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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Paramedic Care:Principles & Practice
Volume 1Introduction to Advanced
Prehospital Care
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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Chapter 11Therapeutic Communications
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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Topics
Basic Elements of CommunicationCommunication TechniquesPatients with Special Needs
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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Communication Components
Communication is the exchange of common symbols.Communication strategies include persistently paying attention to word choices, tones of voice, facial expressions, and body language.
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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Basic Elements of Communication
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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Basic Elements of Communication
Communication consists of:– A sender– A message– A receiver– Feedback
EncodingDecoding
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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Basic Elements of Communication
Failure to communicate results from:– Prejudice – Lack of privacy– External distractions– Internal distractions
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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Trust and Rapport
With good rapport, the people you are serving will follow your lead. Techniques to develop good rapport include:– Using the patient’s name– Address the patient properly– Modulate your voice– Be professional but compassionate
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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Trust and Rapport
Techniques to develop good rapport (cont.)– Explain what you are doing and why– Keep a kind, calm expression– Use an appropriate style of communication
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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Professional Behaviors
First impressions are crucial– The patient relies on visual input
Be neat and cleanPractice good hygieneStay physically fit
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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Professional Behaviors
Maintain an overall demeanor that is calm, capable, and trustworthy.Be confident, not arrogant.Be considerate.
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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Communication Techniques
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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Communication Techniques
General Guidelines– Patients generally respond to questioning in one
of three ways: They may pour out information easily They may reveal some things and conceal others They may resist, hiding information from themselves and, therefore, from you
– Remain non-judgmental
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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Non-Verbal Communication
Consists of gestures, mannerisms, and postures by which a person communicates – Distance– Level– Stance
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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Non-Verbal Communication
Distance
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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Non-Verbal Communication
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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Non-Verbal Communication
Getting down to a patient’s level can help improve communications on a pediatric call.
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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Non-Verbal Communication
A powerful source of effective communication comes with eye contact. Use eye contact as much as possible.Remember to remove sunglasses while working with patients.
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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Non-Verbal Communication
Use an appropriate compassionate touch to show your concern and support.Be careful to touch appropriately.
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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Interview Techniques
Questioning Techniques – Use open-ended questions.– Use direct questions.– Do not use leading questions.
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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Interview Techniques
Questioning Techniques (cont.)– 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.
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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Observing the Patient
Overall appearance– Clothing– Jewelry
Mental statusSpeechMood and energy level
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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Effective Listening and Feedback
SilenceReflectionFacilitationEmpathyClarification
ConfrontationInterpretationExplanationSummarization
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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Interviewing Errors
Providing false assurancesGiving adviceAuthorityUsing avoidance behavior
DistancingProfessional jargonTalking too muchInterruptingUsing “why” questions
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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Patients with Special Needs
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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Sources of Difficult Interviews
Difficult interviews may stem from several sources: – Patient’s physical condition– Patient’s fear of talking
Psychological disorder, language or cultural difference, or even the difference between your ages
– Patient’s intention to deceive
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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Sources of Difficult Interviews
Use the same techniques on a patient who is reluctant to talk to you as you would on any other patient. – Provide positive feedback to any response the
patient provides. – Make sure the patient understands you.– Continue to build trust and rapport with the
patient.
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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Sources of Difficult Interviews
Difficult interviews include:– Children and their parents – Elderly people – People who are blind or deaf – People of other cultures– People who are hostile or uncooperative
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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Childhood Development
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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Children
Start by talking to the caregivers, then gradually approach the patient. – Remember body language
Explain what you intend to do, even to very young children.You must build trust.
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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Elderly Patients
Be respectful. – Always use a formal means of address
Speak slowly and clearly. Interviews might take longer. – Physical limitations– Fatigue
Compassionate touch can be a welcome and important means of nonverbal support. Give choices whenever possible.
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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Sensory Impairment
Blindness:– Tell patient everything you are going to do.– Use touch as a form of contact for reassurance.
Hearing impairment:– Ask patients what their preferred method of
communication is.
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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
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.– Avoid imposing on the patient your own beliefs,
values, and patterns of behavior.
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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
If Using Interpreters
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.
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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Interpreters
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.
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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Hostile or Uncooperative Patients
Set limits and boundaries.Document unusual situations.Consider having a same-sex witness ride in the ambulance.If your safety is in jeopardy, keep away from the patient.
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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Hostile or Uncooperative Patients
Have an appropriate show of force if necessary.Know local policy regarding restraints and psychological medications.Use law enforcement if needed.
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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
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.
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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 1: Introduction to Advanced Prehospital Care, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Summary
Basic Elements of CommunicationCommunication TechniquesPatients With Special Needs