EBP Flashcards
What are the 4 themes in the NMC code
Prioritise people, practise effectively, preserve safety and promote professionalism and trust
What is nursing?
A profession/ calling
intrinsic
Service to others
Requires specialist skills and knowledge FLORENCE NIGHTINGALE
Explain the regulation for nurses
NMC- protect the public
Maintain a register
Giving a protected title to nurses
Establishing how fitness to practise would function and be in action
Made it an offence for someone to falsely represent themselveslvez as being on the register
Public perception of nurses
:) all angels and do no wrong
:( not caring, scandals- mid Staffordshire report- poor care, poor attitude, poor communication, incompetence
What do patients want from their care?
Be treated well
Have high quality care
Nurses that keep them safe physically and mentally
Treated with compassion, respect and empathy
Treated as a person not a case
What is the purpose of the NMC?
Protect the public
Uphold fitness to practice
Sole funding Is by registration fees
What is the baseline of the NMC
The standard of below which professional practice must not fall below (education, training, conduct and performance)
What is the focused role of the NMC?
Define standards
Mentor adherence to standards
Act when standards are not being met
Where does confidentially arise from?
autonomy
What is confidentiality?
Implied promise healthcare professionals won’t go and spill their info.
The right that the persons medical info etc is kept secret (Apart from the healthcare team however they will only need to know what they need to know)
Why is trustworthy so important?
Without trust the relationship between the healthcare professional and the patient would break down and if the patient does not share necessary info then the healthcare professional cannot do their job
What is consequentialism?
Theory that suggests that actions should be determined by the consequences- the healthcare should be guided to bring out the greater good for the greatest amount of people.
Consequence could be wrong for the patient even if it is the right treatment!
Eg if the professional divulges confidential info then the patient may not seek healthcare again
What is the Caldicott Review?
Ensures that information that can identify an individual is protected and that information can only be used when it is appropriate to do so.
Eg must have a justified purpose
Must be necessary to give information to another healthcare professional
Access should be a strict need to know basis
Comply with law
When can you share information with others?
When a patient gives consent for info about their care and treatment to be shared with family members
THEY MUST BE COMPETENT, know what is going to be disclosed, reasons for disclosure, consequences, whom, and how much info will be given
When can you share info with others?
When a court law requires it
Public interest must be balanced with the private interest in maintaining confidentiality
What is safeguarding?
Protecting vulnerable people from harm
What happens if there is a safeguarding issue?
NMC must act if you think a patient is in danger, go higher and report it to safeguarding
What is paternalism?
Paternalism is when you interfere with someones autonomy, with the intent of preventing harm or promoting good.
Doctors will sometimes withhold info from their patient
What is candour?
Being open, honest, transparent.
If harmed by healthcare the professionals must inform patient and must offer a remedy
Describe being open
Allowing concerns and complaints to be raised without fear
Making sure that questions are answered
Describe being transparent
Sharing info with staff, the regulators and the public about the performance
Who should apologise
The person that made that mistake
Lead clinician even if it isn’t their fault
Describe the professional duty of candour process
1) Tell patient when something has gone wrong
2) Apologise to patient and family
3) Offer an appropriate remedy
4) Explain fully to the patient- STM and LTM effects
Does saying sorry mean you accept legal liability?
NO- right thing to do and shows regret
What are the 3 things a patient expects in an apology?
What happened
What can be done to deal with harm caused
What will be done to prevent someone else being harmed
When should you say sorry?
In a way they can understand
At a time and place that suits them
Be considerate and respectful
What are notifiable incidents?
Any unexpected or unintended incident that causes moderate harm or worse
What is a near miss?
An adverse incident that had a potential to cause harm but didn’t
What is a regulator?
CQC- carry out regular inspections that determine whether or not standards are being met for safe, effective, compassionate and high quality care
What is nursing care?
The provision of care where a patient needs to be provided for- not just by a nurse
What are regulated activities
Personal care Accommodation Treatment of diseases Surgical procedures Maternity and midwifery services Nursing care
What are the 2 types of harm?
Moderate and severe
What is moderate harm?
Requires a moderate increase in treatment eg unplanned surgery, increase in care, prolonged time in hospital, transfer to another treatment
What is severe harm?
Permanent damage
Lessening of sensory, physiological, psychological functions
DEATH
Not part of natural course of patients treatment
What is whistleblowing?
When a worker passes on info concerning a wrong doing to supervisor/ tutor
Why don’t nurses raise concerns?
shunned, suspended, frightened, sacked, not action would be taken, loss of friendships
What is negligence?
Failure to take proper care over something
Defendant was owed a duty of care
The harm was caused by carelessness
What is duty of care?
A moral or legal obligation to ensure safety of others
What is the legal aspect of duty of care?
Off duty should only have duty of care if caused accident
What is the professional aspect of duty of care?
Off duty always have duty of care IF COMPETENT
What causes negligence?
If standard of care falls below the standard
When negligence is taken to court, who are judged against?
Against what a reasonable professional would do in the same situation
If I am a student nurse and was taken to court, who would I be judged against?
A newly qualified nurse
What are the four main ethical principles?
Autonomy
Justice
Beneficence
Non-malificence
Describe autonomy
Right to make own decision and take actions based on personal views
Describe justice
Treat people equitably, distribute benefits and burdens fairly (Eg personalised treatment- people get the same right that they get the best treatment for them
Describe beneficence
Do right thing for the patient
Describe non-non-maleficince
Obligation not to inflict intentional harm
DO NO HARM
What is fact?
A fact that can be proven with evidence
What is opinion?
Personal, interpretations and cannot be verified with evidence
What is evidence based practice?
Finding the best information to inform your decision-making
What are the 3 things in EBP?
Clinical expertise, best research evidence, patient values and preference
What does EBP require?
Requires that decisions about health care are based on the best available, current, valid and relevant evidence
What happens when practice is not evidence based?
You will not be fit for practice
What is the pyramid of evidence?
1) Animal/ Lab studies
2) Case Report/ Case
studies
NO DESIGN. NO HUMANS
3)Case control studies
4)Cohort studies
5) Randomised
PRIMARY STUDIES/ OBSERVATIONAL
6)Meta analysis
SECONDARY
What are the 4 approaches for research?
Quantitive
Qualitative
Mixed methods
Review
Describe qualitative data
Learn about people’s experience through discussions/ interviews
Gives insight and detailed descriptions
What is nursing?
Both a science and an art
Describe quantitive data
Uses a LARGE number of participants
explores C+E
Used to compare treatments
Is to support fact based decisions for groups NOT INDIVIDUALS
What are both types of primary research?
Know the facts- informed and technically competent
Need to change behaviour of patients
What makes research good?
Clear question Sound theoretical basis Logical Limits bias through recruitment Has implications
What is the research hierarchy?
1) single case study- used when there is no evidence= small sample size
2) Descriptive studies- Provide several viewpoints, use theoretical framework from previous case studies
3) Generalisable conceptual studies- larger diverse sample, provide info that can be applied to all
What come hand in hand with evidence when speaking to a patient
Trustworthiness- they have to trust the healthcare professional to listen to the advice/ evidence you’re giving
What is your responsibility?
Professional responsibility to make evidence based decisions
What is the alternative to whistle blowing?
Invited criticism
Culture that values feedback
Multiple channels of disclosure
What is the research process?
1) Idea
2) Research question
3) Prioritising
4) Plan
5) Funding
6) Ethics approved
7) collect data
8) Analysing data
9) interpret data
10) tell people results
11) Change practice
12) re-evaluation
What is ethnography?
Understanding a culture within that culture, in the point of view of that culture
participants observe
unstructured
Researching something from that cultures point of view
What is the grounded theory?
Make own theory
Social processes
Shows solutions
What is phenomenology?
Living in their world seeing it from their point of view
study of lived experience
researchers need to remove values/opinions
What are the data collection methods for qualitative research?
Interview
Focus group
Observation
Summarise qualitative data
Understand meaning
Coloured by judgements but this can be a benefit
gives insight and depth- peoples experience
What is face validity?
does the procedure look like its effective and will measure what its supposed to measure
What is construct validity?
degree of which a test measures what it claims to measure
What is criterion validity?
extent to which a measure predicts an outcome for another measurement
What is discriminate validity?
tests whether concepts/ measurements that are not supposed to be related are actually related
What are the levels of measurement for quantitive data?
nominal- categories
ordinal- categories but have order within categories
interval- difference between 2 values is meaningful
ratio- same as interval but starts at 0
What is stratified sampling?
group
random sample out of each group
random population
proportional
What is special about random sampling?
everyone has the exact same chance of being picked
What is purposive sampling?
Selective sampling- pick certain characteristics of population- stop when saturated
What is test re-test reliability?
Give same tests to same respondents and should get the same results
What is inter-rater reliability?
Degree of agreement among different raters
What is the process of qualitative data analysis?
Familarise yourself with data
Generate codes
Review themes
Describe the mid-staffordshire report
Neglect of patients- not washing, no water, dirty bed sheets
changes: tougher inspections, recruited more nurses, able to speak out if have concerns, more transparency over treatment, put patients in driving seat
What is the ethical issues with informed consent?
Autonomy
What is informed consent?
Making sure a patient is making a right decision by ensuring they have sound understanding
How can you check if someone is giving informed consent?
Patient-teaching= check patient understanding by asking them to repeat what they understand
Asses for paternalism
What is epidemiology?
studies that look at prevalent incidence or distribution of diseases
What is prevalence?
Proportion of a population who have a specific characteristic in a given time period
What is incidence?
measure of the number of new cases of a characteristic that develops in a population
What are the key concepts of research for quantitive research?
1) recruitment- define population, big sample
2) Sampling-random, convenience etc representative of pop
3) Data collection- valid and reliable way of collecting data
4) Data analysis- summarise data using statistical tests
