Chapter 6 Flashcards
- Gender groups: Male or female
- Racial groups: Distinguished by skin color and other physical characteristics
- Generational groups: Generation Y (millennials), generation X (those born between the early 1960s and 1980), baby boomers, and the elderly
- Geographic groups: North or south; east coast or west coast; native cultures in Hawaii, Alaska, and on and around reservations, plus areas where ethnic culture endures because large numbers of immigrants from a certain country have settled there, such as Mexican influences along the southern borders of Texas and California and the Scandinavian heritage in Minnesota
- Sexual preference groups: Heterosexual, gay, lesbian, bisexual, and transgender
- Religious groups
- Groups based on nonracial physical characteristics: Blind, deaf, disabled, and/or obese
- Socioeconomic groups: Low income (unemployed, welfare recipients, uninsured, underinsured), middle income, or affluent
- Groups with various types of family structure: Singles, unmarried couples with and without children, traditional nuclear families, single mother or single father heads of households, parents with children and grandchildren, and large, close-knit extended families
Cultural groups
- Patients expect to know and understand details of their conditions and treatments.
- Direct eye contact is expected; avoid excessive direct eye contact with members of the opposite sex to avoid any hint of sexual connotation.
- Emotional control is expected. Privacy is important and must be respected.
- Decisions are made by individuals for themselves and may be made by either parent for a child.
- Independence is valued, and self-care concepts are generally accepted.
Anglo-American
-patients may not trust “white institutions” such as hospitals, and may be easily upset by what they perceive to be discrimination. Be especially sensitive to this issue.
* Do not refer to a man as a “boy” or a woman as a “gal.” These terms are often perceived as insulting. Address individuals using their titles and last names.
-The father or eldest male may be the spokesperson or primary decision maker.
* They may believe that disease is caused by improper diet, exposure to cold or wind, punishment by God for sin, or voodoo spells.
* Many have a present time orientation
African American
- The patient may indicate agreement with no intention to follow through; therefore, it is important to explain reasons for compliance with instructions and to ask open-ended questions instead of those that can be satisfied with a “yes” or “no” answer.
- Avoid direct eye contact and hand gestures.
-There are no pronouns - Tremendous respect is accorded to the elderly.
- Traditional healing methods include coining, cupping, the use of herbs, and changes in temperature.
Asian
This group includes Hindus and Muslims (followers of Islam) from India, Pakistan, Bangladesh, Sri Lanka, and Nepal.
East Indian
- Direct eye contact may be perceived as rude or disrespectful, especially among the elderly.
- Silence may indicate acceptance or approval.
- Men should avoid shaking hands with women unless they extend their hand first.
- The father or eldest son usually has decision-making power after other family members have been consulted.
- Husbands may answer questions addressed to their wives.
East Indian
- Family members are likely to want to stay with patients and assist them with activities of daily living rather than allowing these tasks to be done by professional caregivers.
- Patients may refuse certain foods or medications that they believe will upset the body’s hot-cold balance. Avoid ice water unless requested. A high fat content in food may be perceived as healthy.
- Many have a present-time orientation
- Patients may respond to pain with loud outcries, depending on the audience. Men may be more expressive around family members than with health professionals.
- Traditional wives will defer to their husbands for decisions that involve care for themselves or their children.
Hispanic
- There is a tendency to be loud and expressive, especially during childbirth, when someone has died, and when in pain.
- Family members may feel responsible for ensuring the best care possible, and so may make emphatic demands of health care personnel.
- Sexual segregation is extremely important; therefore, same-sex caregivers should be assigned whenever possible. Every effort must be made to maintain a woman’s modesty at all times. Women do not wish to remove their headscarves (hijabs), especially in the presence of men.
-Do not eat pork
-The evil eye of envy may also be thought to cause illness or misfortune
Middle Eastern
- Stories and metaphors may be used to communicate ideas. For example, a story about a neighbor who is ill may be a patient’s way of describing his own symptoms.
- Long pauses in a conversation usually indicate that careful consideration is being given to a question. Do not rush the patient.
- Loud or aggressive behavior is considered offensive and should be avoided.
- Direct eye contact should be avoided, both as a show of respect and because some may believe that this threatens the loss or theft of their soul.
- Traditional healing may be combined with the use of Western medicine.
Native American
- Family members will be anxious about patients and will expect frequent updates about progress, treatments, and tests.
- Loud, abrasive demands for attention may be a reflection of the fact that this attitude was necessary to meet one’s needs
- A warm, caring attitude on the part of caregivers is especially welcome.
Direct eye contact and a firm, respectful attitude are comfortable. Address patients using titles and last names. Hand gestures and facial expression may be used by patients, especially when not proficient in English
Russian
a system designed to provide benefit
medical regimen
discriminating against someone based on his or her size
Sizeism
requires radiographers to
put aside all personal prejudice and emotional
bias, rendering services to humanity with full
respect for the dignity of humankind
The ARRT Code of Ethics
-eye contact
-touch
-apperance
Nonverbal Communication
Reassures the patient that you are both capable and caring
positive touch
Ability to give the speaker your full attention and focus
-respond to what has been said
Listening Skills
Ability to use language and content that is appropriate for your patient
Verbal Skills
revealed by nonverbal behaviors and also by tone of voice and choice of words
Attitude
Valuable strategy in communication and should not be confused with aggression
-desirable behavior characterized by a calm, firm expression of feelings or emotions
Assertiveness
Undesirable behavior characterized by anger or hostility
Aggressiveness
An indication of a clear understanding of the message
Validation of Communication
Neither party can be certain that all elements of a message have been correctly understood
Without validation
Interferes with our ability to process information accurately and appropriately
Stress
Suggestions to improve communication effectiveness in a crisis situation:
- Lower your voice, and speak slowly and clearly when a situation is highly emotional.
- Be nonjudgmental in both verbal and nonverbal communication.
- Do not allow an upset individual’s inappropriate actions or speech to goad you into a similar response.
- When you are uncertain whether the listener has understood you, request an answer. For example, “Did you read the consent form? What did it say?”
The quality of having the ability or tendency to function independently
(Self determination)
Autonomy
Addressing the patient
Valid choices
Avoiding assumptions
Assessment through communication
Therapeutic communication
Communication with Patients
Introductions are normally first.
Avoid impersonalizing patients, such as identifying
patient by the exam rather than by name.
Address patient appropriately.
Avoid use of “honey,” “sweetie,” or other such names
Addresing the patient
Defined as alternatives that are all acceptable to
you
Provide patient with a sense of participation in his or her care
Valid choices
Helps in preventing errors during procedures
Avoiding Assumptions
Use of routine positioning techniques for all
outpatients
Patient understood and followed preparation
procedures for contrast
Common assumptions
Combining observation with therapeutic
communications to determine patient’s ability
to cooperate with the examination
Assessment Through Communication
A process in which the healthcare professional
consciously influences a client or helps the client
to a better understanding through verbal or
nonverbal communication
Therapeutic Commmunication
-Rejecting
-Disapproving
-Disagreeing
-Advising
-Requesting an explanation
-Indicating the existence of an external source
-Belitting feelings
-Denial
-Changing the subject
Deterrents to Therapeutic Communication
-Using silence
-Accepting
-Giving recognition
-Using general leads (using neutral expressions to encourage continued talking by the client)
-Placing the event in time or sequence
-Making observations
-Encouraging description of perceptions
-Restating
-Reflecting
-Focusing
-Exploring
-Giving information
-Seeking clarification
-Presenting reality
-Voicing doubt
-Attempting to translate into feelings
-Suggested collaboration
-Summarizing
Therapeutic Communication Techniques
Patients who do not speak English
The hearing impaired
Deafness
Impaired vision
Inability to speak
Impaired mental function
Altered states of consciousness
Special Circumstances That Affect Communication
Federal law guarantees the patients the right to (patient’s who do not speak english)?
Effective communications
The use of family members as interpreters are problematic because
They tend to edit conversation
When using the interpreter
Look at the patient when speaking
Talk to, not about, these persons.
Get the patient’s attention before starting to speak.
Face the person, preferably with light on your face.
Hearing loss is frequently in the upper register, so
speak lower as well as louder.
Speak clearly at a moderate pace, and do not shout.
Avoid noisy background situations.
Rephrase when you are not understood.
Be patient.
Communicating with individuals who have hearing loss
Becomes more and more essential when hearing is impaired
Visual clues
They have their own culture
Deaf persons
Chart should be flagged to alert care providers that patient is
Deaf
-Does not respond to noises or words spoken out of the range of vision
- Uses lip movements without making a sound or speaks in a flat monotone
-Points to the ears and mouth while shaking the head in a negative motion
-Uses gestures or written motions to express the need for paper and pencil
Alert patient is totally deaf
Ability to function depends on degree of vision
loss and length of time since sight was lost or
impaired.
Impaired Vision
2 ways blind people ask for assistance when needed-
-Some will prefer to touch your elbow as a guide
-Others will prefer a description of the surroundings
is a defect or loss of language function in
which comprehension or expression of words is
impaired because of injury to language centers in
the brain.
Aphasia
is a defect or loss of language function in
which comprehension or expression of words is
impaired because of injury to language centers in
the brain.
Aphasia
Some can write; others will nod to indicate understanding
Inability to speak
Loss of the ability to see, hear, or speak is a communication impairment and not a reflection of
The individual’s ability to think
Inappropriate to treat adults with mental
disabilities as if they were children.
Repeating instructions is often useful.
Impaired Mental Function
Requires two patient identifiers to validate identity before proceeding with patient care or services
The joint comission
Change in the ability to respond, react, and cooperate can result from injury, illness, medication, alcohol, or drugs.
Altered States of Consciousness
Two points in communicating with patients who are drowsy or in a stupor
- They cannot be relied upon to remember instructions
- They are not responsible for their actions or answers
Any patient with decreased level of unconsciousness
Must be kept under constant and close observation
1-2 years
Toddler
3-5 years old
Preschooler
birth to 1 year old
neonate and infant
6 to 12 years old
School age
13 to 18 years old
Adolescent
46 to 64 years old
Middle adult
65 to 79 years old
Late adult
19 to 45 years old
Young adult
80 years and older
Old adult
A discriminatory attitude toward elderly that includes a belief that all elderly are ill, disabled, worthless, and unattractive
Ageism
-it is important to be aware of your tone of voice and facial expression
-keep them tightly wrapped in a blanket, except when they must be uncovered for imaging.
- strong bond is established between parent and infant, so involve the parents in the examination and keep them in the infant’s line of vision as much as possible. When parents cannot be present during the examination, remember that infants feel most secure when being held, so hold and cuddle the child to meet this need.
-Never leave an infant on a flat surface unattended. Keep the crib rails up at all times, and immobilize the infant during the examination whenever it is necessary
Neonate
-communicate using two- and three-word sentences.
-They like to explore and manipulate their environment
-Allow the toddler choices when possible, and when necessary, explain to parents that immobilization techniques will need to be used to obtain the child’s radiographic images.
-Allowing the toddler to take a favorite blanket or toy to the radiology department may help promote a feeling of security.
Toddler
-They are demonstrating increasing independence; they are conversational and able to share information with you; and they can cooperate more fully, but they also fear a loss of self-control and need to make valid choices even
-This age group also has a short attention span, and a demonstration is often more effective than verbal instruction.
more than do adults.
-use praise and rewards for good behavior and cooperation.
Preschooler
-Children in this age group can think logically about anything that can be touched and seen.
-Give concrete information about the examination; be specific about the body areas or parts that will be affected. Be honest and let them know whether they will experience any pain or discomfort.
School age
-fear threats to their physical appearance and loss of control and independence
-Respect their concern for modesty and fear of embarrassment
-This age group has moved past the physical or concrete properties of a situation and is capable of understanding abstract principles.
-Avoid using an authoritarian approach and involve them in as much decision making as possible.
Adolescent
-are searching for and finding their place in society
-They may be struggling with moving from dependency to roles of responsibility with higher education, the start of a career, marriage, children, and the care of aging parents.
-Involve them and their significant others in the procedure and any decision making. Tailor your instructions and explanations about the procedure to their level of understanding.
Young adult
- may be experiencing lifestyle changes and changes that affect them physically and cognitively
-there may be vision and hearing loss, decreased short-term memory, decreased balance and coordination, loss of bone mass and skeletal height, loss of skin elasticity, and a decreased metabolic rate, which will make them less tolerant of heat and cold.
-Allow them to make choices and involve them as much as possible in the examination.
Middle adult
Developing slowly and persisting for a long period
Chronic
-May require special attention
-A decrease in mental acuity may make it necessary to present one idea at a time, emphasize concrete rather than abstract ideas, keep distractions to a minimum, use tactile cues, and ask for feedback to ensure understanding.
-Keep instructions simple and give one instruction at a time. Using valid choices and treating older patients with the respect due any adult helps them to maintain their sense of identity.
Late adult
Opportunities
During the explanation of procedures
While responding to patient concerns
As part of the instructions needed to prepare for a
procedure
During instruction for follow-up care
Written materials useful for complex preparation
or follow-up
Patient Teaching
Your communication with families often involves the transfer of practical information.
Empathy and patience are required.
Useful information:
Restrooms
Cafeteria
Waiting areas
Length of procedure
Delays encountered
Follow-up care
Communication With Patient Families
Prediction of a probable outcome of a disease
Prognosis
Cooperation with other healthcare providers
makes it easier to accomplish common goals
for patient.
Good interpersonal communication skills are
essential.
Effective, efficient communications
Be a good listener.
Avoid gossip
Communication with Coworkers
Identification of a disease
Diagnosis
Kübler-Ross stages of grief:
-Denial
-Anger
-Bargaining
-Depression
-Acceptance
experiences frustration, outrage; may vent
on healthcare workers
Anger
refuses to accept the truth; may refuse to
discuss the possibility of loss or death
Denial
attempts to earn forgiveness or
mitigate loss by being “very good”
Bargaining
often acquiescent, quiet, and
withdrawn, and may cry easily
Depression
accepts the loss or impending death
and deals with life and relationships on a more
realistic, day-to-day basis
Acceptance
Gerk term “hos”
a place of shelter
A service rather than a place
Hospice
A substance or treatment that soothes or relieves but is not intended to cure
Palliative treatment
The branch of medicine concerned with the study, diagnosis, and treatment of malignancy
Oncology
