LEADERSHIP AND CITITZENSHIP

Question 1

Define leadership

Answer 1

The capacity to influence people, by means of personal attributes, and/or behaviours, to achieve a common goal.

Question 2

What are some contemporary challenges for healthcare?

Answer 2

Inequality in health eg access
Growing population
Pay and funding eg cuts
Lifestyle eg office/work from home
Mental Health
Technology
Influence of social media
Social expectations
Politics eg privitisation of healthcare
Non communicable diseases

Question 3

How does citizenship and physiotherapy intersect?

Answer 3

Inclusion and participation
Equity and access
Advocacy and empowerment
Health promotion and community engagement
Social and environmental considerations

Question 4

What are the four CSP standards?

Answer 4

That CSP members:
- Take responsibility for our actions
- Behave ethically
- Deliver an effective service
- Strive to achieve excellence

Question 5

Summarise the standards of proficiency

Answer 5

Practice safely within scope of practice
Legal and ethical boundaries
Health and wellbeing
Autonomoud professional and own judgement
Culture, equality and diversity
Confidentiality
Effective communication
Working together
Maintaining records
Reflecting and reviewing
Quality
Key concepts and knowledge
Skills
Safe
Promoting health and prveenting ill health

Question 6

Summarise the standards of conduct, performance and ethics

Answer 6

Protecting and promoting interests
Communication
Limit of knowledge
Delegate
Confidentiality
Manage risk
Safety
Honest
Keep records

Question 7

What is clinical governance?

Answer 7

Organisations accoundtable for improving quality of their services and safeguarding high standards of care by creating and environment in which excellence and clinical care will flourish

Elements:
- risk management
- patient and public involvement
- education and training
- information and data
- clinical audit
- staffing and wokrforce
- research and development

Question 8

What are the HCPC standards for continuing professional development?

Answer 8

Maintain up to date records of CPD activities
CPD benefits to self and society
Written profile of CPD if requested

Question 9

What is critical reflection?

Answer 9

Process of learning through and from exerience
Self aware and critically evaluating
Gain new understanding and improve future practice
Life long learning

Question 10

What is the what, so what, now what model in regards to critical reflection?

Answer 10

What:
What was my goal, what did i do, what was i feeling, what went well, what went poorly

So what:
So what was important, what knowledge can inform me, what did I learn about myself?

Now what:
Can I do to improve my knowledge, what can I do to improve my skills, what can I do differently?

Question 11

What questions do holm and steohenson 1994 apply to critical reflection?

Answer 11

What was my role in this situation?
Did I feel comfortable or uncomfortable? Why?
What action did I take?
How did I and others act? Was it appropriate?
Did I expect anything different to happen? What? Why?
What knowledge from theory or research can I apply to this situation?
What broader issues – for example, ethical, political or social arise from this situation?
What do I think about these broader issues?
Do I feel I have learned anything new about myself?
Has it changed my thinking in any way?
How could I have improved the situation for myself or the service user?
What can I change in the future?

Question 12

What are the steps involved in Gibb’s 1988 reflective cycle model?

Answer 12

Description
Feelings
Evaluation
Analysis - use of knowledge/research
Conclusion
Action Plan

Question 13

What is the SBAR communication tool?

Answer 13

Situation: introduce yourself, provide basic details, explain situation

Background: brief overview and relevent clinical details

Assessment: relevent clinical findings, vital signs etc

Recommendations: what you would like to happen, further action, clarification

Question 14

What are the different types of communication?

Answer 14

Verbal
Non-verbal/body language
Paralanguage: pitch of voice, volume, rhythm, inflections and hesitation.
Listening
Touch

Question 15

Describe shared decision making

Answer 15

A combination between the system, professionalism an the patient.

Patients and clinicians work collaboratively to determine investigations, management plans and support needed based upon individual preferences and relevant evidence (NICE)

Question 16

What characteristics create an effective environment for communication?

Answer 16

A caring atmosphere
Appropriate information
Attitude and listening
Aligning and responding
This allows members to feel pshycholgically safe.

Question 17

What is person centred care?

Answer 17

Acknowledging patient’s experiences, stories and knowledge and provide care that focusses on and respects patients values, preferences and needs by engageing the patient more in the care process.

Question 18

What are some benefits of effective communication?

Answer 18

Reducing uncertainty
Enhance greater patient engagement in decision making
Improve patient adherence to medication and treatment plans
Increase social support, safety and patient satisfaction in care.
Essential in enhancing patient centred care and positive care outcomes.

Question 19

What are the key elements of effective communication?

Answer 19

Deliver a clear message

Barriers:
language differences, cultural differences, physiologic barriers, cognitive impairment, emotional barriers,

Question 20

What is population health?

Answer 20

Improving health of the entire population. Physical and mental health outcomes and wellbeing of people within and across local, regional or national population, while reducing health inequalities. Action on the wider determinants of health.

Question 21

What are some of the wider determinants of health?

Answer 21

Housing - overcrowding and poor quality
Transport - access other areas, traffic accidents
Employment - quality of work, job security, hazards
Education - people with a Uni degree by age 30 live 5 years longer, health literacy and earning potential
Income - ability to buy health improving goods, income stress
Location - access to quality green areas, exposure to pollutants.

Question 22

What do you want to know about physical activity when taking a history?

Answer 22

Current physical activity/exercise?
Intention to do physical activity/exercise
Past physical activity/exercise and preference
Is it safe to do physical activity/exercise? (current symptoms and past medical history?

Question 23

What are some validated measures of activity?

Answer 23

Use of an activity diary
Use of a validated questionnaire eg IPAC
Use of a pedometer
Use of an activity monitor/GPS system

Question 24

What are the ACSM guidelines on activity?

Answer 24

30 minutes of moderate-intensity 5 days per week
OR
75 minutes of vigorous intensity exercise spread across the week
Or a combination of both
AND
Muscle strengthening 2x per week
Strengthening, balancing and coordination.

Question 25

What is the transtheoetical model?

Answer 25

Focusses on the decision making of the individual and is a model of intentional change.

Precontemplation - no intention. Identifies reasons for not considering exercise. Advice about health risks of inactivity.
Contemplation - within 6 months. Identify barriers to exercise, solutions to overcome and set goals.
Preparation - within 30 days. Set SMART goals, ensure that the patient understands the advice.
Action - less than 6 months. Remind the patient of the heath benefits, establish possible reasons for relapse and address them.
Maintainance - more than 6 months. Evaluate current exercise regime, and boost confidence with positive reinforcement.

This is cyclical and not linear.

Question 26

What is the 5 A’s intervention approach?

Answer 26

Ask - current and past PA
Assess - stages of change
Advise - depending on stage of change
Assist
Arrange - follow up

Question 27

What is the FITT principle?

Answer 27

Frequency
Intensity
Time
Type

Question 28

What are some barrier to behaviour change?

Answer 28

Overlooking context - we must use personal context with patients
Choice overload - we must simplify the options
Decision fatigue - we must keep instructions simple
Old habits - focus on consistency
Social determinants - leverage social factors
Incremental progress - make everything measurable Hyperbolic discounting - focus on short term results
Relapse - set reasonable expectations
Poor goal setting - create SMART goals.

Question 29

How do patients describe their expectations of healthcare?

Answer 29

In 3 distinct domains
Health outcomes - improvement in their health
Individual clinicians - expectations from clinicians and their previous experiences with clinicians
Health care system - the ‘system’ as an entity.

These 3 domains are interrelated.

Question 30

What are the basic principles and expectations of patient clinician communication?

Answer 30

Mutual respect
Harmonized goals
A supportive environment
Appropriate decision partners
The right information
Transparency and full disclosure
Continuous learning.
Attentive listening
Taking enough time
Building patient’s trust in the physician’s competance
Giving patients the feeling that the physician is doing all they can.

Question 31

What are some sociocultural factors that effect patient’s expectations?

Answer 31

Migration status, refugee status, ethnicity, caste, social class, sexuality, age, co-morbidities, gender, disability, passive expectations, active expectations

Social Location and Habitus
Expectations of care
Experiences of health system interaction
Health systems response eg resources, policies, organisational processes.

Question 32

Discuss the importance of compassion in health care?

Answer 32

Reduced patient symptom burden
Improved quality of life
Improved quality of care ratings

Question 33

What is person centred care?

Answer 33

A philosphy of health care practice which reflects the needs, values and preferences of the individual to optimise their experiences of care.

Key aspects: fully involving the person’s perspectives, needs, values, or preferences. Optimising the person’s experience with care, considering the relationship between the person and the professional.

Question 34

Give some examples of empathetic communication

Answer 34

Help me to understand what it feels like to…(be in your shoes, cope with the pain)
You must be feeling…(overwhelmes, sad, frustrated, isolated, exhausted, anxious)
How can I help you…(get through this, keep motivated, focus on the positives, cope)
It sounds like you’re…(nervous about, angry about, anxious about, confused about)
You seem to get really…when…(you mention that, we talk about)

What are some of the things you would like to achieve as a result of this support?
What is important to you at the minute?

Question 35

What is the virtuous circle of person centredness by Shaun Maher?

Answer 35

Attentiveness enables attunement builds trust generates therapeutic alliance produces better outcomes reinforces kinshippromotes kindess directs attentiveness…

Question 36

What is the SPIKES acronym for breaking bad news?

Answer 36

S - setting up: privacy, relevant information, who else needs to be there, sit down, connect, manage time constraints and interruptions.

P - patient’s perception: before you tell ask, open ended questions, what have you been told so far, what are your understandings, if there a suggestion of denial or mismatch, correct misinformation if necessary.

I - Obtaining patient’s invitations: what level of disclosure does the patient desire? Are you the type of person who likes to know everything that is going on?, may have to stagger information delivery.

K - giving knowledge to the patient: warning shot (eg unfortunately), tailor delivery to level of vocab, avoid bluntness, give info in small chunks, silence is vital, emotion reaction is likely, check regularly and repeatedly.

E - emotions with empathetic responses: observe and identify the emotion, I can see this is not the news you were hoping for, connecting statement, avoid giving false hope, reduces patient’s sense of isolation.

S - strategy and summary: is the patient ready to make a plan, resent rehab options, shared decision making, framing hope in terms of what is achieveable, answer any questions.