Chapter 1: Preparing for the Patient Encounter PDF

Learning Objectives =================== - Define patient-centered care and identify its key elements. - Identify the major factors affecting communication between the patient and clinician. - Differentiate among the stages of the clinical encounter and the communication strategies a...

Learning Objectives =================== - Define patient-centered care and identify its key elements. - Identify the major factors affecting communication between the patient and clinician. - Differentiate among the stages of the clinical encounter and the communication strategies appropriate to each stage. - Apply concepts of personal space and territoriality to support patients' privacy needs. Learning Objectives =================== - Employ basic rules to ensure the confidentiality and security of all patient health information. Identify the key abilities required for culturally competent communication with patients. - Identify the steps in assessing a patient's learning needs, including how to overcome any documented barriers to learning. Respiratory Therapist's Role in Patient Assessment -------------------------------------------------- - Assist Physicians with diagnostic reasoning - This calls for critical thinking - Cognitive skills in communicating - Selecting assessment tests - Interpreting results - Formulating solutions - Evaluating treatment plans Patient-Centered Care ===================== - Three main elements: - Individualized care - Patient involvement - Provider collaboration - Two-way partnership between providers and patients (and families). - Care given is consistent with each individual's values, needs, and preferences - Patients become active participants in their own care Essential Elements of PatientCentered Care ------------------------------------------ Copyright © 2018, Elsevier Inc. All Rights Reserved. Factors Influencing Effective Communication ------------------------------------------- Copyright © 2018, Elsevier Inc. All Rights Reserved. ### Stages of Patient-Clinician Interaction - **Pre-interaction stage** - Review of patient chart - Make initial assessment of pt - Clarifies your role in patient care - **Introductory stage** - Introduce yourself and where from - Your purpose - Check armband with permission - Establish positive rapport - Look for resistance behavior and act appropriately ### Stages of Patient-Clinician Interaction - **Initial assessment stage** - Brief assessment determining patient's illness - Brief physical assessment - **Treatment and monitoring stage** - Begin tx after assessment - After a few minutes reassess vital signs, BS - Record positive and negative effects of tx - Any adverse effects, stop tx, monitor, document and inform appropriate health care team. ### Stages of Patient-Clinician Interaction - **Follow-up stage** - After tx has ended - Reassess vital signs - Clean equipment, replace equipment as needed - Return pt to pre-tx position if needed - Let pt know when you will return - Thank patient ### Communicating the Assessment Findings - Document the tx and include the following: - Date and time - Type of treatment/procedure (ABG's) - Drugs and dosages - Result of response to tx including adverse effects - Goals, objectives or end-point criteria for tx ### Communicating the Assessment Findings Privacy and Confidentiality =========================== - All information is confidential - You do not discuss any patient with anyone not caring for the patient - Violations can be subject to legal recourse Health Insurance Portability and Accountability Act - Passed by Congress in 1996 to increase one's ability to transfer health care information from one provider to another - Title II of this law took effect in 2003 and established rules for disclosure of Protected Health Information (PHI) - Only approved health care providers can have access to PHI Copyright © 2018, Elsevier Inc. All Rights Reserved. Use of Space ------------ - Social space: 4 to 12 feet from the patient - Useful for the initial introduction - Personal space: 18 inches to 4 feet from the patient - Useful for the interview - Intimate space: 0 to 18 inches feet from the patient - Useful only for the 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, and expressing genuine concern - Self-awareness - Knowledge of one's own cultural beliefs as well as any potential stereotypes one might hold about particular groups Culturally Competent Communication - Situational awareness Ability to recognize misunderstandings associated with patient-provider cultural differences as they occur during a patient encounter - Culturally competency - Clinician should be able to adapt to the specific situation by individualizing the communication approach in a manner consistent with the patient's (and family's) values and beliefs Copyright © 2018, Elsevier Inc. All Rights Reserved. Ten Rules for Clinical Etiquette 1. Maintain a professional appearance 2. Identify yourself-name and role 3. Call patient by Mrs, Mr, Miss, Ms 4. Respect and preserve patient's modesty 5. Do not rest foot on bed, or sit on bed 6. Keep pt's info confidential 7. Do not discuss pts prognosis with others or in front of patient 8. Do not argue in front of patient 9. Do not criticize the actions of others on health care team in front of or near patient 10. Keep disagreements and criticisms out of patient's chart Copyright © 2018, Elsevier Inc. All Rights Reserved.