Copyright © 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 1 Chapter 11 Patient Interactions

Copyright © 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 2 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 Fear of the unknown is profound Fear of loss of control

Copyright © 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 3 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. FIG Maslow’s hierarchy of needs.

Copyright © 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 4 Patient Dignity Deals with a patient’s self-esteem Patients feel a strong loss of power over their fate Embarrassing situation that they feel isolates them from others Loss of privacy and access to loved ones Feelings of guilt on several fronts

Copyright © 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 5 “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.”” Richard K. Croteau, MD, Executive Director for Strategic Initiatives for TJC Communication Is Critical to Success

Copyright © 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 6 Communication Process Message Receiver Feedback Sender

Copyright © 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 7 Communication Essentials Patient care communication must be patient- focused. Communication needs to be accurate and timely. Always remember to consider communication and relating with patient’s family and visitors. As a technologist, communicate within your Scope of Practice.

Copyright © 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 8 Verbal Communication Spoken words Written words Voice intonation Slang and jargon Organization of sentences Humor

Copyright © 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 9 Nonverbal Communication Paralanguage Body Language Touch Professional Appearance Physical Presence Visual Contact

Copyright © 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 10 Touch FIG Proper palpation is accomplished by using fingertips to provide precise and gentle localization information. A, Proper use of a single fingertip. B, Proper use of several fingers. C, Improper use of the palm.

Copyright © 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 11 Points to Consider Average American reads at the 8 th to 9 th grade level 44% of people age 65 and older read at about the 5 th grade level or lower 48% to 80% of patients age 60 and older have inadequate functional health literacy

Copyright © 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 12 Common Patient Types Seriously Ill and Traumatized Patients Visually Impaired Patients Speech- and Hearing-Impaired Patients Non–English-Speaking Patients Mentally Impaired Patients Substance Abusers

Copyright © 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 13 Mobile and Surgical Patient Communication These unique patient care environments require special patient communication considerations. Begin by calling the patient’s name, identifying yourself to the patient, and explaining the procedure.

Copyright © 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 14 Communication with Patient Family and Friends Professionally introduce yourself. Briefly explain the procedure. Explain why they must leave the immediate area during the exposure.

Copyright © 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 15 Age as a Communication Factor Patient age must be factored into communication techniques. Age is not a barrier to effective communication.

Copyright © 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 16 Age Groups Infant Birth to 1 year old Toddlers 1-3 years old Preschoolers 3-5 years old School-aged children 5-10 years old Adolescents years old Young adults years old Middle-aged adults years old Mature adults 65 years old and older

Copyright © 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 17 Pediatric Patients Come down to their eye level to talk. Speak softly and less authoritatively. Set up equipment before the child enters the exam room. Soften room lighting. Avoid loud and dramatic equipment movements. Use gentle touch. Maintain eye contact. FIG “To stand tall in pediatrics, you have to get down on your knees.” Entering the child’s environment by squatting to the child’s eye level can begin a rewarding relationship.

Copyright © 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 18 Physical Changes of Functional Aging Slowing psychomotor responses Slowing of information processing Decreased visual acuity Decrease in senses Copyright © 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 18

Copyright © 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 19 Respiratory System Decreased cough reflex Shallow breathing Decreased pulmonary capacity Kyphosis Copyright © 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 19

Copyright © 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 20 Musculoskeletal System Osteoporosis Arthritis Decreased muscle strength Atrophied muscle mass Fear of fractures Copyright © 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 20

Copyright © 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 21 Cardiovascular System Decreased cardiac efficiency Orthostatic hypotension Arteriosclerosis DVT General feeling of tiredness Copyright © 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 21

Copyright © 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 22 Integumentary System Loss of skin elasticity Change of skin texture Loss of touch sensation Diminished sensation of heat or cold Loss of subcutaneous fatty layer Copyright © 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 22

Copyright © 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 23 Gastrointestinal System Loss of appetite Decreased secretions Decreased GI motility Decreased sphincter muscle control Copyright © 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 23

Copyright © 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 24 Dealing with Older Patients Maintain eye contact. Speak clearly and more slowly. Speak to them, not away from them. Keep them warm if needed. Ask permission to touch. Demonstrate compassion. Ask them what makes them more comfortable. Explain thoroughly and keep them informed. Treat them with respect and patience.

Copyright © 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 25 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.

Copyright © 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 26 Terminal Patients 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.

Copyright © 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 27 Five Stages of Grieving Process 1.Denial and Anger 2.Bargaining 3.Depression 4.Preparatory Depression 5.Acceptance

Copyright © 2012, 2007, 2002, 1997, 1991, 1984, 1979 by Saunders, an imprint of Elsevier Inc. All rights reserved. 28 Conclusion 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.