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PPS Flashcards

1
Q

HUMAN RIGHTS ACT 1998
What is the WHO definition of health?
How does this link to the HRA?

A
  • The state of complete physical, mental + social wellbeing + not merely the absence of disease or infirmity.
  • The highest attainable level of health is the fundamental right of every human being.
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2
Q

HUMAN RIGHTS ACT 1998
When did the HRA come into force?
What is the importance of it?

A
  • 2000 + is set out in the European Convention on Human Rights.
  • (Should) form part of an organisations decision-making process to ensure people’s rights are respected + is part of all policy making.
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3
Q

HUMAN RIGHTS ACT 1998
What are the underlying assumptions with the HRA?

A
  • State/organisations have a duty to uphold these rights + they’re universal.
  • All basic rights are claim rights i.e. others wanting things.
  • The irreducible moral status of individuals demands that people are treated in ways that are compatible with that moral status.
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4
Q

HUMAN RIGHTS ACT 1998
What are some issues with the HRA?

A
  • ?Universal or Western concept (FGM, judicial executions).
  • Which interests are significant enough to justify it being a human right?
  • Can absolute claims conflict? All rights are interdependent + inter-related.
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5
Q

HUMAN RIGHTS ACT 1998
What are the 5 articles that are frequently engaged in healthcare?

A

Art 2 – the right to life.
Art 3 – the right to be free from inhumane + degrading treatment.
Art 8 – the right to respect for privacy + family life.
Art 12 – the right to marry + found a family.
Art 14 – the protection from discrimination (sex, race, sexuality etc).

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6
Q

HUMAN RIGHTS ACT 1998
What is meant by absolute rights?
Give some examples

A

They’re never limited i.e. they hold under ALL circumstances.
- Art 3, Art 4 (prohibition on slavery + enforced labour), Art 7 (protection from retrospective criminal punishments).

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7
Q

HUMAN RIGHTS ACT 1998
What is meant by limited/qualified rights?
Give some examples

A

They are limited under explicit + finite circumstances.
- Art 2 (limited), Art 5 (the right to liberty), Art 8 (qualified).

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8
Q

HUMAN RIGHTS ACT 1998
Explain why some rights may be limited/qualified.

A
  • Art 5 – if your freedom affects other’s safety.
  • Art 2 – medical Tx a pt requests is not a right. Obligation upon state to take appropriate steps to safeguard life but cannot impose a disproportionate burden on the authorities to provide unlimited resources.
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9
Q

HUMAN RIGHTS ACT 1998
What is the exceptionality criteria with the HRA?

A

Applicable to public bodies like NHS trust where they adopt a general policy for the exercise of ‘administrative discretion’, to allow for exceptions from it in ‘exceptional circumstances + leave those circumstances undefined’.

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10
Q

HUMAN RIGHTS ACT 1998
What are some topics in individual rights vs. collective groups?

A
  • Should vaccines or blood/organ donation become compulsory?
  • Is screening a form of collectivism?
  • Wearing a face mask to prevent spread of disease despite disagreement.
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11
Q

RESOURCE ALLOCATION
What is rationing?

A

Where resource is refused because of lack of affordability rather than clinical ineffectiveness.

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12
Q

RESOURCE ALLOCATION
Why have rationing needs increased in terms of resource allocation?

A
  • Shift from acute>chronic complex conditions.
  • Increase in choice + availability of more expensive drugs.
  • Medicalising what used to be ‘normal’ physiology (childbirth, menstruation).
  • Ageing population with increasing demand on services.
  • Funding has barely increased.
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13
Q

RESOURCE ALLOCATION
What are the 3 ethical theories in context of resource allocation?

A
  • Egalitarianism.
  • Maximising/Utilitarianism.
  • Libertarian.
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14
Q

RESOURCE ALLOCATION
What is the concept of egalitarianism?

A
  • Provide all care that is necessary + required to everyone.
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15
Q

RESOURCE ALLOCATION
What are the pros/cons of egalitarianism?

A

Pros:
- equal for everyone (supports belief people deserve equal rights/opportunities)

Cons:
- economically restricted,
- tension between egalitarian aspirations + finite resources.

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16
Q

RESOURCE ALLOCATION
What is the concept of maximising/utilitarianism?

A
  • Healthcare should be distributed to bring about the best possible outcome (criteria that maximises public utility).
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17
Q

RESOURCE ALLOCATION
What are the pros/cons of maximising/utilitarianism?

A

Pros:
- resources allocated to those most likely to receive most benefit.

Cons:
- those with ‘less need’ receive nothing.

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18
Q

RESOURCE ALLOCATION
What is the concept of libertarian?

A

Each individual is responsible for their own health, wellbeing + flourishment i.e. incentives for behaviour change, screening participation paid (all paid with savings made from better health outcomes).

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19
Q

RESOURCE ALLOCATION
What are the pros/cons of libertarianism?

A

Pros:
- onus on pt therefore may be more engaged.

Cons:
- not all diseases are self-inflicted,
- should people be held accountable for their current/future health?

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20
Q

RESOURCE ALLOCATION
What is the harm principle in relation to Libertarian theory?
What is the con to this principle?

A
  • People should have autonomy in life so long as it doesn’t affect anyone else, even if others see actions as being wrong
  • BUT doesn’t appreciate the impact choices has on others
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21
Q

RESOURCE ALLOCATION
What is Johnson’s rule of rescue?

A

A tension sometimes arises between the injunction to do as much good as possible with scarce resources + the injunction to rescue identifiable individuals in immediate peril, regardless of the cost.

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22
Q

RESOURCE ALLOCATION
Give an example of Johnson’s rule of rescue.

A

It’s a perceived duty to save endangered life through disproportionate efforts regardless of cost + usually seen in vulnerable groups like children.
- E.g. treat rare cancer in child with experimental drug that may be effective.

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23
Q

RESOURCE ALLOCATION
What is meant by a sustainable process?

A

One that meets the needs of the present without compromising the ability of future generations to meet their own needs.

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24
Q

RESOURCE ALLOCATION
What are the aspects of sustainability

A
  • Economic factors.
  • Social factors.
  • Environmental factors.
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25
Q

RESOURCE ALLOCATION
Explain how the NHS can contribute to unsustainable practice

A
  • NHS emissions come directly from everyday clinical practice.
  • E.g. inefficient use of resources which can lead to clinical waste (over investigating, overprescribing, over intervention).
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26
Q

RESOURCE ALLOCATION
How can we respond to the unsustainable practices in the NHS?

A
  • Reduce clinical waste via appropriate prescribing, pt education to improve adherence.
  • Requires system-level action i.e. changes through legislation.
  • Encourage active travel (improved air quality + reduced risk of CVD).
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27
Q

RESOURCE ALLOCATION
What is the ladder of interventions?

A
  • Starts at doing nothing/monitoring.
  • Next steps are education or enabling choice (can be via changing the default).
  • Ends with incentives, disincentives + then restricting/eliminating choice.
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28
Q

MEDICAL NEGLIGENCE
Define negligence

A

A breach of duty of care which results in damage.
- There is failure to take proper care over something.

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29
Q

MEDICAL NEGLIGENCE
What 4 questions should be asked when negligence is suspected?

A
  • Was there a duty of care?
  • Was there a breach in that duty?
  • Did the patient come to any harm?
  • Did the breach cause the harm?
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30
Q

MEDICAL NEGLIGENCE
What 2 tests can be used to decide if there was a breach in a duty of care?

A
  • Bolam test = would a group of responsible doctors do the same?
  • Bolitho test = would it be reasonable of them to do so?
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31
Q

MEDICAL NEGLIGENCE
What factors influence how much money a patient may get from a successful negligence claim?

A
  • Loss of income.
  • Cost of extra care.
  • Pain + suffering.
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32
Q

MEDICAL NEGLIGENCE
What are 6 broad factors which contribute to negligence?

A
  • System failure.
  • Human factors.
  • Judgement failure.
  • Neglect.
  • Poor performance.
  • Misconduct.
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33
Q

MEDICAL NEGLIGENCE
Explain what is meant by system failure.

A
  • Computer system may shutdown > losing notes.
  • Pt may be unconscious + unable to communicate so important info lost at critical moment.
  • Hackers could access computer systems = remove confidential information.
    – Confidentiality breaking in this way could be negligent.
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34
Q

MEDICAL NEGLIGENCE
Explain what is meant by human factors?

A
  • Personal factors (having a bad day>mistakes).
  • Teamwork problems (miscommunication, tensions between staff).
  • Working environment (lighting, space).
  • Decision density (leaving one person to make all decisions = pressure so more likely to make a mistake).
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35
Q

MEDICAL NEGLIGENCE
Explain what is meant by judgement failure?

A
  • Defective decision making, bias.
  • Analytical or intuitive.
  • Wrong amount or type of information, wrong decision making strategy.
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36
Q

MEDICAL NEGLIGENCE
Explain what is meant by neglect.

A
  • Not showing enough care.
  • Falling below expected standard.
  • Often chain of minor failures which may/may not lead to harm.
  • Can be multidisciplinary (communication + assumptions).
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37
Q

MEDICAL NEGLIGENCE
Explain what is meant by poor performance.

A
  • Repeated minor mistakes or not learning from mistakes.
  • Usually extends beyond attitude to pt care (timekeeping, reliability, illness).
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38
Q

MEDICAL NEGLIGENCE
Explain what is meant by misconduct.

A
  • Deliberate harm, covering up errors, improper relationships (staff/pts).
  • Fraud/theft/abuse i.e. falsely claiming sickness, substance misuse.
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39
Q

ERROR
Define error?

A

A preventable event that can cause or lead to an unintended outcome.

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40
Q

ERROR
What can medical error lead to?

A

Medical error is a preventable event that can lead to pt harm.

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41
Q

ERROR
What should you do in the event of a Patient Safety Event?

A

Notify, inform patient, explain + apologise under the Duty of Candour policy

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42
Q

ERROR
What are 2 types of medical error?

A
  • ADVERSE EVENT = incident that results in pt harm.
  • NEAR MISS = event which had potential to cause harm but didn’t develop further thereby avoiding harm.
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43
Q

ERROR
What are some different types of human (individual) errors?

A
  • Omission (required action delayed/not taken).
  • Commission (wrong action taken).
  • Sequence (action taken in wrong order).
  • Fixation (regular act so don’t recognise if something goes wrong).
  • Negligence (actions/omissions do not meet standard of an ordinary, skilled person).
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44
Q

ERROR
What are 4 broad classifications of errors?

A
  • Intention.
  • Action.
  • Outcome.
  • Context.
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45
Q

ERROR
What is meant by intention?

A
  • Failure of planned actions to achieve desired outcome.
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46
Q

ERROR
What are 3 types of intention error?

A
  • SKILL-BASED (action made is not what was intended i.e. performing well-known task>little attention>error if distracted).
  • RULE-BASED (incorrect application of a rule/incorrect plan or course of action taken i.e. in emergencies).
  • KNOWLEDGE-BASED (lack of knowledge in a certain situation.
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47
Q

ERROR
What are the issues with knowledge based errors?

A
  • Automatically make us prone to actions not as planned.
  • Memory may contain mini-theories rather than facts (liable to confirmation bias).
  • Limited attentional resources.
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48
Q

ERROR
What is meant by action?

A
  • Generic factors (omission, intrusion, sequence).
  • Task-specific factors (wrong blood vessel/organ/side, bad knots in surgery).
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49
Q

ERROR
What is meant by outcome?

A
  • Near miss.
  • Death/injury/loss of function.
  • Successful detection + recovery.
  • Prolonged intubation/stay in ICU.
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50
Q

ERROR
What is meant by context?

A
  • Equipment + staffing issues.
  • Accumulation of stressors.
  • Interruptions + distractions.
  • Team/organisation factors.
  • Nature of procedure.
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51
Q

ERROR
What are some red flags for errors?

A
  • Anomalies.
  • Broken communication, missing information or confusion.
  • Departures from normal practice.
  • Stress.
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52
Q

ERROR
What are the 10 types of basic error?

A
  • Sloth.
  • Fixation + loss of perspective.
  • Communication breakdown.
  • Poor team working.
  • Playing the odds.
  • Bravado + timidity.
  • Ignorance.
  • Mis-triage.
  • Lack of skill.
  • System error.
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53
Q

ERROR
What is sloth?

A

not bothering to check results accurately, inadequate documentation.

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54
Q

ERROR
What is fixation + loss of perspective?

A

early unshakable focus on Dx, inability to see bigger picture.

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55
Q

ERROR
What is communication breakdown?

A

unclear instruction of plans, not listening to/considering other’s opinions.

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56
Q

ERROR
What is poor team working?

A

some out of depth, some under-utilised.

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57
Q

ERROR
What is playing the odds?

A

choosing the common + dismissing rare.

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58
Q

ERROR
What is bravado + timidity?

A

working beyond competence/without adequate supervision (opposite for timidity).

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59
Q

ERROR
What is ignorance?

A

lack of knowledge, not knowing what you don’t know.

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60
Q

ERROR
What is mis-triage?

A

over/underestimating the seriousness of a situation.

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61
Q

ERROR
What is lack of skill?

A

lack of appropriate skills, teaching or practice.

62
Q

ERROR
What is a system error?

A

environmental, technology, equipment or organisation features. Inadequate safeguards build into system.

63
Q

ERROR
What behaviour is lacking in each basic error?

A
  • Sloth (conscientiousness).
  • Fixation + loss of perspective (open mindedness, situation awareness).
  • Communication breakdown (effective communication).
  • Poor team working (good teamwork).
  • Playing the odds (probability assessment).
  • Bravado + timidity (humility).
  • Ignorance (self-awareness).
  • Mis-triage (prioritisation).
  • Lack of skill (effective technical skills.
  • System error (good system deisgn).
64
Q

ERROR
Give an improvement for…
i) sloth.
ii) fixation + loss of perspective.
iii) communication breakdown.
iv) poor team working
v) playing the odds.

A

i) attention to detail, full documentation.
ii) recognition of clinical patterns but considering facts that don’t fit.
iii) being approachable + open, listening, clear explanations.
iv) clear team structure, leadership + roles.
v) evaluation based on scenario features as well as likelihood.

65
Q

ERROR
Give an improvement for…
i) bravado + timidity
ii) ignorance.
iii) mis-triage.
iv) lack of skill.
v) system error.

A

i) accurate self-evaluation, open communication of mistakes.
ii) aware of own abilities + limitations.
iii) appreciation of the relative importance of each situation.
iv) being properly trained in your role.
v) system designed to be easy to use, complete + with design features that identify potential risk.

66
Q

ERROR
Define a never event.

A

A serious, largely preventable patient safety incident that should not occur if the available preventative measures have been implemented.

67
Q

ERROR
Give some examples of never events.

A
  • Medical = wrong route for chemo (i.e. intrathecal vincristine scenario).
  • Surgical = wrong site or retained object.
  • Mental health = escape of transfer pt, suicide.
68
Q

ERROR
What organisations must the hospital trust report never events to?

A
  • National Reporting and Learning Systems (NRLS).
  • CQC.
  • Strategic Executive Information System (StEIS).
69
Q

ERROR
What are the consequences of never events?

A
  • Financial penalties.
  • Reputation loss.
  • CQC visit.
  • Fitness to practice meetings.
70
Q

ERROR
What are the 2 perspectives on error?

A
  • Person approach = focus on the individual at fault.
  • System approach = focus on the working conditions/organisations at fault.
71
Q

ERROR
What is the concept of the person approach to error?

A
  • Looks at + blames an individual/group of individuals.
  • States errors are the product of unpredictable mental processes (inattention, distraction, negligence).
  • Focusses on the unsafe acts of people on the frontline.
72
Q

ERROR
What are the cons with the person approach to error?

A
  • Anticipation of blame promotes ‘cover up’ + need for a detailed analysis to prevent recurrence (retraining, discipline).
73
Q

ERROR
What is the concept of the system approach to error?

A
  • Adverse events are the products of many causal factors.
  • The whole system has some kind of flaw at fault to blame.
  • Adapt system to prevent recurrence (recognise errors + implement defences).
  • Errors occur due to interaction between active failures + latent conditions.
74
Q

ERROR
How can errors + harm be reduced?

A
  • Simplification + standardisation of clinical processes.
  • Checklists + aide memories (SBAR).
  • Team training.
  • Risk management programmes to remedy latent factors.
  • Mechanisms to improve uptake of evidence-based Tx patterns.
75
Q

ERROR
What tools can be used for risk identification?

A
  • Incident reporting.
  • Complaints + claims.
  • Audit, service evaluation + benchmarking.
  • External accreditation.
  • Active measurement/compliance.
76
Q

ERROR
Name the 2 models for errors.

A
  • Swiss Cheese model.
  • Three bucket model.
77
Q

ERROR
Explain the concept of the Swiss Cheese model

A
  • An organisations defences against error are modelled as a series of barriers, represented as slices of cheese.
  • The holes in the slices represent weaknesses in individual parts of the system.
  • The holes are continually varying in size + position across the slices.
  • System failure occurs when a hole in each slice momentarily aligns.
78
Q

ERROR
What is the difference between latent failures and active failures?

A
  • Latent failures = flaws to the system e.g. organisational influences (culture, politics), unsafe supervision (oversight, Mx issues), preconditions for unsafe acts (lack of training, system + tools used).
  • Active failures = unsafe acts that are mistakes + errors at the frontline – the sharp end of the stick.
79
Q

ERROR
What is the concept of the three bucket model?

A
  • Error evolves due to interaction between personal, environmental + physical factors as well as organisation – this tool can help stratify risk.
80
Q

ERROR
What do the 3 buckets represent in the 3 bucket model?

A

Self, context + task.

81
Q

ERROR
Three bucket model – what comes under self?

A
  • Level of knowledge (newly qualified, senior support available, unaware of current protocols).
  • Level of skill (competence + experience).
  • Level of expertise (confidence, automaticity, expectations/assumptions).
  • Current capacity to do task (fatigue, stressors, illness, life events).
82
Q

ERROR
Three bucket model – what comes under context?

A
  • Equipment (maintenance, availability, usability, power sources).
  • Physical environment (lighting, surfaces, noise, temperature).
  • Workspace (working environment, handovers, layout).
  • Team + support (leadership, trust, briefing + reflection).
  • Organisation + Mx (communication, safety culture + reporting, workload).
83
Q

ERROR
Three bucket model – what comes under task?

A
  • Errors (omission, commission, fixation, sequence).
  • Task complexity (calculations, double checking).
  • Novel task (unfamiliar events, rare events, new ways of working).
84
Q

ERROR
What are some common issues with accidents/safety in healthcare?

A
  • Wrong Dx>wrong plan.
  • Medication reconciliation (if forget to reconcile the meds list then pts may end up with duplicates, interactions).
  • High concentration medication solutions.
  • Pt identification.
  • Pt care handovers.
85
Q

ERROR
Why is safety compromised so often in healthcare?

A
  • Complex, high risk environment.
  • Responsibilities are often shared.
  • Practitioners often take risks unknowingly.
  • System, pt + practitioner interaction.
  • Resource intensive.
86
Q

ETHICS
Define ethics.

A

system of moral principles + a branch of philosophy that defines what is good for individuals + society.

87
Q

ETHICS
Define morality.

A

concerned with the distinction between good + evil or right + wrong.

88
Q

ETHICS
What are the 4 pillars of medical ethics?

A
  • AUTONOMY (respecting pt’s right to make informed decisions about their own medical care).
  • BENEFICENCE(duty to ‘do good’ i.e. provide benefits to the pt).
  • NON-MALEFICENCE (duty to ‘do no harm’ i.e. not doing bad.
  • JUSTICE (ensuring all pts treated equally + equitable i.e. fairness in distribution of Tx).
89
Q

ETHICS
What is the concept of Utilitarianism?

A
  • An act is evaluated solely in terms of its consequences to maximise good + minimise harm.
90
Q

ETHICS
What are the cons of utilitarianism?

A

treats minorities unfairly to promote majority happiness,
how do you define what is good?

91
Q

ETHICS
What is the concept or virtue ethics?

A
  • Focuses on the person who is acting – do they express good character?
  • An act is only virtuous if the person is acting with the genuine intention of doing the right thing – are they integrating reason + emotion.
92
Q

ETHICS
What are the cons of concept or virtue ethics?

A
  • virtues are culture-specific + too broad for practical application,
  • no focus on consequences i.e. compassion may lead to not telling harmful truth = lying.
93
Q

ETHICS
What are the 5 focal virtues that are acquired?

A
  • DISCERNMENT (ability to judge well).
  • CONSCIENTIOUSNESS (being thorough, careful + vigilant).
  • COMPASSION (showing concern for others).
  • TRUSTWORTHINESS (ability to be relied on).
  • INTEGRITY (being honest + having good moral principles).
94
Q

ETHICS
What is the concept of deontology?

A
  • Features of the act determines worthiness.
  • Teaches that acts are right/wrong + people have a duty to act accordingly (treat others how you would like to be treated).
95
Q

ETHICS
What are the cons of deontology?

A

consequences not looked at, duties can conflict.

96
Q

ETHICS
What are categorical imperatives?

A
  • Version of deontology.
  • Categorical imperative is a rule that is true in all circumstances.
  • Act in a way you would be willing it to become universal law.
97
Q

GMC DUTIES AS A DR
What are the 4 domains encompassing duties of a doctor?

A

1) Knowledge, skills + performance.
2) Safety + quality.
3) Communication, partnership + teamwork.
4) Maintaining trust.

98
Q

GMC DUTIES AS A DR
Give some examples of the varying duties of a doctor.

A
  • Provide a good standard of practice i.e. keep professional skills updated (1).
  • Recognise + work within limits of competence (1).
  • Take prompt action if think pts safety/dignity/comfort is being compromised (2)
  • Protect + promote the health of pts + public (2).
  • Tx patients as individuals + respect their dignity + confidentiality (3).
  • Work in partnership with pts (3).
  • Work in collaboration with colleagues to best service pts interests (3).
  • Be honest, open + act with integrity (4).
  • Never discriminate unfairly against pts/colleagues (4).
99
Q

GMC DUTIES AS A DR
What are the benefits of doctors using social media?

A
  • Facilitating public access to accurate health information.
  • Improving patient access to services.
  • Establishing wider + more diverse social + professional networks.
  • Engaging with the public + colleagues in debates.
100
Q

GMC DUTIES AS A DR
What are the risks of doctors using social media?

A
  • Loss of personal privacy.
  • Potential breaches in confidentiality.
  • Online behaviour that may be perceived as unprofessional, offensive or inappropriate by others.
  • Risks of posts being reported by the media or sent to employers.
101
Q

DIVERSITY EDUCATION
Define culture.

A

a socially transmitted pattern of shared meanings by which people communicate, perpetuate + develop their knowledge + attitudes about life.

102
Q

DIVERSITY EDUCATION
Define acculturation.

A

Adapting to a new culture.

103
Q

DIVERSITY EDUCATION
Define stereotypes.

A

generalisations about the ‘typical’ characteristics of members of a group.

104
Q

DIVERSITY EDUCATION
Define ethnocentrism

A

the tendency to evaluate other groups according to the values + standards of one’s own culture group, especially with the conviction that one’s own culture group is superior to others.

105
Q

DIVERSITY EDUCATION
Define prejudice.

A

attitudes towards another person based solely on their membership of a group.

106
Q

DIVERSITY EDUCATION
Define discrimination.

A

actual positive or negative action towards the objects of prejudice.

107
Q

DIVERSITY EDUCATION
What makes up someone’s individual culture?

A
  • May be based on heritage, as well as individual circumstances + person choice – it’s a dynamic entitiy.
108
Q

DIVERSITY EDUCATION
Explain the iceberg model of culture.

A
  • Parts of culture which are visible from the surface (can be deducted from appearance e.g. you can have idea of their age, nationality, ethnicity, gender).
  • Parts of culture which you cannot possibly see from the surface (more embedded within the person e.g. socioeconomic status, occupation, health, religion, education, sexual + political orientation).
109
Q

DIVERSITY EDUCATION
How can we bridge cultural distance?

A
  • Self-awareness = being aware of your own feelings + reactions.
  • Respectful curiosity = suspend judgement, don’t assume –ask.
  • Greater the culture distance, more likely it is that any assumptions you make will be wrong.
110
Q

DIVERSITY EDUCATION
What are the benefits of diversity training?

A

Pts – adherence more likely as more satisfied with their care, fewer diagnostic tests + referrals, pt Sx burden is reduced.
Drs –fewer complaints, more time efficient.

111
Q

DIVERSITY EDUCATION
What are some challenges + solutions concerning diversity in healthcare?

A
  • Language barriers (longer appts, interpreters).
  • Fasting + needs for medications (speak to religious leader ?exemption).
  • Health beliefs such as different expectations in Dr/Pt relationship (paternalistic), Jehovah Witnesses’ refusing blood (talk to pts + understand their beliefs, education).
  • Expectations of healthcare system private vs. NHS (education).
  • Taboos (i.e. sexual health in some cultures).
112
Q

COMM DIFFICULTIES
From a SALT perspective, what is meant by…
i) speech?
ii) language?
iii) pragmatics?
iv) comprehension?
v) expression?

A

i) converting language into an audible form.
ii) can be spoken, writing, gestures. It’s to do with words + how we put them together.
iii) how language is used (turn taking, eye contact).
iv) aka receptive language – understanding language.
v) aka expressive language – producing language.

113
Q

COMM DIFFICULTIES
What happens in speech impairment?

A
  • Words are unaffected, output is affected
114
Q

COMM DIFFICULTIES
How may speech impairment present?

A
  • Dysarthria (imprecise/slurred speech),
  • Apraxia (speech sounds in the wrong order),
  • Stammer/stutter (dysfluent speech)
115
Q

COMM DIFFICULTIES
What are some causes of speech impairment?

A
  • Stroke,
  • Cerebral palsy,
  • Acute brain injury,
  • MND.
116
Q

COMM DIFFICULTIES
What happens in language impairment?

A

Can relate to written or spoken language + is where ability to understand concepts unaffected just ability to understand the means of the message.

117
Q

COMM DIFFICULTIES
How may language impairment present?

A
  • There may be trouble understanding some words, longer phrases or grammar etc.
  • May present as unreliable yes/no, no language produced, word-finding difficulties.
118
Q

COMM DIFFICULTIES
What are some causes of language impairment?

A
  • Stroke,
  • Dementia (primary progressive aphasia),
  • Acute brain injury.
119
Q

COMM DIFFICULTIES
What happens in a pragmatic impairment?

A
  • May be a feature in many conditions (Autism-spectrum disorders).
  • May present as atypical body language, difficulties with turn-taking.
120
Q

COMM DIFFICULTIES
What happens in voice disorders?

A
  • Acute vs. chronic.
  • Causes – laryngectomy, common cold, GORD, Parkinson’s, environmental pollutants.
121
Q

COMM DIFFICULTIES
What are the impact of communication disorders?

A
  • Everyday activities (difficulty with work, shopping, transport).
  • Social engagement (difficulties ordering food).
  • Relationships (both parties may get frustrated, may lead to isolation).
  • Healthcare (more vulnerable to medical errors, may face prejudice).
122
Q

COMM DIFFICULTIES
What are some strategies to support communication?

A
  • Simplify language, use visual aids, check the person has understood, don’t rush.
  • E.g. break down into smaller chunks, gestures, recap, speak slowly, one Q at a time, different methods of communication, repeat yourself.
123
Q

TEACHING SKILLS
How should a skill be taught?

A
  • Breaking the task down into smaller components.
  • Utilising an internal commentary.
  • ‘See one, do one, teach one’.
124
Q

TEACHING SKILLS
What is Peyton’s 4 step procedure for skill training?

A
  • Trainer demonstrates without commentary./
  • Trainer demonstrates with commentary.
  • Learner talks through + trainer does.
  • Learner talks through + does.
125
Q

TEACHING SKILLS
What are some critiques of Peyton’s 4 step procedure?

A
  • Insufficient time for learner to practice.
  • Insufficient feedback.
  • Lack of clarity + thoroughness.
126
Q

TEACHING SKILLS
What is a method used in small group teaching?
Give examples.

A
  • Tutor facilitation rather than teaching.
  • Micro-facilitation by dividing into smaller groups.
  • E.g. rounds (each student has 1m to talk), circular interviewing (students ask each other questions), buzz groups.
127
Q

TEACHING SKILLS
What are the key responsibilities of small group teachers?

A
  • Manage the group, activities + learning.
  • Facilitate the learning by leading discussions, asking open-ended Qs, guiding process + task, enabling active participation of learners + engagement with ideas.
128
Q

TEACHING SKILLS
What fundamental questions should a small group teacher ask themselves?

A
  • Who am I teaching? (Numbers, levels, names).
  • What am I teaching? (Topic, type of expected learning i.e. knowledge, skill, behaviours).
  • How will I teach it?
  • How will I know if the students understand/understood?
129
Q

TEACHING SKILLS
What are some question strategies?

A
  • Evidence = how do you know that? Evidence?
  • Clarification = can you give me an example? Explain this term?
  • Explanation = why is that the case?
  • Linking + extending = how does this idea support/challenge what we explored earlier?
  • Hypothetical = what might happen if?
  • Cause + effect = how is this response related to that?
  • Summary + synthesis = what remains unsolved/uncertain?
130
Q

TEACHING SKILLS
What is the tripartite model of types of learning?

A
  • Surface.
  • Strategic.
  • Deep approach.
131
Q

TEACHING SKILLS
What is meant by surface?

A
  • Fear of failure.
  • Desire to complete a course.
  • Learning by rote + focus on particular tasks.
132
Q

TEACHING SKILLS
What is meant by strategic?

A
  • Desire to be successful.
  • Leads to a patchy + variable understanding (well organised form of surface learning).
133
Q

TEACHING SKILLS
What is meant by deep approach?

A
  • Intrinsic, vocational interest, person understanding.
  • Making links across materials, search for deeper understanding of the material, look for general principles.
134
Q

TEACHING SKILLS
What are 4 different types of learner?

A
  • Theorist = complex situation, can question ideas, offered challenges.
  • Activist = new experiences, extrovert, likes deep end, leads.
  • Pragmatist = wants feedback, purpose, may like to copy.
  • Reflector = watches others, reviews work, analyses, collects data.
135
Q

TEACHING SKILLS
What is Kolb’s learning cycle?

A
  • Conclusions from experience (theorist).
  • Experience (activist).
  • What can I do differently next time? (pragmatist).
  • Review + reflect on experience (reflector).
136
Q

TEACHING SKILLS
What is the relevance of different types of learners?

A

Individuals should choose activities which best match their learning style + identify least dominant style so that they can strengthen these.

137
Q

TEACHING SKILLS
What is meant by intuitive thinking in decision making?
What are some biases?

A
  • Ability to understand something instantly without conscious reasoning.
    Biases: confirmation bias (tendency to favour information that confirms or strengthens their existing beliefs or theories).
138
Q

TEACHING SKILLS
What is meant by analytical thinking?
What are some cons?

A
  • Lacks skills at estimating odds or values but excels at measuring + calculating them. This is the basis of evidence-based medicine.
    Cons: slow, resource intensive, cognitively demading.
139
Q

TEACHING SKILLS
What is the dual process theory?

A
  • Intuitive thinking with its irresistible combination of heuristics + biases, together with analytical thinking, using evidence-based medicine.
140
Q

LEADERSHIP
What are the 5 leadership styles?

A
  • Authoritarian.
  • Participative.
  • Delegative (Laissez-faire).
  • Transactional.
  • Transformational (inspirational).
141
Q

LEADERSHIP
What is the concept of authoritarian leadership?

A
  • Allows one leader to impose expectations + define outcomes.
142
Q

LEADERSHIP
What are the pros/cons of authoritarian leadership?

A

Pros:
- consistent results,
- time spent on crucial decision reduced.

Cons:
- v strict,
- lack of staff creativity/innovation,
- lack of group input.

143
Q

LEADERSHIP
What is the concept of participative leadership?

A

Rooted in democratic theory to involve team members in the decision-making process> feeling included, engaged + motivated to contribute.

144
Q

LEADERSHIP
What are the pros/cons of participative leadership?

A

Pros:
- encourages staff creativity,
- increases staff motivation.

Cons:
- decisions may be time-consuming,
- poor decisions may be made.

145
Q

LEADERSHIP
What is the concept of delegative leadership?

A
  • Focuses on delegating initiative to team members, letting things take their own course without interfering.
146
Q

LEADERSHIP
What are the pros/cons of delegative leadership?

A

Pros:
- environment of independence,
- experienced staff can offer experience.

Cons:
- downplays role of leader,
- leaders avoid leadership,
- staff may abuse.

147
Q

LEADERSHIP
What is the concept of transactional leadership?

A

Leader sets clear goals + uses “transactions” such as rewards, punishments etc to get the job done. Staff know how their compliance is rewarded.

148
Q

LEADERSHIP
What are the pros/cons of transactional leadership?

A

Pros:
- staff motivation + productivity increased,
- reward system.

Cons:
- innovation/creativity minimised,
- less leaders created,
- seen as coercive.

149
Q

LEADERSHIP
What is the concept of transformational leadership?

A
  • Leader inspires the followers with a vision + then encourages + empowers them to achieve it. The leader serves as a role model for the vision.
150
Q

LEADERSHIP
What are the pros/cons of transformational leadership?

A

Pros:
- high value on corporate vision,
- high morale for staff,
- not coercive.

Cons:
- leaders can deceive staff,
- may need consistent motivation/feedback.

151
Q

LEADERSHIP
What leadership model is best suited for healthcare and why?

A
  • Transformational.
  • It places the needs of pts, carers + families at the centre of all work + people can intervene when necessary.
  • I.e. speak up if risk to pt, continually improve system, talk to seniors if lack of skill, knowledge or resources.

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