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109 Cards in this Set
- Front
- Back
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Principle focus of purtillo ch. 8?
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Deals with how the patient tells his story
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What kind of story is a person's medical story?
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A person’s medical history is an unfolding story
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How can the "health story" be told?
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The “health story” can be told from the perspective of the patient, the medical record or the textbook
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How is our communication recognizable?
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Our communication is recognizable because of it’s format, ie: SOAP note P. 148
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How do we shape the story of our pt.?
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We shape the story of our pt. when we decide what is important enough to put in our notes
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Focus of purtillo ch. 9?
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respectful communication
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Purpose of Verbal Communication in Health Professions?
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establish rapport, obtain information about condition/progress, confirm understanding, relay information to other health professionals, pt/family education, other: encourage pts, support, report technical data
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A large amount of misunderstandings between health professional to pt or to other health professionals is due to a...?
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breakdown in verbal communication (VC). Said with the wrong tone or heard out of context.
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Models of communication- most PT’s and PTA’s use?
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the interview method to determine the patient’s complaint. Focus on the facts. Set of questions. However, it may be the patients goal for a knowledgeable person to just really listen and understand
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best way for clinician to show understanding of patient's concerns
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A dialogue model better meets this need. It minimizes the disparity in power and helps build a bridge to your pati
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Face to face communication
key points to remember... |
fewer places to hide fear and discomfort. Can use verbal and non-verbal communication. Promotes greatest trust
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Make sure you introduce yourself to your patient, tell them why you are seeing them, what your role is and what is their expected participation. Reintroduce yourself if it has been several days since you have seen them.
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Make sure you introduce yourself to your patient, tell them why you are seeing them, what your role is and what is their expected participation. Reintroduce yourself if it has been several days since you have seen them.
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Presenting Material
key things to remember |
know your audience: age, language barrier, anxiety, mental status
know your purpose |
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Vocabulary
Potential problems |
use wrong words omit important ideas, long, rambling descriptions confuse pts. other: HP must switch back and forth from professional jargon to lay terms (therapists who have difficulty speaking in lay terms are often viewed as uncaring by the Pt
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Presenting Material
ATTITUDES |
how the pt perceives you feel about them: caring, concern, frustration, uncertainty or fear. Pts also know if you are lying or placating them from your attitude
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Presenting Material
Tone of voice |
inflections of your voice, voice quality that can change the meaning of your words (what are you doing?, Oh: anger, pity, disappointment, pleasure, gratitude, exuberance, terror, disbelief)
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Presenting Material
VOLUME |
loud or soft. Can convey anger "that's fine", uncertainty "sure I know", "biceps is C5". Can also get attention: loudness (back away), soft whispers (lean closer). It is very important to determine if a pt can hear before adjusting your volume
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Presenting Material
Voice Clarity |
use lay terms and be technically correct. strive for clarity and to be articulate with a reasonable volume and speed. important to give idea of the length of time you will be here from the onset
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Presenting Material
ORGANIZATION of IDEAS |
stay on your point. Do not ramble. People who can not organize their thoughts on a procedure either know too little or too much about the subject. Always break things down into component parts
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Two types of Humor...
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useful and destructive
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Useful Humor
main idea |
can help pt cope with stress, see irony in the situation, or constructively express hostility or anxiety. It is OK to make fun of yourself not of the pt. It is OK for the pt to make fun of him/herself as long as it does not become destructive.
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Destructive Humor
main idea |
people who continuously put themselves down, verbal fencing between the pt and therapist
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Effective Listening:
analytical |
specific info and arranging
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Effective Listening:
directed: |
answers specific questions
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Effective Listening:
attentive |
general info for overall picture
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Effective Listening:
exploratory: |
for one's own interest
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Effective Listening:
courteous |
obligation
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Effective Listening:
appreciative |
for pleasure (music)
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Effective Listening:
passive |
overhearing, not attentive
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Goals for effective communication for the PTA
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improve acuity (hearing the pt)
improve ability to determine if the pt has heard you. |
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Problems with listening skills
mind set? |
often people have a set frame of mind (already know what you are going to say) and tune out (parents and teenagers)
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Problems with listening skills
selectivity? |
pts often only pick out ideas they are comfortable with and tune out everything that is too complex or ambiguous for them.
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Problems with listening skills
literalness? |
pts also tend to take everything literally (skip a day diet joke)
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Keys to better listening
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Be selective in what you listen to.
Concentrate on central themes. Judge content rather than style or delivery. Listen with an open mind Summarize what you heard before speaking again. Clarify what you heard before speaking again |
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Sensory Overload
main idea in regards to communication... |
Not everyone processes information at the same rate. You must be able to vary your instructions to what the pt can perceive. You must be able to listen to your pts and to help know when overloaded.
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Verbal Communication To Groups
key points to remember |
1) group dynamics
2) know what stage of development group is in 3) know how to work w/ the group to keep on task and share a mutual purpose. |
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Stages of Group Development
GROPING |
why am I here- orientation
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Stages of Group Development
GRIPING |
searching for individuality- war
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Stages of Group Development
GROUPING |
togetherness and shared purpose- we
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Stages of Group Development
GRINDING |
getting the task down- problem solving
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Four stages of group development...
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Groping
Griping Grouping Grinding |
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Other Forms of Communication
writen- key points to remember |
has visual cues and can be re-read and studied. Must be organized (HEP and informed consent), best if used in conjunction with verbal communication
E-mail: best for test results or for very specific Q’s. |
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Interview model of communication:
3 parts... |
1) Introduction
2) body 3) closing |
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Interview model of communication:
introduction- main idea |
what, establishes relationship
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Interview model of communication:
Body- main idea |
how, do the work
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Interview model of communication:
CLOSING- main idea |
do you understand
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Interview model of communication
benefits... |
highly structured, used for evaluations, to procure information, to provide information and to persuade to continue therapy.
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REMEMBER: WHAT YOU SAID AND WHAT THEY HEARD CAN BE VERY DIFFERENT. GET IN THE HABIT OF HAVING THE PT VERBALLY REPEAT YOUR INSTRUCTIONS
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REMEMBER: WHAT YOU SAID AND WHAT THEY HEARD CAN BE VERY DIFFERENT. GET IN THE HABIT OF HAVING THE PT VERBALLY REPEAT YOUR INSTRUCTIONS
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Non Verbal Communication
4 main types |
1) Facial expression- eye contact
2) Body Language 3) Physical Appearance 4) Touch |
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Non Verbal Communication
Touch- TAPE: main idea? |
Touch
Assess Progress Exercise |
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Demonstration:
when used? |
used to supplement verbal instructions concerning an activity that must be repeated by the person (i.e. crutch walking etc)
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Demonstration
Keys to its effective use... |
perform in full view and beside the pt
avoid the mirror effect of being in font of the pt |
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Proxemics
definition: |
Study of how space is used in human interactions
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Proxemics
Height- key points to remember |
used to communicate authority: standing over someone puts pts in a submissive role; by standing over a person in a WC. (get down to their eye level, so you can make eye contact)
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Proxemics
Distance Awareness- key points to remember |
amount of personal space, differs in various cultures
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Proxemics
In middle class American culture how many zones of contact are there? |
4
Intimate, Personal Distance, Social Distance, Public Distance |
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Proxemics
intimate zone, distance? |
very close contact with another person
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Proxemics
personal distance? |
1 1/2 - 4 feet, at arms length
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Proxemics
social distance? |
4 - 12 feet, more formal business and social discussions
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Proxemics
public distance |
12 - 25 feet or more, no physical contact, little direct eye contact
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Distance zones change with different cultures and should be honored as able. Body odors also determine some distances, the definition of body odor as well as bad breath differs with each culture.
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Distance zones change with different cultures and should be honored as able. Body odors also determine some distances, the definition of body odor as well as bad breath differs with each culture.
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Nonverbal Communication
Time Awareness... main idea |
is culturally derived. Our society and our departments depend on punctuality. Other societies find it an insult to be on time
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Other forms of nonverbal communication
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Written:charts, wipe off board, letter boards, picture boards
Computers; voice and electronic tools (answering machines, e-mails) sign language |
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: BE AWARE THAT SOME "NORMAL" ACCEPTED NONVERBAL GESTURES ARE OFFENSIVE IN OTHER CULTURES AND WE MUST BE SENSITIVE TO CULTURAL DIFFERENCES.
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: BE AWARE THAT SOME "NORMAL" ACCEPTED NONVERBAL GESTURES ARE OFFENSIVE IN OTHER CULTURES AND WE MUST BE SENSITIVE TO CULTURAL DIFFERENCES.
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Needs of the Patient
Reassurance, main idea |
offering information that you can stand behind with certainty, helps deal with worries of pt
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Needs of the Patient
Trust, main idea |
Trust- a level of comfort that one can rely on the person of power not to hurt or exploit them, that you will maintain their confidentiality and meet a reasonable level of care.
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Needs of the Patient
Competence, main idea |
having the skill to provide the intended service and the diligence to stay current
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Needs of the Patient
Caring, main idea |
paying attention to and responding
You are the only one that cares…? |
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Transference
main idea |
process of shifting one's feeling about a person in the past another person. It can be negative or positive
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Counter-transference
main idea |
transference by a health professional to a patient. The pt. needs to feel like you see them as an individual.
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Fromm's 4 basic elements to build a caring relationship:
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concern
responsibility respect knowledge |
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Fromm's 4 basic elements to build a caring relationship:
concern, main idea |
encouraging the growth or progress of the other person
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Fromm's 4 basic elements to build a caring relationship:
responsibility, main idea |
responding to the other not simply out of duty, but rather as a voluntary desire to meet the needs of the other person.
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Fromm's 4 basic elements to build a caring relationship:
respect, main idea |
realizing the individuality of the other person
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Fromm's 4 basic elements to build a caring relationship:
knowledge, main idea |
trying to discover what is important to the other person Trust can grow on the foundation of caring
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Dependence and empowerment
when do patients begin to become dependent? |
pts become dependent (to some extent) the minute they interact with a healthcare provider
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Dependence and empowerment
2 types of dependence... |
1) Detrimental
2) Constructive |
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Dependence and empowerment
detrimental, main idea |
over-dependence): intense self depreciation and desire to find their identity in someone else ( business wives) have a neurotic need to cling. It can occur by the pt or the HP.
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Dependence and empowerment
detrimental: who is at fault? |
One or both players can be involved where they are no longer helpful to each other but are unable to terminate the relationship gracefully. (Cranston vs. Minier)
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Dependence and empowerment
constructive, main idea |
based on mutual respect, no clinging or loss of individual identity, enhances individual potential and each person is responsible for his or her progress, the limits are clea
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Empower the pt - encourage simple control and autonomy. Respect the patient’s authority as a decision maker in their health care.
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Empower the pt - encourage simple control and autonomy. Respect the patient’s authority as a decision maker in their health care.
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What does primum non nocere mean?
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first inflict no harm.. this is primary in our practice to inflict no mental, physical or emotional harm
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The physical and emotional boundaries between you, as a PTA, and the Pt should always be guided by the goal of facilitating a pts well being and maintaining respect in the interaction.
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The physical and emotional boundaries between you, as a PTA, and the Pt should always be guided by the goal of facilitating a pts well being and maintaining respect in the interaction.
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What is a professional boundary?
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The physical and emotional limits that are appropriate to maintain while in the HP and pt relationship.
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Sexual harassment:
main idea? |
includes any conduct that falls short of having sexual intercourse, but would be viewed as ethically and legally unacceptable
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What is unconsented touching considered?
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BATTERY
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Consented touching
main idea |
informed consent allows you to touch a pt but does not give you the right to invade a persons space or cross cultural boundaries without permission
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Sexual touching:
Main idea |
you can not make contact with a pt with intent to harm him/ her physically or psychologically. You may be charged with physical or sexual abuse
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When is it OK to cultivate a sexual relationship with a patient?
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Not even consensual. People have lost their licenses for having sexual intercourse with their pts
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Emotional and Psychological Boundaries:
Enmeshment, main idea? |
when yours or the pts psychological and emotional responses and attachments interfere with the pts respect. People who become enmeshed set their pt. up for disappointments and emotional let down. Synonymous with detrimental dependence
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Emotional and Psychological Boundaries:
pitty, main idea? |
you may find a type of pt that you prefer not treat due to inability to distance yourself and remain objective.
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Overidentification
main idea? |
difficulty seeing the pt as a unique individual, you may stereotype or counter transfer or believe that you have had an identical experience.
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how do caring and enmeshment differ?
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You have to be able to give sympathetic acknowledgment to the pts problem, but set boundaries to remain professionally objective.
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Out of control affection
when does this occur? |
occurs when you go over the boundaries and the pt feels their is more to the relationship than their is.
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Maintaining Boundaries
when the pt. reveals too deep of emotions you should... |
refer to the appropriate person: clergy, psychologist, and SW
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Maintaining Boundaries
when should you share stories of your own experience? |
only share stories of your own experience occasionally and thoughtfully
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Maintaining Boundaries
how is Respectful Interaction achieved? |
respectful interaction is achieved when the person is looked at as a unique individual
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Components of respectful interaction
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respect for others values and needs.
attention to pts challenges. attention to our shortcomings competence. trustworthiness genuine caring. attention to boundaries. professional closenes |
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how do you know when you achieve professional closeness?
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when you have knowledge that you are exhibiting appropriate conduct and there is integrity about the situation
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Integrity
main idea? |
a high level of consistency between what you say and what you do.
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how does a clinician help the patient believe him?
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there must be: an integrity among the words, actions and perceived character traits of the professional
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Time management:
when is it OK to cut corners? |
never cut corners with a pt treatment
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Time management:
should a clinician be flexible with their schedule? |
be as flexible as possible with your schedule
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Tips for good pt interaction
(read and understand, 1 of 2) |
remove the pt from crowded areas to decrease distraction
sit down to show that the pt is important enough to give your time do not talk about how busy you are |
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Tips for good pt interaction
(read and understand, 2 of 2) |
approach the pt slowly and gracefully, even if you ran to get to their room
maintain good eye contact give the pt your full attention and squelch interruptions |
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Nurture your patients:
points to keep in mind... |
Personal comfort- hygiene, temperature, comfort
Personal interest- be interested in your pts personal lives Expanding awareness- talk about what is going on in the world |
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Details, Details, Details
little things mean a lot such as... |
getting ice water
extra blankets tissues |
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Be careful not to spend so much time and energy on the little things that you forget the therapy.
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Be careful not to spend so much time and energy on the little things that you forget the therapy.
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Gifts from a patient
key points to remember... |
– Reiterate to the pt that you are aware that the intent is to thank you, accept compliments and gifts graciously, encourage gifts that can be shared by the entire staff.
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