Therapeutic Communications Presence Regional EMS System January 2014 Continuing Education Objectives  Outline the basic components of effective interpersonal communication  Discuss the techniques of effective verbal communication  Describe means of communication other than verbal. Objectives  Understand special considerations in communicating with older people, children, hearing impaired patients, visually impaired patients and non-English speaking patients  Demonstrate communication techniques that can be used with challenging patients Poor Communication Skills  Miscommunications  Lack of understanding  Poor listening  Missed non-verbal cues Communications  Huge part of the job  Patient  Family  Bystanders  Co-workers  Mutual aid providers  Emergency Department Communication Components  Communication is the exchange of common symbols:  Written  Spoken  Body language  Signing Not As Easy As It Sounds  Barriers to good communication  Patients in crisis ↑ Anxiety  You are a stranger  Not know the code It helps if . . .  Word choices  Tone of voice  Facial expressions  Body language Communication is helped by  Two way street  Generally want to help  Empathy vs. sympathy Basic Elements of Communication Communication consists of a sender, a message, a receiver, and feedback. Creating the Code  Describe the simple object in the picture without saying what it is.  Use simple directions of lines and circles  Don’t use the name of the object in your description.  Don’t say what the object is used for in your description Failure to Communicate (1 of 2) Prejudice:  Or lack of empathy  Lack of privacy:  Inhibits the patient’s responses  Failure to Communicate (2 of 2)   External distractions:  Traffic, crowds, loud music, EMS radios, TVs Internal distractions:  Thinking about things other than the situation Patience and flexibility are hallmarks of a good communicator. Trust and Rapport (1 of 2) Use the patient’s name.  Address the patient properly.  Modulate your voice.  Be professional but compassionate.  Trust and Rapport (2 of 2) Explain what you are doing and why.  Keep a kind, calm expression.  Use an appropriate style of communication.  Professional Behaviors (1 of 2)  First impressions are permanent. Professional Behaviors (2 of 2) Be neat and clean; practice good hygiene.  Stay physically fit.  Maintain an overall demeanor that is calm, capable, and trustworthy.  Be confident, not arrogant.  Be considerate; wipe your feet, etc.  Communication Techniques Sometimes you can read a person like a book Getting down to a patient’s level can help improve communications on a pediatric call. An open stance. A closed stance. “Don’t invade my space” Eye Contact Use eye contact as much as possible.  Remember to remove sunglasses while working with patients.  Use an appropriate compassionate touch to show your concern and support. Questioning Techniques (1 of 2)    Use open-ended questions. Use direct questions. Do not use leading questions. Questioning Techniques (2 of 2) 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.  Observing the Patient Overall appearance  Clothing  Jewelry  Mental status  Speech  Mood and energy level  Listening and Non Listening  Pseudo listening  Selective listening  Insulated listening  Defensive listening  Ambush listening  Insensitive listening Feedback and Active Listening  Encoding  Interpretation  Feedback Effective Listening and Feedback      Silence Reflection Facilitation Empathy Clarification  Confrontation  Interpretation  Explanation  Summarization Interviewing Errors  Providing false assurances  Giving advice  Authority  Using avoidance behavior  Distancing  Professional jargon  Talking too much  Interrupting  Using “why” questions Patients with Special Needs Sources of Difficult Interviews    Patient’s physical condition. Patient’s fear of talking. Patient’s intention to deceive. Children  Adjust to age Always treat elderly patients with the respect that they deserve. Sensory Impairment   Blindness:  Tell them everything you are going to do.  Use touch as a form of contact for reassurance. Hearing impairment:  Ask the patient what their preferred method of communication is. 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. Interpreters (1 of 2)     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. Interpreters (2 of 2) 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.  Hostile or Uncooperative Patients (1 of 2) Set limits and boundaries.  Document unusual situations.  Consider having a same-gender witness ride in the ambulance.  If your safety is in jeopardy, keep away from the patient.  Hostile or Uncooperative Patients (2 of 2) Have an appropriate show of force if necessary.  Know local policy regarding restraints and psychological medications.  Use law enforcement if needed.  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. Review  Consider the following questions as a group.  IDPH site code: Use site code assigned to your agency for 2014.  If doing this CE individually, please e-mail your answers to:  Shelley.Peelman@presencehealth.org  Use “January 2014 CE” in subject box.  IDPH site code: 06-7100-E-1214  You will receive an e-mail confirmation. Print this confirmation for your records and document in your PREMSS CE record book. 1. Creating a message is also known as: A. B. C. D. alliterating encoding receiving drafting 2. Which of the following represents an example of an external distraction to communication? A. B. C. D. lack of empathy Prejudice loud music in the background thinking about your family or job 3. Standing below the patient’s eye level indicates: A. a willingness to let the patient have some control over the situation B. equality C. an air of authority D. that you are completely confident and in control of the situation 4. A difficult patient interview could stem from which of the following: (you may choose more than one) A. B. C. D. E. the patient’s disease process patient’s fear language differences cultural differences patient age 5. Appropriate questioning techniques include all of the following except: A. asking only one question at a time B. listening to the patient’s complete response C. using medical terminology as much as possible D. using open-ended questions 6. When transferring patient care to emergency department staff, the EMS Provider should: A. wait with the patient a maximum of 5 minutes; if no ED staff come to get report, go ahead and leave B. leave the hand off report at the receiving desk C. introduce the patient by name to the receiving doctor or nurse and say good-bye to the patient before leaving D. leave as soon as the receiving doctor or nurse looks at the patient 7. A reason for failing to communicate might be: A. B. C. D. lack of privacy providing feedback decoding the message non verbal communication 8. Empathy is the identification with and understanding of another’s situation feelings and motives. A. True B. False 9. Before entering a patient’s intimate zone to take vital signs or listen to breath sounds, the EMT should ask permission. A. B. True False 10. Using questions that begin with “why” are important because it forces the patient to focus on the causes of events. A. B. True False Answers 1. 2. 3. 4. 5. 6. 7. 8. B C A All A, B, C, D, E C C A True 9. True 10. False