Professional issues VIva Flashcards
(101 cards)
1
Q
4 main arenas paramedic face accountability for their actions
A
Criminal law
Employer
Professional body
Civil law
2
Q
4 main purposes of a professional body (e.g. HCPC)
A
Protective function - protect the public and the registered professionals.
Deterrent function - deters registrants from breaching standards and duty of care. Rules and standards in place.
Regulatory function - ensuring registrants maintain competence, CPD etc. 2 year audit.
Educative function - helps to notify and educate registrants.
(Griffith & Tengnah, 2014)
3
Q
4 elements needed to be present for negligence to be proven
A
Must be duty of care-owning a dog
Breach of DOC- you know your dog can be agressive but still let it off the lead in a childrens play ground and it bites a child.
Reasonably foreseeable- If the dog wasnt off the lead a child would be unharmed.
Resulting in harm- the child suffered from a severe bacterial infection.
4
Q
Elements needed to be present for negligence to be proven
A
Must be duty of care.
Breach of DOC.
Reasonably foreseeable.
Resulting in harm
5
Q
Compare ‘standard of care’ and ‘duty of care’
A
Standard of care - required level of proficiency, competence, professional. (Bolam test: measured against similar practitioner for their opinions.)
Duty of care - legal and moral obligation to ensure the health, safety and well being of the patient.The case of Kent v Griffiths focused on the determination of whether the London Ambulance Service (LAS) owed a duty of care to an individual who suffered harm due to the delayed response of the ambulance. The court emphasised that the LAS, as a provider of emergency medical services, had a duty to respond promptly and adequately to calls for assistance. The delayed response in this case was deemed to be a breach of this duty, leading to the harm suffered by the claimant. Case asthma attack that lead to respiratory distress.
6
Q
Name/describe some model(s) of health promotion
A
Stages of change model - different changes we go through when making changes. Precontemplation, contemplation, determination, action, maintenance, recurrence.
Health belief model - model developed to explain and predict health-related behaviors.
Tannahil - three overlapping spheres of activity: health education, prevention, and health protection.
7
Q
The 6 C’s of care
A
Care
Compassion
Competence
Communication
Courage
Commitment
8
Q
The 9 protected characteristics of the Equality Act
A
Age
Disability
Gender reassignment
Marriage and civil partnership
Pregnancy and Maternity
Race
Religion or belief
Sex
Sexual orientation
9
Q
The 4 main principles of medical ethics
A
Respect for Autonomy
Non-meleficence
Beneficence
Justice
10
Q
What is autonomy? (Principle of medical ethics)
A
People have the right to control what happens to their bodies. (An informed, competent adult, can refuse or accept treatments)
11
Q
What is beneficence?
A
Doing good for the patient. Each situation and patient should considered individually
12
Q
What is non-maleficence?
A
Non-maleficence is a fundamental principle in medical ethics which dictates that medical practitioners have a duty to do no harm or allow harm to be caused to a patient through neglect. Prevent harm from occuring
13
Q
What is justice?
A
What is right and fair in any given situation.
(E.g. Two patients with chest pain/same symptoms, should receive the same level of triage, care, treatment)
14
Q
What is the doctrine of double effect?
A
Doing something morally good, but may have morally bad side effect. (E.g. Cannulation)
15
Q
List and/or describe the 7 Caldicott principles
A
- Justify the purpose of using the info.
- Don’t use unless absolutely necessary.
- Use minimum necessary data.
- Access is on a need to know basis.
- Be aware of responsibilities.
- Understand and comply with the law.
- Duty to share and duty to protect info.
16
Q
What is accountability?
A
Answerable for your acts or omissions. Taking responsibility.
17
Q
What is medical negligence?
A
An act or omission where failing to provide level of care that is expected, thus resulting in harm.
(Remember the things for it to be proven i.e DOC, Breach DOC, Reasonably foreseeable, Resulting in harm.)
18
Q
Explain the key elements for consent to be valid
A
Must be/have:
Voluntary - free from manipulation/coercion.
Informed - be given all the relevant information.
Mental Capacity - must be mentally competent.
19
Q
How can consent be given?
A
Verbally
In writing
Non-verbal/implied (e.g. holding arm out for BP)
20
Q
When is consent not needed?
A
- Lacks capacity due to illness/injury and requires treatment. Acting in best interests.
- Risk to public health (notifiable diseases).
21
Q
Name types of discrimination
A
Direct.
Indirect.
Positive.
Victimisation.
Harrasessment.
Discrimination by association.
Discrimination by perception.
22
Q
What is Gillick competency?
A
Under age of 16 and having enough intelligence, competence and understanding to fully appreciate the risks and/or benefits of their treatment. Refusal can be overruled by parent/guardian.
23
Q
What is respect?
A
Due regard for the feelings, wishes, or rights of others.
24
Q
What is dignity?
A
The kind of care which supports and promotes independence, and not undermine them despite their differences.
25
List types of abuse.
Sexual.
Financial.
Physical.
Emotional.
Modern slavery.
Neglect.
Organisational.
Domestic.
Discrimitory.
26
What are the 5 principles of the MCA 2005?
Always assume capacity.
Support decision making.
Act in best interests.
Can be unwise decision.
Least restrictive.
SCALA. Support decision making. Can be unwise decision. Always assume capacity. Least restrictive. Act in best interests.
27
Describe the 2 stage mental capacity test.
Stage 1 (Diagnostic) - is their a temporary/permanent impairment of mind or brain. If not then has capacity. If not then stage 2.
Stage 2 (Functional) - can the individual:
- Understand the information relevant to the decision.
- retain the information.
- use or weigh up that information.
- can they communicate their decision.
28
Name some models of reflective practice/documentation
Johns model- five cue question: describing the experience, reflection, influencing factors, could I have dealt with the situation better and then learning points.
Gibbs reflective cycle - Description, Feelings, Evaluation, Analysis, Conclusion, Action plan.
Atkins & Murphy - awareness, describe, analyse, evaluate, identify.
29
What was the Marmot review?
Published 11th Feb 2010. To address the social issues affecting health. E.g. The conditions born into, grow, live, work, age.
6 policy objectives about fairer society, best start in life for children, healthy standard of living for all, fair employment.
30
What is the HCPC and its purpose?
The health and care professions Council. To protect the public. Maintain register. Assess and maintain competency, standards of registrants. Ensuring they practice safely, legally and effectively. (Remember functions - protective, educational, deterrent, regulatory functions).
31
What was the Francis report?
Following failings identified in care of Mid Staffordshire NHS foundation Trust. Patients being left soiled. Hungry. Thirsty. Unavoidable deaths. Poor care. Report published 6th Feb 2013. Robert Francis. Made 290 recommendations.
32
What is duty of candour?
Being open and honest when something goes wrong. Inform patient and management. Apologise. Explain. Offer support and advice. PALS. IR1.
Be open and honest with a service user, or carer, when something goes wrong. This means telling them what has happened truthfully, fully and promptly, and explaining any likely side effects.
Apologise to a service user, or their carer, when something has gone wrong.
Take action to put things right where possible, and explain this to the service user, or their carer.
Follow appropriate arrangements for incident reporting, notification and escalation.
33
What is the Mental Capacity Act 2005
To protect and empower people who may lack the mental capacity to make their own decisions about care. Applies to over 16 years. Overseen by Court of Protection if any disputes/breaches.
34
Examples of people who may lack mental capacity.
Dementia.
Severe learning disability.
Brain injury.
Mental illness.
Unconscious.
Acute illness/injury.
35
What is deprivation of liberty?
Depriving someone of their freedom. Placing restrictions on a person, often someone who lacks capacity. ACID test. Case by case basis. Provider needs to apply to local authority for further assessment and legal authorisation. (DOLS)
36
What is the court of protection?
Oversees operation of MCA 2005, deals with issues, disputes. Health and financial matters.
The Court of Protection is a court that deals with decisions or actions taken under the Mental Capacity Act.
37
What was the Caldicott report?
Review commissioned in 1997 by chief medical officer of England, Fiona Caldicott. Focused on how patient information used in the NHS, following concerns of information breaches. Developed the 7 principles.
38
Legislation relevant to confidentiality.
NHS act 2006.
Health and Social Care Act 2012.
Data Protection Act 1998.
Human Rights Act 1998.
39
Explain the 2 questions of the ACID test (DOLS)
The test states a person is deprived of their liberty if:
- They are subject to continuous supervision and control.
- are not free to leave.
40
What are the Fraser guidelines?
Used specifically to decide if children can consent to sexual health advice, contraception, treatment. Without parental consent. Weighs up risk vs benefit to child. E.g. not giving contraception, then likely to get pregnant. Must be Gillick competent.
41
Explain end of life care
EOL care is support and treatment for those in the last days, weeks, months or years of their life. To live as well as possible and die with dignity. Wishes, preferences, beliefs . Links to palliative care. Hospice etc. Considered to be EOL when death likely within next 12 months.
42
Explain the Gold Standards Framework
GSFis a registered charity provides training and support for health and social care staff/professionals. EOL patients. Improves quality, coordination and collaboration, cost effectiveness, reduce hospitalisation.
43
When was the NHS formed?
1948. Idea that good healthcare should be free to all, regardless of wealth etc.
44
What are CCG's
Clinical commissioning groups. Created following health and social care act 2012. Replaced primary care trusts. They are NHS bodies responsible for planning and commissioning of health care services in their local area. There 207 CCGs in England.
45
What is the CQC?
The Care Quality Commission. Independent regulator of health and adult social care in England. Makes sure services are safe and effective, high quality care, upholding the standards.
46
What is primary and secondary care?
Primary - First point of contact for most people. GP, dentists, pharmacists, walk in centres, 111.
Secondary - hospital and community care, planned, specialised.
47
What is duty of confidence?
When one person discloses information to another, where it is expected that info will he held in confidence.
48
Who are we accountable to with duty of confidence? (3 spheres)
What duties
Duty under contract of the employer.
Duty under the law- e.g. data protection
Duty under HCPC code of conduct.
49
What is the GDPR and their principles?
General Data Protection Regulation. Formed by the EU ensuring Europe 'fit for the digital age'. Links to data protection act 2018 UK. 7 key principles.
Lawfulness, fairness and transparency — Processing must be lawful, fair, and transparent to the data subject.
Purpose limitation — You must process data for the legitimate purposes specified explicitly to the data subject when you collected it.
Data minimization — You should collect and process only as much data as absolutely necessary for the purposes specified.
Accuracy — You must keep personal data accurate and up to date.
Storage limitation — You may only store personally identifying data for as long as necessary for the specified purpose.
Integrity and confidentiality — Processing must be done in such a way as to ensure appropriate security, integrity, and confidentiality (e.g. by using encryption).
Accountability — The data controller is responsible for being able to demonstrate GDPR compliance with all of these principles.
50
When can confidentiality be breached?
Serious crime - murder, manslaughter, kidnapping, child abuse.
Threat to national security - serious harm to the security of the state or public order i.e. terrorism.
Risk of harm - child abuse, neglect, safeguarding, infectious diseases I.e polio, anthrax, malaria, measles (notifiable diseases).
Patient consent?
51
What is a health record?
Paper or electronic information recorded about a person, for the purpose of managing their health care.
52
What is the purpose of record keeping?
Primary function - support quality, safety and continuity of patient care.
Secondary function - medico-legal document for investigation. Improve standards of care. Analysis of health trends
53
Explain relevant info to be included in health record?
Should be clear, accurate, legible.
Relevant clinical findings.
Decisions made.
Information given to patients.
Drugs prescribed.
Other investigation or treatment.
Pertinent negatives.
Made at same time as event or ASAP.
Facts not speculation.
Quote comments from pt/carers.
Only use accepted terminology/abbreviations.
54
Benefits of electronic patient record/ePRF
Support and guides for decision making.
Transferable.
Integration of other systems/records.
Easier to read, edit etc.
Easier for auditing.
Greater security.
55
What is consent?
An agreement or permission given from patient to receive care/treatment from provider.
(Written, verbal, non verbal, needs to be voluntary, informed, and have capacity)
56
What is battery?
Intentionally touching a patient without their consent, or consent from carer/guardian if underage or lacks capacity. (Unless it is justified and necessary - the defence of necessity)
57
What is section 2 MHA
Hold for assessment up to 28 days. Following review this must be stood down or upgraded to section 3. Section 2 cannot be extended.
58
What is section 3 MHA?
Up to 6 months for treatment. Can be extended indefinitely.
59
What is section 4 MHA?
Emergency section 72hrs for assessment. Family or AMHP can apply, must be supported by at least one section 7 approved doctor. Used in short notice or OOH situations.
60
What is section 5 MHA?
Holding powers in hospital to stop leaving.
Section 5(4) - nurse holding power up to 6hrs.
Section 5(2) - doctor holding power up to 72hrs.
61
What is section 135 MHA?
Applied for by mental health professional
Warrant issued by local magistrate.
Allows police to enter patient property.
To remove pt to place of safety for MH assessment.
Must be accompanied by AMHP and doctor.
Can be kept in place of safety for 24hrs plus 12hr extension if required.
62
What is section 136 MHA?
Allows police to detain pt in public place suffering MH disorder, and at risk to self or others.
Take to place of safety for MH assessment.
Upto 12hrs. Plus 12hr extension if required.
63
Name a communication model.
The shannon Weaver model of communication is a mathematical theory that says human communication can be broken down in 6 key concepts including: the sender, encoder, channel, noise, decoder and receiver.
Explains how messages can be mixed up and misinterpreted in the process between sending and receiving.
1. Sender: Person or any information source, choosing a message to send.
2. Encoder: Machine that converts the idea into signal that is sent
3. Channel: also known as the medium which is the pathway e.g. the internet when sending an email
4. Noise: internal e.g. sender makes mistake encoding or external e.g. not in control of sender, accent or mumbling e.g. background noise, failed connection or lost letter in post
5. Decoder
6. Reciever- the destination, message in recieved.
64
List 3 main elements of communication.
Body language 55%
Tone of voice 38%
Words 7%
65
Describe/list Maslow's hierarchy of needs.
Physiological needs.
Safety needs.
Love and belonging needs.
Esteem needs.
Self actualization needs.
Maslow's hierarchy of needs is a motivational theory in psychology comprising a five-tier model of human needs, often depicted as hierarchical levels within a pyramid.
66
Types of dignity
Dignity of:
Human being.
Personal identity.
Merit.
Moral status.
67
What is equality?
Creating a fairer society.
Eliminating prejudice and discrimination.
Treating people equally despite differences.
68
What is diversity?
Meaning difference.
Recognising we are all different.
Respecting this diversity.
69
What is discrimination?
Treating a person unfairly because of who they are or certain characteristics they posses. (9 protected characteristics - Equality Act 2010)
70
What is the difference between bullying and harassment?
Bullying - Offensive, intimidating, malicious or insulting behaviour, an abuse or misuse of power through means intended to undermine, humiliate, denigrate or injure the recipient.
Harassment - Unwanted conduct that violates people’s dignity or creates an intimidating hostile, degrading, humiliating or offensive environment. Being targeted.
71
List and/or explain the Gold Standards Framework 7 C's
1. Communication.
2. Coordination.
3. Control of symptoms.
4. Continuity of care.
5. Continued learning.
6. Carer support.
7. Care of the dying pathway.
72
What is clinical judgement?
Involves assessing risks vs benefits or possible actions before committing one way or another (decision making).
73
What is competence?
Maintaining own professional standards and CPD. Adhering to standards, HCPC, employer, law.v
74
What is integrity?
Doing the right thing for the right reason.Being honest and having strong moral purpose.
e.g. about a patients condition and treatment
(Integrity is the practice of being honest and showing a consistent and uncompromising adherence to strong moral and ethical principles and values - Wiki.)
75
4 things to consider in clinical decision making and professional accountability
Is it:
Achievable.
Explainable.
Justifiable.
Defensible.
76
What is a disability?
A physical or mental impairment and, the impairment has substantial or long term adverse effect of the persons ability to carry out normal activities.
Disabilities are not always visible.
77
Name models of disability.
Medical model - disabled as a consequence of heath condition, disease, trauma. Disrupt functioning physically or cognitive.
Functional model - caused by physical, medical or cognitive deficits. Limits ability to perform functional activities.
Social model - limited not by impairment but buy the environment i.e. barriers, lack of social organisation.
78
List some health psychology theories
Psychoanalytic theory (Freud).
Behaviourism (Pavlovs dogs).
Social learning theory.
Health locus of control.
79
Who are considered vulnerable groups?
Disabled, MH, LD, Elderly, Children, Lack capacity.
80
Difference between safeguarding and care concerns
Safeguarding - victim and perpetrator, risk or actual harm.
Care concern - not coping, need additional support.
81
What is RADAR with seen and heard?
'Seen and Heard' to help healthcare professionals and partners protect and identify children and young people at risk of abuse or exploitation. This course is designed to enable all healthcare workers to spot the signs of child sexual abuse and exploitation, and help them create an environment where young people are more likely to disclose.
Respect - value and understand.
Approach - show warmth, comfort.
Discover - be proactive, look, listen.
Ask - be professionally curious, question.
Respond - act, safeguard.
82
What are Caldicot Guardians?
Government Review of Patient-Identifiable Information, chaired by Dame Fiona Caldicott, which reported in December 1997. One of its recommendations was that “a senior person, preferably a health professional, should be nominated in each health organisation to act as a guardian, responsible for safeguarding the confidentiality of patient information.” All NHS and social care organisations must have a guardian. Introduced to NHS 1998, and social care 2002.
83
Explain the NHS constitution
The constitution sets out rights for patients, public and staff. It outlines NHS commitments to patients and staff, and the responsibilities that the public, patients and staff owe to one another to ensure that the NHS operates fairly and effectively.
Renewed every 10 years, handbook is renewed every 3 years legally.
84
What actions to take if patient lacks mental capacity.
Protect and empower, act in their best interests. Follow MCA 5 principles.
85
Explain the two types of Lasting power of attorney
(Lasting power of attorney)
Health and welfare.
Property and financial.
86
Explain what an LPOA is
A person appointed to make decisions on behalf of another when they lack capacity. Must be put in place before person lacks capacity. LPOA's registered with Office of the Public Guardian. Can be either or both relating to patients:
Health and welfare.
Property and financial affairs.
87
Explain the two main policy aims of the Marmot review
1 - to create an enabling society that maximizes individual and community potential.
2 - to ensure social justice, health and sustainability are at the heart of all policies.
C, E (C of E?) - Create enabling society. Ensure justice.
88
Explain the social determinants of health in the Marmot review
The Marmot Review into health inequalities in England was published on 11 February 2010. It proposes an evidence based strategy to address the social determinants of health, the conditions in which people are born, grow, live, work and age and which can lead to health inequalities.
89
Explain the criteria for referring a death to the coroner
- Death occuring during op or before recovering from anaesthesic. (?Medical errors)
- Death in industrial accident/disease and poisoning.
- Death sudden, unexpected or unnatural.
- Death due to violence/neglect.
- Death in suspicious circumstances.
- Death occuring in custody or deprevation of liberty
- Cause of death is unknown
- If a DOL is in place
90
In human factors, explain what a slip, lapse and mistake is
Slips - where the person does something but not what they are meant to do. (E.g. right drug, route route).
Lapses - when the person forgets to do something. (E.g. forget BM).
Mistakes - what the person does what they intended, but it was wrong (rule based or knowledge based mistake).
91
In human factors, explain what things can cause us to make mistakes (e.g. night shifts)
Mental workload.
Distractions.
Physical environment.
Physical demands.
Device/product demands.
Process design.
92
Explain the Swiss Cheese model of organisational accidents
A system has many levels of defence. Each of these levels has holes in it causes by poor design, known as latent conditions. When all the holes line up errors slip through resulting in harm/error.
93
Name/describe some acronyms used for patient handover
SBAR, ATMIST.
Situation, background, assessment, recommendation.
Age, time of incident, MOI/complaint, injuries, signs and symptoms, treatment.
94
Name/describe an assertiveness technique in human factors. When things are going wrong.
PACE
Probe - prompt, "did you know..."
Alert - offer alternative, "can we..."
Challenge - make challenge "I'm concerned... we need to..."
Emergency - warning, "NO", STOP WHAT YOU ARE DOING".
95
What is 'Making every contact count' and why is it important?
It encourage changes in behaviour that have a positive effect on the health and wellbeing of individuals, communities and populations. E.g. smoking cessation, alcohol misuse. Its about making the most of being there with the patient, not just focusing on primary objectives (e.g. "nan down" get them up, quick check and go clear). Encouraging health promotion, guidance, support, referring. (If patient willing and able.)
Making every contact count- we go to the patient and see them in their environment, take opportunities for better health e.g. drug and alcohol awareness.
96
What are the 4 main types of child abuse
Physical.
Sexual.
Emotional.
Neglect.
(FGM)
97
List/explain the two main aspects of verbal communication
Language and vocabulary - communicating on the appropriate level and understanding of the receiver.
Paralinguistic features - tone, volume, pitch, pace, rhythm.
98
List conditions unequivocally associated with death
- Decapitation.
- Massive cranial and cerebral destruction.
- Hemicorporectomy or similar massive injury.
- Decomposition/Putrefaction.
- Incineration.
- Hypostasis.
- Rigor mortis.
- Fetal maceration in a newborn.
99
List circumstances you would NOT start CPR
- Unequivocal signs of death.
- Valid DNACPR/RESPECT (or ADRT refusing life sustaining treatment)
- Terminal illness/EOL suspected cause.
- Arrest 15> min with NO bystander CPR, AND 30> sec Asystole, AND NO exclusion factors present (i.e. drowning, hypothermia, OD, pregnancy, child/neo)
100
Patient records legislation
Data protection act
Access to health records act
GDPR
Health and social act
Caldiocott
101
Model of breaking bad news
SPIKES
S- Setting
P-perception: what do they already know
I- Invitation: how much do they want to know
K- small chunks of info, give them gaps to allow them to understand the info given
E- emotion and empathy, how are they processing the info, tailoring the response to your information
S- Summary and strategy, what happened an what will now happen.
