principles of patient assessment in ems. listening to patients

Principles of Patient Principles of Patient Assessment in EMS Assessment in EMS

Listening to PatientsListening to Patients

IntroductionIntroduction

Establishing a rapport with patient and Establishing a rapport with patient and family is importantfamily is important

Effective communication between EMS Effective communication between EMS provider and patient takes practiceprovider and patient takes practice

Obtaining a good history is often Obtaining a good history is often difficult, yet necessarydifficult, yet necessary

This chapter focuses on interpersonal This chapter focuses on interpersonal dynamics and communications dynamics and communications strategiesstrategies

Communication is a 2-way Communication is a 2-way processprocess

The Feedback LoopThe Feedback Loop

SenderSender ReceiverReceiver MessageMessage EncodingEncoding DecodingDecoding FeedbackFeedback

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Message is CommunicatedMessage is Communicated

Verbal – speaking and observing Verbal – speaking and observing feedbackfeedback

Non-verbal – use of body language Non-verbal – use of body language Non-verbal – understanding of one’s Non-verbal – understanding of one’s

personal spacepersonal space Listening – adjust the environment so Listening – adjust the environment so

it is possible to listenit is possible to listen

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Factors that Facilitate Effective Factors that Facilitate Effective CommunicationCommunication

Is the patient comfortable?Is the patient comfortable? Consider your method of approachConsider your method of approach Professional, respectful introductionsProfessional, respectful introductions Addressing the patient: name and formalityAddressing the patient: name and formality Establishing trustEstablishing trust Consider the environment, modesty, Consider the environment, modesty,

emotional, and biological needsemotional, and biological needs ConfidentialityConfidentiality

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Communication TechniquesCommunication Techniques

Facilitation – positive or negativeFacilitation – positive or negative Open-ended questionsOpen-ended questions Closed questionsClosed questions Reflection – echoing the patient’s Reflection – echoing the patient’s

words to encourage the flow of words to encourage the flow of conversationconversation

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Communication Techniques Communication Techniques (continued)(continued)

Clarification of confusing or Clarification of confusing or ambiguous responsesambiguous responses

Silence is sometimes helpfulSilence is sometimes helpful Explanation to help put the patient Explanation to help put the patient

more at ease more at ease

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Barriers to CommunicationBarriers to Communication

Words and phrases the patient does Words and phrases the patient does not understandnot understand

Technical terms should be kept to a Technical terms should be kept to a minimum (unless dealing with a minimum (unless dealing with a health care worker)health care worker)

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Special ChallengesSpecial Challenges

Hearing impairmentHearing impairment Visual impairmentVisual impairment Speech impairmentSpeech impairment Non-English speakingNon-English speaking Developmental disabilityDevelopmental disability Terminally illTerminally ill

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Special Challenges Special Challenges (continued)(continued)

Hostile patientsHostile patients Anxious patientsAnxious patients Abused patientsAbused patients Patients with multiple symptomsPatients with multiple symptoms Asymptomatic patientsAsymptomatic patients Overly talkative patientsOverly talkative patients

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Communicating with Communicating with ChildrenChildren

Your interview Your interview must be age must be age appropriateappropriate

Kneel down to get Kneel down to get to the child’s levelto the child’s level

Involve the parent Involve the parent or caregiver in the or caregiver in the interviewinterview

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Communicating with the Communicating with the ElderlyElderly

Aging rate differs with the person so Aging rate differs with the person so do not assume all elderly are visually do not assume all elderly are visually or hearing impairedor hearing impaired

Give the patient time to discuss the Give the patient time to discuss the chief complaintchief complaint

Verify information with a family Verify information with a family member or caregiver as necessarymember or caregiver as necessary

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

Cultural ConsiderationsCultural Considerations

Recognize cultural differences in your Recognize cultural differences in your patientspatients

Culture based preferences may conflict Culture based preferences may conflict with usual medical practiceswith usual medical practices

Don’t assume patients with a particular Don’t assume patients with a particular cultural background are different…take cultural background are different…take the time to learn about the culturethe time to learn about the culture

Consider verbal and non-verbal Consider verbal and non-verbal messagesmessages

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.

ConclusionConclusion

Practice your listening skillsPractice your listening skills Do not judgeDo not judge Demonstrate kindness, compassion, Demonstrate kindness, compassion,

and empathyand empathy Understanding basic communications Understanding basic communications

skills is essential to EMS providersskills is essential to EMS providers

© 2003 Delmar Learning, a Division of Thomson Learning, Inc. © 2003 Delmar Learning, a Division of Thomson Learning, Inc.