STRAND 2 – SEMESTER 1

LIFE SPAN

Describe the psychological and sociological perspectives to health and illness

a) health and illness behaviour

b) the cause of illness and disease
c) response to disease and treatment

Pregnancy and childbirth

State the key points of the Barker Hypothesis, discuss the evidence for it and
explain its relevance for health and social policy

Under nutrition at “critical points” effect the body in ways that translate to pathology
in later life. Oxygen critical – slows cell division if not – birth size as marker.

-undernourished mothers –thin babies

-overweight motheres – high CDH case babies

Describe current fertility trends and how these have changed over time

Fewer women are having children

Women are having fewer number of children in family’s
The age of having children from women is increasing.

Provide a brief historical account of changing birthing practices

Technology is increasing, giving women more options. As of 1920 there are

interventions. Women have feelings on the nature of abortion, tests and risks involved.

Short stays in hospital

As of 1960 sharp increase in hospital births
Changed into having “units” of childbirth care at hospitals.

Medicalisation of childbirth has resulted in fewer inductions of forceps aided delivery.

Reflect on the advantages and disadvantages of hospital and home births

Advantages of Home birth – eat what you want, drink what you want, home comfort,
less intervention, don’t like control of hospitals, can have whoever you want there
with you, feel more comfortable with pain and less embarrassment in home.

Disadvantages – If something goes wrong then longer wait until seen by a specialist in
the hospital which can mean the life and death of a newborn. “Doctors know best”.
Safer under technological intervention. Can learn skills such as breast feeding within
a controlled environment.

Understand the experiences and views of woman in relation to childbirth

Women in general tend to believe meetings and talks about childbirth in a hospital
environment to be fragmented and impersonal. Therefore good relationship and
continuity are important.

Reflect on how health services can meet diverse needs

Important for care to be individualised and personal. Each doctor should be told
personal information about the woman and be able to have a continuity of personal
care. Protocols should also be shared across the different groups which will be dealing
with the woman.

Infancy and childhood

Discuss the factors that contribute to infant and early childhood health and
illness, with particular reference to ‘infant bonding’ and ‘breast feeding’

Wealth
Nutrition improvement
Living conditions
Vaccines and Sanitation
NHS
Women have access to more information
Medical advances

Bonding is important – for it can cause the child to grow poorly in the emotional
development and cognitive development (for example women suffering strongly from
post-natal depression show more negate towards the child and care more about their
own feelings and experience)

With lack of ‘warmth’ / Inconsistent and harsh discipline and poor supervision appear
to be responsible for about 30-40% of anti-social behaviour cases. More likely to turn
to drugs. More likely to develop illness in later life.

Breast feeding – promotes early neuro-intestinal development. Avoids antigens in cow

milk which can cause viral infections, diarrhoea and diabetes. Lower blood pressure.
Early solid feeding associated with obesity and CHD.
Discuss the relationship between poor health in infancy/early childhood and risks
of poorer health and/or premature death in later life

Poor health in infancy can relate to poor health in later life. This is because of picking
up bad habits such as smoking, permanently damaging liver from alcohol abuse. Poor
health usually related to being in a lower working class, less money to use on
education and health. Child brought up into same environment and ends up
“following the parents footsteps” and can end in similar conditions and illness.

Discuss the role of parental support during infancy and early childhood

Psychological support encouraged. Help teach education, skills, manners which can
take with them for entire life. Help from feeling of anxiousness, hopelessness and
depression, stop them turning to violence and anti-social behaviour to run away from
their problems.

Discuss the main causes of ill-health and death in children in Britain

Road Traffic accidents

Bronchi related diseases
Measles
TB

Discuss the reasons why some children are more at risk of accidents and
respiratory illness

Passive parental smokers

Less safety places for children to play (poverty)

Discuss the evidence that ill-health in childhood is associated with increase risk
of chronic illness and/or premature death in later life

Studies have shown that children brought up in poverty continue to develop diseases
and live in similar conditions and life styles. Develop diseases which are not kept in
check and end in poverty.

Youth and adulthood

Characterise adolescence as a particular phase in the life-span

Adolescence is not a disease but a stage. It is not always characterised by rebellion

and alienation but is a stage of risk taking behaviour and experimentation of young
people.
Describe the health of young people and their health care needs

Healthiest of all the age groups. Likely care required in sectors of long term diseases
such as asthma and so people at this age can learn how to best deal with and live with
their chronic illness. Happiness a huge factor to concentrate on.

Understand risk-taking behaviour and its consequences, with particular

reference to teenage pregnancy

Adolescents at the stage of experimentation and risk taking behaviour. Usually

because of ignorance or trying to control own path. For example with sexual health
and not wanting to use a condom because you prefer not to. Ignorance and the feeling
of invincibility, thinking it won’t happen to them. Usually takes something to happen
to them or someone close to realise. Unable to see the consequences. Usually results
from poor education.

Reflect on how health professionals might best meet the health care needs of
young people

Ensure information is clear, promote bonds with family, friends and teachers, be sure
to make adolescents aware of the dangers involved in different behaviours during
consultation. Need to be able to reach out on the adolescents level and keep up to date
with adolescent culture in order to relate.

Discuss the psych-social factors that constitute to ill-health and premature death
in adulthood

Martial status, relationships, sexual activity and reproduction, caring responsibilities,

living conditions and life style. The work / life balance.

Discuss the psycho-social factors associated with mental ill-health in men and
woman

Begins usually as mental health problem and progresses to mental illness. Factors are
complex and very personal and relate to sex, ethnic origin and life conditions.
Bereavement and chronic unhappiness are factors. As a child or young adult being
bullied or under cared for can result in mental ill health. Depression is the largest.
Many working days lost. Many people suffer. From being mistreated, abuses or made
to feel worthless. Effects immune system directly, is a symptom for many diseases,
can be the cause also. More likely to be single or lonely. From lower social class,
lower intelligence.

Individual factors – prenatal brain damage. Prematurely, insecure, low IQ.

Family factors – poor bonds with family, teenage mother or single parent.
School – rejection, failure, bullying
Life events – rape, death, divorce, unemployment, homeless
Community – racism, isolation, lack of services, crime and disorder.
 Ageing

Discuss the social and demographic changes in society that affect people’s
experiences of growing old and the types of support that they need

Life expectancy is increasing and birth rate is decreasing. Therefore we are being
plunged into a society of an ageing population. With medical advancements and
technology, it’s being sought that growing old is not as bad as once thought, with the
care being made more available to compensate for the larger numbers of elderly
people. More population at this age group means more money to be put in by the
government.

Discuss the particular difficulties involved in maintaining health in old age

Loneliness, lack of social interaction – resulting in mental health problems.

Transport difficulties and lack of facilities to accommodate also responsible for
depression and feeling of worthlessness and nobody caring.
Biologically the body needs more care and higher requirements to remain healthy
which cannot always be afforded on a pension which is increasingly becoming
smaller and more difficult to live off.

Dying and Death

Discuss the demography of dying and death in Britain

More people dying in hospitals, increased by over 50% in the last 100 years. People
living till older ages with increase in medical care.

Discuss the setting in which different types of dying and deaths take place and
the implications of care

Discuss the changes in attitudes to death, dying and bereavement in British

society

More of a ‘taboo’ subject. Less familiarity of death in society since smaller families,
greater health care so people usually not exposed to death until older, also dying is a
far slower process which can lead to uncertainty.

Discuss the psychological issues involved in dying and bereavement

Types of awareness – Closed / Suspected / Mutual Awareness / Open

5 stages – Denial, Anger, Bargaining, Depression, Acceptance.

Anxieties include – inability to breath, pain and self competence and dignity.
Bereavement stages – Numbness / yearning / despair / reorganisation

Accepting reality of loss

Working through pain
Adjusting to environment
Moving on with life.

Problems with grief

Delayed grief
Chronic grief
Masked grief
Exaggerated grief

Discuss the issues in appropriate care and support for dying people and their
family, relatives and friends

To know when death is coming, to be given chance to prepare, have control of who to
be with, and who to have the chance to say goodbye to.

Have access to information and expertise, along with emotional and spiritual support.

To have control of pain and privacy. Be able to leave a will.

Most important word and ongoing trait, is to have control.

MEDICAL ETHICS

Outline the basic principles of medical ethics and methods of moral enquiry

Two forms of ethical argument

Deontological and Teleological

Deontological – Logic of duties – what is right

Teleological – Base on final outcome, greatest amount of happiness.

4 basic principles – Beneficence, Non-maleficence, Patient Autonomy, Justice

Think for yourself / Think from the standpoint of others / Decide consistantly
Discuss professional responsibility, with reference to working with patients and
the human body

Examine examples of moral dilemmas in medical practice

Consent and Confidentiality

Discuss professional responsibility with particular reference to consent and

confidentiality

It is important for the doctor to act in the best interest of the patient at all times. A
doctor must inform the public if it will danger them, but otherwise is under strict
responsibility to maintain a patient confidence at all times.

Examine the relationship between consent and decision-making capacity at

different stages of the life-cycle

Younger than 16 – only if gillick competent

16 and above in Scotland old enough to employ their own decisions on treatment

Parents or guardians can make choices as long as it’s in the best interest of child

If they are either unable to understand, believe, process the information, then they are
not deemed competent to make the decision. In particular the ability to keep a hold of
the information and make a decision.

Describe the medico-legal aspects of consent and confidentiality and discuss the
practical implication for clinical care, treatment and patient/doctor
communication with special reference to the following –
Children and adolescence
Mental health and old age

Children usually the parents are told, but under certain circumstances if Gillick
Competent then no information has to be disclosed.

With a mental health patient, then the doctor must act in the best interests, taking into
account family wishes, past experiences and information from a carer if possible if the
patient themselves is unable to satisfactorily destroy their case. Old age patients are
often asked a 2nd opinion as well to ensure they are clear on the procedures. It is
absolutely necessary to have consent before an operation but also for research
purposes or for using patient information in evidence surveys.
 Termination of pregnancy

Discuss the clinical, legal and ethical aspects of termination of pregnancy

Clinically if it will impose greater risk upon the mother with the baby being born, than
if it were aborted. This covers mental health and physical health. Also if the baby will
have a high enough chance that it will be severely handicapped it’s clinically thought
right.

Legally has to be before 24 weeks, doctor has to act in good faith and must have a
doctors 2nd opinion. However in an emergency the doctor does not need a 2nd opinion.

If you feel strongly about the matter, you must send them to a colleague for advice. A
doctor does not have to participate in the abortion process if they feel strongly against.

Ethics revolved again – moral rights of fetus, women’s reproductive rights,

responsibilities to existing children and world populous.

Neonate

Discuss the clinical, legal and ethical aspects of decision-making regarding

neonates

Babies with most concern – extremely premature, serious congenital abnormality,

babies who receive injury during or just after birth.

Clinical framework for withholding treatment to neonates –

Brain dead child

Vegetative state child
The ‘no chance’ child
The ‘no point’ child
The ‘unbearable’ situation

Who takes part in the decision making process

Health Care Team

Doctors
Parents
Religious or Spiritual advisors
Courts
Social workers

The double effect – increasing a course of action to relieve pain and suffering,
understanding that the consequence is to hasten death.

Ethically – minimise child suffering, maximise family interaction, ensure all decisions
and consent is in writing. (legal)
 Children and adolescents

Describe the medico-legal aspects of consent and confidentiality with special

reference to children and adolescents

Gillick competent children – i.e under 16 in Scotland but over 12 are thought to have
formation of their own opinions on what happens to them. In E&W they ought to be
listened to but not given full control. Parental consent often sought for but not always
required. Always act in the appropriate manner to save a child’s life or to prevent
serious harm. The child’s health is paramount. Involve the courts if the parents do not
give their consent for something the medical practice believe to be in the child’s best
interest.

Discuss the practical implications for clinical care and treatment and
patient/doctor communication

Ensuring the child understands, believes and remembers the information in order to
judicate a decision in their best interests.

Mental health and Old Age

Describe the medico-legal aspects of consent and confidentiality with special

reference to mental health and old age

Someone is thought to be incompetent if they are incapable to act, make the decision,
understand the decision remember the decision or communicate the decision. Under
these circumstances a family member can be discussed with to make the decision and
also now in Scotland a “Proxy” decider can make the decision as long as it’s in the
patients best interest, and goes as far as possible with what others would also agree
on.

Examine the practical implications for clinical care and treatment and
patient/doctor communication

Terminal Illness

Explain the different kinds of medico-moral questions raised in the care of

terminally ill patients

Moral to allow someone to continue to suffer? Fear that right to request becomes
obligation to request, voluntary becomes non-voluntary. Is it just that a few must
suffer greatly for the purpose of the general society ruling.
Discuss the moral arguments related to euthanasia, acts and omissions, double
effect, and advance statements and examine the practical implications for clinical
care, treatment and patient/doctor communication

Double Effect – death as a side effect, not as a mean to end pain.

Advanced Directive – Decision was required for the set case, was competent, not
forced, was informed correctly.

Medical research

Describe and discuss the ethical principles associated with conducting

medical/health service research

Research most ethical under equipoise. Only should be undertaken if the question of
results are for the betterment of the population. Population undertaking said research
should be aware of side effects, benefits of participating AND not participating and
have access to all available comprehensive knowledge on the study and research to be
taken.

Describe the process and issues to be considered when applying for ethical
approval for medical/health service research
 KEY PSYCHO-SOCIAL CONCEPTS/HEALTH AND ILLNESS IN THE
COMMUNITY

Health and illness

Define the terms: health, illness, disease

Health is different for many people. But the basic given definition is state of being in
good physical health but also mentally and socially sound. Not just the absence of
disease and illness.

Health is what people make of it however.

Disease is a medical condition of abnormal pathology diagnosed by history taking and

diagnosis.

Illness is by definition problems related to health.

Describe the ways of measuring health, illness and disease and their limitations
with particular reference to health and illness in Edinburgh, Scotland and the
UK

Expectation of Life
Quality of Life
Birth and Death Rates

In Scotland it’s worse for Lung cancer and CHD.

Social class and poverty

Describe the relationship between social class and health

Artefact – the different observed can be explained by how the concepts of social class
and health are measured. This may inflate or mask differences.

Social selection – where ones health status may determine ones social class through
social mobility especially due to ill-health

Behavioural/cultural – health damaging or health promoting behaviours are

differentially associated with social class, resulting in social class position causing
good or poor health.

Material – material circumstances, such as poor housing, poor work conditions and
bad environments account for social class differences in health.

Low social class – low health – Inverse Care Law.

Understand how social circumstances influence health and life chances

Less money from income, less affordable area, less doctors. Less money to spend on
health products, less money for education, for sports, for holidays.

Consider some of the difficulties involved in measuring social class

Artefact

Illness can render your employment chances useless, so you can lose your job. Yet
still be in a socially predictable situation. Women working a lot more.

Understand the experience of those living in poverty

Discuss the importance of psycho-social factors, in particular poverty, in the

accumulation of risk factors for ill-health and premature death throughout the
life-course

Reflect on the implications for health care policy, medical practice and health
professionals

Families and Gender

Describe the demographic trends and the diversity in Scotland’s families

Many more single parents, and diverse family trees than before since divorce and
remarriage is more common.

Explore how important the family is in health maintenance

Family is important as a structure to maintain health. Especially proven for men.

Describe and discuss the different health experiences of men and women at
different ages

Reflect on changing gender roles

Women getting into employment more, men helping with children

Consider the implications of this topic for medical practice

 Risk and Screening

Describe how screening programmes have developed

Describe and discuss the aims and objectives of screening

Appraise the ethical issues associated with screening

Consider the different ways in which risk is perceived by different people

Reflect on the role of preventative medicine in modern health care system

Deciding to consult and consulting a doctor

Discuss the psycho-social factors that influence whether or not someone decides
to consult a doctor, with particular reference to pregnant women and parents
with a sick child

Discuss the personal relationship and organisation factors that affect the process
and outcome of the consultation

Describe and analyse patients compliance and discuss the value of the concept of
concordance

Discuss the place of placebos in clinical practice

Complementary medicine

Define Complementary and Alternative Medicine

Outline the main CAM therapies

Describe and discuss the reasons for using CAM therapies

Consider how complementary medicine fits with and relates to orthodox

medicine

Research

Describe the main features of conducting qualitative research