# data[].attributes.body
Since Bernard is known for having bad moods, he might not feel motivated to actively seek the assistance he requires. He can be going through a stage where he doesn't believe anything can make him feel better, therefore he won't take any support. He might be thinking the opposite, in which case he wouldn't require referrals because he thinks he can handle any scenario that comes his way. In addition, he is aware of smoking a lot, which his doctor had noted and repeatedly recommended him to attempt to stop. However, he might be smoking as a coping method, for example having anxiety.

He might be concerned about whether he will be able to finish the treatment regimen that has been prepared for him. He could have a session prior to treatment where he is informed of the plan to address this. This would also allow him a chance to express his worries, making him less anxious when he really begins his treatment. His concerns might be that he wouldn't have another coping mechanism or that he might go through withdrawals. We can assist Bernard with this by explaining that, depending on how long he has smoked, he may go through withdrawal symptoms, but that there are other ways to gradually stop smoking, such as nicotine patches or chewing nicotine gum. - Mohammed Zakir Khan

# data[].attributes.body
An ambulance was called when Sue discovered that Pauline’s leg was at an unusual angle after her fall. This means that a call handler would have taken the call and assigned an ambulance to assess the situation. Paramedics would then be involved in Pauline’s care before taking her into hospital. Pre-hospital checks would have been done such as observations and managing any pain before taking her into the hospital. Pauline was transferred to the local accident and emergency department where an x-ray was performed. This would mean that some nurses and a radiographer would be involved in Pauline’s care. Pauline was informed about her fracture and consented to surgery, again more nurses and doctors would have been involved in her care as well as a surgeon, an anesthesiologist who would put her to sleep and then after care from nurses after her surgery. After surgery the hospital and her GP would stay in contact, she would have a cast on to feel heal and referred to physiotherapy. Bernard has been diagnosed with COPD and has undergone two GP visits for treatment of the condition. Nurses may check on him to see if he is taking the drug and to see how he is doing.

The terminology that the paramedics and the receiving hospital staff members use could create a barrier when the paramedics transfer patients to the hospital. The hospital would have a mix of various types of doctors and nurses, indicating a breadth of knowledge/ability is present. This would also imply that there might be a difference of opinion among those in the various professions on Pauline's case and the best course of action for her recovery. Due to unawareness of Bernard's health and any planned appointments, the carers may find it difficult to collaborate with the GP. - Mohammed Zakir Khan

# data[].attributes.body
A therapeutic relationship that I have experienced was with a paramedic crew that had attended to me when I had broken my elbow and wrist. It was exactly as I had expected, the paramedics were calm, reassuring and very great to me. They behaved professionally, kept me informed and interacted with me even though I was in pain letting me know what they were doing. They were respectful of attending my home and non-judgmental delivering great care. This then influenced me to work in the same healthcare field and make someone also feel better if that includes helping them in an emergency or just having a talk. - Mohammed Zakir Khan

# data[].attributes.body
It is important to be aware that individuals in inter-professional education will come from many areas of the medical field. This indicates that the participants have a variety of expertise. One health practitioner may receive new information, while another may receive repeating information. Another difficulty is that different degrees of expertise and knowledge must be considered when providing education. As a result, not everyone will be familiar with a certain subject because it is outside of their field of expertise.

Providing education and practice presents very similar challenges. There are certain procedures that some people are prohibited from performing due to the various practice scopes. Each professional would tackle the situation in a different way depending on the standards and instructional practices used. The group would become even more disorganized as a result. Another reason is the type of terminology used which could result in a loss of effective communication within the group.

The professionals could be informed before the inter-professional education begins that different healthcare providers would approach the same scenario in different ways. The education should also cover potential training sessions for those who might need more practice before delivering to the general public since they are unfamiliar with a certain skillset. - Mohammed Zakir Khan

# data[].attributes.body
The first issue to consider when working with Kay would be communication. Both trying to express her opinions and comprehend what is being stated to her would be challenging for her. Her ability to interpret facial expressions will make it difficult for her to respond to what is spoken to her in the manner that would be expected. Due to her lack of interaction, hospital staff may assume that she is not interested in what they have to offer. Due to Kay having a set routine that she does daily, being admitted or attending the hospital could affect her routine which would have negative impact on Kay’s health and lead to an outburst or confusion. - Mohammed Zakir Khan

# data[].attributes.body
Countless individuals of vulnerable groups, such as those with mental health issues, are stigmatized as a result of social perceptions of their condition. They could encounter prejudice because people might view them as aggressive or unstable. In the past mental health was seen as a bad thing, people who had suffered from mental health were isolated, locked up and had claimed to be possessed by evil spirits. In today's society mental health is still not as talked about and people sometimes come up with assumptions regarding a person's health. Health care professionals should remain professional and act non-judgmental however, they could unconsciously bias by assuming stuff about the patient before listening to them or think that the individual may be seeking attention. - Mohammed Zakir Khan

# data[].attributes.body
Using Alzheimer's Society as a source, I think Eric is currently having signs of vascular dementia in the intermediate stages and is moving toward the latter stages. Memory loss and issues with decision-making, following directions, cognitive speed, and cognitive ability are early signs of vascular dementia. Eric is exhibiting all these signs since he struggles to remember information on quiz night, forgets to eat, and depends on Sandra to take care of him, such as housekeeping and preparing / cooking meals. Tom would be under stress from his father's vascular dementia. Tom is said to be already dealing with his mental health and alcohol abuse, which would only be made worse by the emotional strain of the severity of his father's condition and the responsibility his mother places on him to maintain her mental health. Given the many responsibilities she must handle in her life including caring for Eric, overseeing their finances, keeping up with housework, and finding time for her son. Sandra would likely feel overburdened and stressed. She consequently has little time to devote to relaxing and caring for her own mental health and wellbeing. - Mohammed Zakir Khan

# data[].attributes.body
Sandra consumes a lot of processed food because she relies on takeaways and ready meals. She'll put on a lot of weight as a result of this. Health issues like excessive cholesterol, heart disease, diabetes, high blood pressure, and several malignancies could result from this. Due to Sandra's excess weight, her joints, especially her knees, experience strain and tension, which might raise the risk of painful and progressive diseases like arthritis. Sandra could also become obese due to her diet and not eating the correct food according to the chart.

In order to help Sarah become more aware of selecting healthier foods, we can give her advice on how to eat well and possibly direct her to websites like the BDA Food Fact Sheet. If Sarah doesn't make healthy dietary adjustments, we can let her know about the probable illnesses such as diabetes, high cholesterol and strokes. We can advise Sarah to increase her activity level in order to promote weight loss. To do this, she can make easy decisions like walking to the supermarket instead of ordering food or going for walks with her son this could help her mentally and physically. - Mohammed Zakir Khan

# data[].attributes.body
What I have learnt from the BDA Food Fact Sheet is that a healthy diet is crucial for optimum health. Eating a variety of meals can enhance overall health, lower your chance of developing diseases including diabetes, osteoporosis (thin bones), heart disease, and stroke, as well as help you control your weight. To improve your health, you should eat sensibly, choose a diversified diet from a variety of foods, abstain from smoking, and stay active. What surprised me was when I was reading about saturated and unsaturated fat was that coconut oil should be avoided and that sunflower oil could be an alternative. I would have thought because coconuts are organic and natural, they would be healthier. This has broadened my knowledge and has influenced me to make a change in my diet and begin to eat more balanced foods and alternatives according to the eat well pie chart. - Mohammed Zakir Khan

# data[].attributes.body
Perspective- it's vital that we as clinicians always understand and are empathetic towards the patients perspective on the situation so as not to cause any distress and build a trusting relationship with the patient
Accessibility- as clinicians all patients should have equal accessibility to our care and resources available
Equity- all patients should receive equal care from us, and it is crucial we make sure there is no unconscious bias from us when treating patients who society may deem to be undeserving of our care
Sustainability- we should always be making sure our ways of treating patients are sustainable. This could include making sure we focus on our own wellbeing and not reaching burn out, so that we can sustain the utmost quality of care throughout shifts and our careers for every patient we meet
Education- every clinician should have equal opportunities to the same level of education within their scopes of practice so that all patients can be treated equally by any clinician that may see to them
Commination- A professional manner should be maintained by clinicians even if the patient is abusive/ rude etc. No patients level of care should deteriorate as a result of personal emotions and vengeance on the behalf of the clinician
Information- correct information should always be provided to the patient at all points of contact and treatment; informed consent should always be provided
Cultures- clinicians should respect the wishes of different cultures and try to understand patients cultural/ religious reasonings as best as they can
Context- clinicians should always provide a friendly and safe atmosphere for the patient
Workforce- the workforce should always remain professional, and no personal relationships or issues between clinicians should affect the way that patients are treated
Systems- systems within healthcare should be reviewed constantly to ensure that they work to provide adequate care to patients
Infrastructure- It's important that infrastructure is kept safe in terms of equipment so as not to cause injury to any patients. Large scale infrastructure such as roads etc must not be failing so that all patients have equal opportunities of access, especially on the road in the pre-hospital environment

# data[].attributes.body
Smoking for Bernard has been a very long term thing and so he will be struggling with addiction. The concept of having to quit will no doubt be very unnerving for him, especially as he is already struggling with his mental health- he may use smoking like many others as a relief of stress, and may be worried that his anxiety will increase if he stops. Bernard may be reluctant to start PR due to his age (80). Often, people of this age deny treatment. This can happen for many reasons, such as 'they've made it this far' without, embarrassment, or views that society engrained in them when they were younger with regards to not getting help. Bernard may be worried that due to him smoking and having COPD, that if he was to start PR, he may look silly and be less able then those who don't smoke. This may mean his anxiety increases even more, affecting his mental wellbeing. He also is used to living a sedentary lifestyle with his wife- having to leave her and go somewhere new may again be a potential factor that can increase has anxiety and lower his already decreasing mood. As he has been smoking for a long time, he may also simply not want to. Compassion and empathy, and the use of VBA will help Bernard; it will be important for him to feel like he isn't being judged and we must make sure he knows it's all his own choice, and no one is forcing him to do anything

# data[].attributes.body
Professionals that may be involved:
- District nurses, ones that particularly may specialise in respiratory issues to help monitor and aid Bernard
- Occupational therapists, to aid both Bernard and Pauline with their mobility
(Bernard due to his COPD, Pauline due to her osteoarthritis and osteoporosis)
-Paramedics- for emergency care of exacerbation of COPD or for falls and NOF's
-GPs- to monitor the progression of Bernard and his COPD, and possibly monitor the low mood
-HCA's/ nurse care assistants- to visit Bernard and Pauline, provide them with some community interaction and care, which will take the pressure off of Pauline
Communication may be a challenge when working collaboratively, especially between emergency services vs district nurses/ carers and GPs. Unless a paramedic also works in primary care, they are less likely to be aware of the social situations, or treatment of both Pauline and Bernard (especially if they don't relay the information themselves). If the carers aren't there at the time of the call, it may be harder for the healthcare professionals to communicate, as the HCAs/ nurses won't have necessarily witnessed what happened.

# data[].attributes.body
One therapeutic relationship I have witnessed was between 2 paramedics when my younger sister had a tonic clonic seizure. The relationship was exactly was I expected; they were calm and professional, with clear communication constantly between them my sister (the patient), and also all of us as a family. They were respectful with regards to the context (my house; very considerate and not annoyed by my cat etc). They also recognised my willingness to help and my knowledge at the time with regards to my sister's epilepsy, as well as my competency with this. For me this was a really lovely gesture as it meant I was involved, and I knew it would help them but also me to fully understand what was going on; I could then relay this to my family at home when my sister had been taken to hospital. Above all they were friendly and reassuring to all of us; when my sister fell into another seizure about 40 minutes later, they still acted with the utmost care for all members of my family.

# data[].attributes.body
A challenge of delivering inter-professional education may arise when it comes to testing and examination in that particular field. While giving inter-professional education from the start will provide a wider range of knowledge and resources across services, the use of inter-professionalism means that education providers may not always be 'specialised' in the particular area of education they are working in, for example if a nurse was to help educate a paramedic. Lines could get blurred and confused as practice does differ in some respects, and future practice could be affected.
When delivering inter-professional practice,  communication could be a real challenge. Similarly to inter-professional education, protocols do differ service to service. If communication is not effective between different types of practice, things are less likely to run smoothly, as people who work in different professions may get confused, or do something entirely different to what was meant to happen.
If you combined inter-professional education in the sense that services were educated at the same time with each other, then delivery of education would be more standardised. This would therefore mean that the communication would naturally improve when working together in inter-professional practice as all services were educated together and so communication pathways are less likely to be confused.

# data[].attributes.body
Kay's ASD means that she is less likely to be able to communicate properly with healthcare providers, whether this is communicating herself and how she feels, or understanding what is being said to her properly. She may take things too literally- this could lead to needing more time to process appointments, or may lead to emotional outbursts if she misunderstands something and becomes upset by it. In acute hospital settings around people who do not suffer with ASD, Kay's ASD may mean she struggles to understand the behaviours of others. She may also find it difficult to empathise with people, which could possibly lead to them being offended or upset by the way Kay presents herself and her body language, even though it is not her fault.

# data[].attributes.body
Mental illness is still a topic that very much carries a lot of stigma with it, even in today's society. Judgement is still very much passed, although as a society we are becoming more accepting of mental illness and it's existence. However, there are still lots of stigma around the regards of medication as a 'quick fix', and with the rising access to research, 'self diagnosis' is also something potentially more prevalent these days. As clinicians we are not immune to unconscious bias. While we have a duty of care, and a clinical understanding others may not, we may find ourselves considering someone more vulnerable simply because they are mentally ill. This could lead to possibly infantising the patient, and unconciously being patronising despite trying to help. More old school clinicians may aslo find it difficult with the unconscious bias purely based off of how society was when they first started vs now- they may be harsher, or overlook certain things as a result.

# data[].attributes.body
With the information given on the Alzheimer's society website, it can be argued that Eric is currently in the progression stage of vascular dementia. Early stages show symptoms such as mild memory loss (seen when Eric can't recall facts in the pub quiz like he used to be able to), and not being able to follow simple series of steps (Sandra now cooks all his meals which he still forgets to finish). However, one symptom of the progression stage is a disturbed sleeping pattern; which Eric does suffer from. Irritability and aggressive behaviour is also common in the progression stage, and the contention between Eric and Sandra over finances leads me to believe that Eric's dementia is progressing further from the early stages. This aggression is likely to be out of character for Eric, hence why Tom and Sandra are struggling to deal with it, as it's out of character form the person they once knew. Developing issues with communication can also be a sign of progression which may be why Eric is not communicating and asking for help as well as the fact he is a proud man- he is losing the ability to do so.

# data[].attributes.body
Possible health issues with Sandra's weight: Higher risk of coronary heart disease; eating over the recommended daily intake, especially from takeaway foods means her fat intake is higher. This means that the chances of plaque build up are higher, and so her chances of having a STEMI/NSTEMI are also increased.
Pickwickian syndrome: while Sandra is currently not bariatric, she is at higher risk of falling into this category as her lifestyle is not active and her diet is not healthy. She is at higher risk of developing COPD like symptoms as a result, which will give her respiratory issues in the long term.
Type 2 diabetes: Sandra is more likely to develop type 2 diabetes due to the high sugar and fat contents from her food, and her not having a balanced meal.
As a healthcare professional, we may be able to make referrals for carers, or organise voluntary care groups like community/ church groups, to once a week come and look after Eric for a few hours, so that Sandra can go and do a proper food shop, which will mean the nutritional value of her meals increase and she is actively getting exercise. These groups could also volunteer to make meals, which are better for Sandra, improving her weight.

# data[].attributes.body
From the fact sheet, I have learnt about the importance of a balanced diet. I have gathered information about the alternatives within healthy eating- for example substituting saturated fats (like butter) for unsaturated fats (like oil). Not everything needs to be fresh; tinned and frozen veg also counts towards your 5 a day. Overall my knowledge of healthy eating has now broadened, and I am better equipped to give advice on diet and lifestyle changes to patients who may need some encouragement to perhaps lose weight to help themselves and their health, which would enable them to better their wellbeing.

# data[].attributes.body
1. Some positive influences on Emma's well-being is that as she is on the ward, she has someone to talk to and Sara offers her advice and reassurance on what she found better when she had her first baby. This can positively impact Emma as she will know a bit more on what can work for her and what may not. A positive impact for Johnno is that he was on the ward with his mother after being born, this allowed him to connect with his mother after birth and get to know who she is. Some negative influences on Emma's well-being is she use to smoke until 15 weeks pregnant which can then link to negative impact on Johnno in the future with his breathing, Emma also moved away from family and friends which meant she could have felt very lonely in times of need as she could not get to her family or see them. It was also possible her past relationship involved some domestic violence which can negatively impact her mental health and self-belief that she would be a good mother. A negative impact on both could also be that Johnno's father is unemployed from the first 6 months meaning they have very little to spend from Emma's maternity income on food and clothes.
An inequality Emma and Sara have is that Sara has family around her that she can turn to as well as having a stable income both from her own job and her husbands.

2. A challenge Sara's son, Jack, may face is that due to his slower development it could mean that he has a slower brain development leading to possibly being held back in school. As well as, immunity issues due to the slow development it could mean Jack is more prone to getting infections and illnesses due to lack of immunity because it does not develop as quickly as others. Another challenge could be breathing problems, Jack had breathing problems the first 5 weeks would could possibly become an underlying issue such as asthma or a lower lung capacity.

3. Some factors in Sara and Jacks life that can help them overcome these difficulties are: Sara's family being around can help support not only Jack but also Sara's well-being e.g., making sure shes well rested and her mental health is good. This also linking in to the social determinant of social and community. Another factors that van help overcome these difficulties is money, both Sara and her husband work and have a stable income, meaning they can provide the necessary things Jack needs e.g., food and clothing. It also means that Jack will grow up in a well built area then linking to a better education as well as better health care access. These linking to economic stability, education access and quality and health care access and quality in the social determinants.

4. A paramedic may be involved with Sara and Jack in the future due to Jack being premature and having surgery at a very early stage, this could mean that he may become ill from the surgery healing e.g., he gets an infection in the site of surgery and becomes very unwell after discharge. Paramedics will be called to assess what has happened and if it needs urgent medical attention. He will also be more prone to illnesses due to having an immature immune system meaning he will not be able to detect pathogens/bacteria as well as fighting them off compared to non-premature babies. (https://www.frontiersin.org/articles/10.3389/fnins.2013.00079/full)
A paramedic may be involved in Emma and Johnno's case in the future, this could be because of financial issues Johnno may not have what Jack will e.g., lots of clothing, warmth and food. This could lead to illnesses such as chest infections, malnourished and due to coldness also pneumonia. Paramedics will be called to assess Johnno and give the correct treatment plan. They may also being called out to Johnno when he's older due to mental health, this can be due to his father being an alcoholic and suspected domestic abuse to his mother that he could witness as a child, Johnno could develop depression or anxiety towards men. Paramedics may be called out to him due to possible suicidal tendencies/attempts or they could be called out due to the father needing medical attention from alcohol poisoning/injuries from abuse. The paramedics and ourselves as student paramedics can talk to Johnno and refer him to the correct professionals e.g., social services or mental health clinics as well as referring to GP for assessment of mental health and start him on medication. As a student paramedic the most we would be able to do is talk to Johnno and offer some advice but would be up to the senior paramedics to make a finalised decision on what should happen e.g., could possibly take them to a&e for safety and call police or call police to house to investigate etc.
- Tannie

# data[].attributes.body
Overall I scored 61, this meant that I was very resilient and I am capable of being prepared for when this change or go wrong and take negative feedback onboard and act on it. I feel as I do well in adaptability as I am able to change my ways of working and attitude according to the situation at hand, as well as my social support as I am a very friendly and bubbly person that includes everyone. Personally I feel like my confidence in myself and my skills could be worked on and made better, this is so when I am executing a care plan/treatment plan I can be confident within in myself I have chosen the correct thing.- Tannie

# data[].attributes.body
Challenges of delivering inter-professional education:

There are many different professions that fall under health care, with many ways of practise. These all differ from each other but working together can help a patient to the best quality care. Each role is taught differently, and they all learn different things through this education, this requires time and patience. It requires funding which the NHS struggle on due to the number of patients and conditions seen in a day have risen rapidly in recent years, as well as requiring manpower which again has decreased over the last few years.

Challenges faced:

Some challenges faced from delivering inter-professional practice is, due to the many professions there are communication can be a big challenge. This is because each profession is taught different therefore, they will have different diagnosis, treatments, beliefs and opinions on a patient's condition compared to another profession. This can then result in the best quality of care not being reached for the patient making their condition worse or prolonging an intervention for it.

Solutions:

A solution could be to ensure not too many professions are involved with the care quality and ensuring that all professions that are involved communicate effectively not only to each other but to the patient. This is so the patient is not told different things and can be confident in the people looking after their health and well-being. Another solution could be instead of healthcare professionals having closed discussions where they tell another practitioner what they have done and think, not leaving any room for the other to offer an idea, but rather to have an open discussion with an open mind as everyone has seen different things and if they work together, they will achieve the best treatments and quality of care will increase.

# data[].attributes.body
A condition that still carries stigma is mental health. Mental health use to be seen as a bad thing and individuals were shunned out and some would even say they have been possessed by ‘evil spirits’ and ‘demons’ and would from then be avoided. It still carries a stigma today, even though it is widely known and recognised it is still looked down upon as people relate the words mental health to psychiatric facilities and strait jackets. When it really looks at a person’s mind and feelings and why they feel the way they do.

Unconscious bias by seeing a clinician for an individual is that they are seen as weak/weak minded, they will feel like they are the only person going through this, but in reality a lot of people have mental health conditions these days. They may feel looked down on by the clinician because they have gone to someone for help, it may not only feel like the clinician is looking down on them but also family/friends as they may seem ok, and this person will feel like they are the issue and wonder why it is just them. It is also labelled in young people in today's generation as ‘attention seeking’ as they do not understand the full extent of what these conditions are, and this individual will be getting help and extra time in class.

# data[].attributes.body
Health issues Sandra can face from weight issues:

It was said that Sandra and Eric eat ready meals/take out/confectionary snacks instead of a proper meal due to Sarah becoming so busy. These foods can cause issues with an individual's blood sugars and blood pressure due to the lack of necessary nutrients needed in a healthy diet. These can then cause issues with her cardiovascular system causing things such as, high cholesterol, cardio diseases, heart failure and a stroke. Not only could it affect the cardiovascular system but also the digestive system such as constipation as the intestines will not be working as they should be due to lacking in the correct nutrients.

Due to Sandra sitting down a lot as well due to driving everywhere and caring for Eric as well as before having to retire she was a secretary which includes a lot of sitting down, it can cause strain on bones as it would result in bones weakening due to lack of use. It can also cause strain because of the extra weight gained, this would cause more pressure on the bones when standing and moving. This can cause conditions such as arthritis, which is inflammation of their joints. She could also get Osteoporosis which is due to a lack of calcium for a long period of time causing the bones to become weak and brittle.

As a healthcare professional we can help support Sandra by identifying what we can change to ensure that she gets a healthier diet/lifestyle. This can also include safeguarding Eric as it would be clear she cannot look after him alone anymore, by doing this it could lead to Sandra becoming more active by going to see Eric. We can also advise Sandra how to eat healthier and inform her that what she's eating now does not contain all the nutrients she needs and point her in the direction of advice that she would be able to access such as the Eatwell Plate. We can also inform Sandra of the consequences to her health if she does not start eating healthy and become more active. We can encourage her to walk to the shops or drive to the supermarkets then do a shop and bring it back just so she is not sat down too much.

# data[].attributes.body
(1)     Are there are potential reasons as to why Bernard may not want to be willing to accept this referral?

Bernard may not be willing to accept his referral due to the fact he has been smoking for a while therefore relies on this as an escape/coping mechanism. And stopping smoking may mean he becomes more harder to care for due to the fact he will not have another coping mechanism. He may also find Pauline’s health stressful to him as he would want to look after her and ensure she is ok as he is the man in the relationship. He could have taken on the stigma of the man looks after the wife and this is how he coped with it.

(2)     What might his worries or concerns be and how might you help him to negotiate these concerns?

His worries may be that he could get withdraws from it or he would not have another coping mechanism. We can help him with this by telling Bernard that depending on how long he’s smoked he could experience withdraws but there's alternatives to slowly stop smoking such as nicotine patches, gums, sprays etc. So, this could lessen the withdraw symptoms he may have experienced. We can also suggest other healthy coping mechanisms such as gardening, cooking, painting etc. And help point him in the right direction of how to accomplish these e.g., talking to the GP of these and they can give him leaflets on what he can do.

# data[].attributes.body
(1) What professionals may be involved in Pauline's and Bernard's care?

General Practitioner (GP)- A general practitioner will be involved in both Pauline and Bernard's care. This is because Bernard has COPD that is managed by medication they would have had to prescribe, as well as managing the last 2 episodes of exacerbation he has experienced. They would be involved with Pauline's care due to her hypertension, osteoarthritis and osteoporosis; she would have been diagnosed with these through the GP and had check-ups for them.

Hearing specialist- they would be involved with Pauline’s care through the GP due to her hard of hearing and use of hearing aids.

Paramedics- they would be involved when Pauline has her fall and took her into to the accident and emergency department (A&E).

Radiographer- they would be involved due to Pauline having an x-ray carried out.

Nurse/doctor- would be involved in Pauline’s care within the hospital due to patients needing triage and then the results of the x-ray. They would have given Pauline her options on what she can do, regarding the fractured neck of femur.

Surgeon- they would be involved in Pauline’s care due to the consent she had given for the surgery.

Domiciliary carers- they may be put in place to support Bernard whilst Pauline spends time in the hospital, due to him not being independent.

(2) Identify any potential challenges to those professional working collaboratively?

The domiciliary carers may struggle to work collaboratively with the GP due to the lack of knowledge on Bernard's conditions and if he had any upcoming appointments.

# data[].attributes.body
1)      Potential reasons Bernard may not want to accept this referral is potential embarrassment in going to such classes due to stigma around smoking. Bernard also didn’t feel ready to quit smoking yet, as said in the case study, therefore he may simply not want to accept any form of help for his condition. Bernard’s anxiety may also contribute to him declining such referrals as he may feel nervous about attending pulmonary rehabilitation especially with other people.

2) Bernard might be worried about the judgement of others in the rehabilitation and to help him overcome these concerns I could remind him of the importance of such referrals and convince him that he has others supporting him. He may also feel worried as he may feel as if he is not ready to quit smoking. In such scenarios I would encourage him to utilise both behavioural supports such as stop smoking services and helplines as well as potential

# data[].attributes.body
1)      Some challenges of delivering inter-professional education could be creating one agenda or curriculum that includes the intertwined roles and responsibilities of all the working professions. Another challenge is the education being provided must take into account the various levels of knowledge and training. Therefore, not everyone will have prior understanding of certain topics as it is not in their original scope of practice.

2)      Some challenges of delivering inter-professional practice could be understanding of different terminology and communication techniques within each field. This could lead to potential miscommunication or misunderstandings in the workplace. Also, certain individual may be new to some techniques and training, so they may require more patience before doing so.

3)      Possible solution for these challenges would include delivering quality education with facts highlighting the similarities within the profession as well as focusing on building on the difference. This will ensure each profession understands why the education is important. The education being provided should also include possible training sessions for certain individuals who are new to a particular skill and require more practice before delivering to the public.

# data[].attributes.body
According to The Foundation for People with Learning Disabilities, Autistic Spectrum Disorders (ASD) present in multiple ways, for example some individuals may have difficulty in understanding and communicating with others and have a more literal use of language. This means they may not understand modern colloquial or metaphors. Many individuals also face difficulty in socialisation or empathising with others. A final symptom in ASD may be difficulty in engaging with activities outside their particular interest, and therefore have a difficulty coping with changes in their routine.

Kay may have difficulties engaging with health care providers in the community due to a potential lack of socialisation skills as a potential symptom of her ASD. This suggest that her potential difficulty in the language of others could mean she may feel confused when addressed by health care providers.

Despite healthcare providers giving health and lifestyle advice to Kay, she may not understand the meaning behind these changes and feel frustrated as she may not wanted to change her routine. This in turn may make her harder to advise as she wouldn’t want to infract from her norm.

# data[].attributes.body
According to Alzheimer’s society, I believe Eric is currently in the middle stages of vascular dementia and is progressing to the later stages due to the symptoms he is currently experiencing. Early stages of vascular dementia present as problems making decisions, following steps, speed of cognitive abilities and memory loss. Eric is experiencing all these symptoms as he is unable to recall facts at quiz night, forgets to eat meals, and relies on Sandra to care for him, for example cooking. Additionally, some symptoms led me to believe Eric is experiencing progression in this disease for example, he often wakes up at night, is experiencing frustration with certain activities and is experiencing changes in his behaviour, all of which are associated with progressive stages of vascular dementia. Sandra is feeling overwhelmed by this experience due to the impact of Eric dementia on the family. This overwhelmed feeling may also stem from her lack of personal time and managing finances, which has also put strain on her relationship with Eric. Tom is also feeling stressed, this is not only due to his father’s dementia, but also due to his own mental health, as he suffers from depression. He may also be experiencing challenges with his university workload, causing him more tension, therefore using alcohol as a coping mechanism.

# data[].attributes.body
Some risks Sandra may encounter due to her weight are chronic conditions. This is due to her increased consumption of takeaways, which are high in saturated fats and when overly consumed can cause detrimental health conditions, such as diabetes and high cholesterol. Other risk factors with gaining weight include breathlessness, joint and back pain, these are considered a risk for Sandra as she is Eric’s career and therefore caters for a majority of responsibilities in the household which may be physically depending, hence putting pressure on her health. As a healthcare professional, I would support Sandra in achieving a healthier weight primarily through education. I would explain the importance of maintaining a healthy diet and how consumption of excessive fast-food can lead to potential chronic health conditions such as diabetes. I would also encourage Sandra to take talks and try to be more mobile, for example going out to get groceries. I would also organiser a potential career to aid Eric at home whilst Sandra can also care for her own wellbeing.

# data[].attributes.body
From the fact sheet I have learnt, the importance of eating well in order to avoid the risk of chronic conditions such as diabetes and cancer. It has also explained the difference between saturated and non-saturated fats, which enabled me to gain a deeper understanding between the two, as well as understand how using alternative products can help maintain a healthy lifestyle by for example, lowering cholesterol levels.  Something that may seem surprising to many people is eating fish twice a week, however majority of people will already have knowledge of this from previous education however lifestyle and background may influence food choices and diets.

# data[].attributes.body
Sandra is Eric’s carer, due to his vascular dementia this may initially put pressure on their relationship removing him as an outlet for Sandra to express any of her worries to due to him being private and not wanting to discuss his condition. Alongside this, her son, Tom, who she normally speaks to has begun to abuse alcohol due to his worsening depression. This puts Sandra at risk of mental health issues as she doesn’t like to leave Eric on his own so she is quite isolated with no one to talk to in a stressful situation.  There are multiple factors putting Sandra at risk of obesity, due to convenience she has begun to rely more on microwave/takeaway meals for both her and Eric. Due to her caring for Eric, she doesn’t have enough time for exercise and drives everywhere in order to save time. Sandra also shops online as she doesn’t have enough time to shop in person where this could potentially be a source of exercise as she would be walking around. Due to her eating an increased amount of food which is often unhealthy, and lack of exercise Sandra would be at risk of obesity. Obesity is associated with multiple life-threatening diseases including diabetes, heart disease, stroke and some types of cancer for example. Health care professionals can support Sandra in multiple ways. First it is clear that Sandra cannot manage Eric’s condition on her own so its important that a safeguarding referral is put in place for home carers to help Eric which gives some free time for Sandra. The extra help provided by carers will allow Sandra to have enough time to walk instead of drive allowing exercise into her diet, the extra time will also allow Sandra to cook instead of relying on ready meals meaning that shell have a healthier and more balanced diet aswell as being able to control portions more, so she doesn’t eat any excess.

# data[].attributes.body
Bernard stated that he did not feel ready to quit, because of this he hasn’t accepted the referral from the GP which would provide him with support for stopping. Because he doesn’t want to quit yet he might think that there would be no point in attending the support offered by his GP. Bernard may be afraid of wasting peoples time and funding for him to go and not quit so would rather not attend.

Bernard might be afraid to quit smoking due to the worries of withdrawal symptoms he may have to face on top of COPD. Due to Pauline recently falling and having surgery Bernard may be under an increased amount of stress as Pauline is his primary carer, for him smoking may be a way to alleviate stress and worry so he may be worried that quitting will make these feelings worse. When referring Bernard it would be helpful to mention that he can not only get treatment by prescription but also support. This would mean that Bernard doesn’t have to experience the tougher withdrawal symptoms and attending the referral for pulmonary rehabilitation will allow for him to become more active again as he was before his last exacerbation, this will also relieve Pauline of stress when recovering.

# data[].attributes.body
Interprofessional education may be hard to implement due to the different scopes of practice between professions. Learning content can’t be standardised as there are such different levels of knowledge between individuals working in healthcare. It may also be hard to organise interprofessional education due to lack of time and funding.

Challenges of interprofessional practice include that there may be a lack of trust between professions to get tasks done so practice doesn’t work as a team. Due to the difference in levels of authority and experience so there may be a lack of respect.

Possible solutions in order to overcome challenges of interprofessional working may be to integrate education on other professions so it is better known what is in each individual scope of practice. Everyone working in the team should be respected no matter their skillset or knowledge level, this will build trust between members.

# data[].attributes.headline
Kirsty - Helping Bernard Improve his Wellbeing 

# data[].attributes.subject
Kirsty - Helping Bernard Improve his Wellbeing 

# data[].attributes.body
Are there potential reasons as to why Bernard may not want to be willing to accept this referral?

Bernard may be reluctant to attend appointments such as to PR due to his current problems with mobility. Bernard reports not wanting to walk into town with Pauline or do exercise as they make his shortness of breath worse. This may influence him not to attend support, as the thought of getting there is unpleasant to him, even though it aims to alleviate the problem he is suffering with.

Additionally, Bernard may prefer to spend as much time as he can at home, to look after his wife Pauline who is recovering from a NOF fracture. This may make him reluctant to accept support as appointments are regular and take time that he could be using to care for his wife.

What might his worries or concerns be and how might you help him negotiate these concerns?

As Bernard is worried about leaving his wife on her own while he attends support, we can inform him that Pauline can still be looked after by health professionals such as home carers, while he is not there, to ensure her health and wellbeing is protected. If this is to no avail, we could recommend to him that he reads up about his COPD and how he can manage his shortness of breath online, so that he is better equipped to deal with it, while also being present to care for Pauline.

Additionally, if Bernard is worried about his mobility getting him to the appointments, we can advise him that there are other means of attending, such as by bus or taxi. Also, we can explain to him that the support services are there to alleviate his symptoms of breathlessness, so getting to appointments will soon become less of a problem for him as he progresses, and he will also be able to comfortably accompany his wife into town due to the help of the classes.

Would the service mentioned in the video be suitable for Bernard’s mental health concerns?

I agree that the service discussed in the video would be very beneficial for Bernard’s mental health. The service would allow him to call for professional psychologists, who can provide information about reducing anxiety and methods to brighten his mood, as well as strategies to care for his wife Pauline. This is suitable for Bernard as it means he does not have to leave the house to attend appointments, a potential strain on his COPD, and therefore may make him more likely to accept the support and utilise it regularly.

# data[].attributes.body
What professionals may be involved in Pauline and Bernard’s care?

Radiologists are responsible for X-Raying Pauline’s injury and identifying the NOF. Surgeons will be required to treat Pauline’s NOF as well as occupational therapists to assist with the recovery of her mobility. Potentially, counsellors may need to attend to Pauline if she is significantly upset by her injury. Home carers and community care nurses may then be required to verify that Pauline is recovering and managing well in her own home post-surgery.

In Bernard’s case, he may require the use of emergency health professionals such as paramedics in the case of another COPD exacerbation. Additionally, carers may need to look after him as Pauline’s surgery may prevent her from being as attentive as required.

Identify any potential challenges to these professionals working collaboratively.

High waiting times and unavailability of professionals may reduce collaboration, as they cannot work in cohesion with each other to provide adequate care for Pauline and Bernard. Additionally, differing opinions and conflicts of ideas may cause disharmony between the professionals. The way in which each professional works may cause problems, such as the use of acronyms that may mean one thing in one profession and a different thing in another. This can also cause vital information to get lost in translation as it is transferred from one professional to another.

# data[].attributes.body
How might each of the above affect the therapeutic relationship?

Perspective – if practitioners and patients have a different perspective on a disorder, way of working or communication, it may cause disharmony between them and prevent the patient from receiving the adequate care they need.

Accessibility – patients who do not have accessibility to certain services will not develop a therapeutic relationship with practitioners, and therefore not receive support.

Equity – if a practitioner considers a patient’s needs and limitations, and provides a treatment plan that acknowledges these, the therapeutic relationship between them and the patient will be significantly strong.

Sustainability – patients who understand the pressures the NHS are under and therefore are compliant with their treatment in order to reduce visits and need for NHS resources will produce a good therapeutic relationship with their practitioners.

Education & Information – practitioners who clearly and comprehensively discuss the details of the diagnosis, interventions and treatments with their patients will cause the patients to be comfortable and content with the quality of care they are receiving, and more likely to be compliant.

Commination – patients and practitioners who are unpleasant to each other will reduce the therapeutic relationship and put a strain on the care to the patient, even though the professional is to remain impartial and non-judgemental at all times.

Cultures – practitioners who do not understand a patient’s particular culture may decrease the therapeutic relationship, as patients feel they are not being treated properly and their needs are not understand. For example, Jehovah’s Witnesses are forbidden by their religion to receive blood transfusions, and so a practitioner who does not understand this or refuses to accept this would be seen as unprofessional and not understanding.

Context – the context of care can affect the therapeutic relationship between the practitioner and the patient in a multitude of ways. For example, if the professional is better versed in a condition a patient has, they may have a better therapeutic relationship with them as opposed to a patient with a condition they are less skilled at.

Workforce – a decreased workforce in the NHS can mean there is a smaller ratio of health professionals to patients, meaning professionals have to cater to multiple patients. This can decrease the therapeutic relationship between them and all patients as they have to divide their time and attention between all of them, meaning most feel inadequately attended to.

Systems – the utilisation of systems can improve a therapeutic relationship, as practitioners who read up on their patients past illnesses, medication and how they manage it can build a sense of understanding with the patient, who will feel they are receiving quality and appropriate care for their needs.

Infrastructure – failing infrastructure such as road blockages and power outages can decrease the therapeutic relationship as professionals are unable to attend work and care for their patient.

What really is a therapeutic relationship?

I would argue a therapeutic relationship is largely concerned by how a practitioner builds rapport with their patient, understands their medical problems, acknowledges their needs and limitations and devises a treatment plan that is best suited to them. This is all vital for ensuring the patient feels comfortable in the hands of their health professional, and confident that they are receiving high-quality appropriate care by someone who is competent in delivering it.

Think of therapeutic relationships you have had or seen: what were the characteristics, how did the health professional behave and how did you feel?

Thinking about past experiences I have had with paramedics, I have had overwhelmingly positive encounters, as they provided a calming and reassuring atmosphere as they treated my mother who I was concerned for. As I was relatively young, the paramedic behaved appropriately towards my age, keeping me distracted with the TV show I was watching at the time, and explaining to me in a way that I could comprehend what is wrong with my mother, and how they will be able to treat her. I remember feeling reassured and confident in the paramedics that they could achieve what was promised due to the way they presented themselves to me.

# data[].attributes.body
What do you think the challenges of delivering inter-professional education?

Health professionals of different professions may differ in the way they perform treatments, causing conflict and ambiguity between them. Education requires time, manpower and funding on behalf of the NHS, all of which they already currently struggle with, so this may exacerbate this.

What are the challenges that are faced when delivering inter-professional practice?

Inter-professional practice requires an extreme quality of communication skills between different practitioners, which is often difficult to achieve. Different practitioners may have altering opinions about the diagnosis of the patient, how to manage the patient and whether to refer them to different medical pathways. This decreases the quality of care directed towards the patient.

Can you suggest some possible solutions for these challenges?

Reducing variability in practice may help to promote consistency among the way in which different health professionals provide treatment and help eliminate conflict of ideas and interests. Having different professionals communicate with each other more often, may increase their cohesion with each other and therefore increase the quality of their care towards the patient.

# data[].attributes.body
Activity 3 - How might Kay’s behaviour present that makes it more difficult for her to engage with health providers in either the community or acute hospital settings who may aim to give her health and/or lifestyle advice?

Kay may struggle with communication as a symptom of her autism, meaning speaking with health professionals may be difficult, such as understanding information and conveying to them what she wants and needs.

Additionally, problems with social understanding may mean Kay inadvertently acts inappropriately in a hospital setting, as she is unable to empathise with other patients and act in line with what is socially acceptable. For example, Kay may present her frustration about not being able to be seen by a health professional first, despite the presence of other patients.

As autistics often find it difficult to cope with change, Kay may be overwhelmed by information given by health professionals opting for her to change her lifestyle, such as eating habits, as to produce a healthier wellbeing. It can therefore be difficult for her to put this advice in to practice, as she may prefer her current routine of eating habits. Also, Kay may struggle just being in the hospital, or having to stay there for treatment, as it massively differs from her usual living arrangements and can trigger anxiety and stress for even the most mentally healthy of people.

# data[].attributes.body
Activity 1 – What health conditions do you think carry a stigma in our society today? What unconscious biases may be shown by the attending clinician?

I would argue that obesity and its implications carry a large stigma, even in our modern society. Firstly, the individual may be likely to feel self-conscious about themselves, and therefore have a low self-esteem and a declined mental health. This may make them reluctant to seek help for their condition, due to the perceived judgement.

Although health professionals are supposed to remain non-judgemental and impartial to every patient they treat, they still may exhibit some unconscious biases towards patients who are obese. For example, the clinician may assume that the patient is in this condition due to faults of their own, such as over-eating and under-exercising, which may decrease their responsiveness to the patient. However, they may forget that obesity can be due to disorders that are of no fault of the patient, such as genetics, psychological disorders, medications, hypothyroidism and polycystic ovary syndrome. It is important the clinician remains impartial as to reduce the stigma surrounding obesity and protect the wellbeing of the patient.

# data[].attributes.body
Challenge 3 – What stage may Eric be in his disease and why are he, Sandra and Tom feeling the way that they do.

I would argue that Eric is in the early-to-middle stage of his vascular dementia, as he still has the capabilities to meet his friends in the pub every week, however he has symptoms indicative of this, including memory loss at quiz nights and confusion about time as he wakes in the night.

Eric is feeling frustrated with his condition, as he reported to be a ‘proud and private man’. This would cause him to be embarrassed of his illness in front of his friends and family, and highly likely to underplay the severity and help he needs as to maintain pride and a sense of independence.

Sandra would be feeling extremely overwhelmed and stressed, as she has a multitude of factors to balance in her life such as caring for Eric, managing their finances, keeping up with house chores and making time for her son Tom. This leaves her with little time to focus on unwinding and looking after her own mental health, as well as processing the fact that her husband is progressively unwell. Sandra’s increased weight is explicable by this as she is likely to use high-fat convenience foods to save time, and resort to snacking unhealthily as a comfort for her declining mental health.

Tom would also be feeling the pressure of his father’s vascular dementia. Tom is reportedly already struggling with his mental health and misusing alcohol, which would only be exacerbated by the pressure his mum puts on him to support her mental health and the emotional weight of the severity of his father’s condition.

# data[].attributes.body
What significant health issues might Sandra (from the case study) be at risk of due to her weight?

From eating food that is high in cholesterol, fat and salt, usually present in convenience foods such as ready meals and takeaways, Sandra is creating a significant risk to her health. High-cholesterol and high-fat foods can increase her risk of developing cardiovascular disease, coronary heart disease and strokes due to the fatty deposits narrowing the lumen of the arteries, reducing blood flow. Foods that are high in salt are a known risk factor for physical impairments such as hypertension, heart failure and kidney diseases.

Additionally, Sandra’s extra weight causes exertion and stress on her joints, particularly her knees, which can increase the likelihood of developing painful and incurable disorders such as arthritis.

As a healthcare professional, what could you do to support Sandra in achieving a healthier weight?

Firstly, we can advise Sarah about how to eat healthily, potentially referring her to websites such as the BDA Eatwell Plate, so she can be more conscious about making healthier choices in the type of food she consumes, the proportion of food groups to each other, and the volume of food when she is preparing it.

Secondly, we can inform Sarah about the potential disorders I previously discussed which she may develop if she does not make positive changes to her diet. This may increase her incentive to eat healthier, as she wants to be physically able to care for her husband Eric.

Finally, we can recommend that Sarah is more active in order to facilitate weight loss. This includes making simple choices such as walking to the shops, or even working out at home so that she can still exercise while being around to care for her husband. This exercise will not only significantly improve her physical health, but also her mental health as exercise is a good cause for endorphin release.

# data[].attributes.body
Challenge 1 – Read through the BDA Fact Sheet on healthy eating – reflect on what you have learnt, does anything surprise you?

From reading the information, I have learnt that the food we eat is a risk factor for a multitude of conditions. I was surprised to learn the large amount and wide variability of diseases that are highly influenced by food intake, which has made me think more about my own eating habits and the actions I could take to reduce my risk of developing some of these diseases such as heart disease and osteoporosis.

Additionally, I was surprised to learn the scale of recommended protein consumption, which appears to be around a third of the size of carbohydrates and vegetables respectively. This is because protein-rich foods, especially meats and fishes, usually make up a large percentage of the average person’s meal, when this should actually be scaled down. I was under the assumption that lean meats and oily fish are not overly harmful and are a good source of protein, so eating them in high moderation would be recommended, however this information taught me otherwise.

Finally, I was positively surprised to learn the wide variability of foods that can be eaten in order to maintain a healthy diet in accordance with the recommendations. Eating healthy does not have to mean eating foods you don’t enjoy, as there are several alternatives for every recommendation. For example, if you don’t like chicken, you may prefer an oily fish or lean mince. It was also interesting to note that eating well can be achieved by those of different diets, such as vegan, as protein can be acquired from foods such as beans, nuts and chickpeas, not just the commonly known meats.

# data[].attributes.body
What are the positive and negative influences on Emma and Johnno’s health and well-being? ​Focus on any inequities you can identify between herself and Sara​

Emma will undertake a lot of stress due to her husband’s alcoholism, unemployment and violent tendencies. Her constant worry about whether Johnno’s father is mentally capable of caring for him, whether they have the financial stability to support Johnno and finally whether Johnno is safe around his violent father will become a drain on her mental wellbeing. Additionally, with Emma living in Glasgow and her family living in Aberdeen, Emma cannot rely on a supportive network to help her raise her son, so she will have to on her own. This means she hasn’t the time for employment, and has to rely on Johnno’s father to make a living. These negative factors could cause Emma to develop mental health disorders such as post-natal depression. This can also affect her baby Johnno’s mental well-being, as a lack of happiness in his mother has, as stated, affected her ability to bond with him, meaning he cannot form an attachment with her and may grow up with a decreased mental well-being. This is contrasted to Sara, as Sara seems to have a very supportive and stable environment in which to raise her children. She has a family nearby, her own home, and her and her husband both have jobs yielding a finance capable of supporting children. Sara, unlike Emma, has also had a child before, so she is more experienced and therefore less nervous about how it is to raise a child. However, Emma’s friendship with Sara can be a positive influence on Emma’s mental well-being. This is because Sara can guide Emma about raising children, so that Emma is not totally on her own. Additionally, it is stated that Johnno’s father eventually found employment, which may provide some relief to Emma as it aids financial stability, however with it being in Coventry it may mean Johnno does not form an attachment with his father – which can be a strain on his and Emma’s marriage, and Emma and Johnno’s mental well-being.

What challenges may Sara’s son face within the next year of his life? ​

As Jack underwent a bowel surgery as a neonate, he is more prone to infections in the early stage of his life. These infections may cause other complications and require him to attend frequent hospital visits if they seem to threaten his development or life. It is also mentioned that Jack has a poor sleeping pattern. A lack of sleep in babies can cause insufficient neural and brain development, which may cause him not to develop as effectively as the other babies his age. His lack of sleep may also keep his parents awake, causing them to become tired, and therefore less effective at bonding with him. This can also disrupt the attachment formed between Sara’s son and his parents, causing him to become avoidant of them.

Can you identify factors in Sara’s case study that may help her, and her son, overcome some of difficulties they are currently facing? (Consider social determinants of health)​.

The major social determinant that will help Sara and her son overcome difficulties is the financial stability they experience. This is because financial stability means that Jack’s parents can afford to support him and send him to classes that will allow him to catch up with the development of other children his age (for example, paying for extra reading tuition). Additionally, sending Jack to school with other children means he will naturally integrate and develop alongside them, building up academic and social skills along the way. Finally, Jack has good access to medical services, such as hospitals and GP surgeries, and his father is a mental health nurse, so he will have a good idea of any mental disorders developing in Jack due to his complications at birth, and can help him reverse them.

Consider the role of a paramedic and share how you may be involved with either of these cases in the future with your peers: e.g. children’s nurse may need to support Sara’s son, from looking at Johnno when he is 16 he may need support of mental health services: consider impact of prematurity and difficult birth risks to Sara’s son – if he develops atypically what might your role be? ​

As a student paramedic, I will be attending a multitude of jobs involving paediatric patients such as Johnno and Jack. I may have to treat complications that have arisen from their childhoods. For example, Johnno may have developed severe anxiety from growing up without a prominent father figure, and may need the support of a student paramedic during an anxious episode. Furthermore, Jack’s premature birth and slower development may cause atypical motor abilities, such as limited limb movement, or inability to stand up properly. He may require a student paramedic due to pain and injuries caused by these complications.

Moreover, a student paramedic is profoundly responsible for ensuring the safeguarding of paediatric patients. If I was involved in Johnno’s case, I would check for signs of abuse due to the violent nature of his father. This would include checking for unnatural bruising and injury that seem to be caused by an external force. If I suspected abuse, I would take the appropriate pathways to ensure the child is safe, which could include the involvement of the police or social services.

# data[].attributes.body
On the resilience quiz, I achieved a score of 47/100. This means that I sit in the middle of the spectrum, the high end being extremely resilient, and the low end being less resilient. The quiz was based on 4 characteristics that are said to be the main components of resilience, including: confidence, social support, adaptability and purposefulness.

My confidence score was 11/20, which is significantly lower than I was hoping for. This is because when new challenges are presented to me, usually out of my comfort zone, I can lack self-belief and have small doubts that I am going to fail. However, I believe that sometimes these small doubts aid my success, as they motivate me to work harder to reach my goals, as too much confidence can cause me to become complacent and very passive in my work, meaning my chances of failure are heightened. Nevertheless, confidence is still vital for resilience as lacking so can have a prolonged negative impact on my mental health, and cause my mind set to eventually automatically expect failure. This is maladaptive for student paramedic practice as lacking confidence can not only decrease the quality of my practice, but can instil nervousness into the patient, causing them to feel more distressed about their condition and untrustworthy of me, the student paramedic. I will attempt to increase my confidence levels by altering my thought patterns to think more positively, and dwell more on successes rather than failures. Any failures I do encounter I will use as a foundation to learn from and build my skills for future successes.

My social support score for resilience was moderately high at 14/20. This is because I am very contented with the support network I have built around me as a student paramedic at Coventry University. This network includes a wide range of people, such as my university lecturers, my paramedic science coursemates, my flatmates and friends and family back home. My university lecturers allow me to gain exclusive information about what it means to be a paramedic, I can confide in my coursemates who understand how it feels to be a student paramedic at Coventry University and my other friends and family provide an outlet for me to stay mentally healthy by spending time and talking with them. I feel that my support network is very well-rounded and reliable, as I have had multiple pleasant experiences with them, all pushing me to achieve my goals as a student paramedic.

My adaptability score came in at 13/20, which is very mid-range, however I would prefer it to be higher for the sake of my own practice. I believe my score was slightly impaired due to the fact that I can find it daunting to come round to new ways of working and thinking. Even though I eventually do find strategies to tackle new challenges, it causes me considerable stress, which negatively affects my mental health and makes me question my own commitment. However, I do have an outlet for stress in the form of playing competitive football. This allows me to gain endorphins from exercise, take out pent up tension on the game, and refresh my mind and body for new challenges. I feel this works well for me. Nevertheless, I will work in future to improve my adaptability in the first place, by learning to be more open and enthusiastic to new challenges, and feeling confident in my own ability to tackle them.

Finally, my purposefulness score came in disappointingly low at 9/20. This is because, as a student paramedic who has not been out on the road as of yet, I feel unfamiliar with what it means to be a student paramedic. However, this trait will undoubtedly improve as I progress in placement, and I will feel more committed to the job role I wanting to undertake as a career.

# data[].attributes.headline
Kirsty - How Social Determinants Affect Practice

# data[].attributes.subject
Kirsty - How Social Determinants Affect Practice

# data[].attributes.body
Having no access to affordable health services of decent quality can negatively affect the health of patients that student paramedics attend. Patients may lack this access due to multiple reasons, such as being financially disadvantaged, lacking the mobility to attend services, being hindered by mental health disorders or simply not knowing about these health services. Student paramedics can reverse this by referring patients to specific services suited and affordable to them, and arranging measures for patients to be transported to them. Additionally housing can affect student paramedic’s practice in a multitude of ways. Housing such as high rise flats can be somewhat inaccessible to paramedics, meaning that it is difficult to deliver high quality treatment, especially when patients are time-critical or have mobility issues, meaning transporting them down stairs to the ambulance can be challenging. Housing can also affect practice, as sub-standard living conditions can exacerbate a patient’s conditions, such as lack of sufficient ventilation exacerbating respiratory disorders including COPD and asthma. These affect practice as student paramedics have to treat more conditions due to sub-standard housing.

# data[].attributes.body
One of the priorities on the agender was providing better mental health. As a student paramedic I can help to improve this priority by suggesting teams of specialists to the patient in order to ensure they received the best possible options for the improvement of their wellbeing.  Specialist such as CRISIS teams, GP referrals or any other safeguarding team that can improved the patient’s health and wellbeing.

# data[].attributes.body
Many individuals within vulnerable groups are stigmatised based on the social judgement around their condition, for example, individuals with mental health.  They may face discrimination, as they could be perceived as erratic, dangerous or unstable. Unconscious bias attending clinicians may show towards such patients could be being overly cautions or too sensitive about the topic around them. Another condition that may carry stigma in today’s society is obesity. Many people may immediately see an obesity individual and assume their condition was solely due to negligence in maintaining a healthy lifestyle. However, some individuals may be battling a mental health crisis, family problems or potentially death of a loved one. They may face an unconscious bias from clinicians, as they may assume the weight gain was from lack of a healthy lifestyle.

# data[].attributes.body
In todays society HIV (human immunodeficiency virus) and AIDS (acquired immune deficiency syndrome) still carry stigma although this has improved since the 1980’s where the pandemic was at its peak. Some other health conditions that carry a stigma could include skin conditions, obesity, mental health conditions such as BPD, irritable bowel syndrome (IBS) and many others. Unconscious bias is shown by some health care professionals to individuals with stigmatised conditions, these are attitudes which are held subconsciously and affect the way a person feels and behaves towards others. Health care professionals may show unconscious bias by drawing conclusions about an individual or patient based on their health condition due to stereotypes, or by focusing only on their condition when treating rather than a holistic approach for the presenting complaint. This can lead to the patient not gaining the appropriate care that is required.- Paige

# data[].attributes.body
1) The negative influences on Emma and Johnno's health and well-being is that Emma smoked until she was 15 weeks pregnant and this could effect the development of a child in the mothers womb such as having a heart or lung condition. Emma also wants to start smoking again after giving birth which could affect her milk supply and production of milk if she decides to breastfeed the baby. Loneliness is another negative factor because the father hasn't been able to visit her and she hasn't had her family also visit her which concludes in her not wanting to be discharged yet as she may not be comfortable being left alone with a baby. Emma is also worrying about if she would be able to afford stuff due to the father being made redundant and she does not understand how the benefits system works and what financial support is available for her. This could mean having this type of stress could detach her feelings towards the baby as she'll be concentrating on those worries more than actually bonding with the baby. A positive is that Emma was comfortable and confident with letting the health visitor know about how she was feeling and Johnno is being looked after by his father at home. Emma did stop smoking at 15 weeks when she found out she was pregnant which means she does care about the health of the baby.

2) Sara's son may face some challenges within the next year of his life as he was born premature. He spent 5 weeks as a baby in hospital because of breathing difficulties and a surgery on his bowels. This means he would have continuous visits to monitor his health and see improvements. This means his development may be slower than his peers as he was born premature which means more hospital visits within the first few years. He could feel isolated and struggle socially as he's spending more time in the hospital rather than with spending his time with family and friends.

3) Sara is a mother of two and a teacher which means she already has experience with children. She appears to be financially stable as both parents have paying jobs and they live in their own home. Sara's husband has some medical knowledge as he is a mental health nurse which would be useful and Sara could get help from her husband when stressed etc.

4) As paramedics, we may be called to Sara's son because om being born premature and having early life health difficulties, which may lead to subsequent issues that damage his quality of life and involve our help. If Emma and her child continue to have problems, we may be going out to a mental health crisis because of the stress caused. We could provide different kind of support for example in Emma's case we could help with finding food banks that could help with the financial aspects so that they are being fed and Emma could get an appointment with her GP and get referred for some counselling. Sara could receive support from paramedics and other health care professionals such as doctors and paediatric nurses that specialise in care for children. - Mohammed Zakir Khan

# data[].attributes.body
As a student paramedic social determinants effect our practice  in the UK as we are able to access free education from the age of 5 to 18. This provides a good foundation in either getting a job, going to university or to study an apprenticeship. If going into further education at university a student loan can be taken out to study the degree of your choice. Many universities would also have financial help available such as grants and bursaries that could minimise the stress of not being able to afford your degree. This is especially helpful for student paramedics as there is a NHS Learning Support Fund available to help support you in your studies such as to buy books, equipment, help with travelling to placements etc. This helps with being able to focus on the degree, develop and learn new skills which would be beneficial in our practice as registered paramedics. - Mohammed Zakir Khan

# data[].attributes.headline
Social media health promotion campaigns- Zak

# data[].attributes.subject
Social media health promotion campaigns- Zak

# data[].attributes.body
As student paramedics we could help promote the national agenda through the use of social media and technology. Most adults and children in the UK have access to a sort of technology which could include a smartphone, smartwatch, televisions or another type of device. By using social media and technology a larger audience of people could be targeted including the younger generation who could be educated about the national agenda and understand the importance. An example is explaining the effects of substance abuse such as drugs or alcohol which would be unhealthy in people diets and explain how socially and physically the effects would have an impact on their lives. - Mohammed Zakir Khan

# data[].attributes.body
In the quiz I was scored a 47 which indicates that I am not easily defeated however, improvements can be made. This means I should look at the issues Im facing from another perspective and use my strengths to overcome them. I was scored 9/20 on my confidence which I would massively agree with, I struggle on a daily with my confidence, self-doubting if Im able to carry out certain tasks and if I am making the correct decision. Another element I could improve on is purposefulness which was scored 9/20 as well. This means I have to set clear and achievable goals that would give me the motivation and shows that Im passionate to achieve them. The two elements that I had scored the highest were social support which had scored 12/20 and adaptability which had scored 13/20. These two would have been the highest because I would say Im a sociable person that would get along with most people forming good relationships, asking friends for help and family for advice. Being adaptable means that I understand where I have gone wrong, reflecting on them and coming up with different ways to improve on them. Having done this resilience quiz has taught me to be more confident in my decisions and have more purpose and motivation when doing so. This will massively help as a paramedic in the future as I would be making critical decisions regarding the care for a service user. - Mohammed Zakir Khan

# data[].attributes.body
1.      There are some inequalities between Sara and Emma which could affect both Emma and Johnno’s health and wellbeing negatively. Firstly, the factor that Emma’s husband is an alcoholic could affect both her and Johnno. As Johnno grows up if he sees his father being aggressive to his mother, he may think that this is the right way to behave which may affect his own future relationships, as well as his mental wellbeing. However, Sara’s husband is in a secure job suggesting he is financially stable, whereas Emma’s husband was unemployed for the first 6 months of Johnno’s life which may affect them both financially which could lead to health problems in Emma and Johnno. Such as, malnutrition and unhealthy eating habits. Also, Emma doesn’t have as much family support as Sara, as her family are not close by. This may lead to wellbeing issues with Emma as she may struggle with her mental health as she may feel as though she is coping alone with no one to turn too. A positive influence on Emma and Johnno’s health and wellbeing is that there were no complications during Johnno’s birth. This means there is a more likely chance Johnno is fit and healthy and means this may help Emma’s wellbeing if she didn’t experience a traumatic birth.

2.      As Sara’s baby, Jack, was premature, this can cause challenges with his development. Premature babies are less likely to interact with others compared to babies who are full term. This may affect Sara’s sons’ social development. Being premature can also affect a baby’s physical development which may cause him challenges in his first year, as well as the breathing problems which Jack is already experiencing. Also, his breathing problems could be related to asthma or Broncho pulmonary dysplasia, which is a lung disease which can develop in premature babies causing swelling and scarring in the lungs. Babies who have this are more likely to get breathing conditions such as pneumonia which could be another challenge Jack faces in the first year of his life.

3.      A factor which may help Sara and her son is that her and her husband are both employed, and Sara is a teacher. Firstly, this means it is ore likely Sara and her son will have access to healthy food choices which could positively impact both of their health as it deters away from conditions such as obesity. Also, it suggests Jack is also more likely to have access to education as Sara is a teacher. This could help improve his mental wellbeing, as well as his social development. It also suggests, as they have a stable income, they are likely to have access to good housing, as poverty is proven to reduce lifespan. It suggests this won’t be an issue for the improving their overall mental health. Another factor is that Sara’s family are around for support. This could positively impact Sara’s mental health as it means she has support and also people to lean on if she is in need.

4.      As a future paramedic, one way which I may be involved is if I was to visit Emma’s home for any reason e.g. Emma’s partner’s alcohol addiction having caused a health issue. If I suspect domestic violence, I will need to get the appropriate services involved. For example, putting Emma in contact with domestic abuse helplines. I may also need to contact social services if I suspect there is domestic violence in the home, as there may be a risk to Johnno’s health and wellbeing. Another way I may be involved is, if there are any health risks with Saras son Jack, for example, if he develops pneumonia due to his prematurity. I may be involved as a paramedic and need to transport him to the hospital, helping to treat him. A paediatric nurse and doctor may then be involved further in Jack’s care. If Johnno develops mental health issues because of the issues with his father or for any other reason, I may be involved as a paramedic. Emma or himself may call for an ambulance because of this. I could then contact the crisis team or CAMHS (if he is under 18). I could also have to transport him to hospital to see the RAID team or call the mental health triage car to help. -Leila

# data[].attributes.body
When doing the quiz I got 51, showing I have room for improvement.  I often lack confidence in decisions leading me to overthink especially after I've done something. I have a really positive outlook and see the good in situations so I will try to focus on this attribute and ensure that if anything goes wrong in practice I can identify this and correct it so it won't happen again.- Paige

# data[].attributes.body
Overall I scored 57, this means I do have some resilience, however there is still room for improvement.  The areas I did well on are social support, meaning I am good at building relationships within the workplace, as well as adaptability, meaning I can understand my failures, adapt my approach and changing it where necessary.  The main area I could improve on is confidence, I could have more confidence in my decisions.

# data[].attributes.body
Social class is a socioeconomic position under structural determinants in accordance with the World Health Organisation framework known as, The Commission for Social Determinants. Social class can have an effect on an individual’s vulnerability, exposure, and outcome of health. This means that due to the disproportionate distribution of materialistic resources certain individuals of working classes are put at a disadvantage due to intermediary determinants of health. Such determinant include if the individual or family have enough financial means to have access to a clean home, healthy food, and clothing for winter. Previous studies have shown that people in low socioeconomic areas require more emergency treatment leading to an increase in ambulance calls. In turn this affects one’s practice as a large volume of calls may be illnesses and conditions that are caused due to financial factors such as poor living conditions, depending on that individual’s social class. As a student paramedic, I can contribute to improving the social determinant by potentially educating individuals on the importance of health or refer them to specialist to improve any financial or social stress they have encountered.- Sumaiyyah

# data[].attributes.body
Alcohol as a general social determinant of health massively affects both physical and mental health. The use of alcohol physically affects our health if used too regularly, not in moderation or even abused, most commonly leading to liver damage amongst other factors of physical health. Mentally, alcohol misuse affects judgement, can increase confidence too much, lowers our inhibitions, and acts as a depressant if too much is consumed. This leads to poor mental health; long term misuse can lead to alcohol abuse and addiction. As students, drinking culture is a huge factor that can affect our practice. Binge drinking on nights out can lead to poor decisions, in which the general public can be witnesses, which does not give off a good impression as student paramedics for the future of the paramedic service. Binge drinking at weekends can also affect judgement even after the initial 'drunk' effects wear off. Drinking at the weekend does not mean the effects of alcohol will have fully worn off if a shift is on a Monday, and so our capabilities will be reduced as students.- Lucy

# data[].attributes.body
Improvements in housing, improved mental health and general health. Housing costs such as rent impacts negatively on health. Housing tenture, outdoor temperature, indoor air quality, dampness, housing design, rent subsides, relocation, allergens and dust mites, home accident prevention, fire prevention and homelessness are major factors on someone’s health. As a paramedic, you can help prevent these by contacting landlords or the police if you get a call to poor living conditions, helping a patient to be less at risk - Erinn

# data[].attributes.body
Employment can impact health both positively and negatively, if an individual is unemployed it can cause bad mental health such as depression which can lead to things such as addictions. This could affect a paramedics practice as if the healthcare environment have staff shortages it can cause stress and a feeling of pressure on a healthcare practitioner which can lead to burnouts in staff and poor health e.g., weakening immune systems due to lack of sleep and incorrect nutrition intake. As a student paramedic this could also lead to stress on us if our mentors/teams we work with are experiencing burnout they could become more irritable and short tempered with not only us and other colleagues but with patients as well. We could improve this by ensuring that if we are concerned for any of the individuals we work with or for ourselves we communicate this efficiently with the correct people.- Tannie

# data[].attributes.body
Education is key to reducing poverty and helps to equalise those of different socioeconomic backgrounds. Its been proven that poverty significantly reduces an individual's lifespan and poverty and education have a direct link. Children who have grown up in poverty are more likely to underachieve at school or drop out. Often teaching doesn't differ when looking at different schools however the opportunities that children in private education often have in comparison to state-funded schools in a lower-income area vary.  Children in poverty often can't afford to pay for extra help such as tutors and higher-quality books/ revision guides, this creates a gap in education between lower and higher incomes. School provides a safe space for some children living in poor, violent, or abusive households so lockdown will have impact those children the most.
Gaining an education is generally associated with better health throughout life, it equips people to achieve stable employment with secure incomes, adequate housing, the ability to provide for a family, and cope with ill health. So for those who don't gain an adequate education, it reduces the likelihood they will live in a safe environment and be able to provide for their children, creating a cycle of poverty.-Paige

# data[].attributes.body
A patients access to food has a large affect on their health. If a patient has limited access to food this can affect many factors such as the patients overall physical health and their mental health. Also, if someone is consuming a large amount of unhealthy foods, this can cause things such as obesity, which is also detrimental to their health. This can affect things such as their life expectancy as well as causing several health problems. As a student paramedic, if we enter a patients home who seems to have this specific social detriment we can do the following; If the patient has limited access to food we can put them in contact with local charities as well as pointing them towards local food banks. If we are concerned about obesity we could help point them towards healthier options and things such as food banks (if needed) which provide these, if they’re struggling to buy healthy food because of financial situations. - Leila

# data[].attributes.headline
Effective response to major incidents- Lucy

# data[].attributes.subject
Effective response to major incidents- Lucy

# data[].attributes.body
Part of the Public Health England five year agenda is to increase the effectiveness of response to major incidents. With the rise of coronavirus and the global pandemic it has caused, PHE aim to better the UK with its health protection system in order to manage future major incidents and hazards. The main aims are to refresh plans for handling influenza pandemics, strengthen the system of health protection at local and national levels and reduce the number of outbreaks of preventable diseases. As student paramedics we will often be first into scene where concepts such as aseptic techniques are not always possible, due to our field of work taking place within public spaces. It’s important as student paramedics that we do not dismiss the concept of clean working environments despite working in pre hospital and non- clinical spaces. By educating ourself and implementing strategies such as use of effective PPE and hygiene, we as student paramedics are able to increase the cleanliness of the environments we work in, and therefore decrease the spread of things such as influenza, thus contributing to the overall strength of protection against things such as influenza at a local level, when working within our community.- Lucy

# data[].attributes.body
Sterile equipment is kept within plastic packaging to maintain an aseptic environment however in the medical field and the ambulance service a lot of plastic waste is produced. The sterile environment is essential to reduce the likelihood of infections etc but in the future, I will take care to open the correct packaging for correct equipment to avoid unnecessary waste.- Paige

# data[].attributes.body
One of the priorities on the agender was providing better mental health. As a student paramedic I can help to improve this priority by suggesting teams of specialists to the patient in order to ensure they received the best possible options for the improvement of their wellbeing.  Specialist such as CRISIS teams, GP referrals or any other safeguarding team that can improved the patient’s health and wellbeing.- Sumaiyyah

# data[].attributes.body
When attending at a patients house try to gain a sense of what they're eating and if this is enough for them or if they eat quite poorly (lots of microwave meals for example). See if there's anyone to help shopping or if safeguarding could potentially be involved as they might not have the ability to properly take care of themselves.- Paige

# data[].attributes.body
When visiting homes where their is a family member is the main carers such as young carers; I will make sure they have sufficient support in place. If this isn’t the case, help to put them in contact with the right services who can offer things such as respite and other services to help make sure they’re managing both mentally and physically. Also seeing whether we need to put them in contact with a care service to help bring additional help into the home if they seem to be struggling. -Leila

# data[].attributes.body
Trying to help with the aims of increasing early diagnosis’ of dementia. As a student Paramedic, if I suspect a patient may have undiagnosed dementia I will help to inform the relevant services in order to try and put a foot in the door and help the patients towards an earlier diagnosis. Also, trying to put patients in contact with charities and organisations such as Alzheimers society. For example if a patient is suffering from loneliness and needs someone to check up on them, as well as being aware of the dementia and watching for any worsening of the condition which may mean they’re no longer able to live on their own. -Leila

# data[].attributes.headline
Working together with ambulance services to improve public health and well-being

# data[].attributes.subject
Working together with ambulance services to improve public health and well-being

# data[].attributes.body
Ambulance staff come into contact with the public millions of times each year and could be playing an even bigger role in helping to provide health promotion advice, care and support. These everyday interactions represent opportunities to start important conversations with people struggling with substance misuse or mental illness or those at risk of cardiovascular disease, social isolation or falls. - Erinn

# data[].attributes.headline
Kirsty - Enhanced data and surveillance capabilities

# data[].attributes.subject
Kirsty - Enhanced data and surveillance capabilities

# data[].attributes.body
The Public Health National Agenda has 10 main priorities for improving public health. As student paramedics, we can demonstrate these different priorities in our daily work. For example, supporting enhanced data and surveillance capabilities by accurately documenting the details of a job including the diagnosis, drugs given and observation results. This can progress public health as it indicates which conditions are prevalent, so more can be done nationally to reduce them. Another priority we can promote as students includes healthier diets, healthier weight. We can achieve this by attending patient’s houses and getting a sense of their eating habits, and providing guidance to them, especially those that are clinically obese or have conditions like high cholesterol due to poor diets. This will improve public health nationally as healthier diets mean people will be less prone to disease and live longer.

# data[].attributes.body
One of the priorities on the agender was providing better mental health. As a student paramedic I can help to improve this priority by suggesting teams of specialists to the patient in order to ensure they received the best possible options for the improvement of their wellbeing.  Specialist such as CRISIS teams, GP referrals or any other safeguarding team that can improved the patient’s health and wellbeing.