Patient Communication, Grief, and SOAP Charting

Listening Types

  • Analytical: seek specific info, categorize
  • Directed: answer set questions
  • Attentive: grasp overall picture
  • Exploratory: driven by own interest
  • Appreciative: for pleasure (e.g., music)
  • Courteous: out of obligation
  • Passive: overhearing without focus

Listening Process

  • Hearing ➔ Attention ➔ Understanding ➔ Remembering

Effective Listening Guidelines

  • Attending: posture/gestures show interest
  • Paraphrasing: restate in own words
  • Request Clarification: admit confusion, ask
  • Perception Checking: validate sensed messages
  • Reflecting Feelings: non-judgmental emotional feedback

Non-verbal Communication

  • Body movement
  • Facial expressions
  • Eye behavior
  • Voice tone

Professional Conduct

  • Never discuss patient condition within patient’s earshot, elevators, etc.
  • Direct family inquiries to RN
  • Treat every patient as family

Psychological Support & Terminal Illness

  • Stages of Grief: Denial → Anger → Bargaining → Depression → Acceptance
  • RCP role:
    • Provide comfort/pain relief
    • Maintain dignity & self-worth
    • Foster acceptance; avoid isolation
    • Be caring, patient, and open; know own feelings

SOAP Charting (NBRC Standard)

  • S: Subjective – patient’s own perceptions (only patient can supply)
  • O: Objective – measurable/observed data (vitals, tests)
  • A: Assessment – professional interpretation of S & O (cause/severity)
  • P: Plan – therapy/actions to resolve A

Subjective Data

  • Direct patient quotes of symptoms, feelings, sensations
  • Not available from comatose/intubated patients

Objective Data

  • Vital signs: HR, RR, BP, T, SpO$_2$
  • Physical findings: breath sounds, cough, sputum, percussion
  • Diagnostics: ABG, PFT, CXR, labs, hemodynamics

Assessment Principles

  • Link each objective finding to a clinical cause
    • Wheeze → Bronchospasm
    • Rhonchi → Secretions
    • \text{ABG pH}<7.35, PaCO_2↑ → Ventilatory failure, etc.

Plan Formulation

  • Therapy targets the assessment’s cause
    • Bronchospasm → Bronchodilator
    • Ventilatory failure/hypoxemia → Mechanical ventilation + O$_2$
  • Specify monitoring (e.g., repeat ABGs)

Rapid SOAP Workflow

  1. Gather S & O
  2. Interpret ➔ A
  3. Select evidence-based intervention ➔ P
  4. Document succinctly, chronologically