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Chapter 11: Patient Interactions
Terms in this set (47)
Legal document prepared by a living, competent adult to provide guidance to the health care team if the individual should become unable to make decisions regarding his or her medical care; may also be called a living will or durable power of attorney for health care.
Exhange of information, thoughts, or messages; includes interpersonal rapport; also includes the accurate conveyance of information, clear self-expression, and transmission of information and ideas to others.
Emotional Intelligence (EI)
Ability to evaluate, perceive, and control emotions.
It simply means the ability to look at yourself and at others in an effort to recognize and understand emotions and to use that recognition and understanding to manage those emotions in both arenas.
Individuals with high EI are said to be more successful on and off the job. In health care, this translates into more effective communication and patient care.
Pertaining to the study of older adults.
Someone who has been admitted to the hospital for diagnostic studies or treatment.
Maslow's Hierarchy of Needs
Model of human needs developed by Abraham Maslow, original hierarchy identifies two types of needs: Deficiency and growth needs were further divided into seven levels, four at the deficiency needs levelly (physiologic, safety, belongingness and love, and esteem) an three in the upper growth needs level ( need to know and understand, aesthetic, and self-actualization).
Essentially, each level of needs must be satisfied before one can proceed to the next level.
EX: students often begin their education at approximately the third level, which relates to belonging or affection needs. Once instructors, classmates, and staff radiologic technologist have accepted the student, he or she must move toward the 4th level, which addresses self-esteem and respect needs. Many students achieve this level during the second year, once many of the required clinical skills have been mastered. Graduation is self-actualization
Exchange of information, thoughts, or messages using methods other than the actual words of speech- for example, tone of voice, speed of speech, facial expressions, and position of the speaker's extremities and torso (body language).
Patient who comes to a health care facility for diagnosis or treatment but does not usually occupy a bed overnight.
Application of light pressure with the fingers.
The use of palm or several fingers is less precise than using fingertips and may in some instances be painful or even offensive to patients
Music of language; cadence and rhythm of speech.
Objective evaluation and determination of the status of a patient.
Ability and right of patients to make independent decisions regarding their medical care.
Messages sent using spoken words; the exchange of information or thoughts; can be dramatically shaped by vocabulary, clarity, tone, pitch of voice, and even the organization of sentences.
To interact effectively with patients, understanding that patients may be in an altered state of consciousness is important.
Patient's fear of what the images may confirm or uncover and causes them to be inconsiderate, arrogant, impatient, rude, or overly talkative or to exhibit other characteristics as they attempt to cope with their situation.
Is the initial patient communication skills. Initial patient assessment by the technologist usually comes int he form of a chart or procedure request review or both.
the 2nd patient assessment by the technologist usually comes in the form of verbal communication. All health care professionals should introduce themselves to their patients, explains he procedure to patients, and obtain a brief history.
What are the two main classifications of patients?
Inpatients and outpatients
is someone who has been admitted to the hospital for diagnostic studies or treatment. In general, these persons occupy a hospital bed for longer than 24 hours.
is someone who has come to the hospital or outpatient center for diagnostic testing or treatment but doe not usually occupy a bed overnight.
They often expect to be seen immediately on arriving in the department because they have a scheduled appointment.
Apologizing for delays and trying to keep waiting patients up to date on their status is certainly appropriate and important.
Interacting with the patient's family and friends:
Thinking about how the family and friends feel or considering how concerned you would be about a member of our own family would help. But the technologist must also be aware and remember that he or she is prohibited from rendering a diagnosis at any time and of any sort.
Abnormal or rude behavior may be the result of anxiety, concern, or stress.
An important point to remember is that family and friends often listen closely to everything a professional says. Any statements in response to this type of question may be construed as diagnosing, which is practicing medicine without a license and is illegal. The best response is usually to indicate that the findings are available to the referring physician and that only he or she can provide the information.
Methods of Effective Communication:
Vocabulary, clarity of voice, and even the organization of sentences must be at a level appropriate for the patient.
Humor is well documented as a value in the medical settings. Using humor to relax and open up conversation is acceptable.
Paralanguage is the music language. Patients receive signals about your attitude toward them from the pitch, stress, tone, pauses, speech rate, volume, accent, and quality of your voice.
Body Language- Patients quickly perceive nonverbal communication such as the tone of voice, speed of speech, and position of the leaker's extremities and torso.
Positive nonverbal cues increase the quantity and quality of communication and improve the history. EX eye contact, smiling, responding candidly, and using a friendly tone of voice.
Negative nonverbal cues also can be used to i improve history. For example: looking puzzled may prompt the patient to elaborate on exactly ow an injury occurred and may provide the radiologist with details on the direction of the force that caused a fracture.
Touch- 3 types:
1. touching for emotional support.
2. Touching for emphasis.
3. Touching for palpation.
Professional appearance- look confident and competent and makes patients feel comfortable.
Personal Hygiene- behavior similar to appearance.
Physical Presence- Posture is I'm portent because it is perceived as relating to confidence and self-esteem. Facial expressions.
Visual Contact- Eye contact may help ensure that questions, instructions, and other information have been understood.
What are the various types of patients?
Seriously ill and traumatized patients.
Visually impaired patients.
Speech-impaired and hearing-impaired patients.
Mentally impaired patients.
Seriously Ill and Traumatized Patients:
May act differently from other patients because of pain, stress, or anxiety.
First the technologist should try to communicate with the patient while deterring his or her coherence level.
Inability or unwillingness to communicate can be caused by many factors, including pain, shock, medication reaction, and disorientation.
Working quickly and efficiently while continuing to communicate with the patient is important, even if no response from the patient is forthcoming. Letting the patient know what is going on during a procedure can be reassuring, even when no apparent sign of understanding is evident.
Watching for visual indications of changes in vital signs becomes especially important.
Visually Impaired Patients:
The technologist should attempt to gain the patient's confidence as soon as possible by giving clear instructions before the examination, as well as informing him or her of what is occurring at all times. Reassuring the patient through a gentle touch establishes that someone is near if needed. Continued verbal communication assists persons who are blind and visually impaired with satisfying many of the basic needs attributed to Maslow.
These individuals are blind, not deaf, and talking loudly cannot make them see.
Speech-Impaired and Hearing-Impaired patients:
For persons who can read, the primary means of communication can be writing. The technologist must not insult the patient's intelligence by attempting to simplify terminology. hearing ability does not control intelligence.
Pantomime and demonstration work well with hearing-impaired patients. For example: Counting to three on your fingers, pinching your nose, and taking a deep breath symbolizes to the patient that you need him or her to hold their breath while you count to three. Patients should demonstrate instructions in return to make sure they understand.
provide sign language expert as necessary.
Effective interaction with non-English-speaking patients is greatly enhanced by using touch, facial expressions, and pantomime.
Nearly all such patients understand basic words such as yes, no, and stop. Everyone appreciates any attempt to speak his or her language, even if only to say yes and no.
Telephonic translators has increased and a list of bilingual employees who are available to help.
Mentally Impaired Patients:
These disorders include intellectual disability, organic brain syndromes, emotional or mental illnesses, and specific types of learning disabilities.
Communicating with gentle tones and smiles will often illicit a positive response, although sometimes other measures may be necessary.
Need to be knowledgeable of equipment and immobilization techniques.
Although degrees of mental impairment vary, using a strong yet reassuring tone of voice with these patients is important. A continuous conversation while preparing the patient for the examination usually helps keep the patient calm and aware that the technologist is working with him or her.
The best mode of interaction with these patients often includes assessing their capabilities, attempting to establish a means of communication, using technical knowledge, and working efficiently to decrease the total examination time.
Patients who are under the influence of drugs or alcohol may be relaxed, or they may be hyperactive and irrational. use immobilization techniques as necessary.
Calm, quiet patients are of increased concern because they may react without warning and fall or otherwise injure themselves.
Waiting until the patient becomes cooperative is often best.
Mobile and Surgical examinations:
Many patients who require mobile examination are too sick or injured to be transported to the medical imaging department for their procedure.
Begin by calling patient's name, identifying yourself to the patient, and explaining the procedure. This approach permits assessment of the patient's condition and level of coherence.
Under no circumstances should the technologist assume that a patient does not comprehend comments that are made within the patient's rang elf hearing. Patients may be cognizant although they appear to be comatose.
In interacting with the patient's family and friends, you should introduce yourself, explain the procedure briefly, and explain why they must leave the immediate area during the exposure.
Pediatric patents always require special attention.
"To stand tall in pediatrics, you have to get down on your knees."
Instead of picking a child up and setting him or her on an imaging table, which is the technologist's environment, the tech should squat at the child's eye level, which is the child's environment, to begin with the relationship.
Many hospitals provide soft toys.
Never try to separate a child from a security object such as a blanket or toy unless absolutely necessary for image quality. Even then it should remain within the child's sight.
Infants (Birth to 1 Year)
First communications are established using facial expressions, body movements and other nonverbal behaviors, and vocalizations.
Infants like to be held in a familiar position; observe how the parents are holding the child.
At approximately 8 months of age, most infants express definite anxiety when removed from a familiar person. Permitting the parents to assist with the entire exam if possible is often helpful.
At approximately 12 months of age, children are beginning to develop memories, ideas, and feelings.
Toddlers (1 to 3 years)
Although toddlers may understand simple abstractions, their thinking is basically related to tangible events. They usually cannot take the viewpoint of another (ex: see, it doesn't hurt mommy), and they cannot understand more than one word for something.
Toddlers concept of time is essentially now, and distance is whatever can be seen.
Speak with simple words that are familiar to children.
Preschoolers (3 to 5 years)
Preschool children are not yet able to reason logically or understand cause and effect.
They are very involved with self-image, this is the age at which children may form an opinion that that are sick because they were bad.
They must see or hear something to understand and must be actively involved to maintain their short attention span.
Remarkably cooperative if their trust has been won.
School-Aged Children (5 to 10 years)
At approximately 7 years of age, children begin to think logically and to analyze situations. At this point children can reflect and develop deeper understandings. With these advancements, children often develop a special fear of boil injury, disease, separation from loved ones, death, and punishment.
Special attention is warranted to divert their attention from the negative aspects of various examinations.
Adolescents (10 to 25 years)
adolescence is not a well-defined age group, although it begins earlier for girls than it does for boys. The primary consideration in early adolescence opuses on body awareness, and modesty becomes especially important.
Persons in this age group usually require special consideration to avoid embarrassment when changing clothes and during examinations.
Same sex often eases tensions during procedures.
Middle adolescents are often bridging the gap between peer group influence and early sexual relationships. Persons in this age group are often developing their first real independence and often appreciate being treated as adults.
Late adolescents are often focusing on mature relationships with both sexes and may be financially independent they easily relate to adult conversation although their experience may be limited ins one areas.
Young Adults (25 to 45 years)
Young adults are usually entering new roles of responsibility at home and in their work. They often experience problems in handling their multitude of new roles and may neglect one area while they concentrate on another.
Conversations and interaction should be on the same level as for other adults.
Middle-Aged Adults (45 to 65 years)
Most people have found their place in line and tend to be relatively comfortable with their roles and success (or lack of it). When poor health or a threat of poor health occurs, considerable stress and special concern over how to maintain responsibilities, such as keeping a job and providing for a family, may outweigh personal health concerns. That is one of the reasons that they may delay seeking diagnosis and treatment for troubling symptoms.
Mature Adults ( 65 years and older)
Research shows that most persons 65 and older do not consider themselves old. They tend to consider themselves middle aged. Because of this self-image, radiologic technologist should not attempt to interact with them as though they are geriatric patients.
Remember, this is the age group that will continue to grow, because the first of the baby boomers have turned 60.
The geriatric group will continue to increase in size and importance in american society for many years to come, primarily as a result of improvements in living standard, dietary practices, physical fitness, and medical care
Results in feelings of alienations, which could be worse by lack of respect. The terms such as senior citizens or golden agers constitutes prejudice and discrimination and should be avoided.
The cardinal rule when dealing with these patents are patience and respect.
Geriatric patients are now being classified as what 3 types? and how are they classified?
They are classified not by chronologic but by functional age.
The aging process itself is now didvddd into what two types?
is the gradual and inevitable process of deterioration that begins in childhood and extends through old age.
Secondary aging consists of what?
disease, abuse, and disuse, which are often within control of the individual.
Interacting with the terminally ill patient:
Patients kept in closed awareness or open awareness.
Some patients develop suspicious awareness int hat they watch for clues to their condition bu attempt to keep the health care team from knowing exactly how much they understand. A state of mutual pretense exist when patients, staff , and family all know but are pretending not know in hopes of avoiding interpersonal conflicts.
Denial and isolation may be the initial reactions and should be supported by silence and acceptance of the person without discussing death.
Anger may occur as a result of the realization that life will be interrupted before everything the person planned has been accomplished and feelings that the person will soon be forgotten. Anger is often expressed in terms of complaints about health care. These should be addressed ASAP.
Some patients experience a bargaining stage that focus on hope. This stage may be followed by depression.
Depression often occurs when remission ends and additional treatments must begin. This reaction is normal and should be encourage by giving realistic praise while letting the patient express his or her feelings.
Preparatory depression- comes wight he realization of the inevitability of death and is accompanied by a desire for death as a release from suffering. The most important thing at this time is to permit the behavior. Touch and silence could be appropriate.
Acceptance-the final stage can occur only in enough time to provided and if the patient is appropriately helped through the other stages. This stage is characterized by a near-total lack of feelings.
Patients who are not told of their condition.
Many patients deduce that they are terminally ill but lack assistance in working through the various stages of acceptance.
Is usually considered desirable because it permits everyone to work through the various stages that precede dying.
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