Patient Interactions - Special Patient Populations PDF

Caring for any patient can be difficult and stretch your comfort zone, but there are special circumstances surrounding some patients that add an additional condition. The first patient we will discuss are those that are seriously ill or traumatized. These patients are most likely functioning at the...

Caring for any patient can be difficult and stretch your comfort zone, but there are special circumstances surrounding some patients that add an additional condition. The first patient we will discuss are those that are seriously ill or traumatized. These patients are most likely functioning at the lowest level on Maslow's hierarchy. They have typically been through a barrage of tests and health care workers. They may be unresponsive or even combative, depending on their illness or injury. Our job is to get the best images possible in the shortest amount of time with the least intrusion. Don't forget your communication skills. Even if you feel they do not understand you, continue to communicate. During this program, you will learn about many different illnesses and how they affect the body. You will use this knowledge to perform your exam with the least amount of pain and discomfort to your patient. Another communication skill you will use, perhaps on a higher level than you would with another patient, is your observation skills. It is extremely important that you keep a keen eye on the seriously ill or traumatized patient. Their life is in your hands and you must be able to quickly react in an instant if they decline in any way. Every health care worker has their story of the patient that almost died under their watch. The terminally ill patient brings their own challenges beyond the seriously ill patient. These patients may be going through the stages of grief. Your exam may be a reminder of their diagnosis or your exam may be the deciding factor of their prognosis. Death is a part of life and as a technologist, you will come into contact with death many times throughout your career. Depending on your place of employment, death might be an everyday occurrence for you. If you have never studied the five stages of grieving, I suggest that you read the section in the textbook carefully and you might want to do an internet search and become more familiar. If you can recognize the stage your patient is going through, you will better be able to care for him or her. Remember to not neglect the family that might be present and always be respectful of the wishes of your patient. Often the terminally ill patient might be undergoing a procedure in the radiology department to treat or diagnose an underlying condition. Know your patient's advance directive wishes. For example, if they have decided on a do not resuscitate order. If your patient has a cardiac or respiratory event during your procedure, you need to know how to react. Visually impaired patient can be challenging, but if you use good communication, you should have few issues. Visually impaired does not mean completely blind. Many visually impaired folks will have partial vision and can make out shapes and colors. In radiography, a technologist often relies on sight to explain how they need the patient to position the body part being imaged. If your patient has difficulty seeing details such as this, you need to rely on your words and a light touch to move your patient into the position you desire. Remember, not being able to see does not mean that they cannot hear. I know that sounds funny, but many people will begin talking louder to a blind patient, and typically their hearing is heightened due to their body compensating for the lack of vision. Demonstration of the positioning needed works well with a hearing and speech impaired patient. When you are speaking, make sure you are making eye contact with your patient. Many hearing impaired patients can read lips. If they are unable to read lips, write your instructions down and have them read them. Probably the most common special patient type is the non-English speaking patient. Because of our great diversity in the United States, the non-native English speaker population has continued to grow. Many of these patients will know some English, maybe enough for you to communicate simple instructions, but many may not. If you are engaged in a complex procedure that will require informed consent, you must get a translator even for those that speak limited English. You must make sure that the patient fully understands the procedure and its risks. Each health care facility will have its own policies regarding translation for the non-English speaker. Many facilities will allow an English speaking family member to translate, while others have a strict policy against this practice. Also, some facilities have a strict policy against employees translating if they have not gone through a translation training program at the facility. Most of the hospitals in our area subscribe to a translation service offered over the phone or internet. The employee determines whether this service will be required for the procedure or not. Make sure that you are aware of the policies at your clinical site once you go to the hospital. For the mentally impaired patient, chaotic scenes can sometimes trigger a stress response. Keep your room calm and orderly. Gain the trust of your patient and you will have fewer issues during your exam. Work quickly, but do not rush your patient. Spend the extra time explaining the procedure so that your patient knows exactly what to expect. Often, a mentally impaired patient will be accompanied by a caregiver. Talk with the caregiver to get an understanding of the patient's abilities, likes, and dislikes. We will also encounter the psychologically or emotionally impaired patient. To me, these can be some of the more difficult patients to care for. Depending on the acute situation, you may be unable to leave these types of patients alone in your x-ray room. Pay close attention to the emotional state of the patient and try to keep a conversation going throughout your procedure. As with the acute emotionally impaired patient, an acute substance abuse patient must not be left alone in an x-ray room. Assess your patient's ability to cooperate. Keep the communication moving throughout the exam. Give firm directions and, if needed, wait until the patient is fully cooperative before continuing the exam. As a technologist, you will be called upon to perform imaging procedures in a patient's room or in a surgical suite. Under no circumstances should you assume that a patient does not comprehend comments made near them, whether they are under anesthesia or are unresponsive due to a traumatic event. Even if it feels awkward to you, introduce yourself and explain your procedure. There have been documented cases of comatose patients reporting that they have heard everything around them while they were unresponsive. During mobile exams in a patient's hospital room, there will most likely be family in the room when you arrive. As you are introducing yourself to the patient, also include the family members. While explaining your exam, describe to the family why they must leave the room during the exam, but tell them as soon as you are done they will be able to come back in. Most families will be very cooperative and follow your instructions. Age is also a factor in deciding how you will communicate with the patient. It should not be seen as a barrier, but as another trait of your patient that must be assessed and addressed appropriately. I will now spend a couple of minutes talking about various age groups and their general characteristics. First, we will discuss the infant. Infants are considered birth through one year old. During the first month of life, most behavior is reflexive rather than purposeful. They will be most responsive to a soothing voice and a smiling face. Keep them tightly wrapped unless that wrapping will interfere with the exam. Two to three month old infants will also respond better to a smile and soothing voice. They may prefer a pacifier and will respond best if their family is involved in the exam. Around six to eight months, the infant recognizes family and familiar objects. Keep both close to aid in the cooperation of the infant. At nine months, the infant will experience separation anxiety when away from the family. Use toys as a distraction and make the exam as fun as possible. With infants especially, provide a safe environment. Never leave an infant unattended. If you must leave the room, make sure the parent is with the child and make sure that they understand that you are leaving the room for a moment. If necessary, use a temporary immobilization technique to complete the exam. We will discuss this further in a future chapter. The toddler is one to two years old and is very attached to their family. They are just beginning to speak and may be most resistant to cooperation. Use a soothing voice and make the exam a game. Try to become friends with them before you bring them back to the exam room. Allow them to position themselves as much as possible. Get the family involved in the procedure. By this age, they have had many pictures taken. Use this to your advantage and make the exam picture time. A preschooler is three to five years old and they are now communicating and most likely very independent. Again, make friends and allow them to position possible. Ask them if they have ever had their and explain that this is just a bigger camera. equipment first and then walk them through the you want them positioned. themselves as picture taken Allow them to exam, showing much as before see the them how Demonstration is your best communication method for the preschooler. You may or may not need their family's help, but keep them close so that if there is a problem, you can get them involved very quickly. In general, a pediatric patient ages six and below performs exams better if you will come down to their eye level, speak softly, prepare everything in your room prior to bringing them in so as to avoid loud machine movements, use a gentle touch, and always maintain eye contact with them. A child six to twelve years old is considered a school-aged child. They can think logically, so give them concrete explanations and talk them through the exam. They may ask a lot of questions. Answer them truthfully. Again, demonstration is still a great communication method for this age group. As you show them what you want them to do, talk your way through the exam to give them the verbal clues they need to listen for when you are actually performing the exam. An adolescent is 13 to 18 years old. Special care should be given to make sure you have a private environment for the exam. The teenager may not want their family in the room during the procedure. Under normal circumstances, the teenage patient may act like an adult, but when they are sick, their emotions may be that of a child. Be cognizant of this fact and provide a safe, private place while establishing a rapport with your patient. Explain your procedure fully, using appropriate medical terms, as the teenager does not want to be talked down to. The young adult, ages 19 to 45, may be struggling with moving from dependency to roles of responsibility. With higher education, the start of a career, marriage, children, and the care of aging parents, adapt your instructions and explanations about the procedure to their level of understanding. The middle-aged adult, are ages 46 to 64. They may be experiencing lifestyle changes, and changes that might affect them physically and cognitively. Many chronic conditions may be appearing. Toward the end of this stage, there may be vision and hearing loss, decreased short-term memory, decreased balance and coordination, loss of bone mass and skeletal height, loss of skin elasticity, and decreased metabolic rate. Keep these changes in mind as you provide the instructions and perform the exam. Allow them to make choices and involve them as much as possible in the examination. The mature adult, ages 65 plus, may need special attention as they begin to have increased sensory issues, such as loss of vision and hearing. You may need to increase the lighting in your room so that they can see, and speak a bit louder or alter the pitch of your voice so that they will understand your instructions. But don't assume your patient has hearing loss. Use your best judgment. Ask them. They may also have issues with their gait and standing for long periods of time. While explaining the exam, ask them if they will have any problems performing the exam as requested. If they think they might have an issue with something, modify your normal procedure to accommodate your patient's abilities. In Table 11-2, you will see a series of physical changes that are commonly diagnosed in older patients. Please become familiar with these changes, and then what you might expect while performing an exam in radiology. This list is a short summary of suggestions that will be helpful when interacting with an elderly patient. Maintain eye contact. Speak clearly and more slowly if needed. Always speak to them eye-to-eye rather than away from them. Keep them warm. Always ask permission to touch. Demonstrate compassion and keep them comfortable. Always keep them informed and treat them with respect and patience.