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decoding
  • the act of interpreting symbols and format
  • prompts the receiver to respond to the sender's message
how can decoding fail?
  • if symbols or words sent in the message are unfamiliar to both parties
  • if interpretation of the message is based on different understanding of symbols or format.
  • carefully select words that cannot be easily misinterpreted
therapeutic communication
  • a planned, deliberate, professional act that involves the use of communication techniques to achieve two purpsoes"
  • 1. a positive relationship with the patient
  • 2. a shared understanding of information between the patient and the paramedic
  • these two factors aid in the attainment of the desired patient care goals
what important effects can therapeutic communications have?
  • can improve the paramedic's interaction with the patient
  • ensure better patient care
  • defuse potentially violent situations or prevent them from escalating
  • reduce risk of lawsuits
communication
  • main element of human interaction
  • verbal and nonverbal behavior
  • includes all the symbols and clues people use to convey and receive meaning
  • to achieve good communication, all participants must take equal responsibility for their part in the process
  • successful only when each person clearly gets the message
six elements of the communication process
  • 1. the source
  • 2. encoding
  • 3. the message
  • 4. decoding
  • 5. receiver
  • 6. feedback
techniques for verbal communication
  • use fewer words to avoid confusion
  • use words that express an idea simply
  • do not use vague phrases
  • use examples if  they will make the message easier to understand
  • repeat the important parts of a message
  • do not use technical jargon
  • speak at an appropriate speed or pace
  • do not pause for long periods or quickly change the subject
encoding
  • the act of placing a message in an understandable format (either written or verbal) for both the sender and the receiver
  • responsibility of the sender, because the sender defines the content and emotional tone of the message
message
  • information that is sent or expressed by the sender
  • should be clear and organized
  • verbal or nonverbal symbols
  • more ways in which a message is communicated, the more likely the receiver is to understand it
receiver
  • person intended to understand the message
  • esentially the decoder
feedback
  • receiver's response to the sender's message
  • verbal or nonverbal
  • the quality of the feedback reveals whether the message's intended meaning was received
sympathy
  • the expression of one's feelings about another person's problem
empathy
  • ability to see a situation from the viewpoint of the person experiencing it
  • uses sensitive and objective communication
ladder of listening
  • L - look at the person speaking to you. this alone conveys the message that you are focused and involved.
  • A - ask additional questions to clarify the answers to your initial questions. remember that you learn what to say by listening to what has been said
  • D - don't interrupt. an interruption is acceptable only when you require clarification
  • D - don't change the subject. the person you are speaking to will indicate when he or she is finished speaking.
  • E - empathize with the person speaking. this send the message that you are an attentive and caring listener
  • R - respond to what is said verbally or nonverbally. a simple nod or leaning slightly toward the person deomstrates your interest and attention. phrases such as "i see" or "i understand" make your response even better
private space
  • comfortable distance from the patient's body
  • about 4 to 5 feet or twice the patient's arm length away
  • a form of subconscious personal protection that varies by individual and by culture
  • patient's may become defensive is space is invaded
  • enetering this space usually causes the patient to back away
traps in interviewing
  • asking the patient "why" questions
  • provide false reassurance
  • offering poor or unwanted advice
  • showing approval or disapproval
  • giving an opinion that takes away the patient's part in decision making
  • changing the subject inappropriately
  • stereotyping the patient or complaint
  • using professional jargon
  • talking too much
  • asking leading or biased questions
  • interrupting the patient
  • being defensive in response to criticism
silence

(helpful techniques for the patient interview)
  • gives patient more time to gather their thoughts
 
reflection

(helpful techniques for the patient interview)
  • echoing (i.e., paraphasing) patient's words allows them to clarify or expand on the information provided
empathy

(helpful techniques for the patient interview)
  • encourages patients to talk more openly
clarification

(helpful techniques for the patient interview)
  • lets patients rephrase a word or thought that is confusing to the paramedic
confrontation

(helpful techniques for the patient interview)
  • focuses the patients' attention on one specific factor of the interview
interpretation

(helpful techniques for the patient interview)
  • links events
  • makes associations or implies a cause
  • is based on observation or conclusion
explanation

(helpful techniques for the patient interview)
  • provides information to patients
  • encourages sharing or facts of objective information
summary

(helpful techniques for the patient interview)
  • provides a review of the interview
  • the paramedic can ask open-ended questions that allow patients to clarify details
general guidelines to help establish good rapport
  • put patients at ease by letting them know you are "on thier side"; that is, you respect their comments, and you are there to help them
  • be alert for and respond to visual clues that a patient needs help
  • show compassion
  • assess the patient's level of understanding and insight. use words and explanations at their level
for the most part, patients communicate with health care providers in three ways:
  • pouring out the information in the form of complaints
  • revealing some problems while hiding others they think are embarrassing
  • hiding the most embarrassing parts of their problem from the paramedic (and personally denyng the issue)
what is the best way to obtain information from the patient?
  • use techniques for open-ended and closed (direct) questions
  • these techniques include resistance, shifting focus, recognizing defense mechanisms, and distraction.
when dealing with an angry or hostile patient, paramedics should:
  • avoid raising their voices to match the angry person's tone
  • have the person identify and describe the cause of anger
  • restate the cause of anger
  • offer a solution (if possible) or empathize and acknowledge the person's feelings
Three methods that can be used use assess a patient's metal staus:
  • observation, conversation, and exploration
the paramedic should use the following guidelines when sensitive issues are discussed with patients:
  • make sure privacy is maintained
  • be confident, direct, and firm with your questions
  • do not apologize for asking a sensitive question
  • do not be judgemental
  • use words that are understandable, but do not be patronizing
  • be patient and proceed slowly
tough interviews generally stem from four factors
  • the patient's condition may affect the inablity to speak
  • the patient may fear talking because of psychological problems, cultural diffences, or age
  • the patient may have a cognitive impairment
  • the patient may want to deceive the paramedic
some guidelines that can be used in interviewing a hostile patients are:
  • try to use normal interview techniques
  • never leave the patient alone without adequate assistance
  • set limits and boundaries with the patient
  • explain the advantages of cooperation to the patient
  • follow local protocol for dealing with hostile patients, including the use of physical and chemical restraints
ethnocentrism
  • seeing one's own life as the most acceptable or best.
  • acting in a superior manner toward another culture's way of life
cultural imposition
  • is forcing one's beliefs, values, and patterns of behavior on people form another culture
factors to consider in communicating with patients of another culture are:
  • some cultures expect health care workers to have all the answers to their illness.
  • different cultures accept illness or injury in different ways
  • nonverbal clues are seen differently in different cultures
  • some cultures consider direct eye contact impolite or aggressive; patients may avert their eyes during an interview
  • paramedics should not use touch as a means of reassurance with members of different cultural groups because touch may be easily misunderstood
  • language barriers my present difficulties
  • personal space is often defined by culture. it also varies by indvidual
intimate zone
  • 0 to 1 1/2 feet
  • visual distortion occurs
  • best for assessing breath and other body odors
personal distance
  • 1 1/2 to 4 feet
  • perceived as an extension of self
  • speaker's voice is moderate
  • body odors are not apparent
  • much of the physical assessment occurs at this distance
social distance
  • 4 to 12 feet
  • used for impersonal business transactions
  • perceptual information is much less detailed
  • much of the patient interview occurs at this distance
public distance
  • 12 feet or father
  • interaction with others is impersonal
  • speaker's voice must be projected
  • subtle facial expressions are imperceptible
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