TRANSITION SERIES Topics for the Advanced EMT CHAPTER Therapeutic Communication 3 3

Objectives Understand communication from a process perspective. Identify useful techniques to facilitate communication between individuals. Discuss how to improve communication with differing cultural backgrounds. Describe strategies on how to communicate with difficult patients.

Introduction Communication is a must in most patient situations the Advanced EMT will encounter. As an active process, communication uses both verbal and nonverbal expressions. At all times, you must remain competent, confident, and compassionate.

Process of Communication Communication begins with the sender encoding the message. The receiver must then decode the message for interpretation.

Communication consists of a sender, a message, a receiver, and feedback.

Techniques That May Facilitate Communication

Guidelines for Initial Contact Establish a positive rapport –Speak and act professionally. –Make introductions and learn the patient's name. –Always gain consent. –Limit interruptions and control surrounding noise. –Be courteous, compassionate, and respectful.

Conducting the Interview A mutually beneficial process The interview is used to gain valuable information –Use all types of communication, including nonverbal.

Nonverbal Communications

A sincere touch can provide comfort to a patient.

Interviewing the Patient Consider age and mental capability. One question at a time; start with open-ended questions. Avoid leading or biased questions. Do not interrupt or talk too much. Do not give false reassurances or inappropriate advice.

Transcultural Considerations Understand that cultural differences exist. Try to learn basic tenets of other cultures. Seek exposure to cross-cultural interactions.

An AEMT should try to achieve cultural competence to facilitate communication.

Challenges in Communication These situations can challenge normal communication: –Family preference issues –Unmotivated or hostile patients –Communicating with age extremes –Patients with disabilities –Non-English-speaking patients

Case Study You are called to a residence for an elderly patient with respiratory distress. You are met at the door by the patient's daughter who is also her primary care provider. You enter the living room where you see the patient lying on a hospital bed with medications on a nearby stand.

Case Study (cont’d) What are some communication difficulties that may arise based on the information provided thus far?

Case Study (cont’d) Scene Size-Up –Elderly female, 80+ years of age –No sign of struggle or trauma –Found in bed in high-Fowler position –Patient looks very dyspneic

Case Study (cont’d) Primary Assessment Findings: –Patient is responsive to verbal stimuli. –The patient cannot speak well due to the dyspnea, and when she does, it is in broken English. –Breathing is labored, but presently intact. –Peripheral perfusion is present.

Case Study (cont’d) How should you approach and communicate with this patient? How can you enlist the help of family members in communicating with this patient? What nonverbal skills could you use to help enhance communication?

Case Study (cont’d) Secondary Assessment: –Patient is found to have a history of COPD, and is on home oxygen. –SAMPLE and OPQRST are completed. –Breath sounds are uniformly distant. –Balance of the secondary exam is non- contributory to the current situation. –Vitals are within normal limits. –The patient is prepared for transport.

Case Study (cont’d) What techniques will you use to communicate with the patient while en route to the hospital? Why should you inform the hospital about the communication barrier before your arrival?

Summary Communication, both verbal and nonverbal, is integral to properly assessing your patient. The Advanced EMT will be presented with communication challenges rather often with the diversity of patients seen by EMS.

Summary (cont’d) The use of techniques discussed in this chapter will greatly enhance the Advanced EMT's ability to communicate when difficulties arise.

Physical and verbal “handing off” of care from one healthcare provider to another. Continuum of care helps to ensure that care is consistent and appropriate. Transfer of Care

Patient's name, age, DOB, address Chief complaint History of present illness or injury (Brief account of patient's current condition) Past pertinent medical history Medications and Allergies Vital signs Transfer of Care (cont’d)

Pertinent findings from physical exam Overview of care provided and patient's response to that care Ambulance Service identifying info Date and time of response Other information that may be important to the initial management of the patient at the hospital or other receiving facility Transfer of Care (cont’d)

Elements included in PCR or Drop Form –Patient's name, age, DOB, address –Chief complaint –History of present illness or injury –Past medical history/medications/allergies –Vital signs –Pertinent findings from physical exam –Overview of care provided and response –Ambulance ID/Date and time of response –Other important information for pt care Summary Required Info for Transfer of Care

1.What elements are included in the verbal transfer of care? 2.You respond to a 65 year old male with chest pain. Practice giving a verbal transfer report for such a patient. Review Questions