HLTOUT010 Communicate in complex situations to support health care assessment
- Subject Code :
Edward Turner is a 78-year-old man who has lived alone for many years following the death of his beloved wife. He has one daughter who is 32-years-old and lives 5 hours away. Edward is supported by good friends and neighbours close by who have taken on many responsibilities to help keep him safe, healthy, and in his own home.
Edward is fiercely independent and has learned a lot of new skills since living alone, but in the past year his health has deteriorated; his arthritis and mobility is starting to make home life difficult. Some of his hardship has been reduced by several appliances being installed in his home to help mobilisation around the house. Although this has meant that Edward has had to make compromises in his life, the supports systems have worked well for some months.
In the past month he has had three falls in his house causing him only superficial bruises; but, one fall required a trip to his GP for a sizable skin tear to his shin.
Sadly, this afternoon, Edwards neighbour arrived to find him on the patio floor with a laceration to the forehead, a swollen left wrist, and chilled to the bone. Edwards neighbour immediately called the ambulance.
On arrival at the scene, you find Edward on the patio floor covered with a blanket and his neighbour by his side. He is agitated, and with a firm voice telling his neighbour to “leave me alone…I’ll wait for my daughter to come!”. More neighbours come to see if they can help and talk about what has happened, while Edward appears to become more annoyed and agitated. You say hello to Edward, but he seems to ignore you. His neighbour says: “his hearing aid is not in…I’ll go look for it”
Later in the day you receive a notification that reveals Emily has made a complaint to the operations manager on the way the situation was managed. The operations manager asks you to write up a report of what had happened.
Please read each question carefully to ensure your response addresses all required components.
- Considering the information in above, discuss why Edward may have been reluctant to have someone call the ambulance?
Edward is very independent and perhaps feeling embarrased to ask for help since this is another fall and may fear his independence will be taken away from him. Edward may feel he is a burden or may not trust the ambulance as he firmly tells the neighnour, he will wait for his daughter.
Edward may fear he might loose his home, and no longer have the support of his friends and neighbours.
2. Identify and discuss three (3) communication strategies you could use to introduce yourself and develop rapport with Edward. Make sure you consider that he does not have his hearing aid in
E.g. use a slow pace in speech - do not use this as a response)
Introduce yourself clearly and do not speak too quickly, ask open-ended questions
Active listening, Seek an overall understanding of what the speaker is trying to communicate, using proper eye contact and verbal responses to patient comments and concerns and
use questions to clarify your understanding, as well as to demonstrate interest in what is being said.
Be empathetic and patient and respectful. Maintaining a calm demenour with Edward
3. Identify two (2) strategies you could use to reduce the external interference (noise) in the immediate environment?
Ask the neighbours politely to clear the space so you can help Edward
if possible move Edward inside to further treat him or possibly use a privacy screen to help the patient feel secure, and treat Edward with some privacy
4. Upon arrival at scene, would touching Edward seem appropriate? You must provide a justification for your answer.
Upon arrival at scene i believe touching Edward may impact negitively as Edward seems to be agitated and distressed.
5. What are three (3) non-verbal communication techniques can be used to reduce Edwards distress and how would this reduce his distress?
Maintaining eye contact, It shows you are interested and that your focus is on them.
Open body position, Avoid crossing your arms over your body – it may appear defensive. When your body position is open, it conveys that you are open to listening.
Mirroring techniques. Sit alongside the patient and angled toward the person rather than directly opposite them. This allows the conversation to feel friendly and nonconfrontational. And being on the same level as someone appears less threatening and can make them feel more comfortable,
6. Identify and discuss the four (4) common zones of proximity with regard to the personal space and the purpose of each.
Zone 1: Intimate (0-45cm)
Intimate zone is used for very confidential communications, or usually touching the patient, for medical reasons,( ie administering medications,physical assessment, washing patient) etc.
Zone 2: Personal (45-120cm)
Personal zone is for taking patients history, personal information any other discussions directly to patients and other family members.
Zone 3: Social (120-360cm)
The social zone is for interactions among acquaintances, allied health personnel
Zone 4: Public (>360cm)
The public space is for the generel public, a place that is generally open and accessible to people.
7. Discuss the privacy and confidentiality issues or concerns you need to be aware of specifically related to interactions by and with Edwards neighbours.
The privacy and confidentiality issues or concerns you need to be aware of in relation to Edwards neighbours are that such delicate and confidential information about the individual should only be in between Edward and the persons treating him, the medical information of the patient given to a health care provider shall not be divulged to others unless the patient gives his consent to disclose such information to others.
The Scenario continued
Edward acknowledges your presence, and now has a hearing aid in his left ear. He allows you to examine him. Your assessment uncovers:
Pulse = 110, Reg
Orientated to time, place, and person
BP = 98/75
Swollen left wrist with a “dinner fork’ deformity
Resp Rate = 24
BGL = 5.1mmol
3cm laceration to left temple – minimal bleeding
ECG Rhythm strip = ‘sinus tachycardia’
He complains of a throbbing pain to his left wrist as a 6/10. You further ascertain that Edward has an allergy to iodine, and has not had any major surgery. He is prescribed Non-Steroidal Anti- inflammatory drugs (NSAIDs) for his arthritis.
You apply oxygen at 4L/min by nasal cannula, dress the wound to his head, and immobilize his left wrist and arm. You inform him of your intentions to take him to hospital and he becomes agitated and angry. He tries to stand and says: “I’m fine! I am not going anywhere until my daughter gets here! Has anyone rang my daughter?” He kicks the patio chair and then shouts, “I know my rights! I’m not leaving my house”
8. Identify and explain three (3) de-escalation measures that may assist in reducing Edwards distress.
Listen to what the issue is and the person's concerns and nod to confirm that you are listening and have understood.
Wait until the person has released their frustration and explained how they are feeling. Express to Edward that he is injured and assure him that you are here to help.
Encourage the Edward to articulate his feelings by clarifying and reflecting on your own understanding of them. Use non-confronting eye contact, ask questions and restate in your own words what you understand Edward is trying to tell you.
9. Analyse the following statements and identify why they could be considered judgemental and impact Edwards feelings.
- "Living here is too unsafe. We need to take you to the hospital to get you fixed and then you will need to find somewhere else to "
Edward is distressed and vunerable, this statement above may escalate the situation further confusing the patient. Suggesting his home is too unsafe is unfairly judging his living situation without professional assessment. Telling Edward he needs to find somewhere else to live will impact negatively on his feelings and vunerable situation increasing his anxiety making him fearful.
b. "Your impaired mobility, secondary to your arthritis, will prohibit normal living. You need immediate medical interventions and then professional assessment prior to placement."
The priority is to reassure and treat the patient accordingly, the above statement is further judging his mobility without professional assessment, suggessting the patient needs immediate medical interventions also indicates he has already been assessed. Secondly this statement may confuse Edward as the terminology might not make sense to him.
c. "I know you're angry about all of this, but it’s no-one elses fault. We would just like you to get you into hospital to be treated and have you assessed."
This demonstrates lack of empathy towards the patient, making him feel like a burden and everything is his fault furthermore not validating his emotions and feelings.
d. For this task you are required to re-construct one of the statements above (a-c). Ensure you reflect communication that encompasses and shows empathy, will support Edwards understanding and validate his emotions/feelings.
Statement C :
'' I know you're angry about all of this, but it's no-one elses fault. We would just like you to get you into hospital to be treated and have you assessed.''
'' I understand this must be a little overwhelming for you, we are here to help you and make you feel safe while you wait for your daughter to arrive, is that ok with you Edward?
e. Discuss Edwards rights related to not wanting to go to hospital, the issues related to
contacting his daughter and discussing Edwards personal information with her. Include in your response the privacy and confidentiality issues related to this situation.
Edward has the right to patient autonomy, the right to make his own decisions. the health care workers can guide and educate on the importance of treatments etc. In this case Edward is reluctant to go to the hospital and its possible he is not quite capable to make decisions as the patient sustained a head injury from a fall. It may benefit contacting his daughter to discuss the situation. In regards to the privacy and confidentiality issues, you maybe able disclose personal information if the patient has consented. Edward has the right to confidentiality of information about medical conditions and treatment.
The Scenario continued
Edward now sits on a chair and you establish that he has attained the mental capacity and physical stability to wait for his daughter to call back.
In the meantime, you take the opportunity to document some patient notes on the patient events.
10. Using the S O A P method of reflective writing, describe your findings.
Subjective: What the patient is telling me or communicating.
Edward Turner aged 78, Patient complains of throbbing pain to his left wrist as a 6/10 pain
Objective: My observations, physical findings, vitals, enviromental information, known
contributing factors.Upon arrival patient seems agitated and reluctant to recieve treatment. Patient was found by a neighbour on the patio floor.
Vital signs represent pulse -110 Bp 98/75 BGL5.1mmol Sao2 = 93?g = Sinus tachycardia
Patient displays swollen left wrist and 3cm laceration to left temple and increased risk of
Application and assessment: Treatments, patients compliance,recomendations, improvements.
Oxygen was applied by nasal cannulation 3L per min, the head wound washed with saline and dressed with sterile gauge and bandage. Arm was immobilized
Plan: What needs to occur/follow up.
- Discuss your role and responsibilities as a health professional from the above scenario and identify the role and responsibilities of one (1) other health professional or stakeholder that you could seek advice, support or information from (e.g. Medical support/paramedics/client case workers).
My role and responsibilites as a health professional in this scenario, provide comprehensive patient care, communicate effectively and appropriately with the patient, ensure patient confidentiality is maintained and protected at all times, ensuring effective, high quality communication of relevant clinical information at clinical handover, provide pre-hospital care and treatment for the patient through attempting to stabilise and/or improve the
patient condition in preparation for and during transportation to hospital.
In this scenario, the stakeholder i could seek advice, support and information from is the patient's daughter. In this situation her roles and responsibilites could include additional information about her fathers condition, power of attourney if he is admitted into a nursing home, be informed of the different levels of care that are needed for the patient as well as any changes in the overall health of the patient.
12. The standardised history framework provides elements that are important for an accurate and detailed patient history (patient interview). Using Edwards circumstances, create two (2) open ended questions for each element identified below. Your response questions for the sub headings (a - f) below need to specifically reflect ‘open ended’ questions to support the gathering of information.
- Present complaint
b. Medication history
d. Social history
- Mental health
f. Further information from 3rd party (e.g. neighbour, daughter)
The Scenario continued
You have documented some information on Edwards patient’s history and treatment and he is now in a calm state. Edwards phone rings and his neighbour answers it: “It’s your daughter Emily” he says and hands the phone over. Edward talks to his daughter and tells her that he has broken his arm, however you hear her voice over the phone and it appears to be loud, high pitched and fast. Edward gives you the phone and says: “…here you tell her!”
You introduce yourself, but before you can say another word Emily demands: “Why is my father not at the hospital? What’s happening to him?”.
You can hear in her voice and phone manner that she is very anxious and concerned about her father’s situation.
13. Describe three (3) verbal communication skills that allow you to introduce yourself and build some rapport with Emily while trying to reduce her anxiety. You must explain why you have picked the specific communication skills and how it will assist reducing Emily’s.
14. Discuss how you could show empathy and build rapport with Emily over the phone in this situation?
- How might Emily encourage her father to go to hospital? Recommend below three (3) ways you could encourage Emily to help her father.
- Assume the situation escalates between the pair and becomes quite What can you do to de-escalate and respond in the immediate timeframe effectively for both Edward and Emily that reflects a caring, firm and confident manner.
Provide two (2) communication/action responses you could apply and discuss how it will likely assist in the de-escalation of the situation for each.
- Patient (Edward)
b. Daughter (Emily)
The Scenario continued
Finally, Edward agrees to go to the hospital and you provide handover to the nurse at arrival. Emily asks for the address to the hospital that Edward will be transported to.
You state that the hospital is on ‘Crystal’ St, but she has trouble hearing you over the phone and she asks you to spell the street name.
17. Use the NATO alphabet communication System to spell out ‘Crystal St’.
S = Sierra
T = Tango
Y = Yankee
L = Lima
S = Sierra
- Use the IMIST-AMBO mnemonic and identify what each letters represents, providing relevant information related to the scenario for
Identification: Patients name, age,sex
I – Edward Turner, 78-year-old Male
Mechanism of injury/ medical complaint eg, presenting problem, how it happened.
M – patient has fallen with laceration to the forehead and a swollen left wrist,
Injuries/Information related to complaint, symptoms and or injuries.
I – 3cm laceration to left temple – minimal bleeding
Patient complains of a throbbing pain to his left wrist as 6/10
Signs, vital signs such as;
S – Pulse = 110, Reg GSC= 15 BP = 98/75
Resp Rate = 24
Treatment and trends, treatments administered and patients response to treatment,
T – trends in vital signs.
Oxygen applied at 4L/min by nasal cannula
Dressed wound to his head, and immobilized his left
Allergies; Allergic to iodine
Medication(patients medical history) Non-Steroidal Antiinflammatory drugs (NSAIDs)
M – for his arthritis.
Background history,patients medical history.
B – Arthritis,reduced mobility, three previous falls, one resulted a skin tear/ bruising.
O – Widowed, lives alone.
Friends/ neighbours close by
19. Discuss how you will clarify Edwards understanding of the situation relevant to the information you have been provided (e.g. age, emotional state)
With the information provided we need to help Edward understand the situation with some key elements such as, clear communication, keeping language simple and concise aswell as expressing emphathy and understanding. Confirm the patients understanding, assimulate what they need to do and why they need to do it. Clarify and question with the patient, furthermore ask open ended questions and encourage the patient to ask questions to further stimulate dialogue aswell as personalising the information given.
20. Assume Edward does not have a clear understanding of his current health situation; what are two (2) communication changes that could assist to support his understanding, and identify why your changes will assist?
Change 1: (20-40 words)
One way to support Edward could be visual aids, such as illustrations, images and videos to help reinforce Edwards understanding of his current health condition. These changes may assist Edward as he has hearing aids, a visual approach could potentially help him understand.
Change 2: (20-40 words)
Avoid medical jargon, breaking down information or instructions into small steps, creating small tasks or key points to simplify any information and support his understanding. These communication changes can and will assist Edward's understanding of his current health situation.
21. Before writing up an incident report for the Operations Manager responding to the complaint, who might you seek assistance or consult with from the organisation and why would they be of assistance?
What resources could you use to support the development of the report and respond to the complaint? You must identify at a minimum two (2) organisational documents relevant to your role and how they will assist in your report respo