2. What is Trauma?
Patient-Caregiver Relationship:
• Theory
• Introducing Jesse: our trauma patient
• Practical Applications
• Depersonalization
• Anxiety
• Vulnerability
3. One definition:
Damage inflicted on the body as the direct or indirect
result of an external force
But we must acknowledge all aspects of it:
An emotional wound or shock that creates substantial,
lasting damage to the psychological development of a
person
4. All patients that we interact with in the radiology
department not only require imaging, but they also
require patient care which addresses all aspects of
trauma
The ability to be a CARING technologist
Studies have shown that caring behavior is interpreted
as clinical competence by a patient.
5. A Theory on
Patient-Caregiver
Relationships
Being open and
receptive
Being genuinely
concerned
Being truly
present
Being morally
responsible
Being dedicated and
having the courage
to be appropriately
involved
The Continuum of Caring
By Halldorsdottir
6. He was rushing to pick up his daughter from school when
he accidently ran a stop sign and another vehicle hit him on
the drivers side. Jessie was transported to the x-ray room in
a cervical collar and with his left leg immobilized. He is
having difficulty breathing. Jessie is attached to IV
infusions and is wearing a high flow O2 mask.
9. Discussing the patient without speaking TO the
patient
Referring to the patient by their injury
Referring to the patient by their location
Speaking to the patient without making eye contact
Requisitions that use umbrella terms such as “trauma”
without any other details
Examples of Depersonalization
10. Make a personal introduction
Refer to patient by name
Make eye contact
Collect more history
Acknowledge that every patient experiences
trauma differently
Acknowledge feelings of pain and distress
Be an active listener
11. Overwhelming of the 5
Senses
Emotional aspects
associated with trauma
Patients often
inadequately informed
about their tests
12. Keep in mind your patient is likely overwhelmed – do not
add to the patient’s overstimulation
Try to alleviate distractions if possible
Inform the patient what is happening and why while using
clear non technical language
Be honest
Be aware of your own comments which may be
misinterpreted
13. Abrupt loss of control
Rely on others for help
Inadequately informed
14. Encourage participation to give a sense of control
Makes producing quality images easier
Ask patient for input on how to make them more
comfortable (eg. loosen clothing, a warm blanket etc.)
Allow patients to chose their own coping strategies
15. “… YOU are 100% of our experience,
even though we are only
a tiny part of your day.”
16. Patient care is equally as important as producing
quality images
Patients come to us feeling very overwhelmed
Small gestures of caring can have a large impact on a
patient
Let’s have the courage to make ourselves a positive part
of their experience
There is no greater reward than knowing you have had
a positive influence over someone’s well being
17. Choiniere, D.B, (2010). The effects of hospital noise. Nursing Administration
Quarterly, 34(4), 327-332
Darshak, M.S, (2006). What makes for a compassionate patient-caregiver
relationship? Journal on Quality and Patient Safety, 32(5), 283-291
Dawood, M. & Gallini, A (2010). Using discovery interviews to understand the patient
experience. Nursing Management, 17(1), 26-31
Monika, J.M.S, Larsson, I.E., Lindencrona, C.S.C, Plos, K.A.E, (2004). Patient
participation in nursing care; an interpretation by swedish registered nurses. Issues in
Clinical Nursing, 14, 35-42.
Rokke, P.D., Fleming-Ficek, S., Siemens, N.M., Hegstad, H.J. (2003). Self-efficacy and
choice of coping strategies for tolerating acute pain. Journal of Behavioral Medicine,
27(4), 343-359
Wiman, E. & Wikbald, K (2003). Caring and uncaring encounters in nursing in an
emergency department. Issues in Clinical Nursing, 13, 422-429
Editor's Notes
First what is trauma? There is more than one definition.
Then the patient caregiver relationship
There are 3 parts to this . First some background theory
Then we’ll introduce you to our make believe trauma pt Jesse
Finally we’ll talk about some practical applications of helping pt’s cope with challenges they often face in a trauma situation such as depersonalization, anxiety and vulnerability
There are several definitions of trauma. Most definitions relate to physical aspects and most people think of these most regularly.
We must recognize that there are psychological and emotional aspects associated with trauma.
1) Providing good patient care goes hand-in-hand with producing quality images. This is especially true with trauma patients. As health care workers, we must remember that a trauma patient has abruptly lost control of their own situation and is in a position of dependence and vulnerability. This is precisely when we need to be MOST caring.
2) The ability to be a CARING technologist is not something we are taught, but is something we must strive towards to provide a holistic experience for our patients. After all, I think we are all in this field of work because we enjoy helping others. We must develop awareness of the patient on emotional and physical levels.
3) This means that if a patient feels well cared for in the radiology department, they feel that their xrays or CT scans are being performed well. We gain the patient’s trust and respect. As a result, these patients are more likely to be agreeable, cooperative, and try their best to help us obtain the images that are needed to aid in their well-being.
5 stages which build on each other. We start from the most basic form of the relationship to the most effective and meaningful relationship.
First, the patient and the technologist have to be able to reach out and respond. This could be as simple as introducing myself to the patient and having him or her acknowledge my introduction.
Next I must be genuinely concerned for the patient this can mean appreciating that the patient has painful injuries and is overwhelmed. Even though I may have x-rayed many trauma patients before I don’t let that get in the way of seeing this patient as a unqiue individual who has likely never been in this situation before.
Being truly present. I need to focus on the patient at this moment. This involves active listening and responding and being present physically and emotionally. I’m not thinking about the pile of req’s waiting or the Grey’s Anatomy show I want to watch tonight. For example, if I have to move the patients injured leg I will watch her face to look for signs of distress – no auto pilot!
The next stage is being morally responsible. This is truly realizing that the patient is completely dependant on me. I am responsible for preserving his or her dignity and fulfilling her needs during the exam. Can you recall a moment when you have been so helpless that you can’t turn your head, scratch your nose or use the bathroom when you need to? Can you imagine relying on someone to help you with this? You can imagine how embarrassing and frustrating this would be. So if the patient needs to use the bed pan I’m not going to make them hold it another 15 minutes because I’m being morally responsible.
“Being dedicated and having the courage to be appropriately involved ” is our ultimate goal. This means that I have the courage to be involved in the patients world. I am not afraid to get in touch with my feelings thoughts and reactions. I can participate and share in his or her concerns. I don’t hesitate to hold the patients hand and reassure him or her that they are in a safe place. I know we have reached this phase when the patient trust me and feels free to ask for help.
Some of you might think that we don’t spend enough time with a patient to establish this, but it’s really just simple acts of caring that don’t have to take a long of time. For example a short conversation can show you are being truly present, giving the patient a warm blanket demonstrates you are being morally responsible and validating the patients feelings of pain or distress can show you are dedicated and you have the courage to be involved in their emotional state.
Imagine what Jesse is going through. What senses is he experiencing?
With the flurry of activity, all the sights and sounds associated with the Emergency department, and all the tests that need to be performed, it’s easy to see how trauma patients are anxious and distracted.
His 5 senses are being overwhelmed. Coupled with being acutely in pain, Jesse’s anxiety level is extremely high.
- being empathetic involves understanding and being aware of what patients are experiencing
- then can help alleviate some of these distractions; make patient feel cared for, gain their trust, and help them to focus on the task at hand
- ultimately allows you to more easily achieve quality images to aid in the patient’s care
Happens a lot when healthcare personal are speaking to each other
We are guilty of this a lot when we say things like, ok here is the femur and the ankle is next
This is stretcher 4
Auto-pilot mode
There are so many degrees of trauma and the type of trauma can really dictate how we plan to perform the exam.
We need more than just “trauma” for our history. By interviewing Jesse we are showing him that we care about what they’ve been through and it will help us figure out the best way to approach the exam.
5) I’m not trivializing Jesse’s experience just because I’ve seen many traumas throughout my career
I’m not going to have the attitude that Jesse is being difficult, his concerns are very real. This is when I really need to empathize.
7) When Jessie tells me things I can show I am listening by repeating back or summarizing what he’s said.
Referred to above. Foreign environment with many distracting stimuli.
Trauma is not just physical. Emotional distractions also cause anxiety.
Not being properly informed of tests results in exams being surprises to the patient.
Have only one tech give instructions, use calming voice, do not contribute to noise
Maintain a quiet environment, give warm blanket, etc.
Inform our patients about their imaging test: what will be x-rayed or scanned, how long it will take, what he will need to do during exam, and describe what you are doing as you do it. Simple terms are easier for patient to understand.
- fewer surprises = less anxiety
4. If something may hurt, let the patient know.
5. eg. Comments about the images or your positioning of the patient.
Not having control of their own situations gives a sense of vulnerability.
Needing to rely on others for even the most simple things.
Not being properly informed of what is happening before exams leaves little room to apply coping skills.
Allowing the patient to have a more active role in the exam will give them a sense of control and combat vulnerability.
Makes our jobs easier since you and patient are working towards a common goal. Added bonus of patient less likely to worry about other distractions and focus on the task at hand – reduces anxiety.
Input allows patient to have a sense of control.
We are all individuals and have our own ways of coping with physical and emotional pain (eg. Blood test)
To me this means we have a much larger impact on the patient then we really appreciate. They will remember their experience good or bad likely for the rest of their lives. If Jesse felt well cared for by me and Brian it will have many implications. He will have a positive attitude towards our profession, our hospital and even the state of healthcare today. This experience also gives us the groundwork for an ongoing relationship with him because odds are we will see him again at some point.
So if you’re going to take anything away from this presentation I hope it’s these things:
2) We can help by keeping them focused on what important and not contributing to their stress
3) Using the patients name, getting a warm blanket, having a positive attitude
4) Not being afraid to put ourselves out there
1) Ultimately, our job as medical radiographers is to provide quality diagnostic images that aids in the medical care of a patient. With trauma patients, this is obvious. However, patient care is every bit as important as producing the images and good patient care is extremely important with trauma patients. The bonus here is that providing good patient care in turn helps us produce quality images more easily and effectively.
2) Even small gestures of caring can have a large impact on a patient. You have the rare opportunity to provide comfort to someone who may be at his or her most vulnerable, emotionally and physically. These are moments that patients will take with them forever, good and bad
