Communication Stations Flashcards
What is the general framework for communication stations?
Introduce yourself
Establish a plan
Establish patient’s initial understanding (open Qs)
Ask if patient has questions or concerns
Explain procedure/test/procedure (avoid jargon, use diagrams, check understanding)
Conclude with a brief summary, give leaflet and offer to meet again/give contact info
What is the target INR for people with AF, PE, DVT, Mechanical valver?
2-3
How would you start a warfarin counselling consultation?
‘We recommend that you start taking a new medication called warfarin because of your —-. Have you heard of warfarin?
I’d like to explain how warfarin works and why it has been recommended that you take this medication’
How would you describe warfarin to a patient?
A medication that thins you blood, reducing the risk of blood clots forming in your heart, lungs and legs. This is why it is important to take it regularly’
What important bits of information do you need to include in a warfarin consultation?
Impact on life (diet, alcohol, activities)
Blood test monitoring and yellow book
Doses and timings, what to do if you miss a dose
What to watch out for/emergency bleeding
What should you warn the patient to look out for and contact GP or NHS-24 immediately?
Bleeding or severe bruising Prolonged nose bleeds Coughing/vomiting blood Black tar like bowel motions Haematuria
What are some common patient concerns about taking opiates
Will I become addicted
Will morphine make me die sooner
If I take morphine now, will it mean it won’t work later on when I really need it?
How would you address the concerns that opiates won’t work later on if you start them now
Tolerance does occur but it doesn’t mean that the drug won’t work, you may just need higher doses
When pain worsens it is usually due to disease progression but the dose can be increased.
Emphasise the use of regular medication and extra to control breakthrough pain
List the common side effects of opiates and what can be done to combat them
Constipation (use prophylactic Senna or lactulose)
Nausea (common but clears after 1 week, cover with anti-emetic)
Drowsiness (usually acute, alternative fentanyl considered)
Myoclonus (esp renal impairment, reduce dose/change opioid)
Hallucination (reduce dose)
Tolerance (increase dose for genuine pain control)
What is usually given for breakthrough pain?
Oramorph
What opiate is more appropriate in patients with renal dysfunction?
Alfentanil
What other things do you offer a patient in chronic pain?
Referral to chronic pain clinic Spiritual/emotion support Relaxation techniques and mindfulness Acupuncture/aromatherapy TENS (transcutaneous electrical nerve stimulation)
Name 8 modifiable risk factors for cardiovascular disease
Smoking Dyslipidaemia Hypertension Obesity Excess alcohol Excess salt Lack of exercise Environmental stress
Lifestyle advice
WAFFLES Weight (BMI 20-25) Alcohol Fruit and veg (5-8 portions a day) Fat (reduce total) Low salt Exercise (30 mins per day, ideally every day) Smoking cessation
What is the technique for breaking bad news?
SPIKES Setting Perception Invitation Knowledge Empathy Strategy/summary
What does the setting involve for breaking bad news
I have given my bleep to a colleague, found a private room, curtains drawn
What does the perception step of SPIKES involve?
What do they know so far?
Current expectations
Concerns of relative
What does the invitation step of SPIKES involve?
Establish whether they want to find out more information
How do you tell people the bad news once you’ve found out that they want to know?
Convey important information, emphasise care that will be done and comfort
Check understanding
Show empathy and recognise response
Explore response further, allow silence, offer tissues
Form a strategy and summary to close the conversation
Give opportunity to speak again
How are you getting home?
How do you respond to a dementia patient when they tell you they ‘have to find their parents and let them know they are okay’?
Don’t correct them by orientating them, they may get distressed
Don’t collude with them because that would involve lying.
Instead, gently redirect them by saying ‘I will make sure your family are informed about what it going on. Who is in your family?’
Other tips for speaking to a dementia patient
Introduce yourself and start by calling them a formal name (eg Mrs Morris) and then find out their preferred name.
Don’t stand over them
Patience, steer conversation when you can
Minimise other distractions and stimuli
Keep questions simple
How can you find out what’s really going on with a patient with dementia?
Talk to nursing staff/OTs to find out baseline functioning level and pattern of behaviour
Get a good collateral history from carers/family
Find out about what their usual response to pain is
What do you do it a dementia patient doesn’t understand what you are saying?
Ensure they can hear you (hearing aids/speak louder)
Use visual cues
Try saying things in a different way
Name some ‘challenging behaviour’ in patients with dementia
Wandering Restlessness Agitation Incontinence Perseveration (repetition) Paranoia Sleeplessness/’sundowning’ Hallucinations Physically or sexually inappropriate behaviour
How do you deal with challenging behaviour from patients with dementia?
Validate: acknowledge the persons behaviour as a personal expression, not simply a symptom of the dementia.
Emotional connection: understand the emotional context behind the behaviour.
Reassurance: Anything from presence and a calming voice, to a gentle hand on their arm.
Activity: being occupied is a great anxiety-reliever! This can help to reduce agitation and give the person the feeling of purpose
