ideals Flashcards
what is the self determination theory?
who came up with it?
distinguishes between intrinsic + extrinsic motivations.
Intrinsic motivation is observed when one engages in an activity out of genuine interest and is truly self-determined
- this is the desired type of motivation for studying as it’s associated with better outcomes
intrinsic motivation can only occur when these three psychological needs are met:
- autonomy
- competence
- relatedness
Olle Th Ten Cate
what are the 4 levels of feedback decribed in ideals this year?
describe them
who’s came up with them?
Task focused
- how well tasks are understood/performed
Process focused
- the main process needed to understand/perform tasks
Self-regulated focused
- self-monitoring, directing + regulating of actions
Person (self) focused
- personal evaluations and affect (usually positive) about the learner
Hattie + Timperley
two models of feedback were discussed: mark 1 and mark 2
- what is the major difference between them?
- who came up with them?
Mark 1 does NOT develop self-regulation
Mark 2 allows comparison between internal feedback (self-regulation) and external feedback
Boud + Malloy
what are the three strands of professionalism?
- behaving responsibly
- self-awareness
- demeanour, moral values + motivation
what sort of unproffessional behaviours do we mean by:
- can’t?
- won’t?
- oops?
which is of most concern to the GMC?
can’t:
- insufficient skills/knowledge
won’t:
- has knowledge/skills but chooses not to follow rules
- no remorse
- of most concern to GMC
oops:
- on rare occasions fails to live up to expecctation
- shows remorse
Theory of planned behaviour:
- what are the three things which affect behavioural intention (+ subsequent behaviour)?
- who came up with this theory?
- attitude toward act or behaviour
- subjective norm
- perceived behavioural control
Azjen
“AZlan meticulously planned his behaviour in lion witch + wardrobe”
describe ‘root cause analysis’
systematic analysis of all the factors which predisposed to, or had the potential to prevent, an error
what are the three basic principals of root cause analysis?
react:
- what were the critical problems?
record
- what were the main contributory factors/root causes?
respond
- what needs to be done?
the three Rs
name three different tools used to carry out root cause analysis
briefly describe them
5 whys
- literally just follow every answer up with ‘why?’
Tabular Timeline
- what happened? what shuld’ve happened? service/care delivery problem?
Fishbone analysis tool
- look at range of factors: patient, task, communication, team, equipment
what are the confidentiality Caldicott guidlines? 6
guidlines related to how to handle confidential information
- justify the purpose of using confidential info
- only use it when absolutely necessary
- use the minimum required
- allow access on a strict need-to-know bases
- understand your responsibility
- understand + comply with the law
PACE
- what is it?
- what does it stand for?
- give an example of it being used in practise
4 tiers of communication. Each one is a measured escalation that systematically (if the problem is not resolved) transfer power from other, to shared + finally to self
P = Probe:
- ‘do you know that…’
- eg: ‘did you know that this patient has a serious allergy to Latex’
A = Alert:
- ‘can we re-assess the situation…’
- eg: ‘I think there might be Latex in the gloves you are using. Let’s just check on the box’
C = Challenge:
- ‘please stop for a minute while…’
- eg: ‘It is against our policy for you to do this procedure wearing Latex gloves if the patient has an allergy. You should not continue’
E = Emergency:
- ‘STOP what you’re doing!’
- eg: ‘Step away from the patient. You will not continue with this. I am contacting the consultant immediately.’
nb this was borrowed from the aviation industry
what are the guidlines widely used to assess whether a child is mature enough to make decisions and understand complications?
- what are they based on?
Fraser guidlines
based on Gillick competence
Quality improvement:
- addresses the gap between…?
- two main principles?
what care IS being delivered and what care SHOULD be delivered
- eliminate inappropriate variation (usually in process steps)
- document any change (usually by measuring outcomes)
name two quality improvement methods used in healthcare
which is most effective? why?
- clinical audit (measuring against predefined standard)
- PDSA cycle (plan, do, study, act)
PDSA cycle:
- as takes audit a step further by focusing on development testing + implementation. Repeated rapid small scale tests of change
what should all aims be?
SMART
- specific
- measureable
- attainable
- relevant
- time limited
what are the three types of measures when carrying out quality improvement?
outcome measures:
- acieving an endpoint
process measures:
- measures of throughput
balance measures:
- checking change hasn’t caused a new problem
what is the best tool to use as a measure of improvement?
statistical control charts (SPC)
ie not just averages
what are serious incidents?
incidents that result in unexpected or avoidable death or serious harm to patients, staff, visitors or public
they also result in a scenario that prevents or threatens an organisation’s ability to continue providing a healthcare system
how are serious incidents investigated?
what are the 4 tools used within this?
Root cause analysis
- timeline
- swiss cheese model
- organisational accident model
- fishbone diagram
identify the CONTRIBUTARY FACTORS having the greatest impact on the episode + would reduce the chances of it happening again
- these are the ROOT CAUSES
then come up with an action plan
what 6 physiological parameters do we measure as part of a NEWS score?
- resp rate
- O2 sats
- temp
- systolic BP
- pulse
- level of conciousness
what is the tool used to hand over information about a patient?
SBARR
- situation
- background
- assessment
- recommendation
- readback
what are the 5 components of emotional intelligence?
- self-awareness
- self-regulation
- motivation
- social skills
- empathy
what is situational leadership?
describe its components
adapting your leadership style depending on the development level of the follower
S1: directing
- high directive
- low supportive
S2: coaching
- high directive
- high supportive
S3: supporting
- low directive
- high supportive
S4: delegating
- low directive
- low supportive
what are the 9 dimensions of the NHS leadership framework?
- leading with care
- sharing the vision
- engaging the team
- influencing for results
- evaluating info
- inspiring shared purpose
- connecting our service
- developing capatibility
- holding to account
define these types of consent:
- valid
- explicit
- implied
valid:
- competent
- received sufficient info
- not under duress
explicit:
- articulated agreement, orally or written
implied:
- signalled by behaviour, after discussion/understands implications
what are the key legal issues around consent?
- needs obtaining BEFORE exam/treatment/care
- adults assumes competent, unless demonstrated otherwise
- usually a process/not a one off
- consent can be withdrawn at any time
- needs sufficient info given in a form they can understand
- voluntary (without duress)
- generally, no one can give consent for another adult
how would you describe ‘sufficient info’ for a patient to consent to a treatment?
- description of treatment (eg)
- effectiveness
- benefits + risks
- alternatives
plus any other info they ask for!
nb leaflet is NOT sufficient! - it is just there to supplement verbal info
also CHECK that they’re understanding the decision being made
what do you do if a patient wants to consent to a treatment but doesn’t want information?
try and find out why they don’t want info
explain that it is still important to understand the options
give the minimal info needed to obtain valid consent
what is delegated consent?
consent taken when individual not competent
describe the roles of these people in delegating consent and what they can and can’t do:
- lasting power of attorney?
- court-appointed deputies?
- independent mental capacity advocate?
lasting power of attorney:
- nominated at a time when patient HAD capacity
- this person can make decisions about the patient’s care when they no longer have capacity
- DOESN’T include decisions about witholding life-saving treatment unless stated
Court appointed deputies:
- cannot override lasting power of attorney
Independent mental capacity advocate:
- represent the views of vulnerable people lacking capacity to make important decisions about serious medical treatment when there are no family/friends who can be consulted
define:
- hazard
- risk
hazard
- things that COULD cause harm
risk
- likelihood that an incident would occur + how bad the consequences would be
what types of incidents are there in the healthcare setting? 5
clinical incidents
- related to planning, organisation, delivery of care, treatment or procedures
- eg delayed diagnosis, misinterpretation of test, equipment error
patient incidents:
- non-treatment related
- eg slips, trips, falls
security incidents:
- eg theft of property, violence, aggression
staff incidents:
- eg slips, trips
information governence incidents
- eg leaks of confidential info etc
what action should be taken with a NEWS score of:
- 0-4?
- 5+?
- 7+?
0-4
- 4 hourly obs
- monitor urine output
5+
- 2 hourly obs
- assessed by registered nurse
- check blood glucose
- strict fluid balance of hourly intake + output
- screen for severe sepsis
7+
- 1 hourly obs minumum
- immediate reg review
- strict fluid balance
- contact critical care outreach team
name 6 different styles of leadership (from first year)
- coercive
- authoritative
- affiliative
- democratic
- pace-setting
- coaching
what types of leadership/management styles are these describing:
- gives rewards when people do well?
- inspire followers to work hard/change system etc?
- are flexible in their approach?
rewards
- transactional
- “transactions occur”
inspiring
- transformational
- “transform your way of thinking”
flexible
- situational
- “change style depending on situation”
what are the 5 stages of grief?
- shock/denial
- anger
- bargaining
- depression
- acceptance
the change curve:
- what is it?
- who came up with it?
- what are the stages?
measures morale and competence against time when a new change is introduced
elizabeth kubler-ross
- shock
- denial
- frustration
- depression
- experiment
- decision
- integration
eight steps to successful change:
- who came up with them?
- what are they?
John Kotter
- establish a sense of urgency
- create a guiding coalition
- develop a clear shared vision
- communicate the vision
- empower people to act on the vision
- create short-term wins
- consolidate and build on the gains
- institutionalise the change
