T ALKING TO P ATIENTS ABOUT I NFECTION C ONTROL W HEN DOES IT HAPPEN - - PowerPoint PPT Presentation

TALKING TO PATIENTS ABOUT

INFECTION CONTROL

WHEN DOES IT HAPPEN?

 Suspected or confirmed diagnosis of an

infectious disease

 Plan of care that involves additional

precautions

 Disease surveillance & reporting  Outbreak notification and control

CONSIDERATIONS

• Enter the conversation with a supportive

purpose.

• What personal history is being triggered?

 What are her/his needs and fears  Do they want /have a support person to be

with them

CONSIDERATIONS (CONT)

• Provide context. For people to understand a

message, they have to know why it's important

• Encourage questions. Don't just ask if people

have questions, encourage them to raise concerns.

• Stay connected. People respond to

communications very differently, even when they're hearing the same information.

ETHICAL FRAMEWORK

FACTS

• CLINICAL ISSUES
• PREFERENCES
• QUALITY OF LIFE /DEATH
• CONTEXTUAL FEATURES

ETHICAL THEORIES

• DEONTOLOGICAL (JUSTICE)
• UTILITARIANISM (DO GOOD)
• COMMUNITARINISM (VIRTUE

ETHICS) VALUES

• PATIENT SAFETY FOR ALL
• MORAL DECISION-MAKING

EXTERNAL FACTORS

• IP&C BEST PRACTICES
• LEGISLATION
• ORGANIZATIONAL POLICY

ETHICAL THEORIES

Deontology (justice) Respect for:

 Individual rights and freedom  Liberty  Duty based

ETHICAL THEORIES -CONT.

Utilitarianism or Consequentialism

 Judges actions by the extent to which they promote the

• verall well-being or utility of society.

 Promotes the greater good

THEORY CONFLICTS

Deontologist could argue that infection control

strategies compromise individual rights and freedom of movement

Utilitarian/consequentialist might counter that

promoting the rights of individuals compromise the greater good of society

RESOLUTION

 Communitarianism - reinforced by Virtue Ethics

 Doing good  Complimentary to deontology and consequentialist

ethical theories

 Double effect and precautionary principle  Trade offs between doing good and avoiding harm  Possibility of harming certain individuals to bring about

• ther goods

JUSTIFYING ACTIONS

 Action itself must be morally good or at least indifferent  The bad effect should not be intended but foreseen as a

possibility

 The good effect must not be produced by means of the

bad effect

 There must be proportionality between the good and

bad effects that justifies the good effect

COMMUNICATION:

The single biggest problem in communication is the illusion that it has taken place. (George Bernard Shaw)

 1. Verbal Messages - the words we choose (~7%)  2. Paraverbal Messages - how we say the words (~38%)  3. Nonverbal Messages - our body language (facial expressions,

position of arms, how we stand or sit) (~55%)

WHAT DO YOU THINK IS HAPPENING HERE? WHAT FEELINGS

ARE TRIGGERED?

AND HERE?

WHAT DO YOU THINK IS HAPPENING HERE? WHAT FEELINGS

ARE TRIGGERED?

AND HERE?

COMMUNICATION

Patients are hesitate to disclose their limited understanding even to their own family(~50%)

According to the Dept. of Health and Human

Services; 9/10 times patients do not receive health information in a way that they can understand or USE it

So how can we overcome this?

SPIKES (6 STEP PROCESS COMMONLY USED IN

ONCOLOGY)

S = Setting up the chat:

 Mental rehearsal (review all the facts, speak with

unit staff)

 Arrange for privacy  Involve significant others  Sit down  Make connection with patient  Manage time constraints and interruptions

SPIKES

P = Assess patients perception

– Before you tell, ASK:

• What is your understanding of (this situation)?

I = Obtain invitation to talk K= Provide knowledge

– Use plain laymen language – Avoid excessive bluntness, – Give information in small chunks, pause to allow

patient to digest information

SPIKES

E = addressing emotions

• I know this is not good news for you
• I am sorry this is so difficult
• You seem deep in thought/worried
• help me understand what you are thinking can you tell me

what you are worried about?

S = strategy and summary

• Patients who have a plan for the future are less likely to feel

anxious and uncertain.

• Involve them in the planning wherever possible
• A summary statement with a resource for questions or

concerns that arise afterwards

CLASS

Context – physical context or setting

 Privacy, body language, introductions

Listening

 Listening skills (open ended questions, use of

silence)

Acknowledge

 Identify and explore the emotion

Strategy for management

 Explore optimal strategy with patient, agree

• n a plan

Summary

 A summary statement with a resource for

questions or concerns that arise afterwards

C.A.R.E.

 Connect – make a personal connection to the patient

and family

 Choice of words, tone of voice, body language, eye contact.  Appreciate – when the patient feels heard, understood

and their situation has been acknowledged

 Listen carefully, acknowledge and express concern

C.A.R.E

Respond – offer positive explanations for the policy  Listen, clarify  Use common language  Explain the process  Offer possible solutions Empower – inspire patients to have confidence in their

ability to contribute to their health and health care

 Find out what they know, expect and have tried  Create choices, offer to help  Look for their strengths

ONE MORE THING

Consider whether this event should

undergo a formal disclosure process.

 Be familiar with your Health Authority’s

process and criteria regarding formal disclosure.

SUMMARY TIPS

 Warm greeting, eye contact, sit down (their level or

lower)

 Plain language: note language that they use to describe

their experience and use it in your conversation

 Slow down – speak clearly and at a moderate pace  Limit content – stay with 3-5 key points  Repeat key points (can use this as a summary)  Graphics – draw pictures or use illustrations whenever

possible

 Create a shame free environment  Encourage questions – “what do I need to go over again”

“what questions do you have”?

THE STORIES OF CAROLYN AND ADRIENNE

 How can we as health care professionals develop or

change our practices based on patients experiences and their stories?

 What is one thing you will do differently based on what

you’ve heard today?

 PICNet experience and VIHA experience.

AT YOUR TABLE, AS A GROUP:

Use either Carolyn’s or Adrienne's story or the

case example on the table:

 Identify 3 important considerations in your

example

 How would have you communicated things

differently? (Carolyn’s or Adrienne’s story)

 How would you approach this? (case example)  What important messages do you want shared?

 How would you do this? (give examples)