Communication 1 Test (Patient Care)

Communication

Exchange of information (verbal or non verbal)

Elements of Communication

Message & Channel

What is Channel?

Method of how the message is transferred

Sender vs. Receiver

Sender = encodes the message

Receiver = decodes the message

Feedback

Receiver’s response

Verbal communication

Exchange of info via words (spoken or written)

Social communication

Small talk, superficial

Establishes relationships

Doesn’t identify or work on solutions

Supportive Communication

Goal oriented, uses more info

Ex: where’s the patient feeling pain? For how long?

What percent of communication is nonverbal?

70-93%

Most communication is nonverbal

Nonverbal communication examples

Touch, facial expression

What are pat answers?

Quick easy answers

Ex: “don’t worry”, “everything will be ok”

Examples of Common Courtesy

Knock before entering occupied room

Introduce self & why you’re there

Give patient privacy

Address person by name

What happens with Patient Satisfaction & Medicare/Medicaid?

Medicare & Medicaid began withholding hospitals Medicare reimbursement based on their quality performance

What does Medicare base their reimbursement on?

Part of the decision (30%) is based on Hospital Consumer Assessment of Healthcare Providers & Systems Survey (HCAHPS) which measures customer satisfaction

Communication Barrier

Anything that interferes with the communication process (nonverbal & verbal)

Can be communicated by senders and receivers

How did COVID 19 impact verbal and nonverbal communication?

Masks caused communication barrier

Difficult to hear person speak

Can’t see facial expressions/cues

What equipment made a big positive impact on communication during COVID?

PAPR equipment (clear face shields); allows you to see face

White boards, walkie talkies, face badges

What impairments make it difficult for someone to communication?

Hearing impairment

Vision impairment

Speech impairment

Mental impairment

Examples of visual impairments? What adjustments can be made?

Cataracts, blindness, near/far sighted

Adjustments: glasses, offer assistance

Examples of hearing impaired? What adjustments can be made?

Deaf, hard of hearing/hearing aid, older age

Adjustments. LOWER TONE, do not shout! Lower frequency is better heard!

Can also reduce background noise, simplify convo.

Examples of speech impairment? Adjustments?

• Mutism (psychological disorder); can be selective or complete mute

• Neurogenic (underlying brain damage/maldevelopment)

• Surgery or trauma

Adjustments = short simple sentences, be patient, repeat if necessary

Speech impairment reasons?

Stroke/brain damage

Larynx removal (special device to speak; belch air from stomach to speak)

Tracheostomy (Trach); can speak 2-3 days/weeks after adjusting to breathing

Mental impairment examples?

Alzheimers

Altered mental status (coma, unconscious)

Psychiatric illness

Adjustments for mentally impaired patients?

Never leave confused/restrained pt alone

Keep calm environment

Be patient

Get support if needed

Use simple direct language, calm tone

What adjustments to make for comatose patients?

Comatose pt can perceive environment

May hear or feel touch

Verbally communicate to patient:

• Introduce self

• Give place/time

• Explain what you’re going to do

• Tell pt when you’re done w exam & when you’re leaving room

Are minors required to be accompanied for diagnostic testing?

Yes

Exceptions only made for: GYN, pregnancy, emergency situations

What is Communication Triad?

Communication method that involves THREE PEOPLE

Example: you, patient, & MD/family member/interpreter

What to include when on a telephone call with a healthcare worker?

Your Name

Department

Why you’re calling

Document their name & number (so you can call back if needed)

What to do if there’s a questionable order from MD?

Always contact the physician to clarify

Inpatient/ER: call receptionist & contact nurse/MD

Outpatient: contact physician office

When presenting cases to reading physician, what required information do you need to present?

• Patient Information

• Reason for Exam

• Labs (if any)

• Prior radiology exam results and dates if any

Delegating task

Entrusting task to someone (usually by person of authority to someone under them)

Delegator = legally responsible for task

Ultrasound students cannot delegate!

When should you refuse a task?

• Not in job description

• Not prepared/trained to do task (don’t know how to use equipment)

• Beyond your legal limits

• Task could harm the person

• Unethical or illegal directions

• Unclear or incomplete directions

• No supervision available

What should you include in technical findings?

• Measurements

• Description of Echogenicity

• Location of structures

• Patient position

• Technical or patient difficulties (bandages)

• Sonographer impressions (only for physician, not for medical report)

Stages of grief?

These are not linear & may occur out of order

1. Denial and Isolation (“must be a mistake”)

2. Anger (“why me?”, hostile)

3. Bargaining (negotiating with God, looking for alternative or quack treatment)

4. Depression (realizes loss, sorrow)

5. Acceptance (more peace & clarity)

What should you have for patient registry information?

At least 2 patient identifiers to confirm the patient: NAME/DOB/MRN Number

When should you check the patients ID?

• Admission (official entry into facility)

• Transfer (moving patient to different unit)

• Prior to any procedure or exam (aka “Time Out”)

• Discharge (official departure from facility)

When should you take a time out?

Immediately before performing the procedure

What should you re-verify during a Time Out?

Correct patient

Correct procedure

Correct site

What is included in Informed Consent?

• Reason for treatment

• What will be done/how it will be done

• Who will do it

• Expected outcomes

• Other treatment options

• Effects of not having treatment

What is Written Consent?

Signed consent form

Patient must sign this prior to any INVASIVE procedures

Must be 18+ or signed by parent/guardian

Must understand what they’re signing (use layman terms)

What is included in Consent Forms?

Brief description of procedure

Risk/complications

Small time frame between signing/having procedure

Pt will not have procedure without signed consent

Examples of ultrasound guided procedures

General: biopsies, -centesis procedures, hysteria on organ, CVS, contrast studies

Cardiac: contrast studies, TEE

Vascular: venous closure, thrombin injections

What to do if you make an error in saving image to PAC system?

Contact IT, fill out form to correct it

What is Advanced Directive?

Gives guidance to loved ones & doctors to know what kind of care you want if you become incapacitated

Living Will

Written legal document

States actions you wish for in the event you can no longer make decisions for yourself

Power of Attorney/Healthcare Proxy

Authorizes a person (agent) who will make healthcare decisions for you if you become incapacitated

DNR

Do not resuscitate

If you don’t have DNR on MOLST (medical orders for life sustaining treatment), they must attempt resuscitation

Does DNR expire?

No

And it goes where you go (hospital, rehab, home, etc)