CH.1 Preparing for the Patient Encounter Flashcards
Role of the Rt in Patient Assessment
–RTs are called to assist the physician in the process of diagnostic reasoning
–this requires that RTs be skilled at critical thinking while evaluating very sick patients
3 Main Elements for Patient-Centered Care
–individualized care
–patient involvement
–provider collaboration
Two-way partnership between providers and patients and families
–care given is consistent with each individual’s values, needs, and preferences
–patients become active participants in their own care
Individualized Care
–empathetic communication
–respect for patient values/privacy
–sensitivity to cultural
Patient Involvement
–patient education
–shared decision making
–patient participation in care
Provider Collaboration
–communication
–coordination
–shared responsibility
Providing Empathetic Two-way Communication
–underlying patient-centered communication
—involves both sending and receiving meaningful messages
–if the receiver does not fully understand the message, effective communication has not occurred
–messages are altered by feelings, language differences, listening habits, comfort with the situations, and preoccupation
Factors Influencing Effective Communication
–Internal Factors: previous experiences, attitudes, values, cultural heritage. religious beliefs, listening habits, feelings
–Sensory Factors: fear, stress, anxiety, pain, mental acuity, brain damage, Hypoxia, sight, hearing, speech impairment
–Enviromental Factors: lighting, noise, privacy, distance, temperature
–Verbal Expression: language barrier, jargon, choice of words/questions, feedback, voice tone
–Nonverbal expression: body movement, facial expression, dress, professionalism, warmth, intrest
Stages of Patient- Clinician Interactions
–Chart Review Stage (Preinteraction): most patient encounters begin with RT reviewing patient’s chart to identify name, age, chief complaints, and history of present illness
–clarify in your mind what your role will be with this patient
–Look a the chart before you see the patient
–if it wasn’t documented its wasn’t done
Stages of Patient-Clinician Interaction
–Introductory Stage: purpose is to introduce yourself to the patient and begin to establish a report
–Look and act in a professional manner
–use patient’s formal name initially until he/she gives you permission to use a first name
–verify patient identification
Stages of Patient-Clinician Interaction
–Initial Assessment Stage: observe patient’s general appearance and response to questions
–identify patient’s baseline condition and need for treatment the physician has ordered
–avoid interrupting the patient
–overlaps with the introductory stage
Stages of Patient-Clinician Interaction
–Treatment and Monitoring Stage: monitoring the patient’s response to the treatment is important
–demonstrating and teaching treatment techniques
–after the initial assessment, you are ready to administer the treatment
–if the patient has side effects, the treatment should be stopped–may need to modify treatment
Stages of Patient-Clinician Interaction
–Follow-up Stage: Let him/her know when you will return and how to contract you if needed
–after treatment is over, take a minute to communicate with the patient
–make sure the patient is comfortable before you leave
–Use the correct word choice
Respecting Patient Needs and Preferences
–Providers must respect each patient’s needs, preferences, and privacy
–the individual patient’s response to disease be determined as part of the initial patient encounter
–care plans should reflect each individual patient’s preferences
Assuring Privacy and Confidentiality
–all information about the patient is confidential
–RTs must not share patient information with others who do not need to know about the patient
–violations of confidentiality are unethical and may be subject to legal recourse
Health Insurance Portability and Accountability Act
–Passed by Congress in 1996 to increase one’s ability to transfer health care information from one provider to another
–Title II of this law took effect in 2003 and established rules for disclosure of Protected Health Information
–Only approved health care providers can have access to PHI
Social Space
– 4 to 12 feet from the patient
–useful for the initial introduction
Personal Space
– 2 to 4 feet from the patient
–useful for the interview
Intimate Space
– 0 to 2 feet from the patient
–useful only for the physical examination
Expressing Genuine Concern
–face the patient squarely
–use eye contact appropriately
–maintain an open posture
–Consider appropriate use of touch: difficult to use when patient is a different gender or from another culture
–be an active listener
Culturally Competent Communication
–Strategies: active listening, attending to individual needs, eliciting patient concerns, and expressing genuine concern
–Self-awareness: knowledge of one’s own cultural beliefs as well as any potential stereotypes one might hold about particular groups
–Situational Awareness: ability to recognize misunderstandings associated with patient-provider cultural differences as they occur during a patient encounter
–Culturally Competency: clinician should be able to adapt to the specific situation by individualizing the communication approach in a manner consistent with the patient’s and family’s values and beliefs
Learning Needs Assessment
–Identify and accommodate barriers to patient learning
–assess the patient’s preferred learning method
–evaluate the patient’s readiness to learn
–determine the patient’s specific learning needs
Questions in the Phase of the Assessment should address
–understanding of the current condition or disease process
-knowledge of prescribes medications
–familiarity with procedures you will implement
–familiarity with the equipment needed for care
–teach-back method
–return demonstration
Barriers to Patient’s Learning
–Age
–Reduced level of consciousness
–presence of pain
–presence of anxiety
–physical limitations
–low educational level
–language
–culture
–religion
–vision and hearing
Creating an Action Plan
–Make them S.M.A.R.T goals
—-S: specific
—-M: measurable
—-A: action oriented
—-R: realistic
—-T: time limited
–Involve the patient and family
–promote infection control
–use the “ Speak Up” initiative
Developing an Action Plan
–include patient goals
–identify the barriers to reaching goals
–develop a plan for overcoming barriers
–determine how action plan compliance will be measured
Standard Precautions
–Hand hygiene
–gloves
–gown
–face masks
–eye protection
-=-respirators
–patient care equipment
–needles and sharps
–patient resuscitation devices
Enhancing Interprofessional Communication
–The Joint Commission defines effective communication as being timely, accurate, complete, unambiguous, and understood by the recipient
—implement active listening and communicating skills
—verify orders as accurate and complete
—decrease errors
—improve patient safety
Coordinating Patient Care
–RTs needs to communicate with an interdisciplinary team to
—schedule procedures at times least likely to conflict with other essential patient activity and most likely to coincide with any relevant drug regimen
—coordinate patient handoffs
Coordinating Patient Care
–Standardized method is the SBAR format
—S: situation
—B: background
—A: assessment
—R: recommendation
Discharge Planning
–time frame for implementation
–clearly defined responsibilities of team members for daily care
–mechanisms for communication among members of the health care team
–arrangements for patient integration back into the community
–plans for medication administration
–strategies for patient self- care as appropriate
–securing and training caregivers
–plans for monitoring and responding to changes in the patient’s condition
–alternative emergency and contingency plans
–plans for use, maintenance, and troubleshooting of equipment
–ongoing assessment of outcomes
–specification of follow-up mechanisms
Sharing Responsibility
–integrated care requires that all the clinicians involved in a patient’s management share a common set of goals and assume joint responsibility for their achievement
–the team as a whole must coordinate individual efforts and evaluate their overall success
–combine interdisciplinary intensive care unit rounds with a daily goals form
Speak Up Method
