Being in a loud, chaotic emergency department may require you to raise your voice. Loud chaotic environments also increase the chances of you, a patient or colleague mishearing important information. If you are going to be asking questions of a personal nature, environment is particularly important.
Emergency department cubicles, and beds in multi-bedded rooms are often only separated by a curtain. If you plan on asking a patient about their drug history or HIV status, for example, then finding a more private environment is essential. Whilst modern mobile technology has brought with it the benefits of instant connection, it can also be a distraction. Ideally, when engaging with a patient you should not be taking calls. Nurses will often carry their own personal mobile phones on their person. This can obviously have benefits such as accessing nursing apps to provide immediate medication information, for example.
Be aware, however, that studies have shown the mere presence of your switched-off smart phone can be a drain on productivity Ward et al. Consider first if you need your phone before beginning an interaction with your patient. Most organisations have their own policies regarding technology in the workplace, it may be worth finding out what yours is.
I know you are busy but could we catch up properly in 15 minutes time? Listen and ask questions. Listening without interrupting is powerful. Open-ended questions provide the most potent way of understanding another person. Closed-ended question:. Open-ended question:. In some exceptionally difficult circumstances — such as the journey of a patient with cancer or someone close to death — people may feel pressured to start to talk about meaningful subjects and intimate thoughts and feelings.
For those who have avoided open communication so far, this is confronting and enormously challenging. Communicating about difficult issues is much easier if the small steps have been taken first. Being assertive involves expressing your own thoughts and feelings without dismissing or abusing the rights of others which is aggression. One of the most important considerations when communication with older adults is allowing them time. Showing any signs of stress or impatience could cause them to shut down and close off from you.
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It is important to show your patient respect, regardless of their age or cognitive ability, and dedicate the right amount of time to allow them to express themselves, so to get the whole story. Another challenge you may encounter when communicating with some older people is that they may not feel comfortable speaking openly with medical professionals, like doctors. If you are their nurse, and available for their concerns, they may be more willing to talk to you than to the doctor, who may only spend five minutes in the room. You might find out something vital to the care and comfort of that patient just by spending a few extra minutes with them.
Be mindful to put things so they are easy to understand, but without coming across as condescending. Try to use language that is simple, clear and non-threatening, while staying honest and true. Base your language on the questions put to you and the cognitive ability of the patient you are speaking with. Be prepared to repeat yourself and express concepts in several different ways to make sure your message is understood.
Including the family is often a big part of communicating with older adults. Always try to keep your older patient in the conversation. Although a lot of what you talk about may not be understood, it is important to show them the respect and dignity of including them in the conversation, and by extension, their care. It may help to have a three-way conversation between the patient, their carer, and yourself.
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When everyone works together to help the patient understand, you stand a much better chance of putting him or her at ease with all that is happening around them. Although she is forgetful, she is still able to live a relatively independent life. She experienced an episode of fainting at Church, that was witnessed by several people, and she was taken to her primary care physician. It took a great deal of talking to her to help Carolyn understand that the fainting spell was, in fact, a major health issue that needed to be investigated.
In addition to restricting her driving privileges, Carolyn needed several tests to rule out different probable causes of her fainting spell. Each test needed to be carefully explained to Carolyn and the information repeated. She wrote down all the key information in a system that she had developed to keep herself from forgetting important points. In the end, she had her tests, however, doctors are still trying to determine the cause of her fainting spells.
It takes careful reminding to keep her from driving her car or performing other actions that may put her in danger. Compared with adults, children have fewer coping mechanisms and it is natural for a child to be scared, and even resistant to some medical treatment. Explaining the procedure to a child can help to reduce anxiety and build the their confidence Burke Your language should be developmentally appropriate.
Offer lots of reassurance, perhaps in the form of a small reward for their resilience and bravery. You may need to moderate your language, get down to the level of the child, and use a positive and non-threatening tone of voice to show them that you mean no harm. As with most communication, careful listening, as well as showing your patient you are listening through positive body language, will serve you well in talking to children patients. Distraction techniques have been shown to be effective in reducing pain and distress during medical procedures in children Duff et al.
A large part of communicating with children patients is the inclusion of their parents or guardians. You are likely to deal with some people who are in a great deal of distress. Try to allay their fears as best you can, answering all their questions as honestly as possible. Some parents may get emotional and you need to be aware of possible angry or sorrowful outbursts. Outbursts such as these can upset your patient, which may go against what you are trying to accomplish.
Try removing the parents away from the child when holding particularly difficult or emotional conversations. Employ active listening techniques , as you would for any other patient and their family.
Daniel is a two-year-old heart patient who is preparing for his second open-heart surgery. Already, starting the IV line has been a traumatic event. She gets down on her knees with Daniel and shows him the hair net he will be wearing, the tubes that will help him breathe, and the mask that would be placed over his face.
Instead of being afraid, Daniel is now fascinated by the new toys in front of him and plays with them. During this time, the nurse takes a moment to talk to the parents about any concerns they have. She helps them to understand the procedure, the heart-lung machine, and the estimated time of the surgery.
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When the nurse prepares to leave after half an hour, both Daniel and his parents are much more at ease. Although all of them are still nervous about the surgery, getting familiar with the process and tools for the procedure has helped calm Daniel so that he — and his parents — can get some much needed rest before his operation.
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First, introduce yourself and identify who you are, your role, and who you are talking about your patient or client. Be sure to use at least three patient identifiers. Provide current diagnosis, concerns or other critical information. Check, update and discuss recent vital signs and observations. Update and discuss relevant medical and support information.
Include the timeline leading up to the situation, e. Provide all relevant clinical assessments such as pathology, recent test data, and any other collected information relating to the patient background. Recommending a solution to the situation may involve a request for further tests, for example. If handing over, this offers the new team member a clear course of action to follow or opens up the lines of communication for further discussion. Confirm your shared understanding of what is to be done. Conclude handover.
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There are several other examples of similar mnemonic tools used to structure handover, including:. It is important for you to be in a healthy mental state when working with a population of patients who are in the process of dying. This means taking care of yourself and allowing yourself time to disconnect from work. When you go home, you need to leave the sadness and emotion of the job at work. Carrying these feelings everywhere with you may make you susceptible to compassion fatigue - a syndrome that can lead to depression, anger and the breakdown of relationships.
The patient deserves the respect of you acknowledging their situation, and not doing so can make them feel as if you are infantilising them.
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However, do not allow yourself to be overcome with emotions either.