Essentially contrasts out the provision of services to health professionals to minimize cost to the consumer - E.g. payments to GPS, medical specialists, allied health professionals and nurses Government provision of health care services Commonwealth - Medical practitioner services - Some optometrists procedures - Limited allied health under direction of a GP - Medicare locals, regional networks of primary medical services - Pharmaceutical benefits scheme (PBS) co-payment scheme between commonwealth and patient - Department of Victorians Affair, private health services for war veterans Public Hospital - Historically, public hospitals acute care - Continuum of care - Free medical and surgery care for acute patients - Patients, inpatients (admitted to a bed) and out patients (non-admitted) - Length of stay, same day or multiple days - Can admit private patients, charged for their care by hospital and doctor. E.g. over sea student - Current reforms, local hospital network or more connected public hospitals in terms of function or geographical location Private Sector - Aim is to reduce demand/ pressure on public health services - Private health insurance - Individual can pay for private insurance in addition to Medicare levy - Health insurance premiums set no variation regardless of health statues - Higher rate if you join a fund after 30 years of age - Usually access quicker (elective surgery) mental health, choice of doctor, chance of hospital, private room, - Access additional health care services unavailable under Medicare e.g. dental appropriate, orthotics. Summary - Both policy and private sectors - Funding for public health care comes from commonwealth, states and territories - Services provision at each level of government - Public hospitals provide free health to those in need - Public hospitals struggle with demand increased waiting times for elective, non-urgent surgery. - Private health insurance aims to reduce demand on public health services - Australian health care system has undergone and continues to undergo significant reform. Aging Dementia Definition Dementia is a general term or a decline in mental ability severe enough to interfere with daily life. Symptoms of Dementia - Memory - Communication and language - Ability to focus and pay attention - Reasoning and judgments - Visual perception Symptoms - Remembering newly learned information - Disorientation - Mood and behaviour changes - Deepening confusion about events - Behaviour changes - Difficulty speaking - Swallowing - Walking Management of health - Health literacy - Medication management - Healthy Eating - Physical Activity - Falls prevention - Alcohol and tobacco (Risk Factor) - Participation - Environments that improve health - Health and older people For older Australians, the main causes of death are heart disease, stroke and cancer. Dementia is the main contributor to burden of disease for people over 85 years (the gap between the population's current health status and the ideal where everyone lives free of disability until the life expectancy age) [14]. Improving care for older people, A policy for Health Services Many Residential Aged Care Facilities undertake case conferences regarding their residents as a way of developing a suitable care plan that is relevant to the needs and goals of the resident. As a family member or loved one of an older person within an Aged Care Facility you are entitled to attend the case conference to discuss any issues and to help develop a plan of care (Melbourne General Practice Network Inc., 2012). Case conference What is a Case conference? Many Residential Aged Care Facilities undertake case conferences regarding their residents as a way of developing a suitable care plan that is relevant to the needs and goals of the resident. As a family member or loved one of an older person within an Aged Care Facility you are entitled to attend the case conference to discuss any issues and to help develop a plan of care (Melbourne General Practice Network Inc., 2012). What Will We Talk About at the Case Conference and How Long Will it Take? A case conference should take between 15 and 30 minutes, however it can sometimes take longer than this depending on what the staff, your loved one or yourself have to discuss (Monash Division, 2012). Every Aged Care Facility will conduct their case conferencing differently, however I have found the following common things discussed at most of the Facilities in which I have worked: The Residents health history and identified needs (e.g. nutrition, toileting, falls, behaviour, mobility). Outcomes and goals that staff, resident and family/friend wish to achieve. Any issues or concerns. Medications that the resident is taking. Who Will Be at the Case Conference? This will also differ between facilities. The case conference will usually be held by a member of management (e.g. DON, Care Manager, Care Coordinator) and/or a Registered or Enrolled Nurse. It may also involve: Care staff General Practitioner Diversional Therapists Physiotherapy Aids Physiotherapists Other members of the Allied Health team (e.g. Podiatrist, Occupational Therapist, Pharmacist, etc.) If there is a certain member of the care team that you would like to attend the conference, make sure to contact the facility prior to the case conference and discuss your wishes with them. What are the Benefits of a Case Conference? - The Western Melbourne Division of General Practice identified many benefits of case conferences, including: - Improved care for the Resident that is focused on their wishes and needs. - Better compliance with care as the Resident gains a better understanding of their care. Increased team effort within the Facility with a higher standard of care. Family and/or friends gain a greater understanding of their loved ones needs. Relatives can feel more involved in their loved ones care. - Better relationship between relatives and staff. - Staff can use the information to input into the Aged Care Funding Instrument (ACFI). - Staff can gain a better understanding of the Residents care plan. Models of illness Klein man`s Explanatory Model "Eliciting the patients (explanatory) model gives the physician knowledge of the beliefs the patient holds about his illness, the personal and social meaning he attaches to his disorder, his expectations about what will happen to him and what the doctor will do, and his own therapeutic goals. Kleinman`s Questions - What do you think has caused your problem? - Why do you think it start when it did? - What do you think your sickness does to you? How does it work? - How severe is your sickness? Will have short or long course? - What kind treatment do you think you should receive? - What are the most important results you hope to receive from this treatment? - What are the chief problems your sickness has caused for you? - What do you fear most about your sickness? Cross cultural Framework 1. Explore the patients/ clients perspective 2. Explain your perspective 3. Acknowledge the difference in opinion 4. Create common ground 5. Settle on a mutually acceptable plan Why is culture important? - Health care is not one size fits all - There are many causes of health inequalities - individual behaviours, provider knowledge and attitudes, organisation of the health care system, and societal and cultural values. - Every ethnic group has its own perspectives and values and many have health beliefs and practices that are different to those of traditional western culture. Many health care providers expect patients to conform to mainstream values. Such expectations create barriers, which are further compounded by language and education differences between patients and providers from different backgrounds. Culture influences health beliefs Illness is culturally shaped in the sense that how we perceive, experience and cope with disease is based on our explanations of sickness, explanations specific to the social positions we occupy and systems of meaning we employ. Culture can influence patients - Attitudes about health care - Ability to understand, manage and cope with illness - Ability to understand a diagnosis and the consequences of medical treatment - Expectations of their roles and the roles of their carer and family - Desire to know about their illness and treatment and how much - Coping and managing with death and dying - Bereavement preferences and patterns - Processes for decision making Culture can also influence providers, identity, health beliefs and behaviours - Our own providers culture and the cultures of the organisations under which we work can influence and shape our interactions with the patient - It is important health care providers have a greater appreciation for cultural differences Cultural Assumption and Stereotyping Generalisationis looking at the tendencies of a majority of people in a cultural group, their values, beliefs and tendency to engage in certain patterns of behaviour, and making generalisations about individual behaviour based on group patterns. Stereotyping automatically applies generalisation to every person in the cultural group, or making generalisations about the group based on the behaviour of only a few individuals. Variations exist within cultures - Cultures influence by geography, history, politics etc. - Beliefs and behaviours within the same culture are also shaped by experiences, circumstances and relationships - It is important to have a general understanding of different cultures, but it is even more important to realize that there are varying beliefs and practices even with a culture Cultural sensitivity - An attitude of openness, acceptance and non-judgmental Effective communication within culture - Negotiate medical treatments and managements with sensitivity - Pay close attention to body language, response, and expressions - Learn to listen and ask patients and careers open ended questions to gain more information - Involve families of patients and other health providers Explanatory models "Explanatory models are notions that patients, families and practitioners have about a specific illness episode. These informal descriptions of what an illness is about have enormous clinical significance, to ignore them are fatal". Klein man`s Explanatory Model "Eliciting the patients (explanatory) model gives the physician knowledge of the beliefs the patient holds about his illness, the personal and social meaning he attaches to his disorder, his expectations about what will happen to him and what the doctor will do, and his own therapeutic goals. Cross cultural Framework 6. Explore the patients/ clients perspective 7. Explain your perspective 8. Acknowledge the difference in opinion 9. Create common ground 10. Settle on a mutually acceptable plan Closing the Loop- show me or teach back Suggested approaches include: - I want to be sure that I explained your medication clearly. Can you tell me how you are going to take this medication? - We covered a lot today about your diabetes, and I want to make sure that I explained things clearly. So lets review what we discussed. What are three strategies that will help you control your diabetes? - What are you going to do when you get home?

Health literacy as empowerment

understanding rights as a patient, navigating the health care system as informed consumers improving overall health through politics and social engagement.

7 Learning styles

visual, Aural, physical, logical, social, solitary

how to know if evidence has quality

who has written it is there a reference list what people said about them what systems do they use