Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Paramedic Care:Principles & Practice

Volume 1Introduction to Advanced

Prehospital Care

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Chapter 11Therapeutic Communications

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Topics

Basic Elements of CommunicationCommunication TechniquesPatients with Special Needs

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Communication Components

Communication is the exchange of common symbols.Communication strategies include persistently paying attention to word choices, tones of voice, facial expressions, and body language.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Basic Elements of Communication

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Basic Elements of Communication

Communication consists of:– A sender– A message– A receiver– Feedback

EncodingDecoding

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Basic Elements of Communication

Failure to communicate results from:– Prejudice – Lack of privacy– External distractions– Internal distractions

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Trust and Rapport

With good rapport, the people you are serving will follow your lead. Techniques to develop good rapport include:– Using the patient’s name– Address the patient properly– Modulate your voice– Be professional but compassionate

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Trust and Rapport

Techniques to develop good rapport (cont.)– Explain what you are doing and why– Keep a kind, calm expression– Use an appropriate style of communication

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Professional Behaviors

First impressions are crucial– The patient relies on visual input

Be neat and cleanPractice good hygieneStay physically fit

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Professional Behaviors

Maintain an overall demeanor that is calm, capable, and trustworthy.Be confident, not arrogant.Be considerate.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Communication Techniques

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Communication Techniques

General Guidelines– Patients generally respond to questioning in one

of three ways: They may pour out information easily They may reveal some things and conceal others They may resist, hiding information from themselves and, therefore, from you

– Remain non-judgmental

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Non-Verbal Communication

Consists of gestures, mannerisms, and postures by which a person communicates – Distance– Level– Stance

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Non-Verbal Communication

Distance

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Non-Verbal Communication

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Non-Verbal Communication

Getting down to a patient’s level can help improve communications on a pediatric call.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Non-Verbal Communication

A powerful source of effective communication comes with eye contact. Use eye contact as much as possible.Remember to remove sunglasses while working with patients.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Non-Verbal Communication

Use an appropriate compassionate touch to show your concern and support.Be careful to touch appropriately.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Interview Techniques

Questioning Techniques – Use open-ended questions.– Use direct questions.– Do not use leading questions.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Interview Techniques

Questioning Techniques (cont.)– Ask one question at a time, and listen to the

complete response before asking the next.– Use language the patient can understand.– Do not allow interruptions.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Observing the Patient

Overall appearance– Clothing– Jewelry

Mental statusSpeechMood and energy level

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Effective Listening and Feedback

SilenceReflectionFacilitationEmpathyClarification

ConfrontationInterpretationExplanationSummarization

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Interviewing Errors

Providing false assurancesGiving adviceAuthorityUsing avoidance behavior

DistancingProfessional jargonTalking too muchInterruptingUsing “why” questions

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Patients with Special Needs

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Sources of Difficult Interviews

Difficult interviews may stem from several sources: – Patient’s physical condition– Patient’s fear of talking

Psychological disorder, language or cultural difference, or even the difference between your ages

– Patient’s intention to deceive

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Sources of Difficult Interviews

Use the same techniques on a patient who is reluctant to talk to you as you would on any other patient. – Provide positive feedback to any response the

patient provides. – Make sure the patient understands you.– Continue to build trust and rapport with the

patient.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Sources of Difficult Interviews

Difficult interviews include:– Children and their parents – Elderly people – People who are blind or deaf – People of other cultures– People who are hostile or uncooperative

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Childhood Development

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Children

Start by talking to the caregivers, then gradually approach the patient. – Remember body language

Explain what you intend to do, even to very young children.You must build trust.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Elderly Patients

Be respectful. – Always use a formal means of address

Speak slowly and clearly. Interviews might take longer. – Physical limitations– Fatigue

Compassionate touch can be a welcome and important means of nonverbal support. Give choices whenever possible.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Sensory Impairment

Blindness:– Tell patient everything you are going to do.– Use touch as a form of contact for reassurance.

Hearing impairment:– Ask patients what their preferred method of

communication is.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Language and Cultural Considerations

Understand that cultures vary and ethnocentrism hinders communication.There is additional fear when a patient cannot understand your language.Avoid cultural imposition.– Avoid imposing on the patient your own beliefs,

values, and patterns of behavior.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

If Using Interpreters

If a child interprets, use an age-appropriate level.The emergency may cause distressing emotions, especially if the interpreter is a child.Speak slowly.Phrase questions carefully and clearly.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Interpreters

Address both the patient and the interpreter.Ask one question at a time, and wait for the complete response.The information you receive may not be reliable.Have patience.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Hostile or Uncooperative Patients

Set limits and boundaries.Document unusual situations.Consider having a same-sex witness ride in the ambulance.If your safety is in jeopardy, keep away from the patient.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Hostile or Uncooperative Patients

Have an appropriate show of force if necessary.Know local policy regarding restraints and psychological medications.Use law enforcement if needed.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Transferring Patient Care

Before patient care is transferred to you, listen to the report carefully.Interact with colleagues with respect and dignity.Give a report to the receiving nurse or doctor.Introduce the patient by name, and say good-bye.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Summary

Basic Elements of CommunicationCommunication TechniquesPatients With Special Needs