Chapter 2 PPI

1. Chapter 2PPI PATIENTS AND COMMUNICATION

2. COMMUNICATION

3. COMMUNICATION YOU NEED TO DEVELOP SKILLS IN CRITICAL THINKING AND PROBLEM SOLVING TO ACCESS PATIENTS UNIQUE NEEDS TO EFFECTIVELY PLAN AND IMPLEMENT CARE.

4. PATIENT EDUCATION IS PART OF THE RADIOGRAPHERS PROFESSIONAL OBLIGATIONS ASSESSING NEEDS IS VITAL WHEN DEALING WITH PATIENTS AND GIVES THE RADIOGRAPHER AN IDEA HOW TO APPROACH A SITUATION.

5. BASIC HUMAN NEEDS • ABRAHAM MASLOW DEVELOPED A PYRAMID BUILT ON HUMAN NEEDS. • PHYSIOLOGICAL NEEDS • SAFETY AND SECURITY • LOVE AND BELONGINGNESS • SELF ESTEEM • SELF ACTUALIZATION

6. MASLOW BUILDING BLOCK

7. PHYSIOLOGICAL NEEDS • BASIC NEEDS FOR FOOD, SHELTER, SLEEP, AIR AND • IF THESE NEEDS ARE NOT SATISFIED A PERSON IS UNABLE TO PURSUE OTHER NEEDS

8. SAFETY AND SECURITY • SEEK A PLACE FREE FROM HARM AND CAN BE SURE OF BEING ABLE TO EARN A LIVING.

9. Love and Belongingness • Seek someone to share life with and seeks a social group. Self esteem • Self regard and the feeling of being self regarded by others beyond family.

10. SELF ACTUALIZATION • TO GROW SPIRITUALLY • ACCOMPLISH DEEDS TO MAKE THEM FEEL THE ULTIMATE GROWTH IN LIFE.

11. THE HALLMARK OF AN EXCELLENT RADIOGRAPHER IS THE ABILITY TO ACHIEVE A POSITIVE DIAGNOSIS OR TREATMENT IN A TIMELY MANNER WHILE MEETING THE UNIQUE NEEDS OF THE INDIVIDUAL.

12. CRITICAL THINKING “ THE ART OF THINKING ABOUT YOUR THINKING WHILE YOU ARE THINKING IN ORDER TO MAKE YOUR THINKING BETTER, CLEAR, MOREACCURATE AND MOREDEFENSIBLE” CRITICAL THINKING REQUIRES THE ABILITY TO INTERPRET, ANALYZE, EVALUATE, INFER, EXPLAIN AND REFLECT.

13. MODES OF THINKING • RECALL • HABIT • INQUIRY • CREATIVITY • RECALL AND HABIT ARE LOWER LEVELS OF THINKING. • INQUIRY AND CREATIVITY ARE HIGHER LEVELS OF THINKING.

14. PATIENT ASSESSMENT EVERY PATIENT AND DIAGNOSTIC PROCEDURE PRESENTS PROBLEMS, RANGING FROM SIMPLE TO COMPLEX. BEGINNING RADIOGRAPHERS SHOULD WRITE DOWN THE PROBLEM SOLVING PROCESS.

15. DATA COLLECTION • SUBJECTIVE DATA THAT INCLUDE ANYTHING THE PATIENT OR SIGNIFICANT OTHER SAYS THAT IS PERTINENT TO THE PARIENTS CARE. • OBJECTIVE DATA THAT YOU SEE,HEAR,SMELL, FEEL OR READ ON THE PATIENTS CHART;ANYTHINGREPORTED BY ANOTHER HEALTH CARE WORKER THAT MAY EFFECT THE PATIENT OR PROCEDURE.

16. DATA ANALYSIS INTEGRATES ALL PARTS OF CRITICAL THINKING. LIST ALL SUBJECTIVE AND OBJECTIVE DATA THEN YOU CAN START TO ANALYZE. THIS REQUIRES THE SKILL OF INQUIRY.

17. PLANNING AND IMPLEMENTATION AFTER DATA ANALYSIS YOU ESTABLISH A GOAL WITH EXPECTED OUTCOMES OR OBJECTIVES FOR ACHIEVING THAT GOAL. PLANNING REQUIRES ALL THE MODES OF THINKING.

18. EVALUATION EACH PATIENT SITUATIONS ARE DIFFERENT THEREFORE ALL PATIENT CARE EXPERIENCES ARE LEARNING EXPERIENCES.

19. EVALUATION QUESTIONS • WERE THE PATIENTS NEEDS MET? • WAS SAFETY MAINTAINED DURING THE PROCEDURE? • DID THE PATIENT COMPLAIN OF PAIN AS THE PROCEDURE WAS DONE? • WHAT CAN I DO DIFFERENTLY NEXT TIME? • DID I USE HIGHER LEVEL OF CRITICAL THINKING SKILLS FOR THE PROCEDURE?

20. MAKE SURE YOU TAKE INTO CONSIDERATION THE PATIENTS ETHNIC AND CULTURAL BELIEFS AS THE INITIAL ASSESSMENT AS PATIENT CARE CONCERNS ARE MADE. YOU MUST TREAT EVERY PERSON AS A PERSON OF DIGNITY AND WORTH AND DESIGN EVERY PLAN WITH THE PATIENTS SOCIOCULTURAL NEEDS IN MIND.

21. COMMUNICATION YOU MUST LEARN TO EFFECTIVELY COMMUNICATE WITH YOUR PATIENTS. YOUR ABILITY TO ACCEPT OTHERS WITH AN OPEN MIND AND TO INTERACT WITH OTHER PEOPLE IS BASED ON LEARNED ATTITUDES AND SELF-UNDERSTANDING.

22. COMMUNICATION • TO BE AN EFFECTIVE COMMUNICATOR YOU MUST DEVELOP SKILLS IN LISTENING, SPEAKING, OBSERVING, AND WRITING.

23. SELF CONCEPT HOW WE FEEL AND WOULD DESCRIBE OURSELF. IT IS MADE UP OF ATTITUDES OF OUR SIGNIFICANT OTHERS TOWARD US AS WE INTERACT WITH THEM OVER TIME. • EVOLVES OVER A LIFETIME • BODY IMAGE

24. ELEMENTS OF SELF-CONCEPT • BODY IMAGE • SELF-ESTEEM • ROLE • IDENTITY

25. SELF-ESTEEM • EVALUATION OF OURSELVES BASED ON THE POSITIVE OR NEGATIVE RETURNS WE RECEIVE FROM OUR BEHAVIORS AS WE LIVE OUR LIVES.

26. NON VERBAL COMMUNICATION • HEAR • SMELL • FEEL THESE UNSPOKEN MESSAGES CAN OFTEN INDICATE HOW THE PATIENT FEELS MORE QUICKLY THAN ANY WORDS CAN!

27. CULTURAL VARIATIONS YOU MUST BE AWARE OF CULTURAL DIFFERENCES. • PERSONAL SPACE • SHACKING OF HEAD • USE OF HUMOR

28. GENDER DIFFERENCES • MEN PREFER INTERACTION • WOMAN PREFER DISCUSSION AVOID SEXUAL INNUENDOES! AVOID FLIRTATIOUS MANNER!

29. THERAPEUTIC TECHNIQUES • GUIDELINES-intro and what you are going to do. • REDUCING DISTANCE-make the patient feel included • SILENCE-use it • LISTENING-a good listener is golden • RESPONDING-make sure the patient is understood • RESTATING-repeating in a different way

30. THERAPEUTIC TECHNIQUES • REFLECTING-directing back to the patient the main idea • CLARIFICATION-lets the pt. know you heard them but you are not clear • OBSERVATION • EXPLORING-questions that relate to the problems of the patient • VALIDATING-verify what the patient has told you • FOCUSING

31. NONTHERAPUETIC TECHNIQUES • Rapid speech • Crowded hall • Noisy area • Complex medical terms • “Don’t worry, everything will be just fine” is a false reassurance.

32. NONTHERAPUETIC TECHNIQUES • JUDGEMENTAL STATEMENTS • FALSE REASSURANCES • DEFENDING • CHANGING THE SUBJECT • GIVING ADVICE • PROBING • DISAGREEING • DEMANDING AN EXPLANATION

33. PATIENT INTERVIEW STRUCTURED-LIST OF WRITTEN QUESTIONS THAT REQUIRE RESPONSES. UNSTRUCTURED-INFORMAL AND IS BASED ON QUESTIONS AND DEPEND ON PATIENT RESPONSES.

34. PATIENT EDUCATION PATIENTS EXPECT TO RECEIVE INSTRUCTIONS. • DESCRIPTION OF ANY PREPARATION NEEDED • APPROXIMATE TIME FRAME OF PROCEDURE • EXPLAIN ANY UNUSUAL EQUIPMENT USED • ANY FOLLOW UP INSTRUCTIONS

35. STAT

36. Suicide • The act of ending one’s own life. Passive suicide-patient refuses treatment even it is brings about death. Active suicide-taking ones life as a conscious act

37. Imaging scenario Pancreatic cancer is diagnosed with two patients, and the CT scan indicates the cancer has spread. One patient has decided to discontinue nourishment to hurry death and the other patients elects to continue treatment to sustain life as long as possible. How do personal values influence the reasons for refusing treatment as compared to continuing it?

38. LOSS AND GRIEF GRIEF IS A NORMAL EMOTIONAL RESPONSE TO THE LOSS OF A LOVED ONE, POSSESSION, SOCIAL STATUS, OR A BODILY FUNCTION OR BODY PART.

39. HOW A PERSON MANAGES GRIEF DEPENDS ON CULTURAL, RELIGIOUS, AND ECONOMIC FACTORS AS WELL AS THE VALUE PLACED ON THE LOSS. • GRIEF IS MORE SEVERE IN CHILDREN AND ADULTS

40. THEORY OF GRIEVING DR. ELIZABETH KUBLOR-ROSS MODEL PHASES OF GRIEVING • DENIAL • ANGER • BARGAINING • DEPRESSION • ACCEPTANCE

41. PHASE 1- DENIAL • DIFFICULTY FACING ONES DEATH PHASE 2- ANGER • THIS MAY HAPPEN IF THE ILLNESS IS LONG SUFFERING. PHASE 3- BARGAINING • THE PATIENT BECOMES A “GOOD PATIENT” HE OR SHE FEELS GUILTY FOR OUTBURST OF ANGER AND FEELS IF I AM GOOD I WILL BE SPARED. THEY MAY SEEK UNUSUAL FORMS OF TREATMENT.

42. PHASE 4- DEPRESSION • The PATIENTS ACCEPTS THE REALITY OF THEIR CONDITION AND BEGINS TO MOURN FOR ALL HE HAS LOST. PATIENT IS OFTEN WITHDRAWN. PHASE 5- ACCEPTANCE • THE PATIENT FOCUSES ON HIS IMMEDIATE SURROUNDINGS AND SUPPORT SYSYEM. PATIENT MAY WANT TO DISCUSS DYING.

43. PATIENT RIGHTS RELATED TO DEATH, DYING AND MEDICAL TREATMENT

44. Professional Duty • Assisting in suicide is illegal • Health care providers are devoted to healing • Assisting in suicide is incompatible with professional obligation

45. ADVANCE HEALTH CARE DIRECTIVE ALL PERSONS HAVE THE RIGHT TO GIVE INSTRUCTION CONCERNING THEIR OWN HEALTH CARE. THESE DIRECTIVES SHOULD BE WRITTEN, SIGNED, WITNESSED AND MADE AVAILABLE TO ANYONE WHO MAY BE IN CHARGE OF THE PERSON IF HE/SHE IS NOT ABLE TO MAKE DECISIONS . A COPY SHOULD BE PLACED IN THE PERSONS MEDICAL DOCUMENTS AND ON THE CHART WHEN ADMITTED TO THE HOSPITAL. THE U.S. CONGRESS PASSED A “PATIENT SELF DETERMINATION ACT” IN 1990

46. Imaging Scenario An imaging professional father is dying of cancer with no hope of recovery. The Father has an advanced directive that he does not want any life sustaining equipment. He becomes unresponsive and a family conflict develops concerning withdrawal of nourishment. Part of the family feels it is in the best interest of the patient-to hasten his death and end his suffering-and another family member views this as killing him. They ask the x-ray tech about the pain and suffering, the issues of passive and active euthanasia and whether not using life sustaining equipment is equal to starving him to death. How should the x-ray tech respond? Is there correct answer?

47. TERMS TO KNOW • LIVING WILL - A DOCUMENT THAT LIST THE PATIENTS WISHES IF TERMINALLY ILL. • DURABLE POWER OF ATTORNEY- DESIGNATES A PERSON WHO WILL MAKE HEALTH CARE DECISIONS FOR THE PATIENT IF THE PATIENT CAN NOT. • DNR- INSTRUCTIONS ON THE CHART THAT DIRECT HEALTH CARE WORKERS NOT TO RESUSCITATE THE PATIENT. • DNI- INSTRUCTS HEALTH CARE WORKERS TO DO NOT INTUBATE. • FULL CODE- FULL CPR IF THE PATIENTS STOPS BREATHING OR THE HEART STOPS.

48. Case study-Terri Schiavo 1990-26 year old Terri Schiavo has a heart attack. She lost oxygen and was put on a feeding tube and oxygen and declared to be in a vegetative state. 1998 Terri Schiavo’s husband filed a petition to stop life support and in 2000 it was granted. Terri’s parents appealed this and it was in court until 2005.The case was appealed 14 times in Florida courts. Finally the courts refused to hear the case and the life support and feeding tubes were removed March 18, 2005. She died March 31, 2005!

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