Altered Level of Consciousness
Rationale: Altered levels of consciousness (Altered LOC) can be a huge challenge in communication with your patient. Altered LOC can be brought on by head injuries, fever, overdose, among other things. The most important item to remember is that the patient can no longer be relied upon during your time together. All explanations you are the giving the patient, all directions, all answers to questions can and should be considered suspect. The patient is not intending to be this way, it just is a matter of fact a healthcare worker needs to contend with. These patients must be kept under the watchful eye of the healthcare staff at all times. However, just because the patient does not seem to be with it, does not mean that they cannot understand you. It should be assumed that no matter the LOC, the patient will be able to recall the conversations that have happened in their presence.
Rationale: The attitude that the healthcare worker expresses can change the course of your relationship with the patient. It is important to be able to match the patient’s demeanor and personality with a certain type of attitude. If the patient seems nervous or scared, try not to make quick movements that can startle them. With every patient you encounter make sure you speak professionally. Speaking professionally, but kind, can get you a lot of latitude when interacting with patients. Lastly, being assertive is always a critical characteristic in healthcare. Assertiveness is about being direct but calm towards the patient. Tell the patient exactly what is going to happen, how it’s going to happen, and when it’s going to happen, but without being bossy or hostile. Once hostility or aggression become part of the relationship with a patient, the chances of the patient shutting down and becoming uncooperative become significant.
Rationale: In modern society, it is becoming important that we embrace multi-cultural attitudes in the ways we interact with others. In healthcare, it is absolutely critical that we understand and embrace a multi-cultural society. There are many nuances to every culture that can create roadblocks in the care of a patient. For instance, some Asian cultures may consider eye contact as impolite or rude. Native Americans can consider touching an invasion of their personal space, and so should be kept to just what is necessary for the procedure. Some Vietnamese cultures smile when they are uncomfortable. These are just a few examples of how our verbal and non verbal communications could be misconstrued if we aren’t sensitive to the cultural diversity around us.
Rationale: It is one thing to be able to care for your patient. It is another thing to understand what your patient is going through and give them your empathy, because you have been there too. Sometimes a patient just needs someone to listen to them. It can take a minute or fifteen minutes, but sometimes it is best to give your patient your ear, and just let them talk. If your patient has been thru a traumatic event, and you are the empathetic ear that has offered to listen, you may be receiving information that no one else will get. Patients do not share all of their information equally in healthcare. Sometimes an inattentive healthcare worker will not get the same history as someone who shows that they care.
Rationale: A physician will typically inform the patient about complex procedures and surgeries. But, depending on the type of procedure being offered to the patient, the medical assistant may be responsible for informing the patient about the procedure and obtaining the proper consent. This involves several steps to make sure you are legally protecting yourself, the institution and the patient. The examination must be described in full, and it must be signed before any sedation takes place. The patient must be of sound mind at the time of signing. If the examination is to be performed on a minor, the parents or guardians must be informed and sign. Only the physician named on the consent may perform procedure. All conditions of the informed consent form must be met before the procedure is allowed to be performed. The most critical note, the informed consent may be revoked at any time by the patient after the document has been signed.
Rationale: Having a strong interpersonal relationship is extremely important on a healthcare team. When interacting with patients, it is important to know that you can trust those around you no matter what situation may arise. Teamwork is the combined effort by a group for a common goal: utilize this idea as often as you can. Always offer positive reinforcement if you see a member of your team go above and beyond for a patient. If a coworker is having a bad day, give them the opportunity to talk it out with you. Being a good listener can go a long way to building good relationships with those around you. However, don’t share the information that is given to you in confidence. The easiest way to lose the relationships you build is by gossiping and confiding in cliques in the workplace.
Rationale: Not all patients are comfortable in healthcare facilities. Not all patients are comfortable sharing their personal lives with people. As a healthcare professional, it pays to be sensitive to all forms of communication, not just the verbal ones. When taking a history from a patient, make sure to pay attention to the patient’s eye contact, fidgeting hands, the patient’s jaw for clenching, and posture. All of these nonverbal cues can communicate to you whether the patient is uncomfortable, possibly withholding information critical to their care, or in a state of pain. The more sensitive the healthcare worker is to these cues, the better the care they can give to their patients.
Rationale: There are a lot of times during the care of a patient that they can feel confused about what is happening to them. Shots with unknown medications, prescriptions for unfamiliar medications, complex diagnoses; it is easy to see how it can be frustrating. It should be the responsibility of every healthcare worker to make sure they are informing the patient of every step of their care. Sometimes this only takes a few words, but it can make great strides towards making a patient feel comfortable in your care. Patient education can be explaining a procedure before you get started, listening to any fears or concerns the patient may have, or explaining possible ramifications (if any) of having the test done. It isn’t always easy to explain the details to patients, but it is always best that they know what to expect.
Rationale: When a patient is visiting a healthcare facility, chances are it is not one of the best days of their life. Typically, a patient has come because there is some pressing health situation. Any situation having to do with someone’s well being is going to create stress. The degree of their stress is directly proportional to their perceived or actual health problem. Whenever someone is under a great deal of stress, it tends to affect their ability to rationally process information and communicate accurately. It is critical to take an accurate history from the patient, and always pay particular attention to their state of mind during the question and answer session. If you perceive that they are really on edge or emotional, it is best to then speak slowly, clearly, and with a lowered voice. If a patient is upset or angry, don’t let their outbursts draw a similar reaction from you. Attempt to diffuse the situation and bring the conversation back to their care.
Rationale: Valid Choices are a way to empower the patient when they would otherwise have no choices. The opportunities to give the patient control are few and far between, but with a little extra consideration, you can let the patient feel as if they have some amount of direction over their care. It is important to note that giving the patient choices over things they cannot control defeats the purpose of this exercise. For example, “Are you ready to get this shot now?” Ultimately, the patient doesn’t have a choice in the matter, so asking the question is pointless and could actually serve to irritate the patient. It is better to give the patient smaller controls, such as, “Would you like a blanket while we wait for the doctor?” Or, “Would you like me to prop the door open in case you need something?” These are decisions that you can reasonably relinquish some control over, that gives the patient an opportunity to make a choice for themselves.