COMMUNICATION

WITH SPECIAL
PATIENTS

Dr. Susi Ari Kristina, M. Kes., Apt

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 SPECIAL NEEDS

◼ The Elderly
◼ Terminally Ill patients (paliative care)
◼ Patients with AIDS
◼ Pediatric patients

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 STUDI KASUS

Buat 6 kelompok untuk tugas kelas sbb:

◼ Berikan strategi komunikasi untuk pasien dengan situasi sbb (20
menit):
▪ Pasien DM (kronik)
▪ Pasien hipertensi (kronik)
▪ Pasien usia lanjut dengan pengobatan osteoartritis (elderly)
▪ Pasien dengan HIV
▪ Pasien TB (low compliance)
▪ Pasien anak dengan asma (teknik inhaler)
◼ Presentasikan di kelas hasil diskusi kelompok anda

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 THE ELDERLY

◼ Elderly account for 30% of all prescription medication taken in the United States
and 40$ of all OTC medication.
◼ The aging process affects certain elements of the communication process in some
older adults.
◼ In certain individuals, the aging process affects the learning process, but not the
ability to learn.
◼ Some older adults learn at a slower rate than younger persons. They have the ability
to learn but they process information at a different rate. The elderly might also have
problems such as poor
◼ vision, speech or hearing.
◼ Therefore, it is very important to set reasonable short-term goals, and break down
learning tasks into smaller components.
◼ It is also important to encourage feedback as to whether they understand the
intended message.

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BARRIERS ASSOCIATED WITH GERIATRY

◼ High prescription drug use

◼ High incidence of illness
◼ Increased risk of drug-related problems
◼ Increased limitations
◼ Reduced cognitive functioning
◼ Decreased medication regimen adherence
◼ Literacy and cultural issues
◼ Healthcare services and affordability

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 STEPS WHEN COMMUNICATING A
GERIATRIC PATIENT
◼ Introduce yourself and ask the patient how pt prefers to be addressed
◼ Describe your role in the patient’s care and goal
◼ Assess pt ability and knowledge
◼ Identify patient-specific barriers and implement strategies to overcome these
barriers
▪ Ask open ended questions as to why pt is taking each medication
▪ Ask pt to explain how he has been using each medication (freq, timing)
▪ Ask pt to describe any concerns or problems with any medications
▪ Ask any problem pt is having and contact the pt’s prescriber
◼ Use active listening skills, gesture appropriately and maintain good eye
contact
◼ Provide support and feedback to the pt and caregiver when appropriate

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 TERMINALLY ILL PATIENTS

▪“An approach that improves the quality of life of patients

and their families facing the problems associated with
life-threatening illness, through the prevention and relief
of suffering by means of early identification and
impeccable assessment and treatment of pain and other
problems, physical, psychosocial and spiritual needs”
▪ Multidisciplinary approach that focuses on the
whole patient and family
▪ Note that the “unit of care” is more than the patient- to
include family/friends, caregivers

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 A Palliative Care understanding
May represent decades Hospice Care riate)
op
Potenti
al (Where Appr
3)
(Benefit, 198
Cure
ic Phases

ve Example of a Bereavement
s s i
A g gre End On Theoretical Model:
t iv e, rials of C e Y “Continuing Bonds”
are e
a ies/T to ar Be
Diagnost

u r
C rap
The C are Life Su rea
rvi ve
a t i ve ies Care vor me
li it s nt
Pal odal
M

Diagnosis of a Potentially
Death Event
Active
Life-Limiting Illness, Dying
Condition (24-72 hrs)
To Include: Remission(s)
Worried Wellness
Cautiously Cured
(Anxious) Survivorship
Chronically well/ill 8
WHO NEEDS PALLIATIVE CARE?

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 INDICATIONS FOR CONSULTATION:
◼ Working definition of palliative care: Patients who are facing a
potentially life-threatening illness. We assist with
1) pain and symptom management
2) hospice information and placement
3) goals of care*
4) patient and family support
5) advance care planning

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 *GOALS OF PALLIATIVE CARE

◼ Alleviate the suffering of the patient and family

by focusing on comprehensive care
◼ Enhancing patient’s quality of life
◼ Assisting patients and families through the
transition from wellness -->sickness --> dying
--> bereavement
◼ Help patients/families navigate their search for
meaning/ hope
◼ Assist patients in developing and achieving goals
--allowing patients to die on their own terms--
World Health Organization 2013

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 PATIENTS WITH AIDS

◼ are not only dealing with life threatening diseases, but also the social stigmas
that often accompany their conditions.
◼ The key is not to treat them as different from others.
◼ Due to the advent of highly effective antiretroviral therapy, health
professionals should adjust their thinking to perceive HIV infections as a
chronic condition rather than a terminal disease.

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 PHASES OF THE AIDS EPIDEMIC

◼ The silent spread of HIV throughout a society.

◼ Rising number of HIV-positive people.
◼ Spread of stigma, discrimination, collective denial, and blame.

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 CAUSES OF STIGMA AND
DISCRIMINATION
Societal:
• Lack of knowledge.
• AIDS association with death.
• Pre-existing prejudices (homosexuals,
prostitutes, IV drug-users – punishment
for their behavior).

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 CAUSES OF STIGMA AND
DISCRIMINATION
Causal (health care settings):
◼ Fear of getting infected.
◼ Lack of resources (drugs or staff).
◼ Insufficient level of knowledge.
◼ Moral values and biases.

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CONSEQUENCES OF SIGMA AND
DISCRIMINATION

For Patient: For society:

◼Psychological trauma. ◼Refusal from testing.
◼Social isolation. ◼Refusal from treatment.
◼Decreased access to ◼Pursuit to conceal HIV
medical services. status by any means.
◼Increased risk of HIV
spread.

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 COMMUNICATION TECHNIQUE: RAISE...

Confidentially Privacy
◼ Mechanism through which the ◼ Auditory privacy (no auditory
patient's right to privacy is interruptions or breaches).
protected.

◼ “The duty of those who receive

◼ Visual privacy (no visual
interruptions of breaches).
private information not to
disclose it without the patient’s
consent"

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 COMMUNICATION WITH CHILDREN

Involving children works:

◼ Children feel listened to, taken seriously, and this helps them to deal
with difficult situations

◼ When children are involved in decision-making and planning, the plans

are more likely to be successful

◼ Services developed with the influence of children and young people

are more likely to meet their needs

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GOOD PRACTICE 1: BUILD COMPETENCE

◼ By providing information so that children and

young people can contribute meaningfully
◼ By giving time and explanations so that they can
properly understand the issues and the process
◼ By being clear about what will be discussed, and
the likely consequences. Be straight about the
boundaries of confidentiality
◼ By giving access to independent advocacy
services if required

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 GOOD PRACTICE 2: PRACTICAL
CONSIDERATIONS

◼ Pay attention to venues and who will be present.

Children should be involved in deciding who, when
and where

◼ Provide interpreters if required

◼ Think about what tools and techniques you will use.

Preparation and planning

◼ Think about the use of new technologies

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 GOOD PRACTICE 3: CREATE THE RIGHT
CULTURE

◼ Children are more likely to talk to people they know

and trust – it takes time to build trust

◼ Feedback and discuss the outcomes, what

happened

◼ Follow up – do what you said you would do

◼ Be flexible in response to what children and young

people say

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 GOOD PRACTICE 4 : CHILD-LED
ASSESSMENTS

◼ Start with what is important to the child

◼ Go at the child’s pace – gradually build a picture

of their needs

◼ Attend to positives as well as negatives

◼ Forms / tick boxes / checklists don’t always work

well for children

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 GOOD PRACTICE 4 : CHILD-LED
ASSESSMENTS

◼ Start with what is important to the child

◼ Go at the child’s pace – gradually build a picture

of their needs

◼ Attend to positives as well as negatives

◼ Forms / tick boxes / checklists don’t always work

well for children

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 CAUTIONS

◼ Sensitivity to children’s plans / schedules

◼ Don’t let children down – be reliable, honest and

accountable

◼ Support carers to support the child involved

◼ Involve other trusted adults outside the family

◼ Don’t just talk – try other methods

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