PATIENTS AND COMMUNICATION

Chapter 2PPI

COMMUNICATION

COMMUNICATION

YOU NEED TO DEVELOP SKILLS IN CRITICAL THINKING AND PROBLEM SOLVING TO ACCESS PATIENTS UNIQUE NEEDS TO EFFECTIVELY PLAN AND IMPLEMENT CARE.

PATIENT EDUCATION IS PART OF THE RADIOGRAPHERS PROFESSIONAL OBLIGATIONS

ASSESSING NEEDS IS VITAL WHEN DEALING WITH PATIENTS AND GIVES THE RADIOGRAPHER AN IDEA HOW TO APPROACH A SITUATION.

BASIC HUMAN NEEDS1. ABRAHAM MASLOW DEVELOPED A

PYRAMID BUILT ON HUMAN NEEDS.2. PHYSIOLOGICAL NEEDS3. SAFETY AND SECURITY4. LOVE AND BELONGINGNESS5. SELF ESTEEM6. SELF ACTUALIZATION

MASLOW BUILDING BLOCK

SELF ACTUALIZATION

SELF ESTEEM

LOVE/BELONGINGNESS

SAFETY AND SECURITY

PHYSIOLOGICAL NEEDS

PHYSIOLOGICAL NEEDSBASIC NEEDS FOR FOOD, SHELTER, SLEEP,

AIR ANDIF THESE NEEDS ARE NOT SATISFIED A

PERSON IS UNABLE TO PURSUE OTHER NEEDS

SAFETY AND SECURITY

SEEK A PLACE FREE FROM HARM AND CAN BE SURE OF BEING ABLE TO EARN A LIVING.

Love and BelongingnessSeek someone to share life with and seeks

a social group.

Self esteemSelf regard and the feeling of being self

regarded by others beyond family.

SELF ACTUALIZATIONTO GROW SPIRITUALLY

ACCOMPLISH DEEDS TO MAKE THEM FEEL THE ULTIMATE GROWTH IN LIFE.

THE HALLMARK OF AN EXCELLENT RADIOGRAPHER IS THE ABILITY TO ACHIEVE A POSITIVE DIAGNOSIS OR TREATMENT IN A TIMELY MANNER WHILE MEETING THE UNIQUE NEEDS OF THE INDIVIDUAL.

CRITICAL THINKING“ THE ART OF THINKING ABOUT YOUR

THINKING WHILE YOU ARE THINKING IN ORDER TO MAKE YOUR THINKING BETTER, CLEAR, MOREACCURATE AND MOREDEFENSIBLE”

CRITICAL THINKING REQUIRES THE ABILITY TO INTERPRET, ANALYZE, EVALUATE, INFER, EXPLAIN AND REFLECT.

MODES OF THINKING1. RECALL2. HABIT3. INQUIRY4. CREATIVITY5. RECALL AND HABIT ARE LOWER LEVELS

OF THINKING.6. INQUIRY AND CREATIVITY ARE HIGHER

LEVELS OF THINKING.

PATIENT ASSESSMENTEVERY PATIENT AND DIAGNOSTIC PROCEDURE PRESENTS PROBLEMS, RANGING FROM SIMPLE TO COMPLEX.

BEGINNING RADIOGRAPHERS SHOULD WRITE DOWN THE PROBLEM SOLVING PROCESS.

DATA COLLECTIONSUBJECTIVE

DATA THAT INCLUDE ANYTHING THE PATIENT OR SIGNIFICANT OTHER SAYS THAT IS PERTINENT TO THE PARIENTS CARE.

OBJECTIVEDATA THAT YOU SEE,HEAR,SMELL,FEEL OR READ ON THE PATIENTS CHART;ANYTHING

REPORTED BY ANOTHER HEALTH CARE WORKER THAT MAY EFFECT THE PATIENT OR PROCEDURE.

DATA ANALYSISINTEGRATES ALL PARTS OF CRITICAL THINKING. LIST ALL SUBJECTIVE AND OBJECTIVE DATA THEN YOU CAN START TO ANALYZE.

THIS REQUIRES THE SKILL OF INQUIRY.

PLANNING AND IMPLEMENTATIONAFTER DATA ANALYSIS YOU ESTABLISH A GOAL WITH EXPECTED OUTCOMES OR OBJECTIVES FOR ACHIEVING THAT GOAL.

PLANNING REQUIRES ALL THE MODES OF THINKING.

EVALUATION

EACH PATIENT SITUATIONS ARE DIFFERENT THEREFORE ALL PATIENT CARE EXPERIENCES ARE LEARNING EXPERIENCES.

EVALUATION QUESTIONSWERE THE PATIENTS NEEDS MET?WAS SAFETY MAINTAINED DURING THE

PROCEDURE?DID THE PATIENT COMPLAIN OF PAIN AS

THE PROCEDURE WAS DONE?WHAT CAN I DO DIFFERENTLY NEXT

TIME?DID I USE HIGHER LEVEL OF CRITICAL

THINKING SKILLS FOR THE PROCEDURE?

MAKE SURE YOU TAKE INTO CONSIDERATION THE PATIENTS ETHNIC AND CULTURAL BELIEFS AS THE INITIAL ASSESSMENT AS PATIENT CARE CONCERNS ARE MADE.

YOU MUST TREAT EVERY PERSON AS A PERSON OF DIGNITY AND WORTH AND DESIGN EVERY PLAN WITH THE PATIENTS SOCIOCULTURAL NEEDS IN MIND.

COMMUNICATIONYOU MUST LEARN TO EFFECTIVELY COMMUNICATE WITH YOUR PATIENTS.YOUR ABILITY TO ACCEPT OTHERS WITH AN OPEN MIND AND TO INTERACT WITH OTHER PEOPLE IS BASED ON LEARNED ATTITUDES AND SELF-UNDERSTANDING.

COMMUNICATION

TO BE AN EFFECTIVE COMMUNICATOR YOU MUST DEVELOP SKILLS IN LISTENING, SPEAKING, OBSERVING, AND WRITING.

SELF CONCEPTHOW WE FEEL AND WOULD DESCRIBE OURSELF.IT IS MADE UP OF ATTITUDES OF OUR SIGNIFICANT OTHERS TOWARD US AS WE INTERACT WITH THEM OVER TIME.

EVOLVES OVER A LIFETIME BODY IMAGE

ELEMENTS OF SELF-CONCEPTBODY IMAGE

SELF-ESTEEM

ROLE

IDENTITY

SELF-ESTEEM

EVALUATION OF OURSELVES BASED ON THE POSITIVE OR NEGATIVE RETURNS WE RECEIVE FROM OUR BEHAVIORS AS WE LIVE OUR LIVES.

NON VERBAL COMMUNICATIONHEARSMELLFEEL

THESE UNSPOKEN MESSAGES CAN OFTEN INDICATE HOW THE PATIENT FEELS MORE QUICKLY THAN ANY WORDS CAN!

CULTURAL VARIATIONSYOU MUST BE AWARE OF CULTURAL DIFFERENCES.

PERSONAL SPACESHACKING OF HEADUSE OF HUMOR

GENDER DIFFERENCESMEN PREFER INTERACTIONWOMAN PREFER DISCUSSION

AVOID SEXUAL INNUENDOES! AVOID FLIRTATIOUS MANNER!

THERAPEUTIC TECHNIQUESGUIDELINES-intro and what you are going to

do.REDUCING DISTANCE-make the patient feel

includedSILENCE-use itLISTENING-a good listener is goldenRESPONDING-make sure the patient is

understoodRESTATING-repeating in a different way

THERAPEUTIC TECHNIQUESREFLECTING-directing back to the patient the

main ideaCLARIFICATION-lets the pt. know you heard

them but you are not clearOBSERVATIONEXPLORING-questions that relate to the

problems of the patientVALIDATING-verify what the patient has told

youFOCUSING

NONTHERAPUETIC TECHNIQUESRapid speechCrowded hallNoisy areaComplex medical terms“Don’t worry, everything will be just fine” is

a false reassurance.

NONTHERAPUETIC TECHNIQUESJUDGEMENTAL STATEMENTSFALSE REASSURANCESDEFENDINGCHANGING THE SUBJECTGIVING ADVICEPROBING DISAGREEINGDEMANDING AN EXPLANATION

PATIENT INTERVIEWSTRUCTURED-LIST OF WRITTEN QUESTIONS THAT REQUIRE RESPONSES.

UNSTRUCTURED-INFORMAL AND IS BASED ON QUESTIONS AND DEPEND ON PATIENT RESPONSES.

PATIENT EDUCATIONPATIENTS EXPECT TO RECEIVE INSTRUCTIONS.

1. DESCRIPTION OF ANY PREPARATION NEEDED

2. APPROXIMATE TIME FRAME OF PROCEDURE

3. EXPLAIN ANY UNUSUAL EQUIPMENT USED4. ANY FOLLOW UP INSTRUCTIONS

STAT

SuicideThe act of ending one’s own life.

Passive suicide-patient refuses treatment even it is brings about death.Active suicide-taking ones life as a conscious act

Imaging scenarioPancreatic cancer is diagnosed with two patients, and the CT scan indicates the cancer has spread. One patient has decided to discontinue nourishment to hurry death and the other patients elects to continue treatment to sustain life as long as possible.How do personal values influence the reasons for refusing treatment as compared to continuing it?

LOSS AND GRIEFGRIEF IS A NORMAL EMOTIONAL RESPONSE TO THE LOSS OF A LOVED ONE, POSSESSION, SOCIAL STATUS, OR A BODILY FUNCTION OR BODY PART.

HOW A PERSON MANAGES GRIEF DEPENDS ON CULTURAL, RELIGIOUS, AND ECONOMIC FACTORS AS WELL AS THE VALUE PLACED ON THE LOSS.

GRIEF IS MORE SEVERE IN CHILDREN AND ADULTS

THEORY OF GRIEVINGDR. ELIZABETH KUBLOR-ROSS MODEL

PHASES OF GRIEVING1. DENIAL2. ANGER3. BARGAINING4. DEPRESSION5. ACCEPTANCE

PHASE 1- DENIAL

DIFFICULTY FACING ONES DEATH

PHASE 2- ANGER THIS MAY HAPPEN IF THE ILLNESS IS LONG

SUFFERING.

PHASE 3- BARGAINING THE PATIENT BECOMES A “GOOD PATIENT” HE OR

SHE FEELS GUILTY FOR OUTBURST OF ANGER AND FEELS IF I AM GOOD I WILL BE SPARED. THEY MAY SEEK UNUSUAL FORMS OF TREATMENT.

PHASE 4- DEPRESSION

The PATIENTS ACCEPTS THE REALITY OF THEIR CONDITION AND BEGINS TO MOURN FOR ALL HE HAS LOST. PATIENT IS OFTEN WITHDRAWN.

PHASE 5- ACCEPTANCETHE PATIENT FOCUSES ON HIS IMMEDIATE

SURROUNDINGS AND SUPPORT SYSYEM. PATIENT MAY WANT TO DISCUSS DYING.

PATIENT RIGHTS RELATED TO DEATH, DYING AND MEDICAL TREATMENT

Professional DutyAssisting in suicide is illegalHealth care providers are devoted to

healingAssisting in suicide is incompatible with

professional obligation

ADVANCE HEALTH CARE DIRECTIVE

ALL PERSONS HAVE THE RIGHT TO GIVE INSTRUCTION CONCERNING THEIR OWN HEALTH CARE.

THESE DIRECTIVES SHOULD BE WRITTEN, SIGNED, WITNESSED AND MADE AVAILABLE TO ANYONE WHO MAY BE IN CHARGE OF THE PERSON IF HE/SHE IS NOT ABLE TO MAKE DECISIONS

.A COPY SHOULD BE PLACED IN THE PERSONS MEDICAL DOCUMENTS AND ON THE CHART WHEN ADMITTED TO THE HOSPITAL.THE U.S. CONGRESS PASSED A “PATIENT SELF DETERMINATION ACT” IN 1990

Imaging ScenarioAn imaging professional father is dying of cancer with no hope of recovery. The Father has an advanced directive that he does not want any life sustaining equipment. He becomes unresponsive and a family conflict develops concerning withdrawal of nourishment. Part of the family feels it is in the best interest of the patient-to hasten his death and end his suffering-and another family member views this as killing him. They ask the x-ray tech about the pain and suffering, the issues of passive and active euthanasia and whether not using life sustaining equipment is equal to starving him to death.How should the x-ray tech respond? Is there correct answer?

TERMS TO KNOW1. LIVING WILL - A DOCUMENT THAT LIST THE

PATIENTS WISHES IF TERMINALLY ILL.2. DURABLE POWER OF ATTORNEY- DESIGNATES A

PERSON WHO WILL MAKE HEALTH CARE DECISIONS FOR THE PATIENT IF THE PATIENT CAN NOT.

3. DNR- INSTRUCTIONS ON THE CHART THAT DIRECT HEALTH CARE WORKERS NOT TO RESUSCITATE THE PATIENT.

4. DNI- INSTRUCTS HEALTH CARE WORKERS TO DO NOT INTUBATE.

5. FULL CODE- FULL CPR IF THE PATIENTS STOPS BREATHING OR THE HEART STOPS.

Case study-Terri Schiavo1990-26 year old Terri Schiavo has a heart attack. She lost oxygen and was put on a feeding tube and oxygen and declared to be in a vegetative state.1998 Terri Schiavo’s husband filed a petition to stop life support and in 2000 it was granted. Terri’s parents appealed this and it was in court until 2005.The case was appealed 14 times in Florida courts. Finally the courts refused to hear the case and the life support and feeding tubes were removed March 18, 2005.She died March 31, 2005!

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