CH.1 Preparing for the Patient Encounter

Question 1

Role of the Rt in Patient Assessment

Answer 1

–RTs are called to assist the physician in the process of diagnostic reasoning
–this requires that RTs be skilled at critical thinking while evaluating very sick patients

Question 2

3 Main Elements for Patient-Centered Care

Answer 2

–individualized care
–patient involvement
–provider collaboration

Question 3

Two-way partnership between providers and patients and families

Answer 3

–care given is consistent with each individual’s values, needs, and preferences
–patients become active participants in their own care

Question 4

Individualized Care

Answer 4

–empathetic communication
–respect for patient values/privacy
–sensitivity to cultural

Question 5

Patient Involvement

Answer 5

–patient education
–shared decision making
–patient participation in care

Question 6

Provider Collaboration

Answer 6

–communication
–coordination
–shared responsibility

Question 7

Providing Empathetic Two-way Communication

Answer 7

–underlying patient-centered communication
—involves both sending and receiving meaningful messages
–if the receiver does not fully understand the message, effective communication has not occurred
–messages are altered by feelings, language differences, listening habits, comfort with the situations, and preoccupation

Question 8

Factors Influencing Effective Communication

Answer 8

–Internal Factors: previous experiences, attitudes, values, cultural heritage. religious beliefs, listening habits, feelings
–Sensory Factors: fear, stress, anxiety, pain, mental acuity, brain damage, Hypoxia, sight, hearing, speech impairment
–Enviromental Factors: lighting, noise, privacy, distance, temperature
–Verbal Expression: language barrier, jargon, choice of words/questions, feedback, voice tone
–Nonverbal expression: body movement, facial expression, dress, professionalism, warmth, intrest

Question 9

Stages of Patient- Clinician Interactions

Answer 9

–Chart Review Stage (Preinteraction): most patient encounters begin with RT reviewing patient’s chart to identify name, age, chief complaints, and history of present illness
–clarify in your mind what your role will be with this patient
–Look a the chart before you see the patient
–if it wasn’t documented its wasn’t done

Question 10

Stages of Patient-Clinician Interaction

Answer 10

–Introductory Stage: purpose is to introduce yourself to the patient and begin to establish a report
–Look and act in a professional manner
–use patient’s formal name initially until he/she gives you permission to use a first name
–verify patient identification

Question 11

Stages of Patient-Clinician Interaction

Answer 11

–Initial Assessment Stage: observe patient’s general appearance and response to questions
–identify patient’s baseline condition and need for treatment the physician has ordered
–avoid interrupting the patient
–overlaps with the introductory stage

Question 12

Stages of Patient-Clinician Interaction

Answer 12

–Treatment and Monitoring Stage: monitoring the patient’s response to the treatment is important
–demonstrating and teaching treatment techniques
–after the initial assessment, you are ready to administer the treatment
–if the patient has side effects, the treatment should be stopped–may need to modify treatment

Question 13

Stages of Patient-Clinician Interaction

Answer 13

–Follow-up Stage: Let him/her know when you will return and how to contract you if needed
–after treatment is over, take a minute to communicate with the patient
–make sure the patient is comfortable before you leave
–Use the correct word choice

Question 14

Respecting Patient Needs and Preferences

Answer 14

–Providers must respect each patient’s needs, preferences, and privacy
–the individual patient’s response to disease be determined as part of the initial patient encounter
–care plans should reflect each individual patient’s preferences

Question 15

Assuring Privacy and Confidentiality

Answer 15

–all information about the patient is confidential
–RTs must not share patient information with others who do not need to know about the patient
–violations of confidentiality are unethical and may be subject to legal recourse

Question 16

Health Insurance Portability and Accountability Act

Answer 16

–Passed by Congress in 1996 to increase one’s ability to transfer health care information from one provider to another
–Title II of this law took effect in 2003 and established rules for disclosure of Protected Health Information
–Only approved health care providers can have access to PHI

Question 17

Social Space

Answer 17

– 4 to 12 feet from the patient
–useful for the initial introduction

Question 18

Personal Space

Answer 18

– 2 to 4 feet from the patient
–useful for the interview

Question 19

Intimate Space

Answer 19

– 0 to 2 feet from the patient
–useful only for the physical examination

Question 20

Expressing Genuine Concern

Answer 20

–face the patient squarely
–use eye contact appropriately
–maintain an open posture
–Consider appropriate use of touch: difficult to use when patient is a different gender or from another culture
–be an active listener

Question 21

Culturally Competent Communication

Answer 21

–Strategies: active listening, attending to individual needs, eliciting patient concerns, and expressing genuine concern
–Self-awareness: knowledge of one’s own cultural beliefs as well as any potential stereotypes one might hold about particular groups
–Situational Awareness: ability to recognize misunderstandings associated with patient-provider cultural differences as they occur during a patient encounter
–Culturally Competency: clinician should be able to adapt to the specific situation by individualizing the communication approach in a manner consistent with the patient’s and family’s values and beliefs

Question 22

Learning Needs Assessment

Answer 22

–Identify and accommodate barriers to patient learning
–assess the patient’s preferred learning method
–evaluate the patient’s readiness to learn
–determine the patient’s specific learning needs

Question 23

Questions in the Phase of the Assessment should address

Answer 23

–understanding of the current condition or disease process
-knowledge of prescribes medications
–familiarity with procedures you will implement
–familiarity with the equipment needed for care
–teach-back method
–return demonstration

Question 24

Barriers to Patient’s Learning

Answer 24

–Age
–Reduced level of consciousness
–presence of pain
–presence of anxiety
–physical limitations
–low educational level
–language
–culture
–religion
–vision and hearing

Question 25

Creating an Action Plan

Answer 25

–Make them S.M.A.R.T goals
—-S: specific
—-M: measurable
—-A: action oriented
—-R: realistic
—-T: time limited
–Involve the patient and family
–promote infection control
–use the “ Speak Up” initiative

Question 26

Developing an Action Plan

Answer 26

–include patient goals
–identify the barriers to reaching goals
–develop a plan for overcoming barriers
–determine how action plan compliance will be measured

Question 27

Standard Precautions

Answer 27

–Hand hygiene
–gloves
–gown
–face masks
–eye protection
-=-respirators
–patient care equipment
–needles and sharps
–patient resuscitation devices

Question 28

Enhancing Interprofessional Communication

Answer 28

–The Joint Commission defines effective communication as being timely, accurate, complete, unambiguous, and understood by the recipient
—implement active listening and communicating skills
—verify orders as accurate and complete
—decrease errors
—improve patient safety

Question 29

Coordinating Patient Care

Answer 29

–RTs needs to communicate with an interdisciplinary team to
—schedule procedures at times least likely to conflict with other essential patient activity and most likely to coincide with any relevant drug regimen
—coordinate patient handoffs

Question 30

Coordinating Patient Care

Answer 30

–Standardized method is the SBAR format
—S: situation
—B: background
—A: assessment
—R: recommendation

Question 31

Discharge Planning

Answer 31

–time frame for implementation
–clearly defined responsibilities of team members for daily care
–mechanisms for communication among members of the health care team
–arrangements for patient integration back into the community
–plans for medication administration
–strategies for patient self- care as appropriate
–securing and training caregivers
–plans for monitoring and responding to changes in the patient’s condition
–alternative emergency and contingency plans
–plans for use, maintenance, and troubleshooting of equipment
–ongoing assessment of outcomes
–specification of follow-up mechanisms

Question 32

Sharing Responsibility

Answer 32

–integrated care requires that all the clinicians involved in a patient’s management share a common set of goals and assume joint responsibility for their achievement
–the team as a whole must coordinate individual efforts and evaluate their overall success
–combine interdisciplinary intensive care unit rounds with a daily goals form

Question 33

Speak Up Method