Level 5 Assignment
Name
KU1561187
Class
16.1
Programme
Chinese Medicine
Level
Level 5 – 2nd year
Title
Lifestyle Audit
Submission Date
Word Count
For all text (including the text in diagrams and tables) but not including the reference list, bibliography, appendices, headers and footers
Part 1 – 1566
Part 2 – 1705
I confirm that (apart from referenced material) the content and structure of this assignment is my own original work.
Signed …………………………………………………………………..
Part 1
Introduction
In my youth, the internet was a wonderful novelty, which gave access to new thoughts, ideas and dreams. These days, it almost seems to have become a distracting crutch. In my lifestyle audit, I have decided to assess my internet use, with the aim of reducing it significantly to a bare, necessary minimum. But why do I feel this is important? Surely ‘surfing’ is harmless, right?
Research has begun to show the effects of constant internet use effect short-term memory (Ericson 2013), potentially create addictions via dopamine releases (Weinschenk 2012), and finally how it can cause stress, sleep disturbances and possible depression (Thorneé et al 2012). Although there is other research pointing to more positive effects as well regarding internet usage (Cotten et al 2014), I have noticed, personally, more negative effects from excessive internet usage in the last few years. I have noticed a poorer attention span, poorer memory, and a sense of compulsion of using it, even when I don’t need to. In other words, an addiction. Consequently, I want to use this lifestyle audit to help change this use, with the long term, more personal goal of establishing deeper reasons for this pattern of behaviour I have adopted.
I will also be incorporating a general audit cycle within this assignment, using the following methodology:
1) What would I like to happen?
2) Is it happening?
3) If not, why not?
4) What can I do to make things better?
5) Have I made it better?
I shall now discuss my lifestyle audit, using the audit cycle to explain the steps I went through.
The Audit Cycle
Step 1 – What Would I Like to Happen?
As we have discussed in the introduction, I would like to reduce or limit my non-work related internet usage. As I have reasoned, I am doing so to improve my concentration, memory and general well-being.
Definitions
It is important I define the terms of internet, usage, etc, and what will count as ‘using’ the internet, as well as methods of measurement. First I shall define what is ‘the internet’ in respects of this audit. For the purposes of this audit, the internet incorporates social media, web exploration, online streaming, but does not include work-related internet usage.
Social media relates to Facebook, Instagram, Twitter, but not messaging applications such as Whatsapp (this is not media, but more communication I would argue), or Skype, or normal email.
Web exploration relates to using web pages via an internet browser.
Tracking, Monitoring, Recording
Tracking and monitoring will be conducted using two different applications. One will be a web-based application, for computer use, the other an iPhone based application, tracking its web usage. The results will be input daily onto spreadsheet, in a simplified format.
Standards and Criteria
However, it is important to have an idea of what indeed, a ‘healthy’ amount of time really is. Recently, a report was released by Ofcom (2015), examining the internet habits of people in the UK. According to the report, on average people use the internet at home 12.6 hours a week. Although the report did not examine the proportion of this which is work related (there was a separate figure for using the internet at work, but with no breakdown of casual vs work use), I felt that for the purposes of this audit, using 12.6 hours as a yard-stick would be a good place to start. Therefore, for my initial standard, I will not be looking to exceed non-work usage, per week, of 12.6 hours.
My criteria and standard are as follows:
Criteria
Internet usage should be kept to a general minimum
Standard
Internet usage shall not exceed 12.6 hours (756 minutes) a week.
Step 2 – Is it Happening?
Initial Monitoring Stage
For my initial monitoring stage, I conducted a one week study, just to see what sort of results I obtained.
The results were as follows:
Web Browser
News (Application)
Social Media
Streaming
Total Minutes
Monday
89
31
4
0
124
Tuesday
57
60
4
0
121
Wednesday
62
45
0
0
107
Thursday
55
43
0
0
98
Friday
47
42
0
0
89
Saturday
33
30
0
0
63
Sunday
40
36
6
0
82
Totals
383
287
14
0
684 (12.6 Hours)
Happily, it is safe to say that I did not exceed my figure of 12.6 hours, and in fact only used it for a total of 11.4 hours over the week. What made this particularly interesting is that even though I have deactivated Facebook, and have been making a conscious effort to reduce my time on the web, I am still using it more than an hour a day on average. However, due to generally being quite busy, I did not stream any movies or TV shows during that week, which would have certainly increased the figure. Normally I would watch something.
I therefore decided to increase my standard to 11 hours a week, but no further, as I suspect in a more normal week, it will be much trickier to stick to this standard, when streaming is happening.
So in regard of the audit cycle, I have discovered that indeed, I am keeping my internet usage lower than average, but I could potentially lower it further.
Step 3 – If not Why Not?
So far it is happening, so this stage does not apply so much at this point.
Step 4 – What can I do to make things better?
I have adjusted my standard to meet these new findings, to an attempt to further minimise usage.
Criteria
Internet usage should be kept to a general minimum
Standard
Internet usage shall not exceed 11 hours (660 minutes) a week.
I will also try to be more self aware when using the internet, and review every day how much I have used the internet through examining the applications.
Step 5 – Have I made it better?
During this 3 week period I constantly checked my usage every day, trying to be conscious every time I used the internet. As can be seen, this certainly paid off:
Week 1
Web Browser
News (Application)
Social Media
Streaming
Total Minutes
Monday
26
18
5
0
49
Tuesday
35
30
9
0
74
Wednesday
50
46
14
0
110
Thursday
24
23
7
0
54
Friday
26
27
8
0
61
Saturday
54
32
10
0
96
Sunday
51
30
9
0
90
Totals
266
206
62
0
534 (8.9 hours)
Week 2
Web Browser
News (Application)
Social Media
Streaming
Total Minutes
Monday
52
28
8
0
88
Tuesday
51
27
8
0
86
Wednesday
24
12
0
45
81
Thursday
29
15
0
0
44
Friday
33
27
8
0
68
Saturday
42
34
0
0
76
Sunday
34
24
4
0
62
Totals
265
167
28
0
505 (8.41 hours)
Week 3
Web Browser
News (Application)
Social Media
Streaming
Total Minutes
Monday
32
12
1
0
45
Tuesday
46
34
0
0
80
Wednesday
22
19
5
0
46
Thursday
41
22
6
0
69
Friday
52
38
0
45
135
Saturday
34
17
0
0
51
Sunday
58
43
0
0
101
Totals
285
185
12
0
527 (8.7 hours)
Interestingly, instead of been under 11 hours a week (660 minutes), I was below in fact 9 on average, even with some streaming. Looking at the results closely, on average I used the web and news applications both on average roughly 100 minutes less than in the initial monitoring stage. There was also some streaming in the last 2 weeks. Making a conscious effort to control my internet usage, although challenging, is rewarding.
So although my internet usage is certainly down, there was also little streaming in this period. I think if I conducted a longer study, involving perhaps 2 months of usage, a different, probably fairer picture would indeed be drawn, which I suspect would total up to around 11 hours a week on average.
I also think if I was still using Facebook, the results would certainly have been the average, if not more.
Generally I am pleased with the results, as it shows that:
1. I don’t use the internet in excess (i.e. compared with UK national average)
2. I was able to in fact control and monitor my usage successfully
However, having reflected on the results, it does surprise me how much I use the internet casually, even if it is low compared to the average. Only 15 years ago, I remember barely using the internet unless it was study or work. How things change.
I also noted by the end, my concentration had certainly improved, and continues to do so. This is important as it shows the audit worked!
In the future, it would be interesting to expand this study to overall phone use, including messaging applications, email and general texting and talking time. I say this as I noticed that during the study, although my internet use was low, I was using messaging applications, making phone calls, etc, which were far in excess of using the internet. For example on one day, I used WhatsApp (a communication application) for 1 hour! Now although this isn’t necessarily a bad thing, as its not related to work, this is very time-consuming. So it could be interesting to repeat the study with this in mind, perhaps just focusing on phone use and seeing the results that come up.
Part 2 – Critical Reflection on Audit and Lifestyle Change
Section A: The potential of audit as a tool for developing your professional acupuncture practice
In this section we shall briefly examine how the use of audit can be applied in professional acupuncture practice. Within the medical community, audit is considered vital for improving procedures, and its primary purpose is to make an estimation of the worth of activities (Baker and Hearnshaw 1999). Indeed, it is a form of assessment (ibid). It is used across the world to improve processes and procedures, better patient outcomes, and progress further opportunities for enhanced service provision (Paranjothy and Thomas 2003).
In audit, there are a variety of different ways to assemble and collect data, and it is important that practitioners identify a suitable way of doing so. Generally speaking, choosing between either qualitative data collection or quantitative data is important, as both will offer different types of data, and therefore learning (Curtis and Drennan 2013). Qualitative research is suitable for more individual, detailed and subjective feedback, particularly with regard to understanding existing clinical practices and changing policies, whereas quantitative research is better for larger data samples, or indeed looking for specific outcomes, and is far more objective in nature (ibid). Qualitative data collection, for example, can involve interviews (structured, semi-structured, open), and quantitative data collection can involve questionnaires (close ended in general), surveys, polls, etc (Baker and Hearnshaw 1999).
Applied to acupuncture, both these methods of data collection can be used for different things. For example, if I was looking to see if patients were happy with the clinic, or felt something could be improved overall, an open, qualitative interview might be useful. On the other hand, patients may not feel comfortable giving feedback in person, and so sending anonymous questionnaires could be a better approach, but again ensuring the questions were open ended to ensure it was still qualitative.
However, if I was looking for large scale feedback about something particularly, such as patient outcomes, I could instead use a quantitative approach, using anonymous, close-ended questionnaires to try to understand further if indeed my treatments were having an effect! I could also apply the quantitative approach to myself, using it for example to time my treatments.
Using either of these approaches, within the framework of audit would be incredibly useful, as it could further improve my ability to treat patients and be a better practitioner. These two data methods are fundamental to the audit cycle, and allow different insights to emerge, depending on the approach. But how else could audit improve my practice?
Firstly, as discussed above it could improve my own processes and procedures. For example, I could use audit to examine:
1) Equipment Provision – is there any way of improving my equipment provision? Is there indeed an issue? I could use self-audit to see if there are any issues, and any efficiencies which could be applied. Such as having adequate stocks of certain needle types, or types of moxa, and use quantitative analysis to see if there are any clear issues or improvements to be made.
2) Patient Intakes (within a Full Traditional Diagnosis) – am I gathering enough, or indeed suitable information about the patient? This could take the form of a quantitative analysis of my own data, compared with the British Acupuncture Council standards, or could even relate to patients feedback via open or close ended questionnaires.
3) Examination of Process of Care – Paranjothy and Thomas (2003) discuss how this is an important aspect in medicine, which of course can be applied to acupuncture. So what measures am I taking to ensure I am helping my patients the most? Am I discussing enough with them lifestyle? Am I ensuring they are warm, comfortable enough on the treatment table? Again, these different aspects could be examined either through self-audit or indeed gathering feedback from my patients.
So within process and procedures, there is some interesting scope for study. One of the most obvious ways of using audit is of course via patient outcomes, for example:
1) Outcomes of treatments for specific conditions – I could use audit to examine whether a particular set of treatments for a set of conditions is successful or not. For example, if I notice I am treating a lot of patients with infertility, I could examine the outcomes of those treatments, using various different methods.
2) Changes to quality of life – I could examine if acupuncture has changed the patients quality of life. This is an interesting topic, as some patients may not have a dramatic improvement in the condition with which they came, but may notice their quality of life has changed. Whether it be mood, energy, etc. Some may not attribute to acupuncture, but a study such as this might reveal a correlation between changes to quality of life and acupuncture, unbeknownst to the patient. This would be best conducted qualitatively, using open ended questionnaires to see what the patients thoughts are.
3) Outcomes for specific treatments types – I could examine the efficacy of using moxa with acupuncture, ensuring that the patients examined had roughly similar sets of symptoms – for example, using moxa for low back pain, or common injuries. I could then attempt to survey the outcomes of using moxa, and examining patient feedback.
So these are just some of the outcomes which could be examined. Finally, the improvement of service provision applied to acupuncture can be considered too. In Paranjothy and Thomas’ (2003) paper, they discuss how the referral and management of patients with cancer can be audited to ensure better management of the patients condition. In the sense of acupuncture, I could examine the following:
1) Frequency of treatment for specific conditions – I could examine how often I am treating patients, and perhaps combined with an examination of patient outcomes, I could audit if there is a need to increase or decrease the frequency of treatments. For example, if someone has insomnia, what is the best frequency of treatments? Once a week? Once a month? What number of treatments seem to work best for which syndromes related to the insomnia? Although ambitious, this could help improve future treatments.
2) Additional modalities – I could audit patients who have used additional modalities while receiving treatment for specific conditions. For example, with those whom I am treating for back pain, I could audit those who have simultaneously received physiotherapy, massage or osteopathy for the condition, to see if they felt those modalities also helped. If so, I could consider developing a referral system for patients with specific conditions, perhaps referring them to specific therapies or therapists if I feel it would help or be more appropriate.
So these are just some of the ways in which ideas of audit, particularly from the medical community, can be applied to acupuncture. Although there are certainly many other ways in which audit can be applied, this is just a taste of all the different ways in which it can be applied.
Section B – The challenge of lifestyle change and how this will inform your work with your patients
Doing the above audit, although somewhat challenging (having to limit my internet usage), it required certainly a lot of awareness and discipline. But more importantly, it required devotion, time and making space in my life to manage and record what I was doing. This is something which I believe is generally quite challenging, but even more so if you are asking a patient to do so!
What I learned more specifically about lifestyle change was that it was important to consider the following things:
1) The difficulty of change – making any change can be very difficult for people. I realised during my audit that looking at my phone is quite the addictive habit, and is difficult to change. Therefore, to change these habits, making gradual, small changes is vital. In my self-audit, I did not attempt to dramatically reduce my internet usage – I did so gently, first in my initial monitoring stage, and then later I did so more. With patients, this is something I would convey. If a patient needed to change their diet, via eating less sugar for example, I would emphasise not making massive, large scale changes, but begin to gently reduce every week how much sugar they were consuming. Eventually, after 4 weeks, they would hopefully be down to a far lower level.
2) Setting realistic targets – I learned that my target, of less than 11 hours, was realistic. However, if I had attempted to reduce my usage to less than 5 hours a week, this would have been foolhardy. I realised that setting realistic targets and goals were vital, and it is easy to create un-realistic targets and this is something to carefully manage when making changes. When talking to a patient, setting realistic goals which they can follow is therefore important. Otherwise it will likely fail, and make the patient feel less confident in themselves and potentially the acupuncturist.
3) Awareness of habits – it made me realise the importance of being aware of ones habits, and how much of a challenge this can actually be. Many of our habits can be unconscious, such as using the internet. Staying aware of how much we are engaging in our habits is a challenge, and requires self awareness. I would ask my patients to try to be aware as possible to their habits, and pay close attention.
4) Record keeping – similar to habits, it can also be a challenge to keep records of ones progress! Several times I nearly forgot to note down my usage, even with the help of the phone application. With following a different audit, such as water intake, exercise, etc, it would have been more challenging. With this mind, I would talk to a patient about ensuring they keep records of their changes, progress. This is so important, as it actually allows a patient to chart how far they have come. It is also useful for the acupuncturist, as this will help see what has been happening.
So in summary, although lifestyle change can be difficult, I would apply these points I learned to my treatments, to help my patient with their own lifestyle changes.
References
1) Baker, R. Hearnshaw, F. 1999. Implementing Change with Clinical Audit. Wiley & Sons: Chichester
2) Cotton et al. (2014) Internet Use and Depression Among Retired Older Adults in the United States: A Longitudinal Analysis. The Journal of Gerontology. Series B, Psychological Sciences and Social Sciences. Sep;69(5):763-71
3) Curtis, E. Drennan, J. 2013. Quantitative Health Research: Issues and Methods. McGraw-Hill Education: Maidenhead
4) Ericson, J. (2013) Information Overload: How The Internet Inhibits Short-Term Memory Accessed on 12th August 2017: [http://www.medicaldaily.com/information-overload-how-internet-inhibits-short-term-memory-257580]
5) Ofcom. 2015. Adults Media Use and Attitudes: Report 2015. Accessed on 21st August 2017: https://www.ofcom.org.uk/__data/assets/pdf_file/0014/82112/2015_adults_media_use_and_attitudes_report.pdf
6) Paranjothy, S. Thomas, J. M. (2003) Understanding Audit. Royal College of Obstetricians and Gynaecologists: Clinical Governance Advice No.5
7) Thorneé et al. (2012) Computer use and stress, sleep disturbances, and symptoms of depression among young adults – a prospective cohort study. BMC Psychiatry. V:12:176
8) Weinschenk, S. 2012. Why We're All Addicted to Texts, Twitter and Google. Accessed on August 12th 2017:
[https://www.psychologytoday.com/blog/brain-wise/201209/why-were-all-addicted-texts-twitter-and-google]