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- listen to pateints and respond to their needs and preferences
- give pateints the information they want or need in a way they can understand
- respect pateints' right to reach decisions with you about teir treatment and care
- support patients in caring for themselves to improve and maintain their health
- take patients views into account when assessing condition
- encourage patients who have knowledge about their condition to use this when they are making decisions about their care

mobility
manual dexterity
phyical co-ordination
continence
ability to lift, carry or move things everyday
sppech or hearing
memory or ability to concentrate learn or unerstand
understanding the risk of physical danger

an alowance paid if someone under 65 years has needed help for more then 3 month and is likely to need it for at least another six months cebause of a severe physical or mental illness or disablity

two components: care component (paid if you need looking after)and mobility component

care component:
highest rate: 70 pound
(you need help or supervision thoughout the day and druing the night)

middle rate: 47 pound
(if you need help with personal care frequentlz of supervision continually thougout the day only or help with personal care or someone to wathc over you during the night or someone while you are on dialysis )

lowest rate: 18 pound
( if you need help or supervision for some of the day or you are unable to prepare a cooked meal)

mobiliy rate: higher rate 49 pound
(if zou have anz of the other more severe walking difficulies)
lower rate 18 pound
(if you ned guidance of supervision out of doors)

-it is paid if you have a mental or physical disability or both
-your disabiity is severe enough for yo to need help caring for yourself
- you are aged over 65 or 65 when you claim it

rates ofr ir for moare than 6 months
highrer rate: 70 pound
lower arte: 47 pound

- taxable benefit for infomal carers  (over 16) who spend at lwast 36 hours a week caring for a person wo gets either
- attendendace allowance
- disbailiy allowance (at middle or higher rate)
- it is not affected by savings but maz affect other benefits
- claimant must earn less than 95 pound per week and bi in ful time education
- rate is 53 pound

- affirm life and regard dying as a normal process
- provide relief form pain and other distressing symptoms
- integrate the psychological and spiritual aspects
- offer a suport system to help pateints
- offer support stystem to help familz to cope during lillness

individual must be able to:
understand the information relvant to the decision

retain this information

use or weigh this information to reach a decision

communicate the decision

older ppatient
complex problems
undergoing vascular cardiothoracic and neurosurgery
emergency rooms
looked after by inexperienced staff

skin burned after operation
delay in cancer diagnosis
bleeding form penis after catheter removed without deflating the ballon
spleen torn during operation
patient addicted to painkillers

leads to longer hospital stays

skill based error
- aka slips and lapses, break in routine, attention diverted

rule based error
- mistake
familar problem but wrong solution

knowledge-based error
- novel situation, no pre-programmend soluation

violation
- deliberate deivations form procedute
may be routine, reasoned, or reckless

predisposing factors
- delazs, rudeness, inattentiveness,
no explanation, no apology, apathy, percieved lack of caring

precipitating factors
the incident itself

there are normaly barriers and defences. in anz risk situation have holes in them, most of the time the holes not not align and a chain of events is stopped. form time to time the holes align.. swiss cheese.

error
an inuntended act or one that does not achiece its intended outcome

patient safetz incident
anz uninteded or unexpected indident which could have or did lead to harm for one or more paitends

latent faoilure
i.e. an accident waiting to happen

acite failure
human error, then icidnet

ensure patients well being
establish what went wrong and whz
identify system failure and report them
recognise personal factors
talk it over iwth a trusted colleuge
express sincere regret
share feelings with pateint

an acknowledgement of the wrong done
accepting responsibilyt for the offence and the harm done
a clear explanation as to why the offence happened
expressing sincere regret
as asssurance that the offence will not be repeated
making amends

“Where there are threats of serious or irreversible damage, lack of full scientific certainty shall not be used as a reason for postponing cost-effective measures to prevent environmental degradation.”

European Commission (2000) Communication from the Commission on the Precautionary Principle
(a) scientific assessment of risk, acknowledging uncertainties and updated in light of new evidence;
(b) fairness and consistency;
(c) consideration of costs and benefits of actions;
(d) transparency; and
(e) proportionality.

-reducing the risks of ill health that result from other people’s actions(drink-driving and smoking)
-reducing causes of ill health relating to environmental conditions (provision of clean drinking water)
-protecting and promoting the health of children and other vulnerable people;
-helping people to overcome addictions that are harmful to health or helping them to avoid unhealthy behaviours;
-ensuring that it is easy for people to lead a healthy life,
-ensuring that people have appropriate access to medical services;
-reducing unfair health inequalities.

Eliminate choice
Introduce laws that entirely eliminate choice, for example compulsory isolation of people with infectious diseases.
Restrict choice
Introduce laws that restrict the options available to people, for example, removing unhealthy ingredients from foods
Guide choice through disincentives
Introduce financial or other disincentives to influence people’s behaviour, for example, increasing taxes on cigarettes, or bringing in charging schemes to discourage car use in inner cities.
Guide choices through incentives
Introduce financial or other incentives to influence people’s behaviours, for example, offering tax-breaks on buying bicycles for travelling to work.
Guide choices through changing the default policy
For example, changing the standard side dish in a restaurant from chips to a healthier alternative, with chips remaining as an option available.
Enable choice
Help individuals to change their behaviours, for example, providing free ‘stop smoking’ programmes, building cycle lanes or providing free fruit in schools.
Provide information
Inform and educate the public, for example, campaigns to encourage people to walk more or eat five portions of fruit and vegetables a day.
Do nothing or simply monitor the current situation.

1 A minimum price of 50p per unit of alcohol sold
2 No junk food advertising in pre-watershed television
3 Ban smoking in cars with children
4 Chlamydia screening for university and college freshers
5 20 mph limit in built up areas
6 A dedicated school nurse for every secondary school
7 25% increase in cycle lanes and cycle racks by 2015
8 Compulsory and standardised front-of-pack labelling for all pre-packaged food
9 Olympic legacy to include commitment to expand and upgrade school sports facilities and playing fields across the UK
10ntroduce presumed consent for organ donation
11 Free school meals for all children under 16
12 Stop the use of transfats

34% herbal medicine, 21% aromatherapy, 17% Homoeopathy. 14% acupuncture/acupressure

2.1% massage, 1.9% osteopathy, 1.9% homoeopathy, 1.6% acupuncture


25% used vitamins/minerals, 10% herbal remedies, 5% dietary supplements, 2% traditional Chinese medicine, 5% aromatherapy

Higher income (30k +)
Post secondary education
Non-manual occupation
Female
Higher age group 36-64 years old
Region (Wales and SE  v. Midlands and North)

dissatisfaction with conventional medicine

technical field:
Lack of treatment effect;
Negative side-effects.

Interpersonal field:
Lack of hope;
Poor doctor-patient relationship.

Belief field:
Control over treatment;
Active role in coping;
Mental and spiritual factors play a role in the origins and promotion and health;
Holism and non-toxicity;
Cultural ‘creatives’
spirituality

interpersoanl field:
Increased role in treatment decisions
Personalised care;
Close relationship with practitioner.

Attraction to CAM

Many diseases are cyclical
Allergies, multiple sclerosis, arthritis and gastrointestinal problems like irritable bowel syndrome all have their ups and downs. Sufferers may seek therapy on a down, so that when an up comes that has to be due to the therapy, doesn't it. Again, only rigorous study design combats this.
Placebo effect
Both the above contribute to what is called a placebo effect. It can be seen as the natural course of things. For instance, some people need no pain relief after surgery [1], making a pre-emptive intervention which claims to reduce pain after surgery a sure win. There will always be some people publicly to declaim its value. Natural "placebo" rates depend on what the problem is and what the benefit is. There will always be some people who benefit without an intervention.
Bets are "hedged"
If a patient improves after a long period of ill-health during which they have taken CAM, CAM which get the credit whether it helped or not (or whether conventional medicine did)

The original diagnosis may be wrong
Mood improvement or cure
The intensity of many CAM interventions and time and attention paid to the patient may induce feelings of well-being.
Psychological investment in alternatives
Either as a ‘creative’ or just taking control and putting the effort into engaging with the CAM regimen

Anxiety reduction – some evidence that placebo pain-relief reduces affective but not sensory pain. However, anxiety may actually alleviate pain.

Expectation – essentially about self-efficacy such that if a patient thinks that and prepare themselves to be in control and have good outcomes from an intervention this tends to happen. Can be so powerful that can seemingly counter drug effects. (i.e. Buckman and Sabbagh (1993) who gave pregnant women an emetic having told them it was an anti-emetic for morning sickness - they reportedly felt less sick!)

Transference – a psychodynamic process of identification of the patient with the doctor and transfer of their anxiety. In some psychoanalytic models this is followed by counter-transfer in which the doctor gives the anxiety back but in manageable form

Meaning effects – combines conscious, unconscious and socio-cultural effects on expectations. Helman (2001:5) ‘The doctor’s office, hospital ward, holy shrine or house of a traditional healer can be compared to a theatre set complete with scenery, props, costumes and script. This script, derived from the culture itself
… tells them how to behave, how to experience the event and what !!to expect from it. It helps to validate the healer, and the power of their methods of healing’
Conditioning – in its classical form the linking of a stimulus, action and response such that in due course the action can be removed and the stimulus alone provokes the response.

medical model
focuses on the clinical diagnosis
on what someobe cant do
sees person as problem and needs to be fixed
medical psycholigical and rehabilitation as answer

social model
focuses on the context
people are disabled by society and not by their body
discrimination prejudice as the rpoblem

disease- impairment (symptoms and signs) - disability (activites and daily living) - handicap (social rules)

has a universal application
functioning encompasses al bodz functions activities and participation

disabilitz covers all impariments, activities , limitations or participation, restriction

protect disabled people (not just the ones with disability)
all serive providers have to take resonable steps to change their practice that would make it difficult for a disabled person to use it

a person is disabled if they have:
-a mental or phzsical impairment that has an adverse effect on their ability to carry out normal day to day activitie and the adverse effect is substantial
-the adverse effect must be long term(meaning it has lasted for 12 months or is likelz to last for 12 months or the rest of their lives)
-progressive or flunctuating conditions coveres (hiv)

- agreement between patient and health care professional respecting beliefs and wishes of patient in determining when, whether and how medicine should be taken
- - alliance in which the helath care profissional realises the importance of the patients decision making about the medication proposed to him

offer your opinion of what is going on, naming where possible
reveal the rationale for your opinion
explain the causation, seriousness, expected outcome, short and long term consequences
elicit the patients bleiefs, reactions, and concers
accept the pateints views, advocate alternative view as necessary