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UNIT 1 CHAPTER 10, 11, 12 •Human Diversity •Patient Interactions •History Taking 1 Human Diversity in Healthcare Chapter 10 2 What is Human (Cultural) Diversity? The ways that people are different The ways that people are alike Cultures impact (and often drive) the uniqueness of the human condition. 3 Why is cultural diversity important in healthcare today? Globalization has resulted in crosscultural or multicultural issues in our society. Multiculturalism can result in misunderstanding (& conflict) caused by cultural differences. Understanding and accepting different types of diversity is key to providing quality patient care to ALL of our patients! 4 Cultural Competency “Possessing a set of attitudes, behaviors and policies that come together in a system or among individuals that enable effective interactions in a cross-cultural framework.” Cultural Competency is a necessary skill in today’s workplace. 5 Diverse nature of humans Age* Disability Economic status Education Ethnicity* Race* Family status First Language Mental & Physical ability* Gender* Geography Lifestyle Physical characteristics Political affiliation Religious preference Sexual orientation* 6 Age Asian cultures revere their elders European and Western cultures value youth over age People of all ages make positive contributions to society 7 Ethnicity Relates to racial, national, religious, linguistic or cultural heritage. Core values of ethnic cultures vary Ethnocentrism – the tendency to view norms and values of one’s own culture as the only acceptable ones. Racism – the belief that one race or culture is superior, using it as a basis for discrimination 8 Ethnicity Ethnic and Racial cultural differences often include linguistic differences Ability to communicate with people from different backgrounds is essential to delivering quality patient care. A failure to communicate can be a danger to the patient and a liability to the healthcare provider. 9 Gender or Sexual Orientation Sexual identity is biological or chromosomal (male vs. female) Gender identity is the “inner sense of maleness or femaleness” and is influenced by (among other things) culture. 10 Mental & Physical Ability 10% world’s population have some type of disability ranging from mild to severe. The intent of the American with Disabilities Act of 1990 is to prevent discrimination against persons with disabilities. 11 Mental & Physical Ability Core Values of Human Rights – – – – Autonomy - Self determination Dignity – Equality – Fair and equitable treatment Solidarity – Requires society to support and maintain freedoms of individuals Later we will talk about Patient’s Rights. Note the similarities! 12 Cultural Competency Attitudes, behaviors and policies that ensure effective interactions in a multi-cultural environment. – – – – – 5 Elements of Cultural Competency Valuing Diversity Cultural self-assessment within the organization Awareness of the dynamics of cross-cultural interaction Incorporating cultural knowledge into the corporate culture Adaptive environment to multicultural issues (i.e., Flexibility) 13 Cultural Competency in Healthcare Clear and unimpeded communication is essential Patients must be treated with respect, understanding and acceptance regardless of cultural differences. The ARRT Code of Ethics preclude discriminatory practices in the delivery of quality patient care. 14 Cultural Competency in Healthcare Communication – Language barriers – Nonverbal communication Space – Proximity/Personal boundaries – Eye contact – Appropriate touching Time – Past, present, future – Prevention vs. treatment 15 Cultural Competency in Healthcare Environmental control – Differences in health practices – Cultural views of illness vs. health Biologic variations – Ethnic or racially-related differences in: Body structure Susceptibility to certain diseases Nutrition Social organizations – Individual oriented vs. family oriented – Youth vs. elder 16 Gender or Sexual Orientation Homophobia – the irrational fear of homosexuality and hostility towards individuals who are or are perceived to be homosexual (gay, lesbian) or bisexual. 17 1. Human diversity consists of which of the following characteristics? A. B. C. D. E. Age Race Mental ability A&B All of the above 18 2. The tendency to view the norms and values of one’s own culture as the only acceptable ones and to use them as standards by which all other cultures are measured is called: A. B. C. D. bias diversity ethnocentrism racism 19 3. The Americans with Disabilities Act of 1990 requires institutions that receive federal funds to make their facilities accessible to the disabled. A. B. True False 20 4. Homosexuality is the irrational fear of individuals who are sexually attracted to persons of the same gender. A. B. True False 21 5. Racism is the belief that one race or culture is superior to another and the use of that belief to discriminate against races considered inferior. A. B. True False 22 Patient Interaction Chapter 11 23 Communication Communication is one of the radiographer’s most important tools. Developing a rapport with your patient is important to gaining cooperation which ensures a quality procedure. It also demonstrates good customer service skills. 24 Maslow’s Hierarchy of Human Needs Self Actualization Self-esteem Love & Belongingness Safety & Security Physiologic Needs 25 Maslow’s Hierarchy of Human Needs Biological Needs must be met first before any other needs can be addressed. Biological Needs include: water, air, food, reproduction; in other words, things an organism needs to survive. What things might happen to you as a patient in a hospital that could threaten this basic need from being met? 26 Maslow’s Hierarchy of Human Needs Safety and Security needs can be achieved once the biological needs are met. Safety and Security needs relate to the how safe and secure a person feels in his/her environment. Example: a homeless person may constantly wavering between meeting biological needs and finding a safe and secure place to stay. 27 Maslow’s Hierarchy of Human Needs Once the more basic needs are achieved, a person looks for love and affection from others. This is important to a person’s well being. It is important for our patient’s well being that they have access to those who meet this need for them. 28 Maslow’s Hierarchy of Human Needs The need for self-esteem is higher up on the hierarchy, which means that is isn’t as important to survival, but once the more basic needs are met, this need becomes important. What type of things might threaten a patient’s need for self-esteem? 29 Maslow’s Hierarchy of Human Needs The highest need in Maslow’s hierarchy is selfactualization. Many people never achieve this level! Do you think these folks have? Radiologic Technology Graduating Class of 2001 30 What do patients fear???? The unknown or unexpected – That is why is it important to explain procedures to patients Pain – Don’t lie to patients. If it is going to hurt, let them know what to expect. If you lie, it breaches their trust in you. Humiliation or embarrassment – Always keep your patient covered up! 31 Patient Fear Loss of….. Life – Many older people think hospitals are a place you go to die! Limb – Physical or Mental function Self-image Loss of all of these things affect a patient’s selfimage. It is also a fear of change! Familiar surroundings (this especially affects children and the elderly) 32 Patient Fears: Loss of... Comfort and/or security – Hospitals are not known for their comfort! Nor are x-ray tables!! Privacy – Body functions – Even with private hospital rooms, think how many people are in and out of them hourly!! 33 34 Patient Fears: Loss of... Dignity – Patients not body parts! Modesty – Hospital gowns! 35 36 Patient Fears: Loss of... Financial – lost work – hospital bills 37 38 Patient Fears: Loss of... Control (freedom, diet) In the hospital, you eat what they bring you!39 Patient Interaction – Developing rapport Introduce yourself to the patient Initial patient assessment – Request – Chart – Direct communication/patient history Explanation of procedure Informed consent 40 Inpatient Considerations Transportation (ambulatory, wheelchair, cart, bed). Waiting room/Privacy/Modesty issues Patient condition can change quickly; Be observant! Beware! Patients are listening and watching everything around them! 41 Outpatient Considerations Patient expectations of appointment time. Acknowledge the patient’s presence. Ongoing communication when delays occur. Family may accompany patient; acknowledge them too! It is good customer service! 42 Patient Communication Communication skills are some of the most important skills that health professionals can develop. 43 Communication: Why is it important? It establishes rapport with the patient. It serves as a vehicle to establish, maintain or terminate a relationship with the patient. It enables information being obtained concerning patient’s condition and progress. It enables relaying of pertinent information or instructions to patient or another member of the healthcare team. 44 Catalysts of Communication Caring - warmth, tenderness, compassion, listening. Trust - dependability, confidence, honesty. Empathy - place yourself in another’s shoes Sympathy - compassion, warmth, kindness, interest, concern (NOT pity) Respect - Acceptance despite differences Humor – relaxes the patient, eases passage through awkward moments (be careful not to be unprofessional!) 45 Barriers to Communication Distractions – Worry – Fear – Events occurring in the environment Cultural issues Filters (blocks) – – – – – – – – – – Preconceived ideas Negative nonverbal cues Language issues Rapid speech Complex medical terminology Language barriers Judgmental statements Cliché statements False reassurances Defending 46 Body Language or Paralanguage (Nonverbal communication) There are NO neutral messages! 50% of communication is Body Language; 40% Tone of Voice; 10% Words! In other words, 90% messages are nonverbal!! Watch what you body is saying!! 47 Body Language (Nonverbal communication) On the Phone: – 70% of the message is communicated through tone – 30% by Words Try saying “hello” with a smile; now without a smile…can you tell the difference? 48 Nonverbal Communication Voice tone & volume What makes up body language? – Gestures (use of hands as well as body) – Posture (angle of head, proximity, leaning forward) – Eye contact (eye contact means different things in different cultures.) – Hands (punctuation, accentuation, clarification) – Facial expression (happy, angry, sad, impatient….) 49 Nonverbal Communication Use of touch – Beware not to invade one’s personal space – Use appropriate touch Emotional support For emphasis (to highlight specific instructions) For palpation (to locate landmarks for positioning) Use of (therapeutic) silence – Provides a channel for both transmitting and receiving messages. Use of listening. – Pay attention – Shows caring – Lean forward, nod head. 50 Nonverbal Communication Professional appearance helps gain the patient’s trust and confidence To the patient, the caregiver’s personal hygiene reflects a person’s professional behavior. 51 Communication Considerations Seriously ill or traumatized patients Visually impaired patients Speech or hearing-impaired patients Non-English-speaking patients – Use of translators Mentally impaired patients Substance abusers 52 Communication Considerations Pediatric patients (large age span – big communication differences) Geriatric patients Terminally ill patients 53 6. The application of empathetic skills will: A. B. C. D. E. promote better health care outcomes increase patient satisfaction increase health care costs a and b all of the above 54 7. The lowest level of Maslow’s hierarchy of needs is: A. B. C. D. self-actualization physiologic needs love and belonging self-esteem 55 8. According to Maslow’s hierarchy of needs, what is the reason patients may behave abnormally during their hospital stay? A. B. C. D. Their physiologic needs aren’t being met. They cannot understand what is happening. They are missing their sense of love and belonging None of the above 56 9. All of the following are examples of nonverbal communication except: A. B. C. D. smiling at the patient asking the patient for a medical history using a friendly tone of voice having a puzzled facial expression 57 10. Why is it important for the radiographer to make eye contact with the patient as she describes the pain in her hand? A. B. C. D. It provides emotional support for a stressed patient. It makes the patient feel that what she is saying is important. It helps to expedite the examination. It reassures the patient of the radiographer’s technical skills. 58 11. Nonverbal communication is not as important as verbal communication with the patient or family members. A. B. True False 59 12. In Maslow’s hierarchy of needs, a patient cannot satisfy the need for love and belonging before satisfying the need for safety and security. A. B. True False 60 As a healthcare professional, and even as a student….. you are a customer service ambassador of each clinical education setting! As such, you must ensure patient safety and excellent care. 61 Five Fundamentals of Service Acknowledge the Patient – By their last name if possible Introduce – “ Hi. My name is Sue Jones and I am a radiography student. I am working under the supervision of Anne RT and will be assisting with your examination today.” Duration – How long the exam will take? – How long the patient will be there? – How long they’ll have to wait for the results? Explanation – Explain the test, the level of discomfort involved (be honest!) – Explain you are going to be checking their name band and why. Thank You – Thank you for choosing (Hospital name) 62 Grief is another issue that Healthcare Professionals have to recognize and deal with. 63 What is Grief? Grief is a normal emotional response to the loss of a loved one, a prized possession, social status, body function or body part Imminent death Management of the grieving process is dependent upon cultural religious and economic factors 64 Kubler-Ross Theory of Grieving Phase 1 – Denial – a defense mechanism Phase 2 – Anger – therapeutic Phase 3 – Bargaining – seeking alternatives Phase 4 – Depression – acceptance of reality; mourning begins Phase 5 – Acceptance - grief 65 Patient’s Bill of Rights American Hospital Association 66 Patient’s Bill of Rights Right to Considerate and Respectful Care Right to know (informed consent) Right to refuse treatment Right to an advance directive (Living will) Right to Privacy Right to Confidentiality 67 Patient’s Bill of Rights Right to review his/her records Right of referral or transfer (to another hospital/physician) Right to know of business relationships Right to consent or refuse participation in experimental treatment Right to expect continuity of care. Right to be informed of hospital policies 68 Patient Rights Related to Death, Dying, and Medical Treatments Science of medical care has intervened and extended life by a mechanical means May not be the wish of the patient Advance directives • Legal document drawn up when patient is well that outlines what patient would like for end-of-life care 69 Patient Rights Related to Death, Dying, and Medical Treatment Types of advance directives • Living Will – document that lists the patient’s wishes if terminally ill • Durable Power of Attorney for Health Care – designates who will make health care decisions for the patient if he or she is unable to do so • DNR – instructions on a patient’s chart that direct health care workers not to resuscitate the patient if he or she stops breathing and the heart stops beating 70 Patient Rights Related to Death, Dying, and Medical Treatment •DNI – instructs health care workers not to intubate the patient if a question of need arises •Full Code – instructs health care workers to initiate CPR if the patient stops breathing and the heart stops beating (Code Blue) 71 13. When family members accompany the patient to the radiology department, both the family members and the patient are treated with professional courtesy and respect. A. B. True False 72 14 What is the acceptable reaction of the radiographer in dealing with a patient in the beginning stage of denial isolation? A. B. C. D. addressing the patient’s feelings about dying offering silence and acceptance of the person, without discussing death supporting the patient’s feelings by discussing the death of one’s own loved one attempting to cheer up the patient by telling jokes 73 15 Which of the following stages of dying is described as the realization that life will be interrupted before everything the dying patient has planned has been accomplished? A. B. C. D. denial depression anger bargaining 74 Patient Assessment and History Taking Chapter 12 75 What is Patient Assessment? The identification, ranking and prioritizing of goals to determine those problems or concerns that can be solved through a systematic process of problem solving 76 Purpose of Assessment in Radiologic Technology Assessment influences the decisionmaking process. It enables the radiographer to provide appropriate patient care while obtaining quality diagnostic images, Patient condition determines not only HOW a procedure is performed but WHAT images are obtained! 77 Characteristics of Assessment Problem-solving Critical thinking Deductive reasoning Analysis Evaluative thought 78 Assessment uses the Scientific Method 1. 2. 3. 4. 5. 6. Identify the problem Recognize limitations to solving the problem (patient or equipment) Identify available resources (accessories or people) Develop alternatives (plan A/plan B) Implement the plan Evaluate the results 79 Patient Assessment includes: Naturalistic observation Physical signs Cultural assessment Assessment of special needs according to: – age – disability 80 Limitations of Assessment Time constraints – Adequate time to size up the patient and ask the appropriate questions Patient cooperation – How able is the patient to provide the necessary information? Experience of the assessor – Does the assessor know what to look for? Personal bias of the assessor – Does the assessor have preconceived notions about the patient 81 Taking a Patient History For Radiographer’s role is to collect a focused history specific to the procedure that is to be performed. 82 Data Collection Objective data – perceptible to the senses (seen, heard, felt) Subjective data – perceptible to the affected individual (emotions, feelings, experiences) Objective data are not necessarily more important than subjective data! 83 Questioning Skills Listening is the most important communication skill! Open-ended questions Facilitate (nod, encouragement) Silence (gives patient time to gather thoughts) Probing questions (to focus interview) Rewording for clarification Summarizing to ensure understanding 84 Questioning Skills Minimize use of medical terminology unless patient obviously understands. Avoid using leading questions – don’t put words in the patient’s mouth. 85 Classification of Problems THE SACRED SEVEN (of chief complaint) Localization Chronology Quality Severity Onset Aggravating or Alleviating Factors Associated Symptoms 86 Localization Where? If possible, have the patient point Be a specific as possible 87 Chronology of Symptoms The order in which symptoms occurred. What symptom occurred first? Second? Duration - When the symptom/problem occurs, how long doe it last? 88 Quality Describes the character of the symptoms Examples: color, consistency, type of cough, what kind of pain (burning, stabbing etc.) 89 Severity Describes intensity of symptoms Can describe quantity or extensiveness Example of a question: “On a scale of 1-10; how bad is the pain?” 90 Onset When did the problem/symptoms begin? How long has the problem/symptoms been occurring? 91 Aggravating or Relieving Factors Are there any things that precipitate (seem to cause or happen before) the patient experiences the symptom(s)/pain? Is there anything that seems to relieve the symptom(s)/pain? Does there seem to a be a predictable progression of events that happens every time the symptom/pain is experienced? Does it happen the same every time it happens? 92 Associated Symptoms Are there any other symptoms that seem to accompany the problem/symptom(s)? 93 Treatments Is there anything that has been prescribed to treat the problem? If so, what is it? Does is provide relief? If so, does it relieve the symptom/pain completely? Partially? 94 Patients View of the Cause Never under estimate the patient’s opinion of the cause of the problem! Ask what the patient thinks is causing the symptom(s)/pain/problem. Never discount the patient’s instincts! 95 What is in a (Hx) History? General Health Childhood illnesses / immunizations Major illnesses * Injuries * Previous Surgeries * Previous Hospitalizations* Transfusions 96 What is in a History? Current Medications * Allergies * (may be significant in procedures requiring administration of contrast media) Emotional health 97 Taking a History It is important to assure confidentiality to the patient. Patients will be more honest and open if they can trust that the information will be treated with discretion Always ask history questions in a private setting! 98 Legal Considerations (Documentation – written record of events) Always use ink Leave no blank spaces or lines on charting record Chart only for yourself; never for others Always correct mistakes (date and initial) 99 Legal Considerations (Documentation) Note both normal and abnormal signs For non-routine incidents or accidents always document with an incident report 100 History Questions for Chest examinations Fever? Pain? SOB (Where? How long?) (Shortness of Breath)? Weight Loss? (unexplained) Hemoptysis Previous Known (coughing up blood)? surgery (what kind?)? heart or lung disease? Anemia? Cough? (Dry? or Productive?) 101 History Questions for Abdominal Examinations Fever? Previous surgery? (type?) N & V (nausea/vomiting)? Distention (abdomen swollen)? – Ascites (fluid collection) Hematemesis (vomiting blood)? Last BM (bowel movement)? Pain? (where, what type, precipitating factors?) Hx of renal colic? (kidney stones, hematuria) 102 History Questions for Extremity (Injury) When and how did it happen? Where is the tenderness (be specific)!? Is there edema (swelling)? Where? (be specific!) Is the wound open or closed (laceration vs. abrasion)? Is there a foreign body (sliver of glass, needle etc.)? 103 Extremity (No injury) Pain? (where? how long?) Fever? Edema (Swelling)? Is there a history of arthritis? Is the pain associated with an activity? 104 Cervical Spine (injury) What is the nature of injury? Where is the pain? Does it radiate? Any paralysis? – Where? Any numbness or tingling? – Where? 105 Cervical spine (no injury) Pain in shoulder? arm? hand? – Does it radiate? Numbness or tingling? Hx of Arthritis? – other joints? 106 Lumbar/Dorsal spine Previous surgery or myelogram? Was there an Injury? – When? What type? Pain? Where? Severity? – Does it radiate? Pain in other joints? Hx of arthritis? 107 Head (Injury) What happened? Where (be specific)? Loss of consciousness? (if so, how long)? Edema (swelling)? If so, where? Laceration? Bleeding? If so, where? Note patient alertness 108 Head (no injury) Vertigo? (dizziness) Headaches? (location, duration) Hx CVA (cerebrovascular accident; ie stroke)? Paralysis? Visual disturbances? Fever? Other symptoms? 109 I.V.P. (Intravenous Pyelogram) Hx of renal colic? Hematuria (blood in urine)? Pyuria (pus in urine)? Previous surgery or stones? Bladder Hx: frequency? urgency? 110 I.V.P. Hypertension (high blood pressure)? Hx of malignancy (cancer)? Anemia? Diabetic? – currently taking glucophage? Allergic History – – Iodine, foods, medications? 111 U.G.I. (Upper Gastrointestinal Series) Intolerance to fatty foods? Pain? – Severity, location, duration, precipitating factors Jaundice (yellow/orange cast to the skin)? Family hx of gallstones? Previous GI X-rays? Previous surgery? 112 U.G.I. (Upper Gastrointestinal Series) N & V? Dysphagia (difficulty swallowing)? Weight loss? Hematemesis (vomiting blood)? Blood in stools (red or tarry?)** 113 U.G.I (cont’d) **Blood in stools can be either bright red or tarry (black) in color. Red stools indicate bleeding from the lower intestines (hemorrhoids for example). Tarry stools indicate bleeding from the upper G.I. Tract. Blood changes color due to digestive juices which change the color to a black or tarry appearance. 114 B.E. Barium Enema Previous GI X-rays? Previous surgery? Pain? – Severity, location, duration, precipitating factors? N & V? Constipation? Diarrhea? Bleeding? (bright red vs. dark/tarry?) Weight loss? 115 16. Who is responsible for obtaining the clinical history from the patient for the diagnostic procedure? A. B. C. D. the radiographer the radiologist the nurse the emergency department physician 116 17. What is the significance of a good clinical history? A. B. C. D. It provides the referring physician’s admitting diagnosis. It provides general information about the patient’s condition. It focuses the radiologist’s attention on a specific area. It translates the patient’s complaints into medical jargon. 117 18. A patient’s vital signs are as follows: heart rate, 95; blood pressure, 120/75; temperature, 99.2º F. This information is considered: A. B. C. D. objective data chief complaint clinical history subjective data 118 19. The patient describes her chest pain by saying, “It feels like someone is standing on my chest.” This information is considered: A. B. C. D. chronology objective data subjective data none of the above 119 20. All of the following are used to provide a better history to the radiologist except: A. B. C. D. encouraging elaboration using probing questions summarizing the details asking close-ended questions 120 21. The primary medical problem as defined by the patient is called: A. B. C. D. the clinical history subjective data the chief complaint objective data 121 Sponsored by: This workforce solution was funded by a grant awarded under the President’s Community-Based Job Training Grants as implemented by the U.S. Department of Labor’s Employment and Training Administration. The solution was created by the grantee and does not necessarily reflect the official position of the U.S. Department of Labor. 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