Patient Encounter Chapter 1

Chapter 1: Preparing for the Patient Encounter

• Learning Objectives: Define patient-centered care and identify its key elements, identify major factors affecting communication between patient and clinician, differentiate among stages of the clinical encounter and appropriate communication strategies.

Learning Objectives

• Apply concepts of personal space and territoriality: Support patients' privacy needs.
• Employ basic rules for confidentiality and security: Ensure confidentiality of all patient health information. Identify key abilities for culturally competent communication with patients.
• Identify steps in assessing patient learning needs: Include how to overcome barriers to learning.

Respiratory Therapist's Role in Patient Assessment

• Assist physicians with diagnostic reasoning (critical thinking, cognitive skills in communicating).
• Selecting assessment tests, interpreting results, formulating solutions.

Patient-Centered Care

• Three main elements: individualized care, patient involvement, provider collaboration.
• Two-way partnership between providers and patients (and families).
• Care is consistent with individual values, needs, and preferences. Patients are active participants in their care.

Essential Elements of Patient-Centered Care

• Individualized Care: Empathetic communication, respect for patient values/privacy, sensitivity to cultural values.
• Patient Involvement: Patient education, shared decision-making, patient participation in care.
• Provider Collaboration: Communication, coordination, shared responsibility.

Factors Influencing Effective Communication

• Internal Factors: Previous experiences, attitudes, values, cultural heritage, religious beliefs, self-concept, listening habits, preoccupations, feelings, illness, privacy.
• Sensory/Emotional Factors: Fear, stress, anxiety, pain, mental acuity, brain damage, hypoxia, sight, hearing, speech impairment.
• Environmental 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, interest.

Stages of Patient-Clinician Interaction

• Pre-interaction stage: Review patient chart, make initial assessment of patient, clarify role in patient care.
• Introductory stage: Introduce yourself and where you are from, your purpose, check armband with permission.
• Initial assessment stage: Brief assessment determining patient's illness, brief physical assessment.
• Treatment and monitoring stage: Begin treatment after assessment.
• Follow-up stage: Reassess vital signs after treatment has ended, record positive and negative effects of treatment, any adverse effects stop treatment and inform appropriate health care team.
• Additional details for communicating assessment findings: Clean/replace equipment as needed, return patient to pre-treatment position (if needed), let patient know when you will return, thank patient, document the treatment and include date and time, type of treatment/procedure (ABG's), drugs and dosages, result of response to treatment including adverse effects, goals, objectives, or end-point criteria for treatment, examples of documentation.

Privacy and Confidentiality

• All information is confidential.
• Do not discuss patients with anyone not involved in their care.
• Violations can be subject to legal recourse (HIPAA).

Accountability Act

• Passed by Congress in 1996 to increase ability to transfer health care information between providers.
• Title II took effect in 2003, established rules for disclosure of Protected Health Information (PHI).
• Only approved health care providers can access PHI.

Use of Space

• Social space: 4 to 12 feet from patient (useful for initial introduction).
• Personal space: 18 inches to 4 feet from patient (useful for interview).
• Intimate space: 0 to 18 inches from patient (only for physical examination).

Expressing Concern

• Face the patient squarely.
• Use eye contact appropriately.
• Maintain an open posture.
• Consider appropriate use of touch.
• Be an active listener.

Culturally Competent Communication

• Strategies: Active listening, attending to individual needs, eliciting patient concerns, expressing genuine concern.
• Self-awareness: knowledge of one's own cultural beliefs and potential stereotypes.

Communication

• Situational awareness: Ability to recognize misunderstandings associated with patient-provider cultural differences during a patient encounter.
• Cultural competency: Clinician adapts communication approach to be consistent with patient's values and beliefs.

Ten Rules for Clinical Etiquette

• Maintain a professional appearance, identify yourself by name and role, call patient by appropriate title (Mrs., Mr., Miss, Ms.), respect and preserve patient’s modesty, do not rest foot or sit on bed, keep pt’s information confidential, do not discuss prognosis in front of patient, do not argue with patient, do not criticize other health care team members in front of the patient, keep disagreements and criticisms out of patient’s chart.

This quiz explores the concepts of patient-centered care and the key elements affecting communication between patients and clinicians. It also addresses the role of respiratory therapists in patient assessment and the importance of privacy, confidentiality, and cultural competence in communication. Test your knowledge on these essential topics.