CH3 Communication and critical thinking skills

What is communication?

Communication is a two-way process

What is the foundation of successful personal and professional relationships?

Communication

When is communication successful?

Successful only when the sender and the receiver understand the message the same way

What does nonverbal communication consist of?

Eye contact, facial expressions, body language, gestures, posture, tone of voice, and touch.

What may contradict a patient’s verbal message?

Nonverbal cues

What communication skills should be developed?

The ability to listen and convey interest, compassion, knowledge, and information.

What are effective verbal communication guidelines?

Prepare your thoughts before you speak; Analyze the intent of each message; Adapt to your physical settings whenever communicating.

What additional effective verbal communication guidelines are important?

Adequately brief the patient; Consider your tone of voice, the rate of your speech, and your body language when communicating; Follow up your communications and ask the right questions to ensure that the patient understands.

What is social conversation?

Polite or friendly exchanges of factual or social information (chitchat)

What does social conversation not provide?

Significant information, identify problems, or result in solutions

Why is social conversation important?

Important in establishing a relationship with patients and creating a climate of supportive communication

What is supportive communication?

More goal oriented

What is discussed in supportive communication?

Important patient information is discussed—how patients feel—and any problems that concern them can be shared.

How does supportive communication help patients?

Helps relieve patient anxiety, anger, or frustration and to learn about any unmet patient needs.

How can sonographers help patients through supportive communication?

By talking through such concerns, the sonographer often can help patients resolve their problems.

What are effective communication guidelines?

Listening; Observing; Responding appropriately; Maintaining silence; Clarifying

What are additional effective communication guidelines?

Repeating; Gathering information; Summarizing; Accepting; Touching

What are common communication barriers?

Talking too fast; Using slang, medical vocabulary, or broad generalizations; “Talking down” to patients; Speaking in hostile or insulting tones; Labeling patients as “complainers” or “disoriented”; Lack of a common language

What happens when communication is cut off?

A listener prevents a conversation from starting or continuing.

Why may patients cut off communication?

If they feel embarrassed, threatened, or distrustful.

How should sonographers respond to patient concerns and feelings?

Listen—without judgment—to their concerns and feelings.

What should be done if you do not know the facts or are not free to discuss them?

Find someone who is authorized to give that information.

What are negative communication traits?

Judgmental responses; Arguing; Solving; Interrupting; Changing the subject; Distractions

What are additional negative communication traits?

False assurances; Untruthfulness; Evasion; Avoidance; False reassurance

What can affect communication?

Physical or emotional states

What should sonographers be careful about in difficult situations?

What they say

What communication techniques can be used with coworkers and patients?

The same techniques of communicating with family and friends

What should be determined for patients with hearing impairments?

If the patient is using any hearing aids.

How should sonographers speak to patients with hearing impairments?

Face the patient directly and on the same level if possible.

What enhances communication with hearing-impaired patients?

Facial expression, body gestures, and touch

What tone of voice should be used with hearing-impaired patients?

A lower tone of voice

What should be reduced when communicating with hearing-impaired patients?

Background noise

What should be done before speaking to a hearing-impaired patient?

Get the patient’s attention before speaking.

What should never be done with hearing-impaired patients?

Never talk from another room.

What should you do if the patient can’t understand you?

Find another way of saying the same thing.

What should be done whenever necessary for hearing-impaired patients?

Write things down

What vision problems may patients with age-related macular degeneration have?

May have no central vision

What vision problems may patients with cataracts have?

May see only blurs or distinguish only light.

What should be promoted for patients with vision impairments?

Patient independence whenever possible.

What should be determined for patients with vision impairments?

Whether the patient wears any prescribed corrective lenses.

How should sonographers walk with visually impaired patients?

Have them hold on to your arm while leading the way.

How should a blind patient be approached?

By saying, “Hello.”

What should sonographers ask blind patients?

How they are used to doing things for themselves

When should blind patients continue doing things for themselves?

Unless their actions would interfere with their safety.

What should patients who are blind be told if you leave the room?

The reason why and when you will return.

How should sonographers communicate with blind patients?

Use touch and tone of voice and avoid nonverbal responses.

How should sonographers communicate with patients who have difficulty understanding communication?

Stand where visible; Speak slowly and clearly in a normal tone of voice; Use common vocabulary and short, simple sentences; Give directions or requests in a simple manner, repeating or rephrasing the directions as necessary; Use simple gestures or pantomime for clarification.

How should sonographers communicate with patients who have difficulty speaking?

Be patient and provide ample time for them to organize what they want to say.

What should sonographers watch for in patients with speech difficulty?

Clues or gestures if the patient’s speech cannot be understood.

Is it acceptable to assist patients with words they cannot say?

It is all right to assist patients with words they cannot say, but do not speak for them.

How should patients with speech impairments not be treated?

Do not treat patients as children.

What should never be done in front of patients with speech impairments?

Never speak with another sonographer or staff member in front of patients as if they were not there.

What can confusion result from?

Memory loss or an illness and can be temporary or long term.

What can accompany drug-related confusion?

Behavioral changes

What type of language should be used with confused patients?

Simple and direct language

How many questions should be asked at a time to confused patients?

Only one question at a time.

How much time should be allowed for a response from confused patients?

Ample time

What techniques should be used with confused patients?

Reality techniques that are based on sensory stimulation by identifying what is happening around them and clarifying who they are.

How should sonographers interact with disoriented patients?

Talk face to face with the patient and praise and encourage a patient’s abilities and attempts to cooperate with your instructions.

What type of environment should be maintained for disoriented patients?

Keep the environment calm to avoid overwhelming such patients with too many people or too much confusion.

How does supportive communication help disoriented patients?

When they get frustrated, anxious, or depressed.

What type of attitude helps support extremely confused patients?

A gentle, caring attitude

Why may patients in restraints become confused?

If unable to interact with their surroundings.

What information should always be provided to patients?

Correct information

Should sonographers support confused beliefs or behavior?

Do not support patients’ confused beliefs or behavior.

How should confused patients be corrected?

Correct them gently with supportive communication, and do not argue with patients who continue to be confused.

Where should communication with mentally challenged patients occur?

In a quiet or private area

How should sonographers speak to mentally challenged patients?

Speak to the mental age of the patient and not his or her physical age.

What qualities should sonographers have with mentally challenged patients?

Be patient, flexible and supportive.

Why should sonographers avoid talking too fast?

This will only frustrate the patient.

What should sonographers avoid doing with mentally challenged patients?

Do not mimic how the patient pronounces words.

What tone of voice should be used with mentally challenged patients?

Speak in a low voice.

Why should sonographers look mentally challenged patients in the eye?

To let them know that you care about what you are saying.

What is a communication triad?

Sonographer, patient and family member can create a triad.

When are communication triads useful?

When patients are anxious, need support or don’t understand the sonographer’s instructions

Who could be the third person in a communication triad?

An interpreter who speaks the patient’s language.

When should triads not be used?

When confidentiality is required.

What are examples of professional communication?

Interviewing patients and instructing patients and their families; Reporting patients’ sonographic findings to other members of the healthcare team; Participating in team conferences, grand rounds, in-service training, and departmental meetings

What are additional examples of professional communication?

Recording information in daily logs, charts, and files; Accessing patients’ charts for hospitalized patients; Contacting the referring doctor’s office; Scheduling patients

How should sonographers speak with referring physicians and interpreting physicians?

Speak with courtesy and respect.

How should sonographers answer physician questions?

Directly and within professional guidelines.

What should sonographers do if requested for a stat reading?

Ask your interpreting physician to provide a stat reading.

Should sonographers offer a clinical diagnosis?

Do not offer a clinical diagnosis.

What should sonographer reports include?

Measurements, comments on echogenicity, location of normal and abnormal structures, and any unusual patient positions, scanning planes, or instrumentation changes required to complete the examination.

What difficulties should be reported during an exam?

Any technical or patient difficulties encountered during the exam.

Are sonographer reports diagnostic reports?

Sonographer reports are not diagnostic reports.

What should ultrasound facilities publish regarding sonographer reports?

Policies that establish exactly what type of information sonographers are permitted to disclose and to whom the disclosures may be made.

What difficult situations do sonographers deal with?

Dying patients or those in danger of losing a pregnancy.

Who identified the five stages of grief?

Elisabeth Kübler-Ross

What is Stage 1 of grief?

Denial and isolation

What should sonographers do before engaging patients in conversation during denial and isolation?

Be sure that he or she has assessed fully the patient’s condition and carefully thought out an approach.

What can help patients during examinations and transfers?

Encouraging a supportive family member to be present

What is Stage 2 of grief?

Anger

What characterizes anger in grieving patients?

Tendency to displace anger in all directions

How may angry patients behave?

Make unreasonable demands or levy unjust criticism at everyone participating in their care.

What should sonographers avoid doing with angry patients?

Do not try to divert the patient with humor or cheerfulness.

Why should sonographers explain the sonographic procedure?

To avoid patient fear or suspicion.

How should sonographers react to angry patients?

Do not react as if the patient’s feelings are personal attacks.

Why do grieving patients display anger?

Through this behavior, patients can unload the intense and often painful feelings they are experiencing.

What is Stage 3 of grief?

Bargaining