PUBLIC HEALTH TO DO Flashcards
(176 cards)
1
Q
PREVENTION + SCREENING
What are the Wilson + Junger criteria for screening?
A
CONDITION
-important
- known natural history
- identifiable latent/pre-clinical phase
THE SCREENING TEST
- suitable (sensitive, specific, inexpensive)
- acceptable
ORGANISATION AND COSTS
- facilities
- costs and benefits
- ongoing process
THE TREATMENT
- effective
- agreed policy on whom to treat
2
Q
EPIDEMIOLOGY
What is the Bradford-Hill criteria for assessing causality?
A
- Strength of association (the magnitude of the RR).
- Dose response (the higher the exposure, the higher the risk of disease).
- Consistency (similar results from different researches using various study designs).
- Temporality (does exposure precede outcome?)
- Reversibility (experiment) – removal of exposure reduces risk of disease).
- Biological plausibility (biological mechanisms explaining the link).
- Coherence (logical consistency with other information).
- Analogy (similarly with other established cause-effect relationships).
- Specificity (relationship specific to outcome of interest).
3
Q
HEALTH DETERMINANTS ETC.
Define allostasis.
A
The stability through change, or homeostasis, of our physiological systems to adapt rapidly to change in environment.
4
Q
HEALTH DETERMINANTS ETC.
Define public health.
A
Defined as the science + art of preventing disease, prolonging life + promoting health through organised efforts of society.
- Population perspective – thinks in terms of groups, not individuals.
5
Q
HEALTH DETERMINANTS ETC.
What are the determinants of health?
A
PROGRESS
Place of residence
Race/ethnicity
Occupation
Gender
Religion
Education
Socioeconomic status
Social capital
6
Q
HEALTH DETERMINANTS ETC.
What are the wider/social determinants of health?
A
- Education, socioeconomic status, unemployment, housing, physical environment etc.
7
Q
HEALTH DETERMINANTS ETC.
What are the 3 domains of public health?
A
- Health improvement.
- Health protection.
- Improving services.
8
Q
HEALTH DETERMINANTS ETC.
what is vertical equity?
A
Unequal treatment for unequal need
(e.g. areas with poorer health may need higher expenditure on health services, common cold + pneumonia require different treatment).
9
Q
HEALTH DETERMINANTS ETC.
what is horizontal equity?
A
Equal treatment for equal need
(e.g. pts with same disease should be treated equally).
10
Q
HEALTH DETERMINANTS ETC.
What are the different forms of health equity?
A
- Equal expenditure.
- Equal access.
- Equal utilisation.
- Equal healthcare outcome.
(All for equal need).
11
Q
HEALTH DETERMINANTS ETC.
What are the 2 main factors affecting health equity.
Give an example of each.
A
- SPATIAL INEQUITY (geographical) – infant mortality rates high in places like Africa but healthcare spending is low in these areas (health inequality + inequity).
- SOCIAL INEQUITY (age, gender, ethnicity, socioeconomic status etc) – socioeconomic inequity as angina Sx higher in more deprived areas but coronary artery revascularisations in those with angina Sx higher in more affluent areas in Sheffield.
12
Q
HEALTH DETERMINANTS ETC.
How is health equity examined?
A
- Supply/access/utilisation of healthcare.
- Healthcare outcomes.
- Health status.
- Resource allocation (health services or others like education, housing).
- Wider determinants of health.
13
Q
HEALTH PSYCHOLOGY
What are the 3 types of health behaviour?
A
- Health behaviour
- Illness behaviour
- Sick role behaviour
14
Q
HEALTH PSYCHOLOGY
What is the role of illness behaviour?
A
- Illness behaviour = a behaviour aimed to seek remedy (e.g. going to Dr/pharmacist).
15
Q
HEALTH PSYCHOLOGY
What is sick role behaviour?
A
- Sick role behaviour = any activity aimed at getting well (e.g. resting, taking prescribed meds).
16
Q
HEALTH PSYCHOLOGY
What is the main theory for explaining why people undertake health damaging behaviours?
A
Unrealistic optimism.
- Individuals continue practicing health damaging behaviours due to inaccurate perceptions of risk + susceptibility.
- They’re aware of risks but don’t think it would happen to them.
17
Q
HEALTH PSYCHOLOGY
In terms of unrealistic optimism, what are a person’s perceptions of risk influenced by mainly?
A
- Lack of personal experiences with the problem.
- Belief that it’s preventable by personal action.
- Belief that it’s not happened by now so it’s not likely to.
- Belief that the problem is infrequent.
18
Q
HEALTH PSYCHOLOGY
What other factors can influence a person’s perceptions of risk?
A
- Stress.
- Health beliefs.
- Cultural variability.
- Situational rationality.
19
Q
HEALTH PSYCHOLOGY
What is meant by medication compliance?
A
- The extent to which a patient’s behaviour coincides with medical advice.
- It’s professionally focused + assumes that the doctor knows best.
20
Q
HEALTH PSYCHOLOGY
What is meant by adherence?
A
- The extent to which the patient’s actions match agreed recommendations.
- More patient centred, empowers patients + considers them equal in care decisions.
21
Q
HEALTH PSYCHOLOGY
What factors can affect compliance?
A
- Side effects of medications.
- Patient perception of risk.
- Socioeconomic status.
- Treatment for an asymptomatic condition (e.g. continuing Abx).
22
Q
HEALTH BELIEF MODEL
What is the Health Belief Model?
A
Behaviour change model that states individuals will change if they –
- PERCEIVED SUSCEPTIBILITY - Believe they are susceptible to the condition.
- SEVERITY - Believe that it has serious consequences.
- PERCEIVED BENEFITS - Believe that taking action reduces susceptibility.
- PERCEIVED BARRIERS - Believe that benefits of taking action outweigh costs.
23
Q
HEALTH BELIEF MODEL
Which part of the model is believed to be most important?
A
Perceived barriers.
- All about the patient having poor self-efficacy (i.e. not being able to stick to a made behaviour change).
24
Q
HEALTH BELIEF MODEL
What can be added to the model to give more information about likelihood of action?
Give examples.
A
Cues to action.
- They can be internal or external + are not always necessary for behaviour change.
- Internal = increase pain, decrease ADLs.
- External = reminders in post, GP advice.
25
HEALTH BELIEF MODEL
What are the pros of this model?
- Can be applied to a wide variety of health behaviours.
- Cues to action are unique component to the model.
- Long standing model.
26
HEALTH BELIEF MODEL
What are the cons of this model?
- Does not differentiate between first time + repeat behaviour.
- Does not consider the influence of emotions + behaviour.
- Cues to action often missing.
- Alternative factors may predict health behaviour such as self-efficacy or outcome expectancy (whether they feel they will be healthier as a result).
27
THEORY OF PLANNED BEHAVIOUR
What is the Theory of Planned Behaviour?
Proposes that the best predictor of behaviour is intention to change behaviour i.e. I intend to give up smoking.
28
THEORY OF PLANNED BEHAVIOUR
What is intention determined by in this model?
ASP
- ATTITUDE = a person's attitude to the behaviour (I don't think smoking is good).
- SUBJECTIVE NORMS = the perceived social pressure to undertake the behaviour (most people who are important to me want me to give up smoking).
- PERCEIVED BEHAVIOURAL CONTROL = a person's ability to perform the behaviour (I CAN give up smoking).
29
THEORY OF PLANNED BEHAVIOUR
What are the 5 points to bridging the intention-behaviour gap?
PPAIR –
- PERCEIVED CONTROL (something an individual feels they are capable of doing).
- PREPATORY ACTIONS (dividing task into sub-goals increases self-efficacy + satisfaction at the point of completion).
- ANTICIPATED REGRET (reflecting on feelings once failed, related to sustained intentions).
- IMPLEMENTATION OF INTENTIONS (biggest one, "if-then" plans – if I need to take my meds in the morning then I will place them here to remind me).
- RELEVANCE TO SELF (can they relate to the behaviour).
30
THEORY OF PLANNED BEHAVIOUR
What are the pros of this model?
- Can be applied to a wide variety of health behaviours.
- Useful for predicting intention.
- Takes into account importance of social pressures.
31
THEORY OF PLANNED BEHAVIOUR
What are the cons of this model?
- Lack of temporal element + direction or causality, no sense of how long behaviour change may take.
- 'Rational choice model' so doesn't take into account emotions.
- Assumes attitudes, subjective norms + perceived behavioural control can be measured.
- Relies on self-reported behaviour.
32
TRANSTHEORETICAL/STAGES OF CHANGE MODEL
What is the Transtheoretical/Stages of Change Model?
Stage theories see individuals located at discrete ordered stages, rather than on a continuum with each stage denoting a greater inclination to change outcome.
33
TRANSTHEORETICAL/STAGES OF CHANGE MODEL
What are the 5 stages?
PC PAM(R)
- PRECONTEMPLATION = no intention of stopping.
- CONTEMPATION - beginning to consider stopping, probably at some ill-defined time in the future.
- PREPARATION = getting ready to quit in near future, set stop date, go to Dr, throw away items (28d).
- ACTION = engaged in stopping behaviour on stop date (6m).
- MAINTENANCE = continues + engaged with abstinent behaviour (6m).
- RELAPSE can occur at any stage of the model.
34
TRANSTHEORETICAL/STAGES OF CHANGE MODEL
What are the pros of this model?
- Acknowledges individual stages of readiness (tailored interventions).
- Accounts for relapse/allows patient to move backwards in the stages.
- Gives temporal element (idea of timeframe/progression, albeit arbitrary).
35
TRANSTHEORETICAL/STAGES OF CHANGE MODEL
What are the cons of this model?
- Not all people move through every stage.
- Change might operate on a continuum rather than discreet changes.
- Does not take into account values, habits, culture, social, economic factors.
36
MOTIVATIONAL INTERVIEWING
What is the Motivational Interviewing model?
- A counselling approach to initiating behaviour change by resolving ambivalence (the state of having mixed feelings/contradictory ideas about something).
37
MOTIVATIONAL INTERVIEWING
What is the role of this model?
- Allow someone to change their behaviour by helping them make a decision about the behaviour – helping someone to see whether the behaviour was bad for them or not.
38
MOTIVATIONAL INTERVIEWING
Where has this shown clinical impact?
Problem drinkers.
39
SOCIAL NORMS THEORY
What is the Social Norms Theory?
- Norms are positive protective behaviours.
- Social norms are behaviours + Attitudes that are most common in groups + are one of the most important factors influencing behaviour.
40
SOCIAL NORMS THEORY
How may belief of norms differ to actual norms?
- Typically, people misperceive the peer norms.
- We typically overestimate the risk behaviour + underestimate the protective behaviours but this does not work when the risk behaviour is the social norm (i.e. alcohol, obesity).
- This means that it allows people who want to do high risk behaviours think they're doing what everyone else is but often not the case.
41
NUDGE THEORY
What is the Nudge Theory?
Give an example.
Changing the environment to make the best/healthiest option the easiest.
- E.g. placing fruit next to checkouts instead of sweets, opt-out schemes.
42
HEALTH NEEDS AX
What is a health needs assessment?
“A systematic approach for reviewing health issues affecting a population in order to enable agreed priorities and resource allocation to improve health and reduce inequalities.”
43
HEALTH NEEDS AX
Define need.
ability to benefit from an intervention.
44
HEALTH NEEDS AX
Define demand.
what people ask for.
45
HEALTH NEEDS AX
Define supply.
what is provided.
46
HEALTH NEEDS AX
What are the 4 types of need?
FENC
- Felt need
- Expressed need
- Normative need
- Comparative need
47
HEALTH NEEDS AX
What is felt need?
Felt need = individual perceptions of variation from normal health (patient feels unwell)
48
HEALTH NEEDS AX
What is expressed need?
Expressed need = individual seeks help to overcome variation in normal health
(patient goes to the doctor)
49
HEALTH NEEDS AX
What is normative need?
Normative need = professional defines intervention appropriate for the expressed need.
(the Dr says what they need)
50
HEALTH NEEDS AX
What is comparative need?
Comparative need = comparison between severity, range of interventions + cost.
51
HEALTH NEEDS AX
What are the 3 perspectives of a health needs assessment?
- Epidemiological.
- Comparative.
- Corporate.
52
HEALTH NEEDS AX
Epidemiological HNA: what is the methodology?
Looks at:
- Size of population - incidence/ prevalence
- Services available - prevention/ treatment/ care
- Evidence base - effectiveness/ cost effectiveness
53
HEALTH NEEDS AX
Epidemiological HNA: what are potential sources of data?
- Disease registry.
- Hospital admissions.
- GP databases.
- Mortality data.
- Primary data collection (e.g. postal/patient survey).
54
HEALTH NEEDS AX
Epidemiological HNA: what are the pros?
- Uses existing data.
- Provides data on disease incidence, mortality, morbidity.
- Can evaluate services by trends over time.
55
HEALTH NEEDS AX
Epidemiological HNA: what are the cons?
- Quality of data is variable
- Data collected may not be data required
- Does not consider felt needs/ opinions of patients affected.
56
HEALTH NEEDS AX
Comparative HNA: what is the methodology?
Compares services/ outcomes received by a population with others
Could compare different areas or patients of different ages etc
57
HEALTH NEEDS AX
Comparative HNA: what might it examine?
- Health status.
- Service provision.
- Service utilisation.
- Health outcomes (mortality, morbidity, QOL, pt satisfaction).
58
HEALTH NEEDS AX
Comparative HNA: what are the pros?
- Quick and cheap if data available
- Shows if services are better or worse than compared group
59
HEALTH NEEDS AX
Comparative HNA: what are the cons?
Can be difficult to find comparable population
Data may not be available/ high quality
60
HEALTH NEEDS AX
Corporate HNA: what is the methodology?
Ask local population what their health needs are
Use focus groups, interviews, public meetings
Wide variety of stakeholders
61
HEALTH NEEDS AX
Corporate HNA: what are the pros?
- Based on the felt + expressed needs of the population in question.
- Recognises the detailed knowledge + experience of those working within the population.
- Takes into account a wide range of views.
62
HEALTH NEEDS AX
Corporate HNA: what are the cons?
- Difficult to distinguish need from demand.
- Groups may have vested interests + may be influenced by political agendas.
- Dominant personalities may have undue influence.
63
HEALTH NEEDS AX
Give an example of a service that is demanded but not needed or supplied?
Cosmetic surgery.
64
HEALTH NEEDS AX
Give an example of a service that is supplied + needed but not demanded?
Anti-hypertensives (as usually asymptomatic)
Routine vaccinations
65
EVALUATION OF SERVICES
What is meant by evaluation?
Evaluation is the assessment of whether a service achieves its objectives.
- Process that attempts to determine as systematically + objectively as possible the relevance, effectiveness + impact of activities in the light of their objectives.
66
EVALUATION OF SERVICES
What is the Donabedian framework and what do each headings mean?
- Structure – what is there.
- Process – what is done.
[Output sometimes included or classified under process].
- Outcome – classification of health outcomes.
67
EVALUATION OF SERVICES
Give some structure examples.
- Buildings = locations where screening is provided.
- Staff = number of vascular surgeons/1000 population.
- Equipment = number of ICU beds/1000 population.
68
EVALUATION OF SERVICES
Give some process examples.
- Number of patients seen in A&E.
- Number of operations performed (may be expressed as a rate).
69
EVALUATION OF SERVICES
Give some outcome examples.
5Ds:
- Death, disease, disability, discomfort, dissatisfaction.
Also:
- Mortality (e.g. 30-day mortality rate).
- Morbidity (e.g. complication rate).
- QOL/patient reported outcome measures (PROMS).
- Patient satisfaction.
70
EVALUATION OF SERVICES
What are some issues with health outcome?
- Link (cause + effect) between health service provided + health outcome may be difficult to establish as many other factors may be involved (e.g. case-mix, severity, other confounding factors).
- Time lag between service provided + outcome may be long (e.g. healthy eating intervention in children + T2DM incidence in adults).
- Large sample sizes may be needed to detect statistically significant effects.
- Data may not be available or may be issues with data quality.
71
EVALUATION OF SERVICES
When considering data quality what should be considered?
CART
- Completeness.
- Accuracy.
- Relevance.
- Timeliness.
72
EVALUATION OF SERVICES
what are the different parts of Maxwell's dimensions of quality?
(3As + 3Es) –
- ACCEPTABILITY (how acceptable is the service to the people needing it?)
- ACCESSABILITY (is the service provided?)
- APPROPRIATENESS (right treatment given to right people at right time?)
- EFFECTIVENESS (does the intervention/service produce the desired effect?)
- EFFICIENCY (is the output maximised for a given input or is the input minimised for a given level of output?)
- EQUITY (are patients being treated fairly?)
73
EVALUATION OF SERVICES
Describe qualitative evaluation methods.
- Consult relevant stakeholders as appropriate (e.g. staff, patients, relatives, carers, policy makers).
- Methodology = observation (participant vs. non-participant), interviews (unstructured, semi-structured or structured), focus groups, review of documents.
74
EVALUATION OF SERVICES
Describe quantitative evaluation methods.
- Routinely collected data (e.g. hospital admissions, mortality).
- Review of records (e.g. medical, administrative).
- Surveys, other special studies (using epidemiological methods).
75
FOOD + BEHAVIOUR
What are some factors promoting excessive energy intake?
- Employment (shift work).
- Characertistics of food (energy density, portion size).
- Social aspect (people usually go out for food).
- Genetics.
- Advertisements.
76
FOOD + BEHAVIOUR
What are the pros of breastfeeding?
- Less picky eaters in childhood.
- More likely to accept novel foods in weaning.
- More likely to have a diet rich in fruit + vegetables if >3m.
- Bodyweight regulation (babies stop feeding when full if breastfeeding whereas bottle-fed infants usually encouraged to finish bottle).
77
SOCIAL EXCLUSION
What are the 3 core principles of the NHS?
- Universal = it meets the needs of everyone.
- Comprehensive = it's based on clinical need, not ability to pay.
- Free = at the point of delivery.
78
SOCIAL EXCLUSION
What is health inequality?
The unjust + avoidable differences in people's health across the population + between specific population groups.
- They go against the principles of social justice as they are avoidable.
79
SOCIAL EXCLUSION
What is the inverse care law?
The availability of medical care tends to vary inversely with the need of the population served.
- I.e. those who need it most, don't access it as much + vice versa.
80
SOCIAL EXCLUSION
What is meant by social exclusion?
The process of being shut out from any of the social, economic, political or cultural systems which determine the social integration of a person in society.
81
SOCIAL EXCLUSION
What populations are vulnerable to homelessness?
- LGBTQ+.
- Ex-service men + women.
- Substance misusers.
- Failed asylum seekers.
82
SOCIAL EXCLUSION
What are some health problems faced by the homeless?
- Infectious diseases (TB, Hepatitis).
- Resp problems.
- Poor condition of feet + teeth.
- Sexual health issues.
- Injuries following violence, rape.
- Serious mental illnesses (e.g. schizophrenia).
- Poor nutrition.
- Addictions/substance misuse.
83
SOCIAL EXCLUSION
What are some barriers to healthcare for travellers?
- Reluctance of GPs to register travellers + visit traveller sites.
- Poor reading + writing skills (many are illiterate).
- Communication difficulties.
- Too few permanent sites.
- Mistrust of professionals.
84
SOCIAL EXCLUSION
What are some barriers to healthcare for the homeless?
- Difficulties with access to healthcare (opening times, appointment + procedures location, perceived ± actual discrimination).
- Lack of integration between primary care services + other agencies (housing, social services, criminal justice system).
- Other things on their mind (people do not prioritise health when there are more immediate survival issues).
- May not know where to go or may be unable to get there.
85
SOCIAL EXCLUSION
What are some barriers to healthcare for immigrants?
- Language, cultural + communication barriers.
- Racism, prejudice, discrimination + stigma.
- Different perceptions of care.
- May not know how the NHS works.
86
SOCIAL EXCLUSION
Define asylum seeker.
a person who has made an application for refugee status.
87
SOCIAL EXCLUSION
Define refugee
a person granted asylum + refugee status, usually means leave to remain for 5 years then reapply.
88
SOCIAL EXCLUSION
Define humanitarian protection.
failed to demonstrate claim for asylum but face serious threat to life if returned. Usually 3 years then reapply.
89
DOMESTIC ABUSE
Define domestic abuse.
Any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between those aged ≥16 who are or have been, intimate partners or family members regardless of gender or sexuality.
- Includes – psychological, physical, sexual, financial + emotional.
90
UNDERAGE SEX
What are the Fraser guidelines?
- Patient understands the advice given.
- It's likely that the patient will continue to have sexual intercourse ± contraception.
- The patient's physical or mental health may suffer as a result of withholding contraceptive advice or treatment.
- It's in the best interests of the patient + the doctor to provide contraceptive advice + treatment without parental consent.
- Patient cannot be persuaded to inform their parents.
91
SUBSTANCE MISUSE
What medication(s) might you use for quick detoxification (of drug use)?
Buprenorphine is 1st line
> Lofexidine in very young / very low level use
Other symptomatic medication
Support from other agencies + teams
92
SUBSTANCE MISUSE
What is the aim of ‘Stabilisation + Maintenance’ following drug use?
How is the medication used?
Harm minimisation
Use methadone or buprenorphine
Titrate from a low starting dose to a maintenance dose.
Keep people alive until they are ready to become abstinent
93
SUBSTANCE MISUSE
What is involved in drug relapse prevention?
Naltrexone tablets are licensed
> check LFTs, Urinalysis
> warnings regarding concomitant heroin use
MDT approach = essential
Constantly relapsing patients may need stabilisation + maintenance to avoid ‘revolving door’
94
ALCOHOLISM
What does persistent drinking throughout pregnancy lead to?
Foetal Alcohol Syndrome
small, underweight babies; slack muscle tone
mental retardation; behavioural + speech problems
characteristic facial appearance
cardiac, renal + ocular abnormalities
95
ALCOHOLISM
What medications might be used to prevent an alcoholic person from relapsing?
Disulfiram -> sensitise against alcohol
Acamprosate -> GABA blocker
Naltrexone -> used in specialist centres
none of these agents are particularly effective
96
ALCOHOLISM
When do symptoms of withdrawal appear?
6-12 hours after last drink
97
ALCOHOLISM
When do seizures occur in withdrawal?
Peak incidence is 36 hours after last drink
98
ALCOHOLISM
When does delirium tremens occur in withdrawal?
Peak incidence is 48-72 hours after last drink
99
HUMAN RIGHTS ACT 1998
What is the WHO definition of health?
How does this link to the HRA?
- 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.
100
RESOURCE ALLOCATION
What is rationing?
Where resource is refused because of lack of affordability rather than clinical ineffectiveness.
101
RESOURCE ALLOCATION
Why have rationing needs increased in terms of resource allocation?
- 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.
102
RESOURCE ALLOCATION
What are the 3 ethical theories in context of resource allocation?
- Egalitarianism.
- Maximising/Utilitarianism.
- Libertarian.
103
RESOURCE ALLOCATION
What is the concept of egalitarianism?
- Provide all care that is necessary + required to everyone.
104
RESOURCE ALLOCATION
What are the pros/cons of egalitarianism?
Pros:
- equal for everyone (supports belief people deserve equal rights/opportunities)
Cons:
- economically restricted,
- tension between egalitarian aspirations + finite resources.
105
RESOURCE ALLOCATION
What is the concept of maximising/utilitarianism?
- Healthcare should be distributed to bring about the best possible outcome (criteria that maximises public utility).
106
RESOURCE ALLOCATION
What are the pros/cons of maximising/utilitarianism?
Pros:
- resources allocated to those most likely to receive most benefit.
Cons:
- those with 'less need' receive nothing.
107
RESOURCE ALLOCATION
What is the concept of libertarian?
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).
108
RESOURCE ALLOCATION
What are the pros/cons of libertarianism?
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?
109
RESOURCE ALLOCATION
What is the harm principle in relation to Libertarian theory?
What is the con to this principle?
- 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
110
RESOURCE ALLOCATION
What is Johnson's rule of rescue?
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.
111
RESOURCE ALLOCATION
Give an example of Johnson's rule of rescue.
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.
112
MEDICAL NEGLIGENCE
Define negligence
A breach of duty of care which results in damage.
- There is failure to take proper care over something.
113
MEDICAL NEGLIGENCE
What 4 questions should be asked when negligence is suspected?
- 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?
114
MEDICAL NEGLIGENCE
What 2 tests can be used to decide if there was a breach in a duty of care?
- Bolam test = would a group of responsible doctors do the same?
- Bolitho test = would it be reasonable of them to do so?
115
MEDICAL NEGLIGENCE
What are 6 broad factors which contribute to negligence?
- System failure.
- Human factors.
- Judgement failure.
- Neglect.
- Poor performance.
- Misconduct.
116
MEDICAL NEGLIGENCE
Explain what is meant by system failure.
- 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.
117
MEDICAL NEGLIGENCE
Explain what is meant by human factors?
- 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).
118
MEDICAL NEGLIGENCE
Explain what is meant by judgement failure?
- Defective decision making, bias.
- Analytical or intuitive.
- Wrong amount or type of information, wrong decision making strategy.
119
MEDICAL NEGLIGENCE
Explain what is meant by neglect.
- 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).
120
MEDICAL NEGLIGENCE
Explain what is meant by poor performance.
- Repeated minor mistakes or not learning from mistakes.
- Usually extends beyond attitude to pt care (timekeeping, reliability, illness).
121
MEDICAL NEGLIGENCE
Explain what is meant by misconduct.
- Deliberate harm, covering up errors, improper relationships (staff/pts).
- Fraud/theft/abuse i.e. falsely claiming sickness, substance misuse.
122
ERROR
Define error?
A preventable event that can cause or lead to an unintended outcome.
123
ERROR
What are 2 types of medical error?
- 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.
124
ERROR
What are some different types of human (individual) errors?
- 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).
125
ERROR
What are 4 broad classifications of errors?
- Intention.
- Action.
- Outcome.
- Context.
126
ERROR
What is meant by intention?
- Failure of planned actions to achieve desired outcome.
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ERROR
What are 3 types of intention error?
- 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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ERROR
What are the issues with knowledge based errors?
- 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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ERROR
What is meant by action?
- Generic factors (omission, intrusion, sequence).
- Task-specific factors (wrong blood vessel/organ/side, bad knots in surgery).
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ERROR
What is meant by outcome?
- Near miss.
- Death/injury/loss of function.
- Successful detection + recovery.
- Prolonged intubation/stay in ICU.
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ERROR
What is meant by context?
- Equipment + staffing issues.
- Accumulation of stressors.
- Interruptions + distractions.
- Team/organisation factors.
- Nature of procedure.
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ERROR
What are the 10 types of basic error?
- 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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ERROR
Define a never event.
A serious, largely preventable patient safety incident that should not occur if the available preventative measures have been implemented.
134
ERROR
What organisations must the hospital trust report never events to?
- National Reporting and Learning Systems (NRLS).
- CQC.
- Strategic Executive Information System (StEIS).
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ERROR
What are the 2 perspectives on error?
- Person approach = focus on the individual at fault.
- System approach = focus on the working conditions/organisations at fault.
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ERROR
What is the concept of the person approach to error?
- 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.
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ERROR
What are the cons with the person approach to error?
- Anticipation of blame promotes 'cover up' + need for a detailed analysis to prevent recurrence (retraining, discipline).
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ERROR
What is the concept of the system approach to error?
- 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.
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ERROR
Name the 2 models for errors.
- Swiss Cheese model.
- Three bucket model.
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ERROR
Explain the concept of the Swiss Cheese model
- 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.
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ERROR
What is the difference between latent failures and active failures?
- 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.
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ERROR
What is the concept of the three bucket model?
- Error evolves due to interaction between personal, environmental + physical factors as well as organisation – this tool can help stratify risk.
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ERROR
What do the 3 buckets represent in the 3 bucket model?
Self, context + task.
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ERROR
Three bucket model – what comes under self?
- 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).
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ERROR
Three bucket model – what comes under context?
- 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).
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ERROR
Three bucket model – what comes under task?
- Errors (omission, commission, fixation, sequence).
- Task complexity (calculations, double checking).
- Novel task (unfamiliar events, rare events, new ways of working).
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ETHICS
Define ethics.
system of moral principles + a branch of philosophy that defines what is good for individuals + society.
148
ETHICS
What is the concept of Utilitarianism?
- An act is evaluated solely in terms of its consequences to maximise good + minimise harm.
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ETHICS
What are the cons of utilitarianism?
treats minorities unfairly to promote majority happiness,
how do you define what is good?
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ETHICS
What is the concept or virtue ethics?
- 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.
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ETHICS
What are the cons of concept or virtue ethics?
- virtues are culture-specific + too broad for practical application,
- no focus on consequences i.e. compassion may lead to not telling harmful truth = lying.
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ETHICS
What are the 5 focal virtues that are acquired?
- 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).
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ETHICS
What is the concept of deontology?
- 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).
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ETHICS
What are the cons of deontology?
consequences not looked at, duties can conflict.
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DIVERSITY EDUCATION
Define culture.
a socially transmitted pattern of shared meanings by which people communicate, perpetuate + develop their knowledge + attitudes about life.
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DIVERSITY EDUCATION
Define stereotypes.
generalisations about the 'typical' characteristics of members of a group.
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DIVERSITY EDUCATION
Define ethnocentrism
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.
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DIVERSITY EDUCATION
Define prejudice.
attitudes towards another person based solely on their membership of a group.
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DIVERSITY EDUCATION
Define discrimination.
actual positive or negative action towards the objects of prejudice.
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TEACHING SKILLS
What is the tripartite model of types of learning?
- Surface.
- Strategic.
- Deep approach.
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TEACHING SKILLS
What is meant by surface?
- Fear of failure.
- Desire to complete a course.
- Learning by rote + focus on particular tasks.
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TEACHING SKILLS
What is meant by strategic?
- Desire to be successful.
- Leads to a patchy + variable understanding (well organised form of surface learning).
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TEACHING SKILLS
What is meant by deep approach?
- Intrinsic, vocational interest, person understanding.
- Making links across materials, search for deeper understanding of the material, look for general principles.
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TEACHING SKILLS
What are 4 different types of learner?
- 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.
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LEADERSHIP
What are the 5 leadership styles?
- Authoritarian.
- Participative.
- Delegative (Laissez-faire).
- Transactional.
- Transformational (inspirational).
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LEADERSHIP
What is the concept of authoritarian leadership?
- Allows one leader to impose expectations + define outcomes.
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LEADERSHIP
What are the pros/cons of authoritarian leadership?
Pros:
- consistent results,
- time spent on crucial decision reduced.
Cons:
- v strict,
- lack of staff creativity/innovation,
- lack of group input.
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LEADERSHIP
What is the concept of participative leadership?
Rooted in democratic theory to involve team members in the decision-making process> feeling included, engaged + motivated to contribute.
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LEADERSHIP
What are the pros/cons of participative leadership?
Pros:
- encourages staff creativity,
- increases staff motivation.
Cons:
- decisions may be time-consuming,
- poor decisions may be made.
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LEADERSHIP
What is the concept of delegative leadership?
- Focuses on delegating initiative to team members, letting things take their own course without interfering.
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LEADERSHIP
What are the pros/cons of delegative leadership?
Pros:
- environment of independence,
- experienced staff can offer experience.
Cons:
- downplays role of leader,
- leaders avoid leadership,
- staff may abuse.
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LEADERSHIP
What is the concept of transactional leadership?
Leader sets clear goals + uses "transactions" such as rewards, punishments etc to get the job done. Staff know how their compliance is rewarded.
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LEADERSHIP
What are the pros/cons of transactional leadership?
Pros:
- staff motivation + productivity increased,
- reward system.
Cons:
- innovation/creativity minimised,
- less leaders created,
- seen as coercive.
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LEADERSHIP
What is the concept of transformational leadership?
- Leader inspires the followers with a vision + then encourages + empowers them to achieve it. The leader serves as a role model for the vision.
175
LEADERSHIP
What are the pros/cons of transformational leadership?
Pros:
- high value on corporate vision,
- high morale for staff,
- not coercive.
Cons:
- leaders can deceive staff,
- may need consistent motivation/feedback.
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LEADERSHIP
What leadership model is best suited for healthcare and why?
- 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.
