1. Chapter 4 Interacting with Patients
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2. Introduction EMR personnel must respond with competence and compassion
Patient behavior can make initial care difficult
Being competent in medicine is important; however, people skills are a critical component of patient care
EMR providers must master emotional and social intelligence and learn the skills of good rapport and active listening to effectively provide the best care for their patients and for themselves
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3. Define Emotional Intelligence
Learning Objective 1
Define Emotional Intelligence
EMOTIONAL INTELLIGENCE
Process of improving our strengths and weaknesses
Working through our inner conflicts
Four steps to bringing about emotional intelligence
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4. Emotional Intelligence
Learning Objective 2
Steps that Bring About
Emotional Intelligence
EMOTIONAL INTELLIGENCE
Step 1: Know yourself before reaching out and trying to help someone else
Step 2: Manage your emotions
If situation is too much to handle, EMR must turn over care to someone else
Step 3: Motivate yourself
Step 4: Have empathy
Kindness and compassion should be used EVERYDAY
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5. Define Social Intelligence
Learning Objective 3
Define Social Intelligence
SOCIAL INTELLIGENCE
Intelligent not just about relationships but also in them
Act with wisdom
USING SOCIAL INTELLIGENCE
Unresponsive patient may hear everything you say
Emotions are contagious
Start interactions with a smile
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6. Steps for Gaining Rapport with Patients
Learning Objective 4
Steps for Gaining Rapport with Patients
ESTABLISHING RAPPORT
Create a connection
Converse with patient
Use skills to establish trust
Patient may be frightened
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7. Steps for Gaining Rapport with Patients
Learning Objective 4
Steps for Gaining Rapport with Patients
STEPS FOR GAINING RAPPORT
Step 1: Get centered
Make eye contact and introduce yourself
Step 2: Establish an alliance
“I am here to help you”
Step 3: Get a contract
“Help me help you”
Decrease patients stress, fear and feeling of helplessness
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8. Communication Elements of Good Rapport
Learning Objective 5
Communication Elements of Good Rapport
ACTIVE LISTENING
Understand, interpret, and evaluate what is heard
Ensure information given was understood correctly
Listening to patients provides better medical care
Could miss useful information
Patient may become angry
Patient may lose confidence
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9. Communication Elements of Good Rapport
Learning Objective 5
Communication Elements of Good Rapport
BODY LANGUAGE
Be careful about the body language used
Be aware on nonverbal signals
Patient may feel disrespected or ignored
Patient may feel judged
Convey positive message with body language
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10. Communication Elements of Good Rapport
Learning Objective 5
Communication Elements of Good Rapport
TONE
Tone of voice
Tone of questions
EMR’s use of tone
Slow, clear, and even speech
Be calm and supportive
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11. Communication Elements of Good Rapport
Learning Objective 5
Communication Elements of Good Rapport
TOUCH
Appropriate touch is critical
Can be therapeutic and reassuring
Watch for nonverbal cues
Facial expressions
Pulling away from touch
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12. Communication Elements of Good Rapport
Learning Objective 5
Communication Elements of Good Rapport
CULTURAL CONSIDERATIONS
Some cultural considerations
Personal space
Direct eye contact
Communication through another person
Refusal of care
Be sensitive to cultural differences
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13. Communication Elements of Good Rapport
Learning Objective 5
Communication Elements of Good Rapport
NEGATIVE VERSUS THERAPEUTIC COMMUNICATION
Negative
Some statements should never be used
Do not give false hope
Therapeutic
Therapeutic statements to be used
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14. Impact of Dealing with Death and Dying
Learning Objective 6
Impact of Dealing with Death and Dying
DEATH AND DYING
EMS professionals face death and dying
Violent and unpredictable settings
EMRs must treat all involved with compassion when responding to scene.
Critical patients cannot always be saved
EMRs may try to cope with death and dying in unhealthy ways
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15. Impact of Dealing with Death and Dying
Learning Objective 6
Impact of Dealing with Death and Dying
CARING FOR A DYING PATIENT
Death, or fear of death
Extremely stressful event
Grief expressed in a variety of ways
Sudden expected loss
Long-term illness
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16. Impact of Dealing with Death and Dying
Learning Objective 6
Impact of Dealing with Death and Dying
STAGES OF GRIEF
Denial: the patient is not convinced that it will happen to him or her.
Anger: “why me” EMR must not react to the anger. Be understanding and sympathetic.
Bargaining: Patient may turn to faith, family or him/herself to try and make a deal to have some control over the present situation.
Depression: Patient understands the situation. Sadness and a feeling of loss may overcome him/her. (Make the patient comfortable at this time.
Acceptance: The patient accepts his/her injury or illness.
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17. Impact of Dealing with Death and Dying
Learning Objective 6
Impact of Dealing with Death and Dying
STRATEGIES FOR AN EMR
Active listening
Patience
Compassion
Remaining focused
Consider cultural differences
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18. Impact of Dealing with Death and Dying
Learning Objective 6
Impact of Dealing with Death and Dying
SIGNS OF OBVIOUS DEATH
Guidelines stating resuscitation not to be started
Decapitation
Postmortem lividity: Discoloration of dependent body parts, usually the areas on which the patient is lying.
Putrefaction: decomposition of body
Rigor mortis: stiffening of all muscles in an unresponsive pulseless breathless person.
An EMR cannot declare someone dead. If any doubt start CPR
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19. Health Care Directive and the EMR’s Role
Learning Objective 7
Health Care Directive and the EMR’s Role
HEALTH CARE DIRECTIVES
Legal document
Patient’s written wishes for medical care
EMR is obligated to begin lifesaving measures unless a health care directive is presented
If uncertain, perform life-saving measures
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20. Health Care Directive and the EMR’s Role
Learning Objective 7
Health Care Directive and the EMR’s Role
DO NOT RESUSCITATE (DNR) pg. 79
An order refusing cardiopulmonary resuscitation (CPR)
Many EMS agencies may have a standing policy to provide patients with resuscitative measures
Many EMS agencies provide resuscitation until patient is brought to hospital to address the DNR
An EMR must know the laws and policies
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21. Summary
EMRs can prepare to communicate with patients by understanding the concepts of emotional intelligence and social intelligence
Because not all EMS calls result in positive outcomes, it is critical to have knowledge of the basics of death and dying
EMRs must be prepared to handle stressful calls, including ones during which health care directives call upon the EMRs to respect the legal wishes of the patient
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