L2, Ch 6: Professional Attitudes and Communications

Issues of Cultural Diversity (4)

• The scope of diversity

• Culturally significant attitudes that may impact communication

• how cultural issues may affect care

• professional responsibilities and ethics in relation to diversity

The Scope of Diversity

Examples of cultural groups one may encounter

• Gender groups: M/f

• Racial groups: Distinguished by skin color and other

  physical characteristics

• Generational groups: millennial, boomers, gen z

• Geographic groups: North or south; east coast or west

  coast; native cultures in Hawaii, Alaska etc

• Sexual-preference groups: Heterosexual, gay, lesbian,

  bisexual, and transgender

• Religious groups

• Groups based on nonracial physical characteristics (the blind, the deaf, the disabled, the obese)

• Socioeconomic groups

• Groups with various types of family structure (singles, unmarried couples with and without children, traditional nuclear families, single parents, parents with children and grandchildren, and large, close-knit extended families)

Culturally Significant Attitudes That Can Affect Communication

• Eye contact, touch, and gestures have different meanings in different cultures

  • Eye contact may be seen as impolite

  • Touching in professional setting should be confined to that needed to provide health care

• important to know the meanings in the cultures that live in your area

How Cultural Issues May Affect Care

• Some ethnic cultures have a high level of sensitivity surrounding modesty and physical contact in health care

• Elders have observed advances in medicine and is unlikely to question the need vs Boomers more conservative/questioning attitude toward medical establishment

• Geographical differences

• Religion (some groups prohibit specific practices)

• Inability to pay for health insurance

• Sizeism - discriminating against someone based on his or her size

Review Box 6.1 Suggestions for Improving Communication and Care With Specific Ethnic Groups

Review Box 6.1 Suggestions for Improving Communication and Care With Specific Ethnic Groups

Review Box 6.1 Suggestions for Improving Communication and Care With Specific Ethnic Groups

important to recognize that not all individuals in a cultural group will share the same characteristics

Professional Responsibility and Ethics in Relation to Diversity

The American Registry of Radiologic Technologists Code of Ethics requires radiographers to put aside all personal prejudice and emotional bias, rendering services to humanity with full respect for the dignity of individuals

• conduct themselves in professional manner

• support colleagues

• respond to patient needs

• deliver patient care/service unrestricted by concerns of personal attributes or the nature of the disease and without discrimination on the basis of sex, race, creed, religion, socioeconomic status

Communication Skills (6)

• Nonverbal communication

• listening skills

• verbal skills

• attitude

• validation of communication

• communication under stress

Nonverbal Communication

• eye contact

• touching

  • professional purpose that is clear to patient

• appearance

  • Appearance communicates how we feel about our work and our patients

    • Neat uniforms

    • Clean examination room

• Interpreted based on cultures

Listening Skills

• Requires more than waiting for your turn to speak

• Ability to give the speaker your full attention and focus

Verbal Skills

Ability to use language and content that is appropriate for your patient

• age appropriate language (ex: pediatric pain vs ow)

Attitude

• Nonverbal cues communicate attitude (ex: crossed arms, stoic face, tense)

• Assertiveness is often necessary (calm, firm, neutral feelings)

  • Not to be confused with aggressiveness (hostile, impatient, anger, frustration)

Validation of Communication

• An indication of a clear understanding of the message

  • smile, nod, ok

  • Without validation, neither party can be certain that all

    elements of a message have been correctly understood.

Communication Under Stress

• Stress interferes with our ability to process information accurately and appropriately

• Suggestions to improve communication effectiveness in a crisis situation:

  • Lower your voice, speak slowly, and clearly.

  • Be nonjudgmental in both verbal and nonverbal cues.

  • Do not allow another’s inappropriate actions or speech to goad you into a similar response

  • Request confirmation when you are uncertain of the listener’s understanding.

Communication With Patients (6)

• Addressing the patient

• Valid choices

• Avoiding assumptions

• Assessment through communication

• Therapeutic communication

Addressing the Patient

• Introductions are normally first

• Avoid impersonalizing patients, such as identifying patient by the exam rather than by name

• Address patient appropriately

  • don’t use “honey, sweetie etc”

• For many people, the stress of hospitalization is reflected in a strong feeling of helplessness or loss of autonomy (self-determination)

Valid Choices

• Defined as alternatives that are all acceptable to you

• Provide patient with a sense of participation in his or her care

  • “gowns vs pants”

  • “do you want to use the bathroom before exam?”

Avoiding Assumptions

• Helps in preventing errors during procedures (ask patient to clarify)

• Examples

  • Use of routine positioning techniques for all outpatients

  • Patient understood and followed preparation procedures for contrast

Assessment Through Communication

• Combining observation with therapeutic communications to determine patient’s ability to cooperate with the examination

  • “how much more can you move, can you get on the table?”

Therapeutic Communication

• Process in which the health care professional consciously influences a client or helps the client to a better understanding through verbal and/or nonverbal communication

• involves the use of specific strategies that convey acceptance and respect and that encourage the patient to express feelings and ideas

• See Table 6-1

Table 6.2 Deterrents to Therapeutic Communication

Special Circumstances That Affect Communication (7)

• Patients who do not speak English

• The hearing impaired

• Deafness

• Impaired vision

• Inability to speak

• Impaired mental function

• Altered states of consciousness

• Important to recognize that sensory deprivation or loss does not affect mental capacity

• Treat patients who are deaf, blind, or speech impaired with respect

Patients Who Do Not Speak English

• Federal law guarantees patients the right to effective communications

• Larger hospitals commonly employ interpreters and provide signs in several languages

• Other facilities have “on-call” interpreters

• Use of family members as interpreters often problematic

  • can’t rely on the info they relay

  • simple instructions are ok

• When using an interpreter, look at the patient when speaking

  • Looking at the interpreter makes the patient feel excluded

The Hearing Impaired

• Talk to, not about, these persons

  • show lips so they can read

• Get the patient’s attention before starting to speak.

• Face the person, preferably with light on your face.

• Hearing loss is frequently in the upper register, so speak lower as well as louder.

• Speak clearly at a moderate pace, and do not shout.

• Avoid noisy background situations.

• Rephrase when you are not understood the first time

• Be patient

Deafness

• Deaf persons have their own culture

• chart should be flagged to alert care providers that patient is deaf

• Certified interpreters usually necessary for effective communications

• don’t shout; use lower voice/deeper voice

Impaired Vision

• Ability to function depends on degree of vision loss and length of time since sight was lost or impaired

• Useful to ask what assistance is needed

  • some prefer to touch your elbow as guide

  • others prefer description of surroundings

• effective communication essential

• Knock on door before entering

Inability to Speak

• Aphasia is a defect or loss of language function in which comprehension or expression of words is impaired because of injury to language centers in the brain

• Helpful to ask nursing staff about useful methods of communication

  • Some can write; others will nod to indicate understanding

• One tool for those who cannot otherwise talk is the handheld electrolarynx. This device is placed on the external throat wall and operates by amplifying vibrations transmitted through the tissues of the neck

Impaired Mental Function

• Abilities vary, so individual assessment is key

• Inappropriate to treat adults with mental disabilities as if they were children

• Repeating instructions is often useful.

Altered States of Consciousness

• Important to communicate as if the patient can hear and respond

• Constant observation is required to avoid accidents.

• Tips:

  • Do not rely on patient to remember instructions.

  • Patients are not responsible for their actions/answers

Age-Specific Communication

• Neonate and infant (birth to 1 year)

• Toddler (1–2 years)

• Preschooler (3–5 years)

• School age (6–12 years)

• Adolescent (13–18 years)

• Young adult (19–45 years)

• Middle adult (46–64 years)

• Late adult (65–79 years)

• Old adult (80 years and older)

• Important to learn and practice age-specific communication skills

  • get on kid’s eye level

• Avoid stereotypes.

• Ageism is a discriminatory attitude toward the elderly that includes a belief that all elderly are ill, disabled, worthless, or unattractive.

Patient Education

• Patient teaching

• Communication with patients’ families

• Communication with coworkers

• Dealing with death and loss

• when you don’t know answer to question, don’t tell patient “I don’t know”

  • offer to find the answer and/or tell them to ask physician

Patient Teaching

• Opportunities

  • During the explanation of procedures

  • While responding to patient concerns

  • As part of the instructions needed to prepare for a procedure

  • During instruction for follow-up care

• Written materials useful for complex preparation or follow-up

Communication with Patient’s Families

• Empathy and patience are required

• Useful information:

  • Restrooms

  • Cafeteria

  • Waiting areas

  • Length of procedure

  • Delays encountered

  • Follow-up care

• Although you should always refer inquiries about diagnosis (identification of condition) or prognosis (prediction of outcome) directly to the physician in charge, an expression of concern can demonstrate empathy. “I know you are worried about Barbara, Mr. Rudd. I’ve let the doctor know you’re waiting for the results.

Communication with Coworkers

• Cooperation with other healthcare providers makes it easier to accomplish common goals for patient.

• Good interpersonal communication skills are essential.

  • Effective, efficient communications

  • Be a good listener.

• Avoid gossip

• Know legal implications of communications with others in the healthcare environment

Dealing with Death and Loss

• Kübler-Ross stages of grief:

  • Denial—refuses to accept the truth; may refuse to discuss the possibility of loss or death

  • Anger—experiences frustration, outrage; may vent on healthcare workers

  • Bargaining—attempts to earn forgiveness or mitigate loss by being “very good”

  • Depression—often acquiescent, quiet, and withdrawn, and may cry easily

  • Acceptance—accepts the loss or impending death and deals with life and relationships on a more realistic, day- to-day basis

Hospice

an approach to care for the terminally ill that seeks to provide comfort without treating the underlying disease.

Palliative

a substance or treatment that soothes or relieves but is not intended to cure.

The principle of providing healthcare services with full respect for the dignity of humankind is:
A. established by law.
B. included in the ASRT Code of Ethics.
C. applicable only to physicians.
D. impossible to implement

B. included in the ASRT Code of Ethics.

Belief in the ancient superstition of the mal ojo, or "evil eye," is most likely to be encountered in individuals whose ethnic background is:

A. Asian.
B. Islamic.
C. Hispanic.
D. Native American.

C. Hispanic.

When confidential patient information is to be transmitted by fax, it should be:

A. transmitted in the standard medical private code.
B. seen only by the receiving physician.
C. preceded by a phone call to the recipient.
D. reconsidered and sent by mail.

C. preceded by a phone call to the recipient.

In the United States, a patient's right to communicate effectively in healthcare situations, regardless of language barriers, is guaranteed by:
A. the Constitution.
B. the ASRT Code of Ethics.
C. the American Hospital Association's Patient's Bill of Rights.
D. federal law.

D. federal law.

Which of the following strategies is NOT an appropriate way to deal with an uncooperative toddler?
A. Use praise and rewards for any good behavior.
B. Set limits in clear terms.
C. Insist that a parent enforce cooperation.
D. Immobilize the child as a last resort.

C. Insist that a parent enforce cooperation.