Ethics And Communication

Question 1

Up to 80% of medical errors is due to what?

Answer 1

Poor communication about
• documentation
• consult with other doctors, nurses, patients
• shift changes and hand overs

Question 2

Name the 5 principles of dealing with the difficult or upset patient according to the universal upset patient protocol in healthcare communications

Answer 2

• Listen to the grievance
• show respect and understanding to the problem - put yourself in their position
. Don’t be confrontational or defensive
• offer a solution to the problem - negotiate within the limits of ethics and the law
• get the patient or relative to agree

Question 3

Define empathy

Answer 3

The capacity to understand or feel what another person is experiencing from within that person’s frame of reference. The capacity to place yourself in another’s position.

Question 4

Name the 6 steps of the universal upset patient protocol in healthcare communications

Answer 4

1. you look really upset
2. Tell me about it
3. I’m sorry this is happening
4. What would you like me to do
5. This is what I propose
6. Thanks for sharing

Question 5

Name the 6 steps of breaking bad news according to Robert Buckman’s six step protocol for breaking bad news

Answer 5

1. Getting started: private setting, comfortably seated, asks who else they want present. “How are you feeling”
2. Find out how much patient knows: about what has been told, technical sophistication, emotional state
3. Find out how much patient wants to know
4. Share the info: decide on agenda before consult, diagnosis, treatment, prognosis, support, coping. Small chunks, stopping often to make sure they understand. Simple language
5. Respond to patients feelings
6. Planning and follow through: management plan, next consultation , appropriate referral, contact number

Question 6

Define ethics

Answer 6

The correct thing to do, what the majority will do, what most people will do

Question 7

Name the 5 principles of ethical practice

Answer 7

• Beneficence
• non-maleficence
• patient autonomy
• justice
• (honesty)

Question 8

Define beneficence

Answer 8

Do good to benefit patients, well-being, cure, improvement.

Question 9

Define non-malifence

Answer 9

First do no harm - end goal for all medical decisions! Even if beneficence, non- malifecence trumps

Question 10

Define autonomy

Answer 10

Patient has final decision regarding their health or otherwise
Non-paternalism

Question 11

Name the surrogate decision makers in order (5)

Answer 11

• Spouse
• life partner
• parent
• adult child
. Brother or sister

Question 12

Define justice

Answer 12

Access to health care
Financial aspects
All treated equal

Question 13

Name the 8 elements of informed consent according to the HPCSA booklet 9

Answer 13

• Voluntary and without constraint
• HIV test preferably written consent but can be implied
• consent must not conflict with good morals or constitution
• patient must be capable of consenting
• pt must give consent personally unless proxy applicable
• pt should know why doctor needs results
• sufficient info about diagnosis, proposed treatment,expected benefits, risks, alt treatment, probable results etc
• patient must actually understand May need interpreter.

Question 14

Name the 5 general ethical guidelines of informed consent for HCP according to hpcsa booklet 9

Answer 14

• Give pts info they ask for or need about condition, treatment and prognosis
• give info in way they can understand by language, literacy, understanding, values, beliefs
• refrain from withholding any info, investigation, treatment that would be in patient’s best interest.
• on going process
. Allow access to medical records

Question 15

Define child according to children’s act

Answer 15

Under 18 years

Question 16

Name 7 procedures that require informed consent

Answer 16

• Surgical investigations
• anaesthesia, including local
• blood transfusions
• chemo and radiotherapy
• some advanced medical tests eg biopsy
• vaccinations
• some sensitive blood tests eg HIV
Document all these!

Question 17

Define Trauma (5)

Answer 17

A person’s emotional response to a distressing experience . unlike ordinary hardships, traumatic events tend to be sudden and unpredictable, involve serious threat to life- like bodily injury or death- and feel beyond person’s control. Most important, events are traumatic to the degree that they undermine a person’s sense of safety in world

Question 18

Define secondary trauma

Answer 18

Trauma develop from exposure to Trauma of another

Question 19

Define vicarious trauma

Answer 19

The transformation that occurs within counsellor/professional as result of empathetic engagement with clients’ trauma material

Question 20

Define compassion fatigue

Answer 20

Fatigue/exhaustion of compassion - natural consequence of working with secondary trauma

Question 21

What are the ABCDs of end of life care

Answer 21

Ask what they want, advanced directive
Better (feel better)
Communicate and identify caregivers
Decisions

Question 22

Name 5 consequences of untreated occupation stress according to NIOSH

Answer 22

• Medical errors and more near misses
• somatic complaints eg changes in eating habits, git distress, headache, fatigue, sleep disorders
• change in work habits eg tardiness, absenteeism
• mental and emotional difficulties eg memory disturb, anger, self doubt, isolation,impaired judgement
• accidents

Question 23

Define primary traumatic stress

Answer 23

Direct physical and psychological injury that occurs as result of traumatic event

Question 24

Define burnout

Answer 24

Gradual emotional exhaustion, depersonalization, reduced sense of personal accomplishment that occurs when work-life domains are unbalanced between organization and worker

Question 25

Name 3 risk factors for medical caregiver secondary traumatic stress

Answer 25

• Severity of exposure
. Duration
• individual vulnerability

Question 26

Define countertransference

Answer 26

Distortion by therapist resulting from therapist’s life experiences and associated with their unoncious, neurotic reaction to client’s transference

Question 27

Define repression

Answer 27

Consciously or unconsciously holding back or fighting, thoughts, feelings, behaviours. Type of self regulation

Question 28

Name 3 components of self regulation

Answer 28

• self monitoring
- self evaluation
•Self-reinforcement