Patients With Communication Challenges and Interviewing with a Second Person in the Room Flashcards
What are some personal behavior changes necessary when using an interpreter?
Talk to the PATIENT, not the interpreter
Use a trained interpreter rather than family member/friend when possible — in person is best but phone services can be used
When family member is used, set ground rules and tell them to translate EXACTLY, avoiding adding/subtracting any information
Position the interpreter behind you
Keep them on the phone for exam and closing, so that you can continue translating what you are going to be doing to examine the patient and what the plan is
What are some changes in speech patterns required when using an interpreter?
Speak in shorter sentences, avoid medical jargon
What are some empathetic behaviors that can be used despite communication barriers?
Facial expressions, eye contact, acknowledgement, human touch
Use cultural competence — regional differences in language, religious or ethnic differences, expectations of treatment, generational differences
Ask the patient to explain what they think is wrong, what they call the problem, what they believe the cause is, how it is affecting their body/mind, what they are most concerned about
Beware of personal bias like ageism, religious bias, or other boundaries
How can the teach-back technique be used to insure pt understanding?
Check for comprehension by asking the pt to summarize
Can also write down tx plan and have interpreter transcribe it in pt’s language —note that written material should be at 4-5th grade level and review it verbally with the patient to verify understanding
Can color-code medications or other tx plans for illiterate pts
What are some strategies for communicating with the hearing impaired?
Ask if they need to lip-read when you are speaking
Position yourself on the better hearing side
Smile and use eye contact, face the light
Do not cover your face or mouth
Use plain language and speak clearly but not too slowly; do not shout
If stuck, write it down
Check for understanding; never say “forget it!”
Communication strategies for low vision/blind pts
Face the pt as you would any other
Ask them how best you can help them with position changes
Blind does not mean cognitive impairment
Communication strategies for cognitive impairment (mentally handicapped, CVA, brain injury, illiterate, low healthcare literacy, etc.)
Talk directly to the pt
May need to illicit info from a caregiver or family member (with pts permission)
Pictures or visual aids may be helpful
5 steps to patient-centered interviewing
- Set the stage for the interview
- Elicit chief concern and set agenda
- Begin interview with non-focusing skills that help patient express him/herself
- Use focusing skills to learn 3 things: symptom story, personal context, and emotional context
- Transition to middle of the interview (clinician centered phase)
NURS mnemonic for responding to feelings/emotions with empathy
N = Name
U = Understand
R = Respect
S = Support
What are some added values to having a third party present during the pt interview?
Provide sense of security/comfort to pt
Can provide info that would otherwise be unavailable
Third party may help explain things to pt, or convince them to have necessary measures taken (admit, labs, tests, etc)
Can help you understand limitations of pt
Pick up on info that the pt might miss
Initial steps to setting up interview when another person is present
Introduce yourself to all persons in the room
Identify who all parties are and their relationship to pt — determine if pt wants them there
Sit close to pt and have other parties move as needed
Express to other parties that you value their input but you will be speaking to pt first then ask them later if needed
Demonstrate empathy and attentiveness to pt and family
Steps taken throughout interview when another party is present
Observe how other parties interact with pt
Weigh whether more or less info is being obtained with them present — may need to ask them to leave
If third part is disruptive in any way, focus on them and gather info they have to offer, then respectfully excuse them from room (a good time is during PE)
T/F: you should ALWAYS insist on having some alone time with the adult patient
True — especially if the pt is female and is accompanied by a male
Ask the partner to wait outside during the PE; allows you to explore possibility of domestic violence, trafficking, etc
If partner refuses to leave, get help from supervisor
Make sure to have chaperone present if performing a sensitive exam
Why is it so important to consult with family/third parties for less responsive, very ill, or dying patients?
You need to identify if pt has advance directive, living will, power of attorney, etc
Family’s wishes need to be heard and they must feel understood
Most states have state consent laws that apply to all minors age 12+ requesting what types of services?
Contraception, STI services, prenatal care, adoption placement, medical care for their child, abortion services
Many states allow, but do not require, a provider to inform a minor’s parent or guardian when the minor seeks service for reproductive care — often left to discretion of physician
