Tuesday 23 May 2017

Recognising and managing conflict between patients, families and health professionals.

Hi all!

I recently attended a course, it was half a day long and was all about recognising and diffusing situations before conflict occurs.

This was the best training I have attended since graduating as a Band 5 physiotherapist. It was a mixture of teaching and workshops, we did role play of certain situations and it really highlighted areas of my communication I should improve in.

I learnt a lot about communicating with parents and patients and what type of thing to avoid. Sometimes you can make a situation much worse, by offering what you see as a useful comment, which just drives a person mad! This course did a great job of highlighting some things health professionals do and say within paediatrics that don't help!

By highlighting these issues and suggesting ways to improve I really feel I have become a better communicator and have helped patients and parents feel happy and understood when difficult situations come up.

 

Here are my key learning points:

-In paediatrics communication is mainly with the parents, but throughout all discussions it is important that the patient has a voice and there needs always need to be considered outside of the parents’ wishes.

-Respond to cue (emotive) words, for example if someone says "I'm really angry we can't have the operation" you respond to the word angry. You engage with the patient and understand what is making them angry. You can only begin to improve a situation once you fully understand the issue! Sometimes people just want to rant and feel understood, let them don’t interrupt.  

-Don't ask people why they are upset it can be quite accusatory, ask them what is making them feel that emotion.

-Don't just offer premature assurance, using the example above saying to the patient/parent "oh it's okay you will probably get it on Monday" is not helpful and will make the situation worse, listening and understanding the situation and then possible discussing reasonable ways forward is a much better option.

-Listen to them and pick up on their emotions, use these to be empathetic towards them, and let them know they are valued by your team.

-Be prepared, there is nothing worse than trying to solve a situation or listen to someone about their problems when you come blind into a situation. Make sure you know the background and know what you want to do and who you want to help. It also saves you asking the same questions every single person has asked before you.

- Similar to the NHS 5 year forward view, prevention is better than cure, so be constantly on the lookout for ways to prevent conflict occurring and if you see a potential issue address it before it escalates!

I would like to thank the medical mediation foundation for running this course, they are doing a lot of great work and have changed my practice.


As a side note, my mother is having a stressful time at work at the moment and always comes home and talks about it, I started asking her about her emotive words, not offering pre-mature assurance and at the end she remarked how great I was to talk to and how she felt much better than she normally does after talking to me! (Hopefully she won’t read this and find out)


Liam

Thursday 11 May 2017

A busy paeds day

Well that was a busy day, I finished an hour late and have just eaten a super healthy Burger King, I was so hungry!

I was on the late shift today and from 18:15 to 20:00 I was the only physio working so you have manage alone. 

During this late shift I treated two patients with two seperate consultants, I have never treated with a consultant before it was great learning and a great experience discussing my clinical reasoning with them. 

I had two patients who were very unwell and both needed a lot of help clearing their secretions! Both had lots of additional problems, but not extensive past medical history's and their sudden illnesses had come a little out of left field. 

One had chicken pox, and actually chicken pox can be really scary, we have had two patients on intensive care with chicken pox recently and both have become really unwell, this current one is taking breaths of approximate 2ml/kg, that works out at a total Tidal volume (size of breath) of 30ml of air. A normal tidal breath for this age would be 140-150 ml/kg, a huge loss! This makes getting oxygen in and CO2 out really difficult, obviously a big issue!

The main challenge this presents is remaining positive whilst treating, parents are often at the bed, and when children become unwell, you cannot afford to show any sign that you are worried whilst they have placed their child's  life in your hands. With physiotherapy this is particularly difficult because in respiratory intensive care the techniques you use do not look comfortable or pleasant and they would hurt you as an adult. Often parents have asked me if their ribs will be broken and even when they know they are mainly cartilage and can't really break it is still very upsetting. So I have found looking confident and remaining professional whilst treating really helps the parents to trust you, and as a new band 5 this is really important.

However as a new band 5 it's really important that you are confident of what you are doing and you don't put yourself in a situation that can cause a patient harm, because unlike being a student you are solely responsible. Whenever I am a bit concerned about treating a patient or I'm not confident, I will always ask to see the patient with a senior member of staff, luckily we have a very experienced team which allows us to do this. 

To end I will tell you a little secret of mine. A not so little part of me absolutely loves having to treat an ill patient who really needs my help, I haven't experienced anything quite like it before, you are really changing their life you know!