1. COMMUNICATION & Patient Interactions Assessment & History Taking RT123/106 rev Fall 2011 DC111 CH. 11 & 12 CH. 11 & 12 1

2. Patient Communication Ch. 11 Interacting with the patient Interacting with family and friends Methods of Effective Communication Age as a factor in Patient Interactions 2

3. Radiologic Technologist Communicating Effectively : Helping others Working with people Making a difference Thinking critically Demonstrating creativity Achieving results 3

4. Abraham Maslow’s 4

5. Why is this important? PATIENT NEEDS Patients may be in altered states of consciousness Patients may be in altered states of consciousness Unfamiliar environment Unfamiliar environment Fear of not knowing their state of health Fear of not knowing their state of health Patients do not have control of the situation – very vulnerable Patients do not have control of the situation – very vulnerable Pt Reactions: Inconsiderate, arrogant, impatient, rude – coping mechanisms Pt Reactions: Inconsiderate, arrogant, impatient, rude – coping mechanisms 5

6. Patient Dignity Patients are usually in the lower levels of Maslow’s Hierarchy - Why? Patients are usually in the lower levels of Maslow’s Hierarchy - Why? Patient dignity must always be remembered and respected Patient dignity must always be remembered and respected Difficult to maintain dignity Difficult to maintain dignity when wearing flimsy gown, vomiting, making a run to the bathroom 6

7. 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!*  *HIPAA Laws - Only discuss what you must know to do your job. 7

8. ID Pt’s Needs show 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? 8

9. Classification of Patients InpatientsOutpatients –Family –Friends 9

10. Methods of Communication VerbalHumorParalanguage Body Language Touch –Palpation Professional Appearance Physical Presence Visual Contact 10

11. Special Condition Patients Traumatized Patients Visually Impaired Patients Speech and Hearing Impaired Patients Non-English Speaking Patients Mentally Impaired Patients Substance Abusers “Pt Skills Lab – later this semester 11

12. 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) 12

13. Children Get down to child size KindnessPatience Never lie! 13

14. GOOD Communication The key to a successful exam for Technologist and Patient. Fosters a TEAMWORK approach to accomplish the goal 14

15. Review Communication Patient Assessment 15

16. 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? 16

17. What is an NG tube? And what is it’s purpose? 17

18. 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 18

19. 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 19

20. HISTORY TAKING (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. 20

21. Radiographer’s Responsibility RT is responsible for insuring patient understands what to expect during examination. Introduction Explanation of exam Inform patient how they will receive their results Risks of examination 21

22. HISTORY TAKING – Ch. Rad Tech’s Role in Clinical Hx Extract as much information as possible Radiologists 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. 22

23. Desirable Qualities for Establishing Open Dialogue Respect Genuineness Empathy Polite Professional demeanor 23

24. Data Collection Objective: Signs that can be seen Subjective: Perceived by the affected individual Examples? 24

25. Questioning Skills Open-ended questions (let pt tell story) Facilitation – encourages pt to elaborate Silence – give pt time to remember Probing questions – focus interview, provide more information Repetition – rewording, clarifies info Summarization – verifies accuracy 25

26. 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? 26

27. 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. 27

28. Clinical Indication Tech must collect a focused history specific to the procedure being performed. Several elements comprise a “complete history”. Sacred Seven… 28

29. 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? 29

30. You never know what you are going to get? 30

31. Good Communication with your patient improves radiation protection How ? Any ideas? 31 Primary Role of the Radiographer

32. 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? 32

33. X-ray Order - Outpatient 86 year old Female RT Hand Diag: Pain What questions are you going to ask her? 33

34. 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 34

35. 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?” 35

36. 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 36

37. 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 37

38. 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 38

39. Primary Role of the Radiographer? 39 Be Cautious of WHAT you say…. And HOW you say it!