Unit 3

Unit 3 - Communication in Patient Care

Key Terms

Verbal Communication

Nonverbal Communication

Cultural Diversity

Health Literacy

Listening

Teach Back Technique

 

Reading Assignment

Introduction to Radiologic Sciences and Patient Care 5th Edition ( Adler and Carlton)
Chapter 10 - Pages 115-125

Chapter 11 - Pages 127-140

 

Course Assignments For Unit 3

Here is what you must complete within Unit 3!!!

1. Reading Assignment

2. Read through the Lesson

3. Complete Discussion #3 (post your response, read the responses of your classmates and respond to them with any comments you may have)

4. The Unit 3 Exam

 

Communication

Addressing the Patient

•After you identify your patient using patient identifiers, introductions should be next. You want your patient to know you.

•Avoid impersonalizing patients, such as identifying patient by the exam rather than by name. This is respecting your patient.

•Address patient appropriately. Many times, a patient will let you know how he/she would like to be addressed.

–Avoid use of "honey," "sweetie," or other such names, many patients do not like these terms.

Verbal Communication

Verbal communication comes in many forms, such as:

•Spoken words

•Written words

•Voice intonation

•Slang and jargon

•Organization of sentences

•Humor

Verbal communication is the sounds and language that we use to relay a message to someone else. Verbal communication is the vehicle through which we express desires, ideas and concepts. It is imperative to have good verbal communication skills in healthcare for many reasons. It is important to the processes of learning and teaching. When we are explaining something to our patient or getting a history from the patient, we are utilizing verbal communication. We also must be able to read and write as a part of our communication. In combination with nonverbal forms of communication, verbal communication acts as the primary tool for expression between two or more people.

It is interesting to note that communication happens like this:

55% = body language

38% = tone of voice

7% = words

This shows that the actual words are a small portion of what is considered communication.

When you verbally communicate with others, it is very important to pay attention to several factors. It is not only what we say, but how we say things. For this reason we need to dicsuss paralanguage. Paralanguage is how we say things. This includes the tone of voice used, where emphasis is placed while speaking, the speed at which you are talking and the volume of the conversation. For example, you can tell a patient that you will gladly show him/her how to get to the lobby, but if your paralanguage is saying something else, the patient will notice.

Nonverbal Communication

•Paralanguage

•Body Language

•Touch

•Professional Appearance

•Physical Presence

•Visual Contact

There are many elements to consider when dealing with patients. Not every form of communication is verbal. Body language speaks volumes about a patient's state of mind. Many people do realize that body language, facial expressions and movements are all part of nonverbal communication. What many people are not aware of is that nonverbal communication can also include touch, eye contact, posture, sounds, smells, the distance between individuals and gestures.

Have you ever heard the phrase, "actions speak louder than words." This is so true.

As radiographers, we must learn to utilize our verbal and non-verbal communication skills. We must always consider differences in our patients. You need to be aware of things like cultural differences, gender and age.

 

Communication Under Stress

Stress interferes with our ability to process information accurately and appropriately. The majority of patients you will encounter will be under stress.

Here are some suggestions to improve communication effectiveness in a crisis situation:

–Lower your voice, speak slowly and clearly

–Be nonjudgmental in both verbal and nonverbal cues

–Do not allow another's inappropriate actions or speech goad you into a similar response

–Request confirmation when you are uncertain of the listener's understanding

 

 

Communication and Cultural Diversity

You will encounter people from very diverse backgrounds. Working in medical facilities, you will be interacting with people from many cultures. It is important for you to be aware of the differences in cultures, respect those from other cultures and adapt to the situation. Your textbook gives examples of the core values of many different ethnic groups that are more prevalent in the United States (Chapter 10 - Pages 115-125).

Human Diversity

Human diversity includes cultural diversity.

Cultural diversity deals with the variety of human societies and cultures and examines their similarities and differences. These differences are what make each person unique and valuable in his or her own right.

Society is made up of many cultures. These cultures establish behaviors of people and can be for a lifetime and provide comfort.

It is important for you to know and understand the differences in cultures and people. The more you know, the better you will be able to communicate.

Cultural Globalization

Globalization means that people now cross borders into other countries to work, go to school, receive medical care, visit, and live.

Nations, societies, and businesses have become increasingly cross-cultural or multicultural.

We are all affected by a changing world society.

Human Diversity Characteristics

There are many human diversity characteristics that we must take into consideration. Diversity is not limited to ethnicity. We need to consider:

•Age

•Ethnicity or national origin

•Race

•Gender or sexual orientation

•Mental and physical ability

•Work style or ethic

•Geographic location

•Lifestyle

•Physical features

•Economic conditions

•Political beliefs

•Religious beliefs

•First language

•Disability

•Education

 

Commication is key!

You need to ensure that your patient understands any communication between the two of you and you must understand the communication as well.

Here are some things to consider when working with different cultures.

1. Most cultures are concerned with appearance and dress. People often make judgments based on the way another looks and dresses. As healthcare professionals, our appearance is very important.

2. Body movement is important. For example, facing away from or towards a person, leaning away from or towards a person or moving away from or towards a person can be significant with different cultures.

3. It is important to consider posture. For example, bowing shows rank in Japan, but it is not done in the US. What we may consider acceptable in the United States, may be offensive in other cultures. Slouching or having your hands in your pockets is rude in some countries.

4. In some countries, it is unacceptable to be animated while talking. It is very common in the United States to see people constantly moving their hands, arms or entire bodies while speaking.

5. Some cultures do not show any facial expressions, while others have very animated facial expressions. A facial expression can mean different things in different cultures.

6. Eye contact is significant. for many cultures, keeping direct eye contact shows that you're interested in the conversation with the other person. In other cultures, eye contact is avoided to show respect.

7. Touch can be one of the most important forms of nonverbal communication. You must be aware of a person's personal space at all times. Something as simple as a handshake can be an insult to someone from another country. In one culture, it may be unacceptable for one gender to touch another. In another culture, only certain body parts can be touched. Yet in another culture, it is unacceptable to be touched at all. So, always be aware of another's personal space. Don't be offended if a patient does not want to shake your hand, etc.

 

Cultural Diversity and Health Care

To provide high-quality care to all patients, you need to understand these six areas of human cultural diversity.

1. Communication - A patient needs to understand what you are telling them. If he/she understands what is going to take place, it will take away a lot of his/her anxiety.

2. Space - Personal space is very important in some cultures. Always remember some people do not like to be touched. When you need to invade someone's personal space or touch them in order to complete a radiographic exam, you need to warn them. You must make sure that you're telling every patient what you're going to do before you do it.

3. Time - Some cultures follow the values of the past, some the present and some look into the future. You must be able to convey to your patient that as a health care professional, you are there to provide services that will help physicians prevent and treat illnesses.

4. Environmental control - This is the ability of the patient to control nature and what is happening to him/her.

5. Biologic variations - Cultures have difference in their biological make-up, such as, skin type and color, hair type, etc. With these variations comes susceptibility to different illnesses and diseases.

6. Social organizations - The roles of individuals varies among the different cultures. Some rely on elders, but others may rely on their children.

 

"Always remember that you are unique, just like everybody else." .......Anonymous

 

Personal Biases

Everyone has some degree of bias. Bias is a real human characteristic and needs to be addressed.

Personal biases, even without conscious thought, play a major role in how individuals perceive others. Dealing with bias requires education and knowledge of other cultures.

 

Assimilation vs. Biculturalism

Assimilation is described as the process by which persons of a diverse (different) culture, over time, give up their original cultural language and identify with, and try to merge into, another culture (usually the majority). This requires the person to give up some of their values, accomplishments, beliefs, and so on, in order to "blend in" with the mainstream.

Biculturalism is the ability of individuals to be able to negotiate competently two or more cultures: the mainstream culture and the individual's own culture. This is a comfortable balance for the individual, between cultures.

 

Embracing Diversity

We must embrace human cultural diversity if we want to successfully communicate with our patients. So, we must have:

-Knowledge of cultural differences

-Respect for others and self

-Know your personal biases and how to overcome them

-Understand the values of the individual regardless of his or her condition in life

-Seek to learn from others you meet and interact with

-Appreciate the societal value of multiculturalism

-Empathy for others

 

Cultural Competency

Cultual Competency is a set of attitudes, congruent behaviors, and policies that come together in an agency, in a system, or among professionals, enabling effective interactions in a cross-cultural or multicultural environment

Becoming Culturally Competent

To become cultually competent you must:

•Gain knowledge of other cultures.

•Be willing to engage other cultures.

•Become an excellent multicultural communicator.

•Recognize the value of empathy and practice it.

•Help others understand the value of multiculturalism.

 

Communication Is Critical to Success

"If there were one aspect of healthcare delivery an organization could work on that would have the greatest impact on patient safety, it would be improving the effectiveness of communication on all levels—written, oral and electronic.""

 

Communication Essentials

There are several things that are essential when communicating with your patient.

Patient care communication must be patient-focused. You need to explain and discuss what you are going to while the patient is in your care in a way that he/she understands.

Communication needs to be accurate and timely.

Always remember to consider communication and relating with patient's family and visitors. Many times, a patient will have someone with him, so you need to communicate with everyone.

As a technologist, communicate within your Scope of Practice. It is not in your scope of practice to give any type of results or treatment recommendations.

 

Common Patient Types

You will encounter many types of patients who are dealing with different circumstances. Some that you need to be aware of are:

•Seriously Ill and Traumatized Patients

•Visually Impaired Patients

•Speech- and Hearing-Impaired Patients

•Non–English-Speaking Patients

•Mentally Impaired Patients

•Substance Abusers

 

Mobile and Surgical Patient Communication

These unique patient care environments require special patient communication considerations. The patient will not be in the x-ray department, so they may not be aware that you are there for imaging purposes.

Begin by calling the patient's name, identifying yourself to the patient, and explaining the procedure. It is always important to explain the exam to the patient and to give him/her the opportunity to ask questions.

 

Communication and Age

Patient age must be factored into communication techniques. It is very important to consider the patient's age and know how to communicate with him/her.

Age is not a barrier to effective communication as long as you know how to communicate with different age groups.

The age of the patient determines how you should communicate with him/her.

Small children can be a challenge to radiograph. Sometimes offering a reward will help, such as, a sticker. Many imaging departments keep stickers to give out to children. You should get down to the child's level and not stand above him/her. You should praise and reassure the child. In many cases, it can help if you ask for the child's help. You should always be honest with the child. Do not tell the child it will not hurt it all if there is a possibility that it will hurt.

 

Some age groups to consider area:

Infant - Birth to 1 year old

Toddlers - 1-3 years old

Preschoolers - 3-5 years old

School-aged children - 5-10 years old

Adolescents - 10-25 years old

Young adults - 25-45 years old

Middle-aged adults - 45-65 years old

Mature adults - 65 years old and older

Pediatric Patients

When imaging pediatric patients, you should:

•Come down to their eye level to talk. It can intimidate them if you are standing above them.

•Speak softly and less authoritatively. If you are loud or gruff, it might frighten the child.

•Set up equipment before the child enters the exam room. You don't want the child to be in the room longer than needed.

•Soften room lighting.

•Avoid loud and dramatic equipment movements. The x-ray room can be a scary place.

•Use gentle touch.

•Maintain eye contact.

 

Here are some more age specific considerations.

Children (Toddlers) Age 1 to 3

These children can be the most difficult! It is at this age that children often throw tantrums and they usually get results. You can suggest that they're having their picture taken and tell them to smile for the camera. This may put the child at ease.

Children (Preschoolers) Age 3 to 5

These children usually want to do things correctly and they like to mimic adults. So, for these children let them be grown-up for the exam. This means that you talk directly to them and involve them in what you're doing. Again, you can suggest that they're having their picture taken and tell them to smile for the camera.

Children (School-Aged) Age 5 to 10

These children are usually eager to please and are most often the easiest to image. One thing you must consider with these children is that they are at a very tender time in their lives. You must be very careful to protect their privacy.

Adolescents Age 10-25

Adolescents can be treated as adults, but be careful to recognize their emotional needs. We also must be sensitive to the pregnancy issue. It may be necessary to ask an adolescent female prepregnancy status away from the parents or guardians. Many adolescent females will not be honest in front of their parents or guardians.

Middle-Aged Adults 45-65

Mature Adults (Senior Citizens) 65 and Older

Middle-aged and mature adults can have many of the same characteristics and needs. So for both, you should always:

•Maintain eye contact. This shows the patient that you are interested in him/her and why he/she is there.

•Speak clearly and more slowly. It may be hard for the patient to follow instructions and to understand you if you are speaking too fast.

•Speak to them, not away from them. If a patient has some hearing loss, it will help them if you are looking at them when you are speaking.

•Keep them warm if needed.

•Ask permission to touch. Always let the patient know when you are going to touch him/her and where.

•Demonstrate compassion. Patients usually don't want to be there, they have to be there, so treat them with compassion.

Treat them as if they were your mother, father, grandmother, grandfather or sibling. Remember, treat others as you would like to be treated.

Ask them what makes them more comfortable. A patient will be more cooperative if he/she is comfortable.

•Explain thoroughly and keep them informed. Keep explaining what you are doing, as you do it.

•Treat them with respect and patience.

Many senior citizens may have special needs. They are normally very tough and will be reluctant to complain. You must take the initiative to treat them appropriately.

You must take into consideration that seniors can have disabilities related to loss of hearing or sight. They may also have painful illnesses that are not outwardly obvious.

While you should be aware that these conditions exist, don't treat the senior patient as an invalid! You should see what their abilities are first, then decide how to proceed.

For example, not all senior citizens have hearing loss. You shouldn't automatically raise your voice when you're imaging a senior----this can be very offensive to those who can hear.

 

Physical Changes of Functional Aging

There is slowing of psychomotor responses.

There is slowing of information processing.

There is decreased visual acuity.

There is a decrease in the senses.

Age Issues2.jpg

Special Communications

Non-English Speaking

All medical facilities should have a way of interpreting to non-English speaking patients. Some facilities have interpreters on duty or on-call.

Other facilities use interpretation phones. With these phones, the patient and the technologist both have receivers. The technologists tells the interpreter what needs to be said to the patient in one phone and the interpreter relays the information to the patient. Even though the patient may have a family member that can interpret, it is important to have a medical professional or certified interpreter. A family member may add or take away information. Also, the patient may not feel comfortable giving all of his/her personal and medical information to a family member. On the other hand, an interpreter, only translates what has been said to the patient and by the patient.

Hearing Impaired

When you're working with a patient with impaired hearing, you can ask the patient how to make the communication better. Each patient can have a different level of hearing and there may be specific things you can do to make it easier for the patient to get the information. Here are some things you can do to make it easier for the patient.

Make sure you're facing the patient when you're talking to him/her, speak clearly and at a slower pace, speak in a lower tone, avoid noisy backgrounds and be patient.

If your patient has a hearing aid, make sure you give all instructions before having your patient remove his/her hearing aid.

Deafness

Many facilities have interpreters for deaf patients which will help you to communicate with them. If you're working with a deaf child, it is important to explain all aspects of the exam to the parents so the parents can assist the child.

Vision Impaired

When working with vision impaired individuals, it is important to find out what assistance the patient may need.

These patients rely on hearing and touch, so some may want to follow the sound of your voice only, while others may want to place a hand on your shoulder or elbow for you to guide them. It is important to have good communication with vision impaired patients.

Impaired Mental Function

When working with patients who have impaired mental function, you should use clear, simple and direct instructions. Take your time with these patients and treat them with respect.

 

Terminal Patients

It is important to understand that death is part of the cycle of life. Radiologic sciences professionals often deal with the dying process as part of acute death events.

This can be a very emotional event, but we must be able to stay professional.

Society's attitudes toward death and dying have changed to become more open and respectful of the terminal patient's wishes and rights.

Dying patients and their families and loved ones need to work through the grieving process in a natural and individualized timeframe.

 

Five Stages of Grieving Process

1.Denial and Anger

2.Bargaining

3.Depression

4.Preparatory Depression

5.Acceptance

 

Health Literacy

Points to Consider

The average American reads at the 8th to 9th grade level.

44% of people age 65 and older read at about the 5th grade level or lower.

48% to 80% of patients age 60 and older have inadequate functional health literacy.

 

Health literacy is the ability to "read, understand and act on healthcare information," or more specifically, "the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions."

 

Many studies have been conducted on health literacy. One study showed that about half of all American adults may have trouble reading important health related documents, such as patient education materials, consent documents and insurance forms because most of these documents are often written at a 10th grade level or higher.

Another study showed that:

42% of patients could not understand directions for taking medication on an empty stomach.

26% could not understand an appointment slip.

60% could not understand the standard consent form.

Elderly people, members of minority groups, immigrants and people with low incomes are likely to have problems with reading. For example, two thirds of adults age 60 and older have an adequate or marginal literacy skills, the median reading level for person receiving public assistance is fifth grade and 40% of blacks and 50% of Hispanics have reading difficulties. However, age, race, birthplace and income level are by no means reliable indicators of literacy or illiteracy.

Patients with low health literacy often have problems communicating with caregivers because, "providers did not listen to them or explain their medical problem and treatment in a way that they could understand." Due to feelings of shame about their illiteracy, low literate patients may be more intimidated by medical settings and hesitant to ask questions or to tell someone they don't understand. In interviews, these patients said that filling out forms and registering for care are the most difficult and embarrassing problems they contended with in healthcare settings and the situation was made worse by staff members who became angry or frustrated with them. Some patients even avoid seeking care rather than be embarrassed. People with low literacy skills often are uninformed or misinformed about health matters.

One patient stated, "If there could be a person that could talk like us, and be kinder, and asked us if we can read, or offer to fill out the papers, and with a smile, so we can feel the person supports us... but if we see their hard faces, how can we ask for help to fill out the forms?"

The most important things healthcare professionals can do to help patients with limited literacy are recognize how pervasive the problem is, be sensitive to the stigma and stress associated with reading difficulties and be quick to offer help tactically. For example, if the patient seems to be struggling with a form or handout, a staff member might say, "A lot of people have trouble filling out these forms or reading this information. Can I help you with it?" or, "Would you like me to read it to you and explain it?"

Most patients prefer to have both oral and written explanations. Information should be presented orally first, with written materials provided as a reminder. When you're providing information to patients orally, listen carefully to the patient's questions and concerns and create an atmosphere of trust and respect.

 

Listening

A major part of the communication between you and your patient is listening. You can tell a lot about a patient by listening to them. When communicating and listening to your patient, often times it helps if you reduce the distance between the two of you. It is hard to actively listen to your patient if you are all the way across the room.

You should have empathy for your patients; you never know what is happening in another persons life. Essentially, put yourself in their shoes.

It's important to give your patient adequate time to respond to any questions you may ask. Don't rush them.

 

Therapeutic Listening - You not need to give your patients advice, just support. Patients don't always want answers, they want someone to truly listen to them.

 

When you're using therapeutic listening, a conversation may go like this:

Patient: I feel so bad today.

Technologist: I'm sorry to hear that; I hope you're better soon.

Again make sure that you're giving them support, not advice. When the patient asks difficult questions, you can answer a question with a question. This may help them to further think about the situation.

Patient: I don't think my doctors helping me.

Technologist: What do you think you should do about that?

When a patient asks you hard questions or says harsh statements:

Patient: I been through so much, I just want to give up.

Technologist: Do think you should give up?

You also need to consider, your patient may be experiencing grief over hearing a bad prognosis. Patients may be angry, afraid or depressed. The patient may also ask for reassurance, give them what they need without using clichés. When a patient receives bad news, he/she may be angry with the entire world. When this occurs you should be very kind and understanding with your patient, but don't be fake. You want to get the exam done as efficiently and effectively as you can. You must be careful with your patients, remember, you cannot give them a diagnosis or tell them what is seen on their x-ray. You do not want to be negative about the facility, the patient's doctor or any other aspect of the patient's care. Remember, you should support the patient and listen to them, but you should not give them advice.

 

Teach Back Technique

The importance of explaining an exam to patient cannot be overstated. You must ensure that your patient understands what will happen prior to the exam, during the exam and after the exam (to include post-exam instructions). Many physicians do not always explain exams to patients, so it is your job to make sure the patient understands all that is involved with the exam.

One way to ensure the patient truly understands what you are saying and explaining to them is to use the teach back technique.

With the teach back technique, after you have explained the exam to the patient, the patient can state in his/her own words the key concepts, decisions and instructions that were discussed.

If the patient is confused by anything that you stated, you can go over it again.

Using the teach back technique you can be certain that the patient knows and understands all aspects of the exam.

 

Communication With Family and Friends

Professionally introduce yourself to the patient's family and friends.

Briefly explain the procedure to them.

Explain why they must leave the immediate area during the exposure.

 

When you take a patient back for exam, it is important to give the family an approximate amount time the exam will take. If the exam is taking longer, it is appropriate to go back to the family and give them an update. If the procedure is going to be a long one, you can let the family know where they can locate things such as vending machines, the cafeteria and restrooms. If at all possible, it is best for a patient's family to wait in the waiting room. In some cases, a family member must accompany the patient into the exam room. You should be sensitive and empathetic with the family member. If the family member gets upset or angry or questions your abilities, remember he/she is under stress and worried about his/her family member. If you cannot calm down the family member and keep him/her calm, you may need to ask for assistance.

 

Patients' Needs

Understand that if patients had a choice between a nice restaurant and visiting the x-ray department, they would naturally choose…!

They are in an altered state of awareness and fear of the unknown is profound.

They may also have fear of loss of control.

 

Maslow's Hierarchy of Human Needs

People strive from a basic level of physiologic needs toward a level of self-actualization.

Each level of needs must be satisfied before an individual proceeds to the next level.

Patients are often at the lower levels of Maslow's hierarchy.

maslow chart.png

 

Patient Dignity

A patient's dignity deals with a his/her self-esteem.

Patients feel a strong loss of power over their fate.

Embarrassing situations may isolate them from others.

They often have loss of privacy and access to loved ones.

They may ahve feelings of guilt on several fronts.

 

Things to Remember:

•Communication skills are essential to good medical imaging.

•A good communication process is a closed loop.

•Communication strategies need to accommodate the uniqueness of each patient.

•Patients enter the health care setting feeling vulnerable and outside their comfort zone.

•Medical professionals recognize these feelings and act with compassion and empathy for the patient's welfare.

•Aging and terminal patients present their own set of patient care challenges.