T ALKING TO P ATIENTS ABOUT I NFECTION C ONTROL
W HEN 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
C ONSIDERATIONS • 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
C ONSIDERATIONS ( 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.
E THICAL F RAMEWORK FACTS ETHICAL THEORIES • CLINICAL ISSUES • DEONTOLOGICAL (JUSTICE) • PREFERENCES • UTILITARIANISM (DO GOOD) • QUALITY OF LIFE /DEATH • COMMUNITARINISM (VIRTUE ETHICS) • CONTEXTUAL FEATURES VALUES EXTERNAL FACTORS • PATIENT SAFETY FOR ALL • IP&C BEST PRACTICES • MORAL DECISION-MAKING • LEGISLATION • ORGANIZATIONAL POLICY
E THICAL T HEORIES Deontology (justice) Respect for: Individual rights and freedom Liberty Duty based
E THICAL T HEORIES - CONT . Utilitarianism or Consequentialism Judges actions by the extent to which they promote the overall well-being or utility of society. Promotes the greater good
T HEORY C ONFLICTS 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
R ESOLUTION 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 other goods
J USTIFYING A CTIONS 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
C OMMUNICATION : 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%)
W HAT DO YOU THINK IS HAPPENING HERE ? W HAT F EELINGS ARE T RIGGERED ?
A ND HERE ?
W HAT DO YOU THINK IS HAPPENING HERE ? W HAT F EELINGS ARE T RIGGERED ?
A ND H ERE ?
C OMMUNICATION 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 O NCOLOGY ) 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 p erception – Before you tell, ASK: • What is your understanding of (this situation)? I = Obtain i nvitation to talk K = Provide k nowledge – 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 C ontext – physical context or setting Privacy, body language, introductions L istening Listening skills (open ended questions, use of silence) A cknowledge Identify and explore the emotion S trategy for management Explore optimal strategy with patient, agree on a plan S ummary A summary statement with a resource for questions or concerns that arise afterwards
C.A.R.E. C onnect – make a personal connection to the patient and family Choice of words, tone of voice, body language, eye contact. A ppreciate – when the patient feels heard, understood and their situation has been acknowledged Listen carefully, acknowledge and express concern
C.A.R.E R espond – offer positive explanations for the policy Listen, clarify Use common language Explain the process Offer possible solutions E mpower – 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
O NE M ORE T HING Consider whether this event should undergo a formal disclosure process. Be familiar with your Health Authority’s process and criteria regarding formal disclosure.
S UMMARY T IPS 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”?
T HE S TORIES OF C AROLYN AND A DRIENNE 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.
A T 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)
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