Week 1 Flashcards
Define Problem Solving
- Working through the problem to find a solution
Define Clinical Reasoning
- Process during which we structure meanin, goals and health management strategies based on clinical data, pt preferences and values, knowledge and professional judgement
Deine Clinical Judgement
- Application of information based on actual observation of a pt combined with subjective and objective data that lead to a conclusion
Define Critical Thinking
- Clarifies goals, examines assumptions, uncovers hidden values, evaluates evidence, accomplishes actions and assess conclusions
Define Clinical Decision Making
- Complexprocessinvolvingobservation,information processing, critical thinking, evaluating evidence, applying relevant knowledge, problem solving skills, reflection and clinical judgement to select the best course of action
What are the three decision making theories
- Normative models
- Descriptive model
- Prescriptive model
What is a Normative Model
- The analysis of individual decisions, using logic, rationality, scientific evidence based decisions: eg clinical trials testing drug efficacy or ‘normal range’ SpO2 reading to minimize judgement error of physiological processes
What theory dictates people should do when making a decision
What is a Descriptive Model
- Examines how people make decisions in reality when choosing the options available to them
What people actually do when making a decision
What is a Prescriptive Model
- A combination of the theoretical aspect of normative theory and observations of descriptive theory. Provides a practical aid to decision making, whilst aspiring to rationality: eg. Frameworks, guidelines, algorithms designed to improve specific decision tasks
What people should/can do when making a decision
How do we explain decision making
- Combination of experience, knowledge, expertise of others, research and available
evidence - Numerous frameworks and models used to explain the process of decision making with many overlapping themes.
What are the two opposing conceptual frameworks underpinning decision making
- The intuitive framework (also known as inductive framework (Hamm, 1988) Data is collected and leads to generation of a hypothesis
- The analytical framework (also known as deductive framework) Hypotheses are used to predict the presence/absence of data to confirm/deny hypotheses
What is Intuition
- Understanding without rationale’ (Benner and Tanner 1987)
- An irrational act
- Guessing
- Unfounded knowledge
- Supernatural inspiration Hunches Non-conscious process
What are the FIve Levels of the Benners Model and the explanations
- Novice = No experience Need rules
- Advanced Beginner = Demonstrate acceptable behaviour Principle- based
- Competant = Same role 2-3 years Deliberate planning
- Proficiant = Whole situations Holistic under standing
- Expert = Intuitive grasp Deep under standing
What are the 6 parts of the Dreyfus skill acquisition
-1. Patternrecognition
2. Similarityrecognition
3. Commonsenseunderstanding 4. Skilledknow-how
5. Senseofsalience
6. Deliberativerationality

Explain Similarity Recognitionin the Dreyfus Model
- Awareness that this patient
reminds you of a similar patient - Sets up conditions for recognising dissimilarities as well
- This is despite objective features of past & current situations
- Helps the expert select the most relevant patients for comparison
Explain Common Sense Understanding in the Dreyfus Model
- Basis for understanding the illness experience in contrast to knowing the disease
- A deep grasp of the culture & language
- Allows flexible understanding in diverse situations
- The language of illness is a human language with emotions & lived experiences.
Explain Skilled know-how in the Dreyfus Model
- Two kinds of knowledge
Polanyi (1974) & Kuhn (1962) - ‘Knowing how’
Practical knowledge -
learnt through skilled practice
Body taking over a skill e.g. how do you ride a bike? - ‘Knowing that’
Theoretical knowledge - Tacit knowledge
Meerabeau (1992)
Describes the expert knowledge
that professionals use, but find difficult to articulate - Technical Rationality
Schon (1983)
Professional knowledge underpinned by rigorous application of scientific theory & technique
Explain Sense of salience in the Dreyfus Model
- Certain events or details stand out as more or less important
- In formal models of judgement, sense of salience is replaced by checklists
- Innate sense of what is happening around you
- ‘Insider’ knowledge
- Expert appraisal allowing
flexibility
Explain Deliberative Rationality in the Dreyfus Model
- The expert practitioner has learnt to expect certain events & selectively attend to certain aspects of the situation
- A means of clarifying the current perspective by considering how your interpretation of a situation would change if your perspective were changed
Explain Pattern Recognition in the Dreyfus Model
- Perceptual ability to recognise relationships without pre-specifying the components of a situation
- Patients present patterns of responses that expert practitioners learn to recognise
- Novices may require a list of features to identify patterns
- Recognition of subtle variations in the pattern
What are the two Analytical Frameworks
- The Hypothetic-Deductive Framework
- Cognitive Continuum Framework
Define the The Hypothetic-Deductive Framework
- Cue acquisition – gathering information/clinical data
- Hypothesis generation – Differential diagnoses
- Cue interpretation – diagnostic testing/observations/history to confirm/refute diagnoses
- Hypothesis evaluation – weighing up pros and cons, choosing evidence based interventions
Define the Cognitive Continuum Framework
- Matches cognitive tasks to the decisions and the clinicians competence
- This is based on all theories and models have different strengths and weaknesses
- Different decisions need different
approaches, so joined together intuition/experimental and analytical/rational to form the cognitive continuum
What can help the decision making process
- Protocols – rigid directions….
- Clinical Guidelines – UK Ambulance Services Clinical Practice Guidelines, NICE guidelines, UK Resuscitation Council – best practice, evidence based
- Algorithms – developed from research evidence and patient data
- Decision matrix – quantitative tool to rank/score options using set criteria to gain a total score – SADS score, APGAR, GCS . Can still remain subjective
How could we become better decision makers
- Maintain desirable attributes
- Inquisitiveness
- Be well informed
- Stay current – CPD
- Be open minded
- Ask for feedback
- Develop communication skills Use available decision matrices
What are the factors that effect decision making
- Confirmation bias
- Optimism bias
- Anchoring
- Information bias - Selective perception - Hindsight bias
- Belief/behavioural bias
Define Confirmation Bias
- misinterpretation of data to suit the decision maker
Define Optimisim Bias
- being over optimistic about what will happen as a result of decision
Define Anchoring
- relying heavily on a single piece of information
Define Information Bias
- seeking too much data which ‘swamps’ the decision process
Define Selective Perception
- giving undue/higher importance to data that supports own views
Define Hindsight Bias
- using hindsight knowledge of previous events to assign higher weight to those same outcomes in future events
Define Behavioural / Beliefs bias
- making decisions whilst being influenced by underlying beliefs
What are Lewins Leadership Styles
- Autocratic (authoritarian) leaders
- Democratic (participative) leaders
- Laissez faire (delgative) leaders
Define what a Autocratic Leader is, with the pros and cons of this style
- Make decisions without consulting their team members
- Useful if quick decisions are needed or team members don’t/can’t have full picture.
- Ignores team expertise/opinion.
- Can be demoralizing
Define what a Democratic Leader is, with pros and cons of this style
- Make final decisions, but take input from team members
- Encourages creativity, and job satisfaction.
- Sense of being valued.
- Not always effective when a quick decision is required
Define what a Laissez Faire leader is, with the pros and cons of this style
- Give team members freedom in how they complete work and set own deadlines
- Provides support with resources and advice, but otherwise don’t get too involved.
- Autonomy can be damaging to those who do not manage their time well, or do not have knowledge/experience to work effectively
Why do we need Clinical Leadership at Organisational Level
- Adapting to change (e.g. new ways of working)
- Thriving from change (e.g. new roles)
- Coping in an ever changing environment of paramedic practice
Why do we need clinical leadership at Individual Level
- Personal development (e.g. career development, progression, financial reward)
- New knowledge (e.g. academic awards)
- New skills (e.g. skills enhancement, evidence based practice)
Why do we need clinical leadership at Patient level
- Greater responsiveness to patient needs
- Improved ability to meet patient needs (e.g. user groups)
- Increasing use of expert patients)
Definition of Human Factors
- Definition - refer to environmental, organisational and job factors, and human and individual characteristics, which influence behaviour at work in a way which can affect health and safety (Health and Safety Executive 2015)
