Therapeutic Communications Presence Regional EMS System January 2014 Continuing Education

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:
 [email protected]
 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