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Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Patient Assessment and Communication in Imaging

Patient Assessment and Communication in Imaging

Chapter 2


IntroductionIntroduction

• As Radiographers, we must learn to asses the needs of the patient and formulate a plan of care that best fits the individual.

– Assessment

– Critical thinking

– Problem solving

– Therapeutic communication

– Patient education


The Health-Illness ContinuumThe Health-Illness Continuum

• All persons seek to maintain a high level of well-being. Health can be defined as the status of an organism functioning without any evidence of disease or disfigurement. Unfortunately a perfect state of health is rarely achieved; therefore, health is seen as on a “continuum.”

• Stress

• Basic needs


Basic Human NeedsBasic Human Needs

• 1. Physiological needs

• 2. Safety and security

• 3. Love and belonging

• 4. Self-esteem and esteem of others

• 5. Self actualization


Critical ThinkingCritical Thinking

• The hallmark of an excellent radiographer is the ability to achieve a positive diagnostic or treatment result in a timely, efficient manner while meeting the unique needs of the individual patient.

– Cognition

– Effect

– Didactic

– Psychomotor

• Learning requires cognitive, affective and psychomotor skills.


Critical Thinking RequiresCritical Thinking Requires

• The ability to interpret

• Analyze

• Evaluate

• Infer

• Explain

• Reflect


Modes of ThinkingModes of Thinking• Recall

– Knowledge of scientific facts that you can recall at a moment’s notice while with patients

• Habit

– You will develop habits that make for the efficient practice of learned skills

• Inquiry

– Using the skills of recall and habit along with higher mode of thinking

• Creativity

– It is used to solve individual problems and to prevent causing the patient discomfort or pain


Problem Solving and Patient AssessmentProblem Solving and Patient Assessment

• Every patient and every diagnostic procedure presents problems ranging from simple to complex.

• The student radiographer must decide how to perform the assignment quickly, efficiently, and as comfortable as possible for the patient.

– Data collection

– Data analysis

– Implementation

– Evaluation


Data CollectionData Collection

There are 2 types:

1. Subjective: Anything that the patient or significant other who accompanies the patient say in regards to their care.

2. Objective: Anything you see, hear, feel, or read on the patient’s chart; or, information given by another health care worker.


Data AnalysisData Analysis

• This part of assessment integrates all segments of critical thinking.

• Once all the data has been collected, you must decide how will you achieve your goal to perform this exam with quality images, patient comfort, and efficiency.

• This method requires demand recall.


Planning and ImplementationPlanning and Implementation

• Planning requires the use of all modes of thinking.

• Theoretical concepts learned from classroom instruction are recalled.

• Implementation of the plan depends on the patient’s problems and the need for assistance to achieve the desired goal safely.


EvaluationEvaluation

• Each patient care situation differs in some way or another. As a student you will observe many approaches to a successful exam.

• One must never cease learning from the patient regardless of how many years of experience he or she possesses.

• Each patient care situation differs in some ways from all others encountered; therefore, all patient care experiences are learning experiences.


Cultural Diversity in Patient CareCultural Diversity in Patient Care

• Culture is defined as: “The socially inherited characteristics of a group of people that are transmitted from one generation to the next” (Fejos, 1959).

• The patient’s culture and ethnicity will play a major role in assessing the patient.

– Culture

– Sociological

– Psychological

– Physiological and Biological

• Cultural and ethnic diversity are a part of the radiographer’s assessment and plan of care.


Patient ExpectationsPatient Expectations

• The patient also has expectations of health care professionals.

• The patient expects professionals to be:

– Concerned

– Clean

– Well groomed

– Professional

– Deliver quality patient care


CommunicationCommunication

• All members of the health care team must learn to communicate clearly and therapeutically with the patients.

• Any problem of communication, whether major or minor, has an impact on the patient’s health care.

• To become a successful communicator you must develop skills:

– Listening

– Observing

– Speaking

– Writing


Non Verbal CommunicationNon Verbal Communication

• There is more to communicate than the spoken word.

• The unspoken or nonverbal aspects of communication can be defined as all stimuli other than the spoken word involved in communication.

• Non-Verbal communication functions in the following ways:

– It may repeat or stress the spoken messages

– It may accent the spoken word

– It may regulate the spoken word

– It may substitute for verbal communication


Gender FactorsGender Factors

• The radiographer must be aware that the manner of communication will vary depending upon the sex of the patient.

• The possibility of a patient requesting a technologist of the opposite gender.

• The radiographer must also be sensitive to the issue of gender in his or her professional interactions with co-workers.

• Avoid sexual innuendoes.


Other Factors that Affect CommunicationOther Factors that Affect Communication

• Paralanguage – has to do with the sounds of the speech, rather than the content.

• A patient who has difficulty standing, sit the patient and make them comfortable.

• If the patient has difficulty hearing, speak louder.

• Speak to the patient.


Establishing Communication GuidelinesEstablishing Communication Guidelines

• Many relationships between the radiographer and patient are brief and it is essential to make the best use of the time.

• Establishing guidelines for interaction is essential.

– Introducing oneself to the patient

– Give an explanation of the exam

– Give an explanation of what is expected of the patient and what the patient can expect from the imaging staff


Obtaining a Patient HistoryObtaining a Patient History

• The goal of a patient history is to obtain necessary information to perform a safe and comfortable examination.

• Obtaining the information accurately demands sensitivity and critical thinking on the radiographer’s part.

• During the history taking process, the radiographer must convey a professional image to ensure the patient’s confidence.


Patient EducationPatient Education

• A patient who comes to the imaging department has a right to expect that he or she will be instructed as to the exam.

– A detailed description of the procedure.

– A description of the purpose of the exam.

– Approximate amount of time.

– An explanation of any unusual equipment.

– Follow up care/results after procedure is complete.

– If the patient questions the exam, do not begin until the problem is resolved.


Loss and GriefLoss and Grief

• Phase I – Denial

• Phase II – Anger

• Phase III – Bargaining

• Phase IV – Depression

• Phase V – Acceptance


Patients Rights Related to End of Life IssuesPatients Rights Related to End of Life Issues• The public’s wishes to make their own determination in

this matter was resolved when the PATIENT SELF DETERMINATION ACT (PSDA) was made law in 1990.

• Advanced Directive

– They are legal documents that are formulated by a competent person that provides written information concerning the patient’s desire if they are unable to make the decision on their own.


Cont.Cont.

• Living will

• Directive to Physician

• Durable Power of Attorney for Health Care (DPAHC)

• DNR

• NO CODE

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Education

patient assessment

individual patient

patient expectations

patient care culture

patient comfort

patient discomfort

patient care situation

patient care experiences