Chapter 15
Therapeutic
Communication and
History Taking
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11-1
Objectives
11-2
The Communication Process
11-3
Communication
• Six basic elements
1. Source
2. Encoding
3. Message
4. Channel
5. Receiver (decoder)
6. Feedback
11-4
The Sender
• Source
• Message
• Encoding
• Channel
11-5
The Receiver
• Receiver (decoder)
• Noise
• Feedback
11-6
Communicating with the Patient
11-7
What Is an Emergency?
• What the patient considers an emergency
may not appear to be an emergency to
you . . .
• Keep in mind:
– Pain is what the patient says it is
– An emergency is what the patient
perceives it to be
11-8
What Is an Emergency?
• You should:
– Accept every call for assistance without
prejudice
– Provide the best emergency care you can
for every patient, without questioning the
validity of the complaint
11-9
Common Patient Responses
to Illness or Injury
•
•
•
•
•
•
Fear
Embarrassment
Anger
Frustration
Sorrow
Pain
•
•
•
•
Anxiety
Depression
Regression
Guilt, shame, or
blame
• Feeling of being
powerless or
helpless
11-10
Approach to the Ill or Injured Patient
• Identify yourself
• Address the patient by proper name
11-11
Approach to the Ill or Injured Patient
• Identify yourself
• Address the patient by proper name
11-12
Interpersonal Distance in the United States
Public space
12 feet or more
Impersonal contact
with others
11-13
Interpersonal Distance in the United States
Public space
12 feet or more
Social space
4 to 12 feet
Much of a patient interview
occurs at this distance
11-14
Interpersonal Distance in the United States
Public space
12 feet or more
Social space
4 to 12 feet
Much of a physical
assessment occurs
at this distance
Personal space
1½ to 4 feet
11-15
Interpersonal Distance in the United States
Public space
12 feet or more
Social space
4 to 12 feet
Intimate space
Touching to 1½ feet
Best for assessing breath
and other body odors
Personal space
1 ½ to 4 feet
11-16
Communicating with the Patient
11-17
Unresponsive Patients
• Do not assume that an unresponsive patient
cannot hear what is being said.
– Talk to him as if he were awake
– Explain what you are doing
11-18
Approach to the Ill or Injured Patient
• Recognize the patient’s need for privacy
• Preserve the patient’s dignity
• Treat the patient with respect
• Recognize the patient’s need for control
11-19
Approach to the Ill or Injured Patient
•
•
•
•
•
Remain calm
Be sympathetic
Listen with empathy
Do not give false hope or reassurance
Use a reassuring touch, if appropriate
11-20
Communicating with Infants
• Young infants (birth to 6 months of age)
– Unafraid of strangers
– Have no modesty
• Older infants (6 months to 1 year)
– Separation anxiety
– Threatened by direct eye contact
with strangers
11-21
Communicating with Toddlers
• Toddler (1 to 3 years of age)
– Strong separation anxiety
– Can answer simple questions
– Can follow simple directions
– You cannot reason with a toddler
– Comfort object (blanket, toy)
11-22
Communicating with Toddlers
11-23
Communicating with Preschoolers
• Preschooler (4 to 5 years of age)
– Use simple words and phrases
– Assure the child he was not bad
– Choose your words carefully
11-24
Communicating with
School-age Children
• School-age child (6 to 12 years of age)
– Introduce yourself
– Talk directly to the child
– Explain procedures
– Allow child to see and touch equipment
– Be honest with the child
11-25
Communicating with Adolescents
• Adolescent (13 to 18 years of age)
– Address an adolescent in a respectful,
friendly manner
– Explain things clearly and honestly
– Allow time for questions
– Do not bargain with an adolescent in order
to do what you need to do
– Do not become angry with an emotional or
hysterical adolescent
11-26
Communicating with Older Adults
• Assume a position directly in the patient’s
line of vision
• Speak directly to the patient in a normal tone
of voice
• Speak slowly and say each word clearly
– Be careful not to “talk down” to the
patient.
• Ask the patient one question at a time and
allow the patient time to respond
• Provide reassurance
11-27
Non-English-Speaking Patients
• Communication with non-English-speaking
patients may require the use of an interpreter
– Avoid interrupting a family member (or
bystander) and interpreter when they are
communicating
11-28
Hearing-Impaired Patients
• Use your normal tone of voice and speak at
your normal speed
• Face your patient directly so that he can see
your face and mouth
• Explain any procedure before providing care
• Be sure to inform the EMS crew arriving on
the scene of the patient’s hearing impairment
11-29
Visually-Impaired Patients
• Approach the patient from the front and
introduce yourself
• Identify any persons with you
• Speak in a normal voice
• Clearly explain any care you are going to
provide before doing so
• Keep the patient and his service dog
together if at all possible
– Do not pet or otherwise distract a service
dog
11-30
Speech-Impaired Patients
• Keep your questions short and to the point
• It may be helpful to ask questions that can be
answered with a yes or no
• Allow the patient time to respond and in his
own way
• Listen carefully to what the patient has to say
– He may even use hand gestures or a
notepad to communicate his needs.
11-31
Responses of the Family,
Friends, or Bystanders
11-32
Responses of the Family,
Friends, or Bystanders
• Family members, friends, or bystanders may
demonstrate many of the same responses as
the patient
• Possible responses:
– Anxiety
– Anger
– Sadness
– Being demanding
– Impatience
11-33
Responses of the Family,
Friends, or Bystanders
• Identify yourself
• Take control of the situation
– Use a gentle but firm tone of voice
– Explain what you are doing to help the
patient
– Speak clearly and use common words
(avoid using medical terms).
– Speak at an appropriate speed or pace, not
too rapidly and not too slowly.
11-34
Responses of the Family,
Friends, or Bystanders
• Assume a helpful posture and face the
person speaking.
• Maintain eye contact while listening
carefully.
• Clarify information that is unclear.
• Avoid interrupting when they are talking.
• Allow family and others to have and express
their emotions
11-35
Responses of the Family,
Friends, or Bystanders
• Comfort them
• Be sympathetic
• Listen empathetically
• Reassure them that everything that can be
done to help will be done
– Do not give false hope or reassurance
11-36
Patient History
11-37
Patient History
• Components
– Chief complaint
– History of the present illness
– Past medical history
– Current health status
11-38
Techniques of History Taking
• Use open-ended questions when possible
– Require the patient to answer with more
than a “yes” or “no”
• Closed or direct questions
– Can be answered with “yes” or “no” or
with one- or two-word responses
– Do not allow an opportunity for the patient
to explain what is wrong
11-39
Techniques of History Taking
• If the patient is unresponsive, gather as
much information as possible by:
– Looking at the scene
– Looking for medical identification tags
– Questioning family members, coworkers,
or others at the scene
11-40
Chief Complaint
• Very brief description of the reason EMS was
called
• Usually in the patient’s own words
11-41
History of the Present Illness
• A chronological record of the reason a
patient is seeking medical assistance
• Includes a detailed evaluation of the patient’s
chief complaint and the patient’s answers to
questions about the circumstances
(including signs and symptoms) that led up
to the request for medical help
11-42
History of the Present Illness
OPQRST
• Onset
• Provocation/Palliation/Position
• Quality
• Region/Radiation
• Severity
• Time
11-43
History of the Present Illness
• Pertinent positive
– Positive finding
• Pertinent negative
– Negative finding
11-44
History of the Present Illness
• Relevant family history
– Ask the patient about related problems of
family members.
– Document the family member’s
relationship to the patient.
11-45
Past Medical History
• Ask the patient about conditions he may
have that may help you determine what the
problem is today
– Trauma
– Medical
– Surgical
• Look for a medical identification tag if
unresponsive or altered mental status
11-46
Current Health Status
• Allergies
– Do you have any allergies to medications?
– Are you allergic to latex?
– Do you have any food allergies or allergies
to insect stings, pollen, dust, or grass?
11-47
Current Health Status
• Medications
– Over the counter (OTC)
– Prescribed
– Vitamins
– Herbs
– Birth control
– Erectile dysfunction
– Other people’s medications
– Recreational drugs
11-48
Current Health Status
• Personal habits
– Tobacco use
– Alcohol use
– Coffee, cola, tea use
– Recreational drug use
11-49
Current Health Status
• Diet / Last Oral Intake
– Number of meals or snacks the patient
consumes per day
– Determine when the patient last ate or had
anything to drink
• What
• How much
• When
11-50
SAMPLE History
•
•
•
•
•
•
Signs and symptoms
Allergies
Medications
Past medical history
Last oral intake
Events leading to the injury or illness
11-51
Questions?
11-52