RADS 210 Final

Social Forces that affect Health Care

-Aging Population

-Increasing health care costs

-Increase in birth rate

HIPPA

Health Insurance Portability and Accountability Act

Ethical Issues

1. Patients right to privacy and confidential information (HIPPA)

2. Laboratory Testing on animals

3. Availability of new drugs (too soon or not soon enough)

Due to increase in number of older citizens:

home health care is increasing, physicians/dentists making house calls, increase in mobile radiography services, visiting nurses

Organ Donation Process

1.coordinate organ procurement in designated service areas, which may cover all or part of a state

2.evaluate potential donors, discuss donation with family members, and arrange for the surgical removal of donated organs

3.preserve organs and arrange for their distribution according to national organ sharing policies

Organs recovered for transplant

heart, lungs, kidneys, liver, pancreas, intestines

Tissues recovered for transplant

eyes/ cornea to restore a person sight, heart valves for valve replacement surgeries, fascia, saphenous and femoral veins, tendons and ligaments, bones of lower extremities

Fascia

fibrous membrane that covers, supports, and separates muscles, subq tissue that connects skin to muscles

-used for organ donation for bladder suspension surgeries or dura replacement for craniotomies

saphenous and femoral veins

used for organ donation for cardio as surgeries where they take the veins and move them

Tendons and ligaments

used for organ donation for reconstructive joint surgeries

when organ donated Bones of lower extremities are used for

spinal surgeries, limb salvage, cancer treatment (bone marrow), corrective birth defects

Issues dominating medical, religious, and political arenas

abortion, in vitro fertilization, surrogate motherhood, genetic engineering, cloning

Genome

all the DNA in an organism, including its genes

Genes

carry information for making all the protein required by all organisms determining how the organism looks, how well its body metabolizes food or fights infection, and sometimes even how it behaves

Goals of the Human Genome Project

· Identify all of the genes in human DNA

· Determine the sequences of the DNA base pairs that make up the human DNA

· Store this info in databases

· Improve tools for data analysis

· Transfer related technologies to the private sector

· Adress the ethical, legal and social issues that may arise from the project

There are approximately how many genes in human DNA

30,000

During the Human Genome Project researchers also studied

the genetic makeup of nonhuman organisms

ex. bacterium, the fruit fly, and the laboratory mouse

inequalities in health care may be attributed to:

-Area (one place might have more than another)

-Economic Status

-Ethnic and minority populations

-Insured vs Uninsured

inequalities in health care: Insured vs Uninsured

availability of services offered for individuals who are uninsured

Inequalities in health care: ethnic & minority populations

the belief that these populations may not receive equitable care, mistrust because of experiments such as Tuskegee Experiment

5 stages of grief

denial, anger, bargaining, depression, acceptance

-studies by Elisabeth Kubler-Ross

anticipatory grief

one faces the possibility of imminent death or loss. start mourning themselves as they anticipate death

grief is a normal response to loss of:

loved one, prized possession, social status, bodily functions, body part

Denial

the initial reaction to grief, seen as a sentence mechanism that should be supported by silence and acceptance without discussing death

Anger

seen as therapeutic as the person realizes that their life with be interrupted, that they will be forgotten

-may be directed toward the healthcare team & family

Bargaining Stage

Focuses on Hope and may be based on religion, it is important to support the patients beliefs, this may reduce stress

-may seek alternative methods of treatment or believe a miracle cure

Depression

occurs when remission end and additional treatments must begin

-begin to accept the impending loss and mourn

Acceptance

the final stage of grief (in response to near death) when person has worked through feelings and understands that death is imminentl, characterized by a lack of feelings

-can only occur if there is enough time and if the patient had been helped through the other stages

Advanced Directives

legal documents that the competent patient gives someone the legal authority to act on the patients behalf should he become incapable of doing so themself

Advanced Directives examples

-Living Will

-Durable Power of Attorney for Health Care

-Do Not Resuscitate (DNR)

Living Will

document that states exactly what the patient wishes at the time of death

durable power of attorney for health care

legal document signed by the patient that authorizes a other person to carry out the wishes of the patient if he is unable to do so himself

Do Not Resuscitate (DNR)

states that the patient has directed that no CPR or other life-saving measures be implemented if the need should arise

Patients are very apprehensive because:

1. of unfamiliar environment

2. they are not in control

3. the uncertainty of the outcome of the radiological procedure

Some patients may arrive in the radiology department at the...

Physiological or survival level because the illness has altered some of their bodily functions or could cause them to lose sleep (level 1)

Power abused by dehumanizing

patients such as:

a. having patients wear flimsy gowns

b. referring to the patient as the stomach, hand, skull

c. placing the patient on the same area with more critically ill patients

d. patients having difficulty getting to the restrooms before vomiting, or evacuating

2 classifications of patients

Inpatients (IP) & Outpatients (OP)

Inpatient (IP)

someone who has been admitted to the hospital for diagnostic studies or treatment

Outpatient (OP)

someone who has come to the hospital for diagnosis but does not occupy a bed

inpatients are transported to the radiology department by:

wheelchair (WC), stretcher (STR), and ambulatory (AMB).

Communication with the Patients Family and Friends

1. they will want to know everything

2. always be courteous

3. smile, be brief, puts patients and family at ease

Communication in Patient Care

verbal and nonverbal communication

- do not use terms of endearment (hunny, love)

Verbal Communication

a. clarity of voice

b. vocabulary

c. should be at an appropriate level of the patient (ie: age)

nonverbal communication

paralanguage, body language, touch, professional appearance, visual/eye contact

Paralanguage

music of language; rhythm, pitch, tone, rate of speech, volume

nonverbal communication

Body Language

facial expressions, hand gestures, body movements

nonverbal communication

3 types of touch

1. touching for emotional support

2. touching for emphasis

3. touching for palpation, which is light pressure with the fingers

nonverbal communication

Professional Appearance

Helps the patient feel comfortable and confident in the technologist's abilities

-nonverbal communication

Visual/ Eye contact

lets the patient know you are attentive to them and that you understand what they are conveying to you; is a nonverbal communication

Age range for pediatric patients

infancy to age 15

Infants are afraid of two things

falling and loud noises

How to interact with pediatric patients

a. must get down to the child's level

b. toys or distractions are effective

c. never try to separate a child from a security object

d. NEVER leave a child alone in a room

e. allow parents to accompany patients

f. let the child touch the equipment

How to interact with adolescent patients

primary considerations focuses on body awareness and modesty, avoid embarrassment, expected to act as an adult, may be perceived as hostile

Age range for Geriatric Patients

65 or older

How to interact with geriatric patients

usually do not consider themselves as old, physical and mental variations will vary, do not talk too loudly or use childish terms

Seriously Ill and Traumatized Patients act differently because of

pain, stress, anxiety

Visually Impaired Patients

- blind or decreased vision

- give clear instructions (descriptive)

- reassure patient with gentle touch

Speech and hearing impaired patients

patients who can read may communicate by writing, pantomime and demonstration are also effective

Non-English speaking patients

•Use touch, facial expressions, and pantomime

•Most hospitals maintain a list of bilingual employees or interpreters

Developmentally/ Mentally Impaired Patients

1. degree of mental impairment may vary

2. use a strong, yet reassuring voice

3. continuous conversation helps keep the patient calm

Substance Abusers

1. assess the patients capabilities

2. work fast

3. may be relaxed or hyperactive and irrational

4. may need assistance from other medical personnel (security guard, nurse)

transesophageal puncture (TEP)

type of surgery used to treat laryngeal or hypopharyngeal cancers, sometimes performed during a laryngectomy

-creating a communication between the trachea and esophagus and restores the ability to force air from the lungs into the mouth

Larynx

organ of voice; voice box

Esophageal Speech

speech produced with air trapped in the esophagus and forced out again

-used by indicated whose voice box (larynx) has been removed (laryngectomy)

Electrolarynx devices

pushes air into larynx to make voice powered by batteries

-can look like a flashlight or be built into a denture or retainer

Factors that Impede Communication (Avoid these)

Colloquialisms, Slang, Medical Terminology

Colloquialisms

phrase that is common in everyday, unconstrained conversation, rather than in formal speech

ex. yall, gonna, wanna, "he needs to step up to the plate"

Slang

vocabulary that is used between people who belong to the same social group and who know each other well, informal language

ex. sis, geek/nerd, pot, salty

Medical terminology

do not use this while communicating with the patient, the patient may not understand the meaning, impending the communication

-use 'lay' terms

Patient Interactions

1. Establish Communication Guidelines

2.Reducing Distance

3.Listening

4.Using Therapeutic Silence

5.Responding to the feeling and meaning of the patients statement

6. Restating the main idea

7. Reflecting the main idea

8. Making observations

Establishing communication guidelines

introducing oneself to the patient and explaining the examination or treatment to be performed

Reducing Distance

the physical distance between the RT and the patient should be reduced; makes the patient feel included and involved

Listening

healthcare provider must overcome their personal bias be sympathetic/ try to understand patients point of view

Using Therapeutic Silence

allows patient to arrange their thoughts

Responding to feeling and meaning of the patients statement

let's patient know they have been heard and understood

Restating the main idea

validates your interpretation of the message from patient

Reflecting the main idea

helps patient to make his/ her own decision

Making observations

regarding patient if they are tense or nervous

Success in life comes from

25% what you know

25% who you know

50% attitude

goal of patient interview

obtain info about patints current and past health status for providing a safe exam or treatment

structured interview

a list of written questions that require direct responses

ex. questions on informed consent

The joint commission defines a patient identifier as:

information directly associated with an individual that reliably identifies the individual as the person for whom the service or treatment is intended

Acceptable patient identifiers may be

-the individual name

-an assigned identification number

-telephone number

-date of birth

-person-specific identifier

Armband

a source where patient identification may be located but is not a patient identifier because they are removable

Process of greeting the patient

-call the last name of the patient

-approach patient and ask full name

-in private area, ask the patient DOB, or reason for their visit

-ask what the patient would like to be called

unstructured interview

informal, based upon questions asked by the healthcare worker that depend upon patient responses to previous requests for information

During the patient interview the radiographer

must convey a professional image

Desirable qualities of an interviewer

- respect

- genuineness in your concern for them and their condition

- empathy, emotional identification with someone else

- write their history down

open-ended questions

these are non-directed, non-leading

-"Let the patient tell the story"

Facilitation

By nodding, or saying "yes" or "okay" it encourages the patient to elaborate

probing questions

they provide more detail as the patient may not know exactly what informative radiographer needs

ex. "when you breathe deeply, exactly where does it hurt you on the left side"

Repetition

rewording, patient may not use same wording as the radiographer

-clarifies information

Summarization

verifies accuracy by condensing what the patient stated

Chief Complaint (CC)

primary medical problem as defined by the patient; important because it focuses the clinical history toward the single most important issue

-the physician determines what this is

The Sacred Seven

1. Localization

2. Chronology

3. Quality

4. Severity

5. Onset

6. Aggravating or alleviating factors

7. Associated manifestations

Sacred Seven

elements needed for a complete patient history

Localization

Area of complaint

ex. "Where are you hurting"

Chronology

time element, duration since onset, frequency

-sec, minutes, hours, days, week

quality

Character of the symptoms

ex. color, sores, lumps, lesions, size, burning, throbbing, sharp, pressure

Severity

the intensity or amount, extensiveness