List 5 internal and external barriers to reflective practice.
- Social norms
- Cultural norms
- Past learned experience
- Peer pressure
- Pressure from hierarchy
Name a framework that can support formal reflective practice.
IDEA
1. Identify the source of the discomfort
2. Describe the situation/events
3. Evaluate the situation
4. Analyse any lessons to take away / Act on lessons
List 5 self-care strategies to maintain resilience.
- Be aware of your job’s boundaries
- Understand/encourage your healthy coping mechanisms
- Recognise your signs of becoming stressed
- Maintain adequate knowledge/skills
- Be mindful of when your values are impacting care
- Reach out to a support network
- Talk it out
- Physical self-care
- Congratulate yourself on jobs well done
- Maintain a life outside of work
List 4 benefits of a healthy palliative care team.
- Best possible care
- Improves productivity
- Improves individual job satisfaction
- Improves problem solving
- Improves intrateam relationships
- Improves recruitment/retention
- Improves growth/expansion of services
- Improves relationships with other teams
List 5 traits of a healthy team.
- Well-defined mission/goals
- Clearly defined roles, even if overlapping
- Shared explicit team values
- Explicit hierarchy of reporting and decisionmaking
- Clear work expectations
- Routine productive evaluations
- Routine teambuilding activities
- Mutual respect within team
- Open communication within team
- Strong leadership
List 3 “high risk” events for team dysfunction.
- New team/growing pains
- Change in leadership
- Personal crisis of team member
- Vicarious trauma (e.g. Bill’s death)
- Disruptive behaviour by team member
List 3 chronic red flags in an unhealthy team.
- Chronic absenteeism
- Chronically missing meetings
- Chronic lack of followthrough on tasks
- 1+ disruptive/burnt out team member
- Constantly needing to work overtime
- Chronic intrateam conflict that goes unresolved
- Cliques
- Overwork preventing nonclinical activities
List 3 steps in conflict management.
- Listen/learn their stories. Ask their needs.
- Attend to emotions (NURSE)
- 1+2 –> shared plan
List 5 tips for effective communication.
- Manners (punctuality, knocking, permission)
- Solicit questions (e.g. “what question do you have” vs “do you have questions”)
- Be clear, direct, specific
- Acknowledge your limitations
- Consistency in messaging
- Reduce changes in providers
- Be matter of fact in conflict (e.g. no name calling)
- Be explicit about rules/expectations
- Be specific when describing problem behaviours (e.g. “your raising your voice is not helpful” vs “stop overreacting”)
What care decision in an acutely declining patient can worsen family stress?
Changing care location
List 5 common sources of family conflict.
- Belief that another family member is providing insufficient care
- Disagreement about the medical reality
- Disagreement about patient’s preferences
- Multiple decisionmakers
- SDM not basing decisions on patient’s wishes
- Distrust of the healthcare providers or system
- Cultural/religious differences
- Reactivation of preexisting conflict
- Different grief trajectories
In one ICU study, what % of treatment decisions led to disagreements between family and care team?
33%
List 3 strategies for management family/medical team conflict.
- Be mindful of your own negative emotions
- Identify the actual source of conflict
- Explore emotions of guilt or remorse, esp. around withdrawal of care
- Explore the grieving loved ones’ relationships with the patient (e.g. “tell me what you’ll miss most”)
- Assess premorbid family dys/function
+ general strategoes for good communication
Name 6 features of a good death.
- Controlled symptoms
- Control of own decisionmaking
- Closure
- Dignity/being recognised as a person
- Time to prepare for the death
- Feeling of still being able to give to others
https://doi.org/10.1016/j.jpainsymman.2019.07.033
Name and elaborate the components of SPIKES.
- S: Setting (location, time, people)
- P: Perception (pt current understanding)
- I: Invitation (ask to share results, ask how they’d like it shared, who should know)
- K: Knowledge (warning shot, share info)
- E: Empathy (NURSE)
- S: Summary (solicit Qs, next appointment, plan)
What are the 4 abilities that define medical capacity?
- Understanding of the facts
- Appreciation of the risks/benefits in their case
- Reasoning (i.e. weighing choices)
- Expressing a decision
What are 4 sample questions to assess each of the domains of decisionmaking ability?
- Can you tell me in your own words [your medical situation]?
- Do you think it is possible for this treatment to help/harm you?
- How would you compare X vs Y?
- Based on what we have discussed, what would you choose?
What are the 3 core features of burnout?
- Depersonalisation/cynicism
- Low sense of personal accomplishment
- Emotional exhaustion
List 5 aspects of culturally sensitive ACP.
- Professional interpreters if necessary
- Solicit their agenda
- Ask how they prefer news to be shared/Qs to be asked
- Open ended questions
- Allow patient/family to decide who is decisionmaker
- Ask them their definitions (e.g. “comfort” “do everything”)
List 6 ways an organisation can combat staff burnout
- Private and comfortable workspaces
- CME opportunities
- Teambuilding/team social events
- Staffing to allow work/life balance
- Acknowledgement of burnout/compassion fatigue
- Safe and regular M&M rounds
- Interprofessional meetings/collaboration
- Ease of taking time off when needed
- Adequate mentoring of new staff
- Adequate supervision by team leaders
