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Thinking about electronic communication from professional to professional, what are the benefits of voicemail/email/text?
- rapid info exchange
- provide updates after official DC summary written
- allow group communication simultaneously regardless of where parties might be
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Thinking about electronic communication from professional to professional, what are the benefits of voicemail/email/text?
- no written record of discussions/decisions
- group discussions might leave someone out
- confidentiality of info (stone devices; public discussion
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Thinking about electronic communication from patient to professional, what are the benefits?
- faster reponse time for patients questions
- facilitates 'team problem solving' of issues encountered by patient in natural environment
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Thinking about electronic communication from patient to professional, what are the problems?
- boundaries
- confidentiality of discussions
- possible HIPPA violations with email sent on non-secured servers or voice mail messages
- emoticon misunderstandings; misspellings misinterpretations
- possibility to decrease face to face discussion time
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Should 'semi-personal communication' (phone messages, emails, information passed to you by a family member, casual comments made by the patient to the aide) be part of an offical record? What if patient provides informal info that contradicts or alters decisions based on something said officially?
- It should be noted but indicate the means of communication and always clarify with the pt
- you are in charge of your pt, not the family--you need to make sure the family member is telling the truth
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Should you friend your pt to provide another communication method? (and can you unfriend them when finished treating them?)
- do not friend pts
- own up to your mistake and make them aware that your relationship is professional
- it goes against policy, I just can't...
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Netea's article recommends that most patients should wait 5 minutes prior to the assessment of their BP. What reasoning did he use? Regardless of rest period, Netea identified several reasons that your BP reading might be inaccurate. Identify 2 of these reasons and what you will do to manage them.
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Bell's article makes it clear that the length of a visit for a patient w/ unvoiced desires is shorter than that for a patient who articulates wants/needs/fears. In this day of cost containment, what arguments does Bell offer to support that it is worth the extra time and cost to encourage patients to take an active role in their care and reveal their hidden agendas? Do you agree? Do you think encouraging active pt involvement is equally important for every PT/OT practice setting?
- worth the time b/c treated better when given time to listen to complaints
- hidden agenda? yes
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Restatement:
repeating speaker's words
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Reflection:
verbalizing content and implied feelings of sender
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Clarification
summarizing or simplifying sender's thoughts
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Which of the three therapeutic listening techniques is more likely to produce a paradigm shift in the listener?
Reflection helps to understand the patients intentions and go to a deeper level
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The medical record is an ongoing account of:
- who the patient is
- what is going on with the pt
- current and past medical history
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For hospitalized pts, the medical record is known as the:
inpatient chart and will be detailed and interdisciplinary. Therapists confirm and supplement info from record by interview
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For outpatients, the medical record is known as the:
outpatient record and its info is limited and discipline specific (Therapists supplement OP records w/ pt interview)
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Movie star X comes to your OP facility for a disc problem. Can you glance through his record to learn his real age?
no
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What if a person from your church was admitted to the ICU. Could you notify the minister at your church that someone should start to bring food to the family?
no, but you can tell the family to contact the minister for support
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Medical record:
legal document that is maintained by facility but doesn't belong solely to the facility
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What OT/PT documents are classified as records?
- everything placed/written in the chart
- OP notes
- justificaiton letters
- recorded communications with case manager
- personal daily notebook
- education materials provided in course of care
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Performing a chart review: therapist looks for...
- electronic security rules: who can access? When/Where? Protecting HIPPA info
- signature page: new but becoming more common; all providers who write in chart print/sign name here
- Chart history:
- -patient demographics (name, age, race, gender)
- -dates of: admission, physician's diagnosis
- medication- prescribed drugs, dosages, and med schedule; allows therapist to determine optimal schedule for intervention and to become aware of possible side effects that affect therapy
- physician orders
- medical history and secondary problems
- -referral to OT/Pt, referral source, services requested
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History and Physical ("H & P")
- physician's initial "work up" of the pt
- contains medical history as well as pertinent family history
- supplemented elsewhere w/ history and physical exam performed by therapist
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Radiology reports:
- information concerning fractures and other pathologies of hard tissues
- myelogram, CT scan, and MRI reports often appear here
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Surgical reports
- usually present in IP charts and should be requested for OP charts
- provide step-by-step outline of surgical procedure and any unexpected occurrences
- helps therapist figure out precautions and contraindications
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Pathology reports:
- sometimes found in lab section
- includes results of surgical biopsies
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Physician Progress notes
- read the physician's progress notes prior to each treatment session to:
- learn how your patient is responding medically
- become familiar w/ goals/expectations of doctor treating pt
- benefit from info gathered through other requested consultations
- --often notes provide only warning of DC plans
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Nurse's notes
- updates on pt's recent status:
- sleep paterns
- level of mobility on unit
- level of self-care on unit
- nutrition, hydration, medication schedule
- supplemented w/ graphic chart--includes pt's recent temperature, pulse and respiration readings
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Lab reports:
- therapist looks for...
- serologic tests
- hematologic tests
- urinalysis results
- --may see reference to bld panel which means 12 most common test requested at once
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Restraint orders:
PT/OT can't put pts in restraints; only by physicians order
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Keeping current w/ chart info in routine inpatient:
consult pt's chart a min of once a day
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Keeping current w/ chart info in unstable inpatient:
consult chart, primary nurse, and physician before every treatment
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Keeping current w/ chart info in routine outpatient:
document in chart every session; add notes from physician or case worker as available
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Important medical info NOT ever included in chart:
- adverse incident report
- provide objective info w/out interpretation
- -details of incident
- -notifications
- -injury, if any
- -medical care, if any
- -witnesses, if any
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Thinking about your interview:
it should have been a process by which info is exchanged b/w individuals through common system of symbols, signs, or behaviors
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What are the 5 E's of communication?
- engage the pt
- empathy
- educate
- enlist
- expectations of pt
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Engage the pt
treat as equal partner
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empathy
share human emotions
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educate
prepare them to make decisions w/ you
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enlist
allocate recovery responsibility
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expectations of pt
be realistic w/out dismissing dreams
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What should your non-verbals look like?
- S=square to pt
- O= open to pt
- L= lean in toward pt
- E= eye contact w/ pt
- R= relax
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How should you introduce yourself to the pt?
using your title to inform them
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Did you arrange your environment for successful interaction?
- comfortable interview setting
- -mod temp
- -stable chair for both
- -confidential area
- avoid barriers b/w therapist and patient
- no distractions
- be sensitive to cultural mannerisms and avoid:
- -excessive eye contact
- -overly intrusive touch
- -entering personal space
- sit on same level w/ patient to enhance info flow
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What attitude did you convey in your interview?
were you acting as if you were a know-it-all and above them??
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Did you listen during your interview?
- therapeutic listening
- -suspending thoughts and paying attention to other person
- empathy, rather than sympathy
- understanding, rather than judgment
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Did your interview include:
- demographics
- pertinent history
- pt's statement of problem
- review of pt's activies and roles
- pt's desired outcome
- additional info from family, etc
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During the interview, did you treat the pt as a team member?
- respect
- be efficent
- provide a roadmap
- plan interruptions
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How should an interview flow?
- large to small issues
- global to specific questions
- tailor interview to pt
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What if the patient can't provide accurate info in the interview or won't provide accurate info?
- other potential sources of info:
- family members (translator if needed)
- spouses/significant others
- other member of health care team
- anyone w/ useful info
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What is abuse?
- demeaning or aggressive behavior against someone w/ which you have a personal relationship
- ranges from threats/hostile environment up to bodily contact with intent to do harm
- in adults, it can be mental, physical or sexual
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What adults are at highest risk for abuse?
- women-all ages and socioeconomic levels
- -pregnant
- -women 17-28 (in a relationship)
- -women w/ income below poverty level
- -women w/ less than HS education
- -women who abuse drug/alcohol or who are w/ partners who abuse substances
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Seeing abuse in an interview:
- some impairments could really stem from abuse
- many injuries result in swelling, bruising, and occur so quickly that the pt really can't remember what happened
- how can we know for sure?
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Common excuses to cover up abuse:
- claims of extreme clumsiness
- denial of knowledge of injury mechanism
- report of injury doesn't match condition
- superficial history...vague when pressed for chronological details
- referred from ER and doesn't have consistent relationship w/ physician
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Clinical observations: poor match b/w symptoms and story:
- TMJ swelling w/out trauma
- frequent falls in pt w/o balance issues
- recent bruising on top of previous bruises
- no contusions to palms/elbows in fall
- whiplash symptoms w/o related injury
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Clinical observations: visible damage:
- outline of object in burn or bruise
- hand shaped bruises
- encircling bruises on upper arms
- restraint marks on wrist/ankles
- cheek bruising
- layered bruises
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Clinical observations: unusual relationship dynamics:
- often accompanied to all visits by SO (significant other)
- SO may answer questions, enter treatmetn booth w/ patient, try to bond w/ provider, intimidate provider, question rationale for examing more than injured area
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Clinical observation: Pt behavior:
- little eye contact
- flinch at sudden movements
- stiff or painful trunk movements
- attire doesn't match weather
- tinted glasses inside
- slurred speech if mouth swollen
- trunk splinting
- using UE's to support breasts
- limited jaw opening
- backing toward plinth, rather than turning back
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