Unconscious bias

Define unconscious bias

Implicit or hidden bias referring to beliefs or attitudes automatically activated without
awareness, formed involuntarily from our experiences.

What are the different types of unconscious bias?

Type Definition

Selective attention Selectively see things and not others, depending on what we

OR are focusing on

Inattentional blindness

Diagnosis bias Label people, ideas or things on initial opinions

Anchoring bias Rely too heavily on one trait or piece of information

Affinity bias Warm up to people who are like us

Halo effect Think everything about a person is good because you like them

Perception bias Form stereotypes and assumptions about certain groups e.g.

ethnic groups, gender, sexual orientation, religion, job title

Confirmation bias Seek information that confirms existing beliefs

Groupthink Try to fit into a group by copying others or holding back own

real thoughts

What is the impact of unconscious bias on healthcare?

- Influence decision making during patient care
- Can result in misdiagnosis, delayed clinical care, patient mismanagement
- Can affect work environment with hiring and promotion
 - Leads to less diversity in healthcare, affecting the delivery of healthcare to
underrepresented segments of population
- Decreases trust, self-efficacy and understanding

What are the different strategies to mitigate unconscious bias?

Organisational Individual

Intentionally
Leadership diversify Self-reflection on
commitment to experiences personal biases
culture change
Cultural humility Question and
Meaningful and curiosity actively counter
diversity training stereotypes
Mentorship and
sponsorship

How is personal bias addressed before and after it occurs?

Before occurrence After occurrence

Be aware of biases and how they may appear Intent and impact are different, so consider
as “intuition” other’s past experiences
Be systematic by using concrete guidelines or Acknowledge own actions were biased and
checklists, with transparency in decision own the consequences
making
Be open to new experiences and to learning Reach out and rebuild trust by self-reinforcing
about different identities behaviours that prevent bias
Health literacy
Define health literacy
It relates to how people access, understand, appraise, and use health information in ways to
benefit their health.

What factors impact health literacy?

1. Knowledge & education
2. Occupation, employment, income
3. Culture, language, race, ethnicity
4. Age & experiences
5. Skills & abilities

What is the importance of health literacy?

- Allows people to know when to consult with a health professional
- To make and keep appointments, e.g. a treatment coordinator, care manager
- To complete patient medical forms and realise their relevance
- To understand instructions that aim to improve/maintain good health, and follow
these instructions - adherence
- To understand health insurance
- To consent to treatments and sign relevant consent forms

Low Health Literacy High Health Literacy

More frequent access of emergency Better patient experience

healthcare
Lower quality of life Improved self-care practice

Higher premature mortality Better health outcomes

Less uptake of preventative health e.g.

screening initiatives
Poorer health outcomes

What are the implications of health literacy?

Aged Care Systems
What is Aged Care?
The aged care system is the people, products and processes that provide aged care services
as well as the environment in which it is delivered.
The Australian aged care system provides subsidised care and support to Aboriginal and
Torres Strait Islander Peoples over 50, and other Australians over 65.

Types of Aged Care

1. Home care
- Commonwealth Home Support Program (CHSP): Older people who wish to
remain in their own home
- Facilities: Personal care, domestic assistance, nursing care, allied health
- Funding: Australian government
2. Residential care
- Residential Aged Care Services (RACS): Provided to older people who require full-
time care & support in a residential setting
- Facilities: Nursing homes, retirement villages, assisted living facilities
- Funding: Australian government

How do consumers access aged care services?

- Assessment to determine what support consumers have or need, and how they
are coping at home
- Regional Assessments Service (RAS): Home support assessment for low-level
support to stay at home
- Aged Care Assessment Team (ACAT): Comprehensive assessment for additional
support
- Funding culturally safe aged care: The National Aboriginal and Torres Strait
Islander Flexible Aged Care Program

What are the two legislations relevant for aged care?

1. Charter of rights – 14 components
2. The Aged Care Quality and Safety Commission rules 2018

What should consumers expect from aged care?

Charter of rights
1. Safe and high-quality services and care
 2. Be treated with dignity and respect
3. Have identity, culture and diversity valued and supported
4. Live without abuse and neglect
5. Be informed about care and services in a way consumers understand
6. Access all information about oneself, including information about rights, care and
services
7. Have control over and make choices about care and personal and social life, including
where choices involve personal risk
8. Have control over and make decisions about the personal aspects of daily life,
financial affairs and possessions
9. Independence
10. Be listened to and understood
11. Have a person of choice, including aged care advocate, to support and speak on one’s
behalf
12. Complain free from reprisal and to have complaints dealt with fairly and promptly
13. Personal privacy and have personal information protected
14. Exercise rights without it adversely affecting the way one is treated

What are the safety standards in Aged Care and how are they
assessed?
Standard 1 Consumer dignity and choice
Standard 2 Ongoing assessment and planning with consumers
Standard 3 Personal care and clinical care
Standard 4 Services and supports for daily living
Standard 5 Organisation’s service environment
Standard 6 Feedback and complaints
Standard 7 Human resources
Standard 8 Organisational governance

Assessed via National Aged Care Mandatory Quality Indicators program:

1. Pressure injuries
2. Use of physical restraint
3. Falls and minor injury
4. Unplanned weight loss
5. Medication management
Carers and support workers
Who is a carer?
Someone who provides unpaid care in an ongoing capacity for another person who needs
additional care and support in their daily life.

It is NOT someone who is paid, volunteers or is contracted for their time.

What conditions can require a carer?

- Disability
- Terminal illness
- Mental health condition
- Frail age
- Alcohol or drug dependency
- Chronic condition

What does caring involve?

- Emotional support
- Providing meals/shopping
- Managing finances/administration
- Decision making
- Assisting with daily activities/transport
- Personal and medical care

What is the difference between the role of a carer and a support

worker in aged care?

Carer Support worker

Unpaid Paid
Provides care and support to family Engaged by people who need support to do
members and friends tasks they may need assistance with
Partner, family member, friend or Formal support to clients
neighbour
For those who have a disability, mental Specifics depend on the client, focus on
illness, chronic condition, terminal illness, tasks that alleviate physical discomfort and
an alcohol or other drug issue or who are promote social connectedness,
frail aged independence, emotional wellbeing and
 general health
Responsible for management of Provide social support via help around the
medications, and also provide emotional home, work and study assistance, personal
and social support, help with organising and care, independent living support, travel
attending appointments, banking and support
dealing with emergencies

Who is eligible for Carers WA and Carer Gateway Support?

- Carers aged 8 years and above
- Supports are independent from Centrelink, My Aged Care & NDIS
- No proof of diagnosis from carer recipient needed
- Needs based approach
- No citizenship or residency requirements
- Not means tested

What does the Carers Recognition Act (2004) entail for service
providers?
- Acknowledge the carer’s role and its importance
- Involve and inform the carer in the care-plan which will have an impact on them
- Take their expertise and knowledge into account for better health outcomes
- Understand that carers have a right to make a complaint about a service that
impacts them

What is the role of podiatrists in residential aged care facilities?

1. Assessment and care plans to identify risk factors for lower limb complications
i. Comprehensive lower limb and foot assessment when a resident is admitted
ii. Podiatry assessment and care plan undertaken every 12 months to cover the
following:
o Presenting complaint
o Allergies
o Relevant medical history
o NVA
o Dermatological assessment
o Footwear assessment
o Mobility assessment
o Identification of clinical podiatry risk level
o Resident’s goals in relation to foot health and mobility
o Podiatry goals including frequency of podiatry management
 o Recommended interventions for staff and family
o 12 month review to assess foot health, resident’s mobility and level
of independence, goals and recommendations met or not met
2. Regular basic foot care for each resident
i. Management of skin and nail disorders, corns, calluses and ingrown toenails,
foot infections and ulcerations
ii. Treatment of the effects of chronic disease and common conditions e.g. bone
and joint disorders, neurological & circulatory disease
iii. Footwear assessment and recommendations and lower limb biomechanics
review for falls prevention, safety and maintenance of mobility
3. Prevention and management of foot wounds and associated infection
i. Require immediate referral to podiatrists to prevent complications such as
foot ulceration, reduced mobility and lower limb amputation
ii. Recognise, treat, debride and determine causing factors e.g. pressure from
footwear, bony prominences, venous or vascular involvement
iii. Wound management plan completed by the RACF with podiatrist, nurse, GP
and carer involvement to ensure effective and efficient treatment
4. Falls prevention including physical safety, maintenance of mobility and
independence, lower limb biomechanics and walking aids
i. Peripheral neuropathy causes – DANGTHERAPIST
ii. Gait changes and falls risk

iii.
Falls
What are the intrinsic and extrinsic factors associated with an
increased risk of falls?

Intrinsic Extrinsic
Changes in vision and hearing Floor surfaces and rugs

Changes in coordination and mobility Lighting

Poor sleep Space to move around

Health conditions Stairs

Cognitive changes Objects and potential obstacles:

Changed behaviour o Walking frames

o Walking sticks
Medications
o wheelchairs

What are the causes of peripheral neuropathy?

DANGTHERAPIST

Diabetes – polyneuropathy; sensorimotor neuropathy for long-standing DM

Alcohol – sensorimotor neuropathy

Nutritional – individual B complex vitamins

Guillain-Barre Syndrome – acute inflammatory neuropathy; immunologically

mediated

Toxicity – drugs, metals, environmental agents

Hereditary – Charcot-Marie tooth disease

Endocrine/entrapment

Renal/radiation/rheumatic

AIDS/Amyloidosis – Autonomic involvement

Paraprotein/Porphyria – motor neuropathy

Infections – diphtheria, leprosy

Systemic – association with collagen diseases e.g. uraemia, sarcoidosis

Tumour – carcinomatous neuropathies; pure sensory or sensorimotor
neuropathy; may be combined with myopathy

What are the gait changes involved in DSPN?

Temporal characteristics
Spatial characteristics
Reduced stride velocity
Reduced stride length
Increased stance phase
Increased double support
Reduced swing phase
Increased CoM sway

Increased ankle sway

Increased hip sway

Reducing falls risk as a podiatrist

1. Footwear
a. Pt to be encouraged to not walk barefoot, especially if they have peripheral
neuropathy
b. Avoid slippers
c. Wear socks with appropriate footwear
2. Insoles
a. Textured insoles for reduced proprioception
b. ~3mm slow release poron for offloading
3. Exercises
a. Increase foot-focused strength
b. Strengthen hip flexors – ease in getting up
c. Shared plan with physio
d. Continuing to stay active to ensure adequate mobility
4. Aids
a. Wheelchairs
b. Walking frames
5. Hospital setting
a. Asking – comprehensive med hx
b. Assessing – comprehensive assessments
c. Reporting – detailed documentation of results
6. Multidisciplinary team approach
a. Home assessment by an Occupational Therapist (OT) to check flooring,
lighting, mats, obstacles
b. Optometrist – visual impairment; need of glasses
c. Audiologist/ENT – hearing aids
d. Family/carers – social support network and pt education
Dementia
Types of dementia
1. Alzheimer’s disease
2. Frontotemporal dementia
3. Lewy body disease
4. Vascular dementia

Modifiable risk factors

DRSOPH
1. Diabetes
2. Renal impairment
3. Smoking
4. Obesity
5. Physical activity reduced
6. Hypertension

Impacts of dementia
1. Delusions/hallucinations
2. Forgetfulness e.g. reduced ability to recognise people
3. Distracted/disinterested
4. Irritated; changes in mood & behaviour; depression/distressed
5. Repetitive actions
6. Difficulty making decisions
7. Reduced motor skills e.g. swallowing, eating, writing, speaking, driving
8. Inappropriate expression of feelings and impulsive behaviour

How to communicate with someone with dementia?

Initial evaluation
- Check hearing and eyesight not impaired
- Glasses, hearing aid etc.

Caring attitude
- Always maintain their dignity and self esteem
- Be flexible and allow plenty of time for a response
- Where appropriate, use touch to keep the person’s attention and to
communicate feelings of warmth and affection
Ways of talking
- Remain calm and talk in a gentle, matter of fact way
- Keep sentences short and simple, focusing on one idea at a time
- Always allow plenty of time for what you have said to be understood
- Use orienting names whenever you can, e.g. “your son Jack”

Body language
- Use hand gestures and facial expressions to make yourself feel understood
- Pointing or demonstrating can help
- Touching and holding their hand helps keep their attention and shows care
- Approach with warm smile and shared laughter

Provide the right environment

- Avoid competing noises e.g. TV, radio
- Stay still while talking – easier to follow when you’re in the person’s line of vision
- Maintain regular routines to help minimise confusion and assist communication
- Repeat the message in the same way for family and carers to avoid confusion

What not to do
- Don’t argue
- Don’t order the person around
- Don’t tell them what they can’t do, instead suggest what they can do
- Don’t be condescending in tone of voice, as this can be picked up even if the
words aren’t understood
- Don’t ask a lot of direct questions that rely on a good memory
- Don’t talk about people in front of them as if they are not there
Palliative care
Definition of palliative care
An approach that aims to improve the quality of life of people, their carers and families, who
are faced with life-limiting conditions.
It prevents and relieves suffering through early identification, assessment and treatment of
pain and other physical, psychosocial or spiritual needs.

Who can provide palliative care?

Most health professionals in hospital or allied health settings can provide palliative care.
These include:
- GP
- Aged care worker
- Cardiologist
- Oncologist
- Social workers
- Allied health providers e.g. podiatrist, dentist
- Family and friends
- Spiritual professionals

This can be provided at home, hospital, hospice, residential aged care facility etc.

What is the difference between palliative care and end-of-life care?

Palliative care End-of-life care

Aims to improve quality of life for people Care provided in the last few years, weeks
with life-limiting conditions e.g. disability and months of their lives.
Treatment of pain and physical, Minimises distress and grief associated with
psychosocial, and spiritual needs. death for the person involved and their
loved ones.

Definition of advanced care planning

It is the process of planning for one’s future health care so their wishes are known, in the
case that they become seriously ill or injured and unable to communicate their preferences
or make decisions.
Who is involved in advanced care planning, including documentation?
GPs, nurse practitioners, RNs and allied health professionals can commence discussions
about planning ahead and help the person create an advance care planning document.

Personal care workers can encourage elderly person to speak with family, friends and
relevant healthcare professionals about their future health plans and wishes.

Values and goals can change over time and plans can be updated.