Transcript Unit 1 - Workforce Solutions

UNIT 1
CHAPTER 10, 11, 12
•Human
Diversity
•Patient
Interactions
•History
Taking
1
Human Diversity in
Healthcare
Chapter 10
2
What is Human (Cultural)
Diversity?

The ways that people are different

The ways that people are alike

Cultures impact (and often drive) the
uniqueness of the human condition.
3
Why is cultural diversity
important in healthcare today?
Globalization has resulted in crosscultural or multicultural issues in our
society.
 Multiculturalism can result in
misunderstanding (& conflict) caused
by cultural differences.
 Understanding and accepting different
types of diversity is key to providing
quality patient care to ALL of our
patients!

4
Cultural Competency

“Possessing a set of attitudes, behaviors
and policies that come together in a
system or among individuals that enable
effective interactions in a cross-cultural
framework.”

Cultural Competency is a necessary skill
in today’s workplace.
5
Diverse nature of humans

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Age*
Disability
Economic status
Education
Ethnicity*
Race*
Family status
First Language
Mental & Physical
ability*
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Gender*
Geography
Lifestyle
Physical
characteristics
Political affiliation
Religious preference
Sexual orientation*
6
Age

Asian cultures revere their elders

European and Western cultures value
youth over age

People of all ages make positive
contributions to society
7
Ethnicity
Relates to racial, national, religious,
linguistic or cultural heritage.
 Core values of ethnic cultures vary
 Ethnocentrism – the tendency to view
norms and values of one’s own culture
as the only acceptable ones.
 Racism – the belief that one race or
culture is superior, using it as a basis for
discrimination

8
Ethnicity

Ethnic and Racial cultural differences often
include linguistic differences

Ability to communicate with people from
different backgrounds is essential to
delivering quality patient care.

A failure to communicate can be a danger to
the patient and a liability to the healthcare
provider.
9
Gender or Sexual Orientation

Sexual identity is biological or
chromosomal (male vs. female)

Gender identity is the “inner sense of
maleness or femaleness” and is
influenced by (among other things)
culture.
10
Mental & Physical Ability

10% world’s population have some type
of disability ranging from mild to
severe.

The intent of the American with
Disabilities Act of 1990 is to prevent
discrimination against persons with
disabilities.
11
Mental & Physical Ability

Core Values of Human Rights
–
–
–
–
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Autonomy - Self determination
Dignity –
Equality – Fair and equitable treatment
Solidarity – Requires society to support and
maintain freedoms of individuals
Later we will talk about Patient’s Rights. Note
the similarities!
12
Cultural Competency

Attitudes, behaviors and policies that ensure
effective interactions in a multi-cultural
environment.
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–
–
–
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5 Elements of Cultural Competency
Valuing Diversity
Cultural self-assessment within the organization
Awareness of the dynamics of cross-cultural
interaction
Incorporating cultural knowledge into the
corporate culture
Adaptive environment to multicultural issues (i.e.,
Flexibility)
13
Cultural Competency in
Healthcare
Clear and unimpeded communication is
essential
 Patients must be treated with respect,
understanding and acceptance
regardless of cultural differences.
 The ARRT Code of Ethics preclude
discriminatory practices in the delivery
of quality patient care.

14
Cultural Competency in Healthcare
 Communication
– Language barriers
– Nonverbal communication
 Space
– Proximity/Personal boundaries
– Eye contact
– Appropriate touching
 Time
– Past, present, future
– Prevention vs. treatment
15
Cultural Competency in Healthcare
 Environmental
control
– Differences in health practices
– Cultural views of illness vs. health
 Biologic
variations
– Ethnic or racially-related differences in:
 Body
structure
 Susceptibility to certain diseases
 Nutrition
 Social
organizations
– Individual oriented vs. family oriented
– Youth vs. elder
16
Gender or Sexual Orientation

Homophobia – the
irrational fear of
homosexuality and
hostility towards
individuals who are or
are perceived to be
homosexual (gay,
lesbian) or bisexual.
17
1. Human diversity consists of which
of the following characteristics?
A.
B.
C.
D.
E.
Age
Race
Mental ability
A&B
All of the above
18
2. The tendency to view the norms and values of one’s
own culture as the only acceptable ones and to use
them as standards by which all other cultures are
measured is called:
A.
B.
C.
D.
bias
diversity
ethnocentrism
racism
19
3. The Americans with Disabilities Act of 1990
requires institutions that receive federal funds
to make their facilities accessible to the
disabled.
A.
B.
True
False
20
4. Homosexuality is the irrational fear of
individuals who are sexually attracted to
persons of the same gender.
A.
B.
True
False
21
5. Racism is the belief that one race or culture is
superior to another and the use of that belief to
discriminate against races considered inferior.
A.
B.
True
False
22
Patient Interaction
Chapter 11
23
Communication

Communication is one of the
radiographer’s most important tools.

Developing a rapport with your patient
is important to gaining cooperation
which ensures a quality procedure.

It also demonstrates good customer
service skills.
24
Maslow’s Hierarchy of
Human Needs
Self
Actualization
Self-esteem
Love & Belongingness
Safety & Security
Physiologic Needs
25
Maslow’s Hierarchy
of Human Needs
Biological Needs must be met first before any
other needs can be addressed.
 Biological Needs include: water, air, food,
reproduction; in other words, things an
organism needs to survive.
 What things might happen to you as a patient
in a hospital that could threaten this basic need
from being met?

26
Maslow’s Hierarchy
of Human Needs
Safety and Security needs can be achieved once
the biological needs are met.
 Safety and Security needs relate to the how safe
and secure a person feels in his/her
environment.
 Example: a homeless person may constantly
wavering between meeting biological needs
and finding a safe and secure place to stay.

27
Maslow’s Hierarchy
of Human Needs

Once the more basic needs are achieved, a
person looks for love and affection from others.

This is important to a person’s well being.

It is important for our patient’s well being that
they have access to those who meet this need
for them.
28
Maslow’s Hierarchy
of Human Needs

The need for self-esteem is higher up on the
hierarchy, which means that is isn’t as
important to survival, but once the more basic
needs are met, this need becomes important.

What type of things might threaten a patient’s
need for self-esteem?
29
Maslow’s Hierarchy
of Human Needs
The highest need
in Maslow’s
hierarchy is selfactualization.
 Many people
never achieve this
level!
 Do you think
these folks have?

Radiologic Technology
Graduating Class of 2001
30
What do patients fear????
 The
unknown or unexpected
– That is why is it important to explain
procedures to patients
 Pain
– Don’t lie to patients. If it is going to
hurt, let them know what to expect. If
you lie, it breaches their trust in you.
 Humiliation
or embarrassment
– Always keep your patient covered up!
31
Patient Fear Loss of…..
 Life
– Many older people think hospitals are a place
you go to die!
 Limb
– Physical or Mental function
 Self-image
 Loss
of all of these things affect a patient’s selfimage. It is also a fear of change!
 Familiar
surroundings (this especially
affects children and the elderly)
32
Patient Fears: Loss of...
 Comfort
and/or security
– Hospitals are not known for their
comfort! Nor are x-ray tables!!
 Privacy
– Body functions
– Even with private hospital rooms, think
how many people are in and out of
them hourly!!
33
34
Patient Fears: Loss of...
 Dignity
– Patients not body parts!
 Modesty
– Hospital gowns!
35
36
Patient Fears: Loss of...
 Financial
– lost work
– hospital bills
37
38
Patient Fears:
Loss of...
Control (freedom, diet)
In the hospital, you eat what they bring you!39
Patient Interaction – Developing
rapport
Introduce yourself to the patient
 Initial patient assessment

– Request
– Chart
– Direct communication/patient history
Explanation of procedure
 Informed consent

40
Inpatient Considerations
Transportation (ambulatory,
wheelchair, cart, bed).
 Waiting room/Privacy/Modesty issues
 Patient condition can change quickly;
Be observant!
 Beware! Patients are listening and
watching everything around them!

41
Outpatient Considerations
Patient expectations of appointment
time.
 Acknowledge the patient’s presence.
 Ongoing communication when delays
occur.
 Family may accompany patient;
acknowledge them too! It is good
customer service!

42
Patient Communication
Communication skills are some of
the most important skills that
health professionals can develop.
43
Communication: Why is
it important?
It establishes rapport with the patient.
 It serves as a vehicle to establish,
maintain or terminate a relationship
with the patient.
 It enables information being obtained
concerning patient’s condition and
progress.
 It enables relaying of pertinent
information or instructions to patient or
another member of the healthcare team.

44
Catalysts of Communication
Caring - warmth, tenderness, compassion,
listening.
 Trust - dependability, confidence, honesty.
 Empathy - place yourself in another’s shoes
 Sympathy - compassion, warmth, kindness,
interest, concern (NOT pity)
 Respect - Acceptance despite differences
 Humor – relaxes the patient, eases passage
through awkward moments (be careful not to
be unprofessional!)

45
Barriers to Communication

Distractions

– Worry
– Fear
– Events occurring
in the
environment

Cultural issues
Filters (blocks)
–
–
–
–
–
–
–
–
–
–
Preconceived ideas
Negative nonverbal cues
Language issues
Rapid speech
Complex medical
terminology
Language barriers
Judgmental statements
Cliché statements
False reassurances
Defending
46
Body Language or Paralanguage
(Nonverbal communication)
 There
are NO neutral messages!
 50% of communication is Body
Language; 40% Tone of Voice; 10%
Words!
 In other words, 90% messages are
nonverbal!! Watch what you body is
saying!!
47
Body Language
(Nonverbal communication)
 On
the Phone:
– 70% of the message is
communicated through tone
– 30% by Words
 Try
saying “hello” with a smile;
now without a smile…can you
tell the difference?
48
Nonverbal Communication

Voice tone & volume

What makes up body language?
– Gestures (use of hands as well as body)
– Posture (angle of head, proximity, leaning forward)
– Eye contact (eye contact means different things in
different cultures.)
– Hands (punctuation, accentuation, clarification)
– Facial expression (happy, angry, sad, impatient….)
49
Nonverbal Communication

Use of touch
– Beware not to invade one’s personal space
– Use appropriate touch




Emotional support
For emphasis (to highlight specific instructions)
For palpation (to locate landmarks for positioning)
Use of (therapeutic) silence
– Provides a channel for both transmitting and
receiving messages.

Use of listening.
– Pay attention
– Shows caring
– Lean forward, nod head.
50
Nonverbal Communication

Professional appearance helps gain the
patient’s trust and confidence

To the patient, the caregiver’s personal
hygiene reflects a person’s professional
behavior.
51
Communication Considerations
Seriously ill or traumatized patients
 Visually impaired patients
 Speech or hearing-impaired patients
 Non-English-speaking patients

– Use of translators
Mentally impaired patients
 Substance abusers

52
Communication Considerations
Pediatric patients (large age span – big
communication differences)
 Geriatric patients
 Terminally ill patients

53
6. The application of
empathetic skills will:
A.
B.
C.
D.
E.
promote better health care outcomes
increase patient satisfaction
increase health care costs
a and b
all of the above
54
7. The lowest level of Maslow’s
hierarchy of needs is:
A.
B.
C.
D.
self-actualization
physiologic needs
love and belonging
self-esteem
55
8. According to Maslow’s hierarchy of needs,
what is the reason patients may behave
abnormally during their hospital stay?
A.
B.
C.
D.
Their physiologic needs aren’t being
met.
They cannot understand what is
happening.
They are missing their sense of love
and belonging
None of the above
56
9. All of the following are examples
of nonverbal communication except:
A.
B.
C.
D.
smiling at the patient
asking the patient for a medical
history
using a friendly tone of voice
having a puzzled facial expression
57
10. Why is it important for the radiographer to
make eye contact with the patient as she
describes the pain in her hand?
A.
B.
C.
D.
It provides emotional support for a
stressed patient.
It makes the patient feel that what she
is saying is important.
It helps to expedite the examination.
It reassures the patient of the
radiographer’s technical skills.
58
11. Nonverbal communication is not as
important as verbal communication with the
patient or family members.
A.
B.
True
False
59
12. In Maslow’s hierarchy of needs, a patient
cannot satisfy the need for love and belonging
before satisfying the need for safety and
security.
A.
B.
True
False
60
As a healthcare professional, and
even as a student…..
you are a customer service
ambassador of each clinical
education setting!
As such, you must ensure patient
safety and excellent care.
61
Five Fundamentals of Service
 Acknowledge the Patient
– By their last name if possible
 Introduce
– “ Hi. My name is Sue Jones and I am a radiography student. I am working
under the supervision of Anne RT and will be assisting with your
examination today.”
 Duration
– How long the exam will take?
– How long the patient will be there?
– How long they’ll have to wait for the results?
 Explanation
– Explain the test, the level of discomfort involved (be honest!)
– Explain you are going to be checking their name band and why.
 Thank You
– Thank you for choosing (Hospital name)
62
Grief is another issue that
Healthcare Professionals
have to recognize and deal
with.
63
What is Grief?
Grief is a normal emotional response to
the loss of a loved one, a prized
possession, social status, body function
or body part
 Imminent death
 Management of the grieving process is
dependent upon cultural religious and
economic factors

64
Kubler-Ross Theory of
Grieving
 Phase
1 – Denial – a defense
mechanism
 Phase 2 – Anger – therapeutic
 Phase 3 – Bargaining – seeking
alternatives
 Phase 4 – Depression – acceptance
of reality; mourning begins
 Phase 5 – Acceptance - grief
65
Patient’s Bill of Rights
American Hospital Association
66
Patient’s Bill of Rights
 Right
to Considerate and Respectful Care
 Right to know (informed consent)
 Right to refuse treatment
 Right to an advance directive (Living will)
 Right to Privacy
 Right to Confidentiality
67
Patient’s Bill of Rights
 Right
to review his/her records
 Right of referral or transfer (to another
hospital/physician)
 Right to know of business relationships
 Right to consent or refuse participation in
experimental treatment
 Right to expect continuity of care.
 Right to be informed of hospital policies
68
Patient Rights Related to Death,
Dying, and Medical Treatments
Science of medical care has intervened
and extended life by a mechanical
means
 May not be the wish of the patient
 Advance directives

• Legal document drawn up when patient is
well that outlines what patient would like
for end-of-life care
69
Patient Rights Related to Death,
Dying, and Medical Treatment

Types of advance directives
• Living Will – document that lists the patient’s
wishes if terminally ill
• Durable Power of Attorney for Health Care –
designates who will make health care decisions
for the patient if he or she is unable to do so
• DNR – instructions on a patient’s chart that
direct health care workers not to resuscitate the
patient if he or she stops breathing and the heart
stops beating
70
Patient Rights Related to Death,
Dying, and Medical Treatment
•DNI – instructs health care workers
not to intubate the patient if a
question of need arises
•Full Code – instructs health care
workers to initiate CPR if the patient
stops breathing and the heart stops
beating (Code Blue)
71
13. When family members accompany the patient to
the radiology department, both the family members
and the patient are treated with professional courtesy
and respect.
A.
B.
True
False
72
14 What is the acceptable reaction of the
radiographer in dealing with a patient in the
beginning stage of denial isolation?
A.
B.
C.
D.
addressing the patient’s feelings about
dying
offering silence and acceptance of the
person, without discussing death
supporting the patient’s feelings by
discussing the death of one’s own loved one
attempting to cheer up the patient by telling
jokes
73
15 Which of the following stages of dying is
described as the realization that life will be
interrupted before everything the dying patient
has planned has been accomplished?
A.
B.
C.
D.
denial
depression
anger
bargaining
74
Patient Assessment and
History Taking
Chapter 12
75
What is Patient Assessment?
 The
identification, ranking and
prioritizing of goals to determine
those problems or concerns that
can be solved through a systematic
process of problem solving
76
Purpose of Assessment in
Radiologic Technology
Assessment influences the decisionmaking process.
 It enables the radiographer to provide
appropriate patient care while
obtaining quality diagnostic images,
 Patient condition determines not only
HOW a procedure is performed but
WHAT images are obtained!

77
Characteristics of Assessment
Problem-solving
 Critical thinking
 Deductive reasoning
 Analysis
 Evaluative thought

78
Assessment uses the
Scientific Method
1.
2.
3.
4.
5.
6.
Identify the problem
Recognize limitations to solving the
problem (patient or equipment)
Identify available resources
(accessories or people)
Develop alternatives (plan A/plan B)
Implement the plan
Evaluate the results
79
Patient Assessment
includes:
Naturalistic
observation
 Physical signs
 Cultural assessment
 Assessment of
special needs
according to:
– age
– disability

80
Limitations of Assessment

Time constraints
– Adequate time to size up the patient and
ask the appropriate questions

Patient cooperation
– How able is the patient to provide the
necessary information?

Experience of the assessor
– Does the assessor know what to look for?

Personal bias of the assessor
– Does the assessor have preconceived
notions about the patient
81
Taking a Patient History
For Radiographer’s role is to collect a focused
history specific to the procedure that is to be
performed.
82
Data Collection
Objective data – perceptible to the
senses (seen, heard, felt)
 Subjective data – perceptible to the
affected individual (emotions, feelings,
experiences)


Objective data are not necessarily
more important than subjective data!
83
Questioning Skills
Listening is the most important
communication skill!
 Open-ended questions
 Facilitate (nod, encouragement)
 Silence (gives patient time to gather
thoughts)
 Probing questions (to focus interview)
 Rewording for clarification
 Summarizing to ensure understanding

84
Questioning Skills

Minimize use of medical terminology
unless patient obviously understands.

Avoid using leading questions – don’t
put words in the patient’s mouth.
85
Classification of Problems
THE SACRED SEVEN
(of chief complaint)
 Localization
 Chronology
 Quality
 Severity
 Onset
 Aggravating or Alleviating Factors
 Associated Symptoms

86
Localization
Where?
 If possible, have the patient point
 Be a specific as possible

87
Chronology of Symptoms
The order in which symptoms
occurred.
 What symptom occurred first? Second?
 Duration - When the
symptom/problem occurs, how long
doe it last?

88
Quality
Describes the character of the
symptoms
 Examples: color, consistency, type of
cough, what kind of pain (burning,
stabbing etc.)

89
Severity
Describes intensity of symptoms
 Can describe quantity or extensiveness
 Example of a question: “On a scale of
1-10; how bad is the pain?”

90
Onset


When did the problem/symptoms
begin?
How long has the problem/symptoms
been occurring?
91
Aggravating or Relieving
Factors
Are there any things that precipitate (seem
to cause or happen before) the patient
experiences the symptom(s)/pain?
 Is there anything that seems to relieve the
symptom(s)/pain?
 Does there seem to a be a predictable
progression of events that happens every
time the symptom/pain is experienced?
 Does it happen the same every time it
happens?

92
Associated Symptoms

Are there any other symptoms that
seem to accompany the
problem/symptom(s)?
93
Treatments
Is there anything that has been
prescribed to treat the problem?
 If so, what is it?
 Does is provide relief?
 If so, does it relieve the symptom/pain
completely? Partially?

94
Patients View of the Cause
Never under estimate the patient’s
opinion of the cause of the problem!
 Ask what the patient thinks is causing
the symptom(s)/pain/problem.
 Never discount the patient’s instincts!

95
What is in a (Hx) History?
General Health
 Childhood illnesses / immunizations
 Major illnesses *
 Injuries *
 Previous Surgeries *
 Previous Hospitalizations*
 Transfusions

96
What is in a History?
Current Medications *
 Allergies * (may be significant in
procedures requiring administration
of contrast media)
 Emotional health

97
Taking a History
 It
is important to
assure confidentiality
to the patient.
 Patients will be more
honest and open if
they can trust that the
information will be
treated with discretion
 Always ask history
questions in a private
setting!
98
Legal Considerations
(Documentation – written
record of events)
Always use ink
 Leave no blank spaces
or lines on charting
record
 Chart only for
yourself; never for
others
 Always correct
mistakes (date and
initial)
99

Legal Considerations
(Documentation)
Note both normal and
abnormal signs
 For non-routine
incidents or accidents
always document with
an incident report

100
History Questions for Chest
examinations
Fever?
Pain?
SOB
(Where? How long?)
(Shortness of Breath)?
Weight
Loss? (unexplained)
Hemoptysis
Previous
Known
(coughing up blood)?
surgery (what kind?)?
heart or lung disease?
Anemia?
Cough?
(Dry? or Productive?)
101
History Questions for
Abdominal Examinations




Fever?
Previous surgery? (type?)
N & V (nausea/vomiting)?
Distention (abdomen swollen)?
– Ascites (fluid collection)




Hematemesis (vomiting blood)?
Last BM (bowel movement)?
Pain? (where, what type,
precipitating factors?)
Hx of renal colic? (kidney stones,
hematuria)
102
History Questions for
Extremity (Injury)
When and how did it happen?
 Where is the tenderness (be specific)!?
 Is there edema (swelling)? Where? (be
specific!)
 Is the wound open or closed
(laceration vs. abrasion)?
 Is there a foreign body (sliver of glass,
needle etc.)?

103
Extremity (No injury)
Pain? (where? how long?)
 Fever?
 Edema (Swelling)?
 Is there a history of arthritis?
 Is the pain associated with an activity?

104
Cervical Spine (injury)
What is the nature of injury?
 Where is the pain? Does it radiate?
 Any paralysis?

– Where?

Any numbness or tingling?
– Where?
105
Cervical spine (no injury)

Pain in shoulder? arm? hand?
– Does it radiate?
Numbness or tingling?
 Hx of Arthritis?

– other joints?
106
Lumbar/Dorsal spine
Previous surgery or myelogram?
 Was there an Injury?

– When? What type?

Pain? Where? Severity?
– Does it radiate?
Pain in other joints?
 Hx of arthritis?

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Head (Injury)
What happened?
 Where (be specific)?
 Loss of consciousness?
(if so, how long)?
 Edema (swelling)? If so, where?
 Laceration? Bleeding? If so, where?
 Note patient alertness

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Head (no injury)







Vertigo? (dizziness)
Headaches? (location, duration)
Hx CVA (cerebrovascular accident; ie
stroke)?
Paralysis?
Visual disturbances?
Fever?
Other symptoms?
109
I.V.P.
(Intravenous Pyelogram)
Hx of renal colic?
 Hematuria (blood in urine)?
 Pyuria (pus in urine)?
 Previous surgery or stones?
 Bladder Hx: frequency? urgency?

110
I.V.P.
Hypertension (high blood pressure)?
 Hx of malignancy (cancer)?
 Anemia?
 Diabetic?

– currently taking glucophage?

Allergic History –
– Iodine, foods, medications?
111
U.G.I.
(Upper Gastrointestinal Series)
Intolerance to fatty foods?
 Pain?

– Severity, location, duration, precipitating
factors
Jaundice (yellow/orange cast to the skin)?
 Family hx of gallstones?
 Previous GI X-rays?
 Previous surgery?

112
U.G.I.
(Upper Gastrointestinal Series)
N & V?
 Dysphagia (difficulty swallowing)?
 Weight loss?
 Hematemesis (vomiting blood)?
 Blood in stools (red or tarry?)**

113
U.G.I (cont’d)
**Blood in stools can be either bright
red or tarry (black) in color.
 Red stools indicate bleeding from the
lower intestines (hemorrhoids for
example).
 Tarry stools indicate bleeding from the
upper G.I. Tract. Blood changes color
due to digestive juices which change
the color to a black or tarry appearance.

114
B.E.
Barium Enema
Previous GI X-rays?
 Previous surgery?
 Pain?

– Severity, location, duration, precipitating
factors?
N & V?
 Constipation? Diarrhea?
 Bleeding? (bright red vs. dark/tarry?)
 Weight loss?

115
16. Who is responsible for obtaining the clinical
history from the patient for the diagnostic
procedure?
A.
B.
C.
D.
the radiographer
the radiologist
the nurse
the emergency department physician
116
17. What is the significance of a
good clinical history?
A.
B.
C.
D.
It provides the referring physician’s
admitting diagnosis.
It provides general information about
the patient’s condition.
It focuses the radiologist’s attention on
a specific area.
It translates the patient’s complaints
into medical jargon.
117
18. A patient’s vital signs are as follows: heart
rate, 95; blood pressure, 120/75; temperature,
99.2º F. This information is considered:
A.
B.
C.
D.
objective data
chief complaint
clinical history
subjective data
118
19. The patient describes her chest pain by
saying, “It feels like someone is standing on my
chest.” This information is considered:
A.
B.
C.
D.
chronology
objective data
subjective data
none of the above
119
20. All of the following are used to provide a
better history to the radiologist except:
A.
B.
C.
D.
encouraging elaboration
using probing questions
summarizing the details
asking close-ended questions
120
21. The primary medical problem
as defined by the patient is called:
A.
B.
C.
D.
the clinical history
subjective data
the chief complaint
objective data
121
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