Transcript ch11 - SchultzMedic

Paramedic Care:
Principles & Practice
Volume 1
Introduction to Advanced
Prehospital Care
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Chapter 11
Therapeutic Communications
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Topics
Basic Elements of Communication
Communication Techniques
Patients with Special Needs
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Communication Components
Communication is the exchange of common
symbols.
Communication strategies include
persistently paying attention to word
choices, tones of voice, facial expressions,
and body language.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Basic Elements of
Communication
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Basic Elements of
Communication
Communication
consists of:
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A sender
A message
A receiver
Feedback
Encoding
Decoding
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Basic Elements of
Communication
Failure to communicate results from:
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Prejudice
Lack of privacy
External distractions
Internal distractions
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Trust and Rapport
With good rapport, the people you are
serving will follow your lead.
Techniques to develop good rapport include:
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Using the patient’s name
Address the patient properly
Modulate your voice
Be professional but compassionate
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Trust and Rapport
Techniques to develop good rapport (cont.)
– Explain what you are doing and why
– Keep a kind, calm expression
– Use an appropriate style of communication
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Professional Behaviors
First impressions are crucial
– The patient relies on visual input
Be neat and clean
Practice good hygiene
Stay physically fit
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Professional Behaviors
Maintain an overall demeanor that is calm,
capable, and trustworthy.
Be confident, not arrogant.
Be considerate.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Communication Techniques
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Communication Techniques
General Guidelines
– Patients generally respond to questioning in one
of three ways:
They may pour out information easily
They may reveal some things and conceal others
They may resist, hiding information from themselves
and, therefore, from you
– Remain non-judgmental
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Non-Verbal Communication
Consists of gestures, mannerisms, and
postures by which a person communicates
– Distance
– Level
– Stance
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Non-Verbal Communication
Distance
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Non-Verbal Communication
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Non-Verbal Communication
Getting down to a
patient’s level can
help improve
communications on
a pediatric call.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Non-Verbal Communication
A powerful source of effective
communication comes with eye contact.
Use eye contact as much as possible.
Remember to remove sunglasses while
working with patients.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Non-Verbal Communication
Use an
appropriate
compassionate
touch to show
your concern and
support.
Be careful to
touch
appropriately.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Interview Techniques
Questioning Techniques
– Use open-ended questions.
– Use direct questions.
– Do not use leading questions.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Interview Techniques
Questioning Techniques (cont.)
– Ask one question at a time, and listen to the
complete response before asking the next.
– Use language the patient can understand.
– Do not allow interruptions.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Observing the Patient
Overall appearance
– Clothing
– Jewelry
Mental status
Speech
Mood and energy level
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Effective Listening
and Feedback
Silence
Reflection
Facilitation
Empathy
Clarification
Confrontation
Interpretation
Explanation
Summarization
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Interviewing Errors
Providing false
assurances
Giving advice
Authority
Using avoidance
behavior
Distancing
Professional jargon
Talking too much
Interrupting
Using “why”
questions
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Patients with Special Needs
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Sources of Difficult Interviews
Difficult interviews may stem from several
sources:
– Patient’s physical condition
– Patient’s fear of talking
Psychological disorder, language or cultural difference,
or even the difference between your ages
– Patient’s intention to deceive
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Sources of Difficult Interviews
Use the same techniques on a patient who
is reluctant to talk to you as you would on
any other patient.
– Provide positive feedback to any response the
patient provides.
– Make sure the patient understands you.
– Continue to build trust and rapport with the
patient.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Sources of Difficult Interviews
Difficult interviews include:
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Children and their parents
Elderly people
People who are blind or deaf
People of other cultures
People who are hostile or uncooperative
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Childhood Development
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Children
Start by talking to the caregivers, then
gradually approach the patient.
– Remember body language
Explain what you intend to do, even to very
young children.
You must build trust.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Elderly Patients
Be respectful.
– Always use a formal means of address
Speak slowly and clearly.
Interviews might take longer.
– Physical limitations
– Fatigue
Compassionate touch can be a welcome
and important means of nonverbal support.
Give choices whenever possible.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Sensory Impairment
Blindness:
– Tell patient everything you are going to do.
– Use touch as a form of contact for reassurance.
Hearing impairment:
– Ask patients what their preferred method of
communication is.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Language and Cultural
Considerations
Understand that cultures vary and
ethnocentrism hinders communication.
There is additional fear when a patient
cannot understand your language.
Avoid cultural imposition.
– Avoid imposing on the patient your own beliefs,
values, and patterns of behavior.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
If Using Interpreters
If a child interprets, use an age-appropriate
level.
The emergency may cause distressing
emotions, especially if the interpreter is a
child.
Speak slowly.
Phrase questions carefully and clearly.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Interpreters
Address both the patient and the interpreter.
Ask one question at a time, and wait for the
complete response.
The information you receive may not be
reliable.
Have patience.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Hostile or
Uncooperative Patients
Set limits and boundaries.
Document unusual situations.
Consider having a same-sex witness ride in
the ambulance.
If your safety is in jeopardy, keep away from
the patient.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Hostile or
Uncooperative Patients
Have an appropriate show of force if
necessary.
Know local policy regarding restraints and
psychological medications.
Use law enforcement if needed.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Transferring Patient Care
Before patient care is transferred to you,
listen to the report carefully.
Interact with colleagues with respect and
dignity.
Give a report to the receiving nurse or
doctor.
Introduce the patient by name, and say
good-bye.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Summary
Basic Elements of Communication
Communication Techniques
Patients With Special Needs
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ