COMMUNICATION & Patient Interactions Assessment & History Taking RT123/106 rev Fall 2011...

COMMUNICATIONCOMMUNICATION& Patient Interactions& Patient Interactions

Assessment & History TakingAssessment & History Taking

RT123/106 rev Fall 2011RT123/106 rev Fall 2011DCDC111111

CH. 11 & 12CH. 11 & 12

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Patient Communication Patient Communication Ch. 11Ch. 11

Interacting with the patientInteracting with the patient

Interacting with family and friendsInteracting with family and friends

Methods of Effective CommunicationMethods of Effective Communication

Age as a factor in Patient InteractionsAge as a factor in Patient Interactions

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Radiologic TechnologistRadiologic Technologist

Communicating Effectively :Communicating Effectively :

Helping othersHelping others

Working with peopleWorking with people

Making a differenceMaking a difference

Thinking criticallyThinking critically

Demonstrating creativity Demonstrating creativity

Achieving resultsAchieving results

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Abraham Maslow’s4

Why is this important?Why is this important?PATIENT NEEDSPATIENT NEEDS

Patients may be in altered states of Patients may be in altered states of consciousnessconsciousness

Unfamiliar environmentUnfamiliar environment Fear of not knowing their state of Fear of not knowing their state of

healthhealth Patients do not have control of the Patients do not have control of the

situation – very vulnerablesituation – very vulnerable Pt Reactions: Inconsiderate, arrogant, Pt Reactions: Inconsiderate, arrogant,

impatient, rude – impatient, rude – coping mechanismscoping mechanisms55

Patient DignityPatient Dignity

Patients are usually in the lower levels Patients are usually in the lower levels of Maslow’s Hierarchy - Why?of Maslow’s Hierarchy - Why?

Patient dignity must always be Patient dignity must always be remembered and respectedremembered and respected

Difficult to maintain dignity Difficult to maintain dignity

when wearing flimsy gown, vomiting, when wearing flimsy gown, vomiting, making a run to the bathroommaking a run to the bathroom

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No No’s…..No No’s…..

Referring to a patient as: Referring to a patient as:

“ “the chest in room 2”the chest in room 2” Always use the patients name!*Always use the patients name!* *HIPAA Laws - *HIPAA Laws - Only discuss what Only discuss what you must know you must know to do your job. to do your job.

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ID Pt’s NeedsID Pt’s Needsshow sensitivityshow sensitivity

Ptalw/NG tube may normally be

friendly and outgoing may prefer to wait in a

location where they do not have to face the public

Other Examples?

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ClassificationClassification of Patients of Patients

InpatientsInpatients

OutpatientsOutpatients

– Family Family

– FriendsFriends

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Methods of Methods of CommunicationCommunication

VerbalVerbal

HumorHumor

ParalanguageParalanguage

Body LanguageBody Language

TouchTouch

– PalpationPalpation

Professional Professional AppearanceAppearance

Physical Physical PresencePresence

Visual ContactVisual Contact

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Special Condition PatientsSpecial Condition Patients

Traumatized PatientsTraumatized Patients

Visually Impaired PatientsVisually Impaired Patients

Speech and Hearing Impaired PatientsSpeech and Hearing Impaired Patients

Non-English Speaking PatientsNon-English Speaking Patients

Mentally Impaired PatientsMentally Impaired Patients

Substance AbusersSubstance Abusers

“Pt Skills Lab – later this semester

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Communication Skills may have to be adapted for the

• AGE as a factor in Patient Interactions• This will be covered in detail during the

Spring semester – RT 124• Children• Elderly• Terminally Ill• Cultural Differences• (ch. 10)

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ChildrenChildren

Get down to child Get down to child sizesize

KindnessKindness

PatiencePatience

Never lie!Never lie!

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GOOD CommunicationGOOD Communication

The key to a The key to a successful exam for successful exam for Technologist and Technologist and Patient.Patient.

Fosters a Fosters a

TEAMWORK TEAMWORK approach to approach to accomplish the goalaccomplish the goal

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ReviewReview

CommunicationCommunication

Patient Patient AssessmentAssessment

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Which of the following is the professional/ respectful way to

greet the patient?A. Maria Gonzales

B. Maria

C. M. Gonzales

D. Maria the BE patient

E. Ms. Gonzales

How do you confirm that you have the correct patient?

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What is an NG tube?What is an NG tube?And what is it’s purpose?And what is it’s purpose?

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How does one communicate with non–English-speaking

patients? (HIPPA)

A. through an English-speaking family member

B. writing the information on a piece of paper

C. slowly enunciating the instructions

D. rescheduling the patient to go to another hospital

E. find a hospital staff member who can translate

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Which of the following statements reflect interactions

with substance abuse patients?

A. restraints may be used for their safety

B. the patient may become agitated or violent

C. the patient should never be unattended while developing films

D. all of the above

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HISTORY TAKING HISTORY TAKING (CH. 12)(CH. 12)

Describe the role of the radiologic technologist in taking patient clinical histories.

Describe the desirable qualities of a good patient interviewer.

Differentiate objective from subjective data.

Explain the value of each of the six categories of questions useful in obtaining patient histories.

Describe the importance of clarifying the chief complaint.

Detail the important elements of each of the sacred seven elements of the clinical history.

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Radiographer’s ResponsibilityRadiographer’s Responsibility

RT is responsible for insuring patient RT is responsible for insuring patient understands what to expect during understands what to expect during examination.examination.

IntroductionIntroduction

Explanation of exam Explanation of exam

Inform patient how they will receive Inform patient how they will receive their resultstheir results

Risks of examination Risks of examination

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HISTORY TAKING – Ch. Rad Tech’s Role in Clinical Hx

Extract as much information as possibleRadiologists often do not even speak

with the patient.Radiologist can be instructed to give

special attention to the exact anatomic area where pain is focused.

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Desirable Qualities for Establishing Open Dialogue

RespectGenuinenessEmpathyPoliteProfessional

demeanor

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Data Collection

Objective: Signs that can be seen

Subjective: Perceived by the affected individual

Examples?

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Questioning Skills

Open-ended questions (let pt tell story)Facilitation – encourages pt to elaborateSilence – give pt time to rememberProbing questions – focus interview,

provide more informationRepetition – rewording, clarifies infoSummarization – verifies accuracy

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Leading Questions

This is an UNDESIRABLE method of questioning. Introduces biases into the history.

Ex: Does the pain travel down your leg? Vs. Where does the pain start and

where does it end?

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Chief Complaint

Focuses attention to the single most important issue.

Patients may have several complaints, but thorough history taking can reveal the main issue or why the patient is there for treatment.

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Clinical Indication

Tech must collect a focused history specific to the procedure being performed.

Several elements comprise a “complete history”.

Sacred Seven…

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Sacred Seven

1. Localization: exact & precise area

2. Chronology: duration, frequency, course

3. Quality: size, color, consistency

4. Severity: intensity, quantity, extensiveness

5. Onset: what was happening when condition occurred

6. Aggravating or Alleviating Factors

7. Associated Manifestations Has There Been Any Trauma? Has There Been Any Previous Surgery?

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You never know what you are going to get?

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Good Communication with your patient improves radiation protection

• How ?

• Any ideas?

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Primary Role of the Radiographer

X-ray Order from the ED

• 24 year old• Female• 2 V Abdomen• Diag: Abd Pain X 2 days

• What questions are you going to ask her?

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X-ray Order - Outpatient

• 86 year old• Female• RT Hand • Diag: Pain

• What questions are you going to ask her?

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All of the following are used to provide a better history to the

radiologist except to:

A. encourage elaboration

B. use probing questions

C. summarize the details

D. ask close-ended questions

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A clinical history for an abdominal x-ray should begin with which of the following

questions?

• A. “Specifically where is the abdominal pain?”

• B. “What type of abdominal problems are you having?”

• C. “How long have you been vomiting?”

• D. “When did you have gallbladder surgery?”

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Why would it be beneficial to include the parents and child in the medical

history interview of the child (under 18) and explanation of the procedure?

• A. helps the child become familiar and comfortable with the radiographic staff

• B. expedites the time spent in the radiographic room

• C. ensures the technical competence of the staff

• D. allows the parents active participation with the exam

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Who is responsible for obtaining the clinical history from the patient for the diagnostic radiographic procedure?

• A. the radiographer

• B. the radiologist

• C. the nurse

• D. the patient’s primary care physician

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What is the significance of a good clinical history?

A. it provides the referring physician’s admitting diagnosis

B. it provides general information regarding the patient’s condition

C. it focuses the radiologist’s attention to a specific area

D. it translates the patient’s complaints into medical jargon

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Primary Role of the Radiographer?Primary Role of the Radiographer?

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Be Cautious of WHAT you say….And HOW you say it!