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COMMUNICATION IN THE MANAGEMENT OF CRITICAL CARE PATIENTS

Prof. Dr. R. Sjamsuhidajat Dr. Tjakra W. Manuaba

OBJECTIVES :

To understand the importance of clear & effective communication in critical care situation. To understand the probable obstacles in communication, and know how to overcome them. To understand the psychological reaction of how a human being will react to a critical or a serious life threatening condition, including a post traumatic stress disorder (PTSD). To understand the patho-physiology of mental disorder in critical care, and when psychiatric consultation should be needed.

The mask, cap and gown are exclusively the scary factors for layman.

How human being faces a Critical Situation (in general)

Emotional Changes. Positive Emotional Changes (Good mood,


happy occasions/ wedding, birthday etc).

Negative Emotional Changes (left by the


train, facing a seriously ill family)

Emotional changes

Usually temporary Depending on Emotional Stability, past

experiences, psychological maturity, internal representation, cognitive processing, traumatic stressor.

Awareness of Emotional reaction. Return toward normal balance (in majority cases)

Severe Physical / Psychological Injuries


Emotional Reaction

Emotional Processing Awareness of Emotional Reaction


Returns

Towards Normal Balance


(majority of cases)

PTSD (small percentage)

Monitor & supportive equipments make medicine less human , on one side,
But a conditio sine qua non on the other side. Medical professionals should make a balance and a wise choice.

HUMAN BEING REACTION


In a Serious & Critical / Traumatic Condition (injury, sickness)
Human reaction would be.

To Fly (to run away From the situation)

To Fight (to face & to cope with the condition)

Painful Intrusive Recollection

A good, clear, and honest communication is the key component of good treatment results.

Painful Intrusive Recollection

Cyclical Reaction of INTRUSION & AVOIDANCE.

Post Traumatic Stress Disorder (PTSD)

PTSD

Suppressed into Subconsciousness

- Becoming chronic - Change of value system - Reappraisal - Disturbance of emotional processing - Failure to complete the emotional processing

Sympathy, empathy & good communication will help the patient to recover.

With sympathetic face and gestures, and by saying : you are going to be okay Sir, We will take good care of you. , is the start of a good communication and eventually trust.

Population in High Risk for psychological problems.


1.Direct Primary Victims

2.Close family & friends of the primary victim


3.Other person, who because of their duties have to relate and to react toward that particular traumatic condition ( Doctors, nurses etc)

Population in High Risk for psychological problems.

Subjectivity and Mistakes


In Medical Judgment In facing un-expected critical situation Tendency of minimizing or exaggeration of serious or mild clinical condition.

Are expected to happen when a surgeon treats their loved ones, him/ herself. They should trust the treatment fully to other doctors. Ethical Consideration? Shortcoming of a doctor ?.

By Understanding The Whole Psychological Process in Critical Situation

BETTER COMMUNICATION

-Clearer -More effective & efficient communication -Honesty -Trust -More accurate information -Prevention of violent situation -Informed consent -Legal aspects

Other Specific Problems in Communication

The use of particular drugs, such as narcotics, tranquilizers, analgesics, anesthesia make communication difficult to focus. Operational fatigue (doctors, nurses, Lab/ radiology
technicians).

Psychological Condition of patients, families


(former experience, and emotional processing)

Critical Setting (close building/ rooms, sophisticated


MEDICAL TECHNOLOGIES, nurses/ doctors with masks/ gown/ gloves)

Sophisticated test without information

Stress factor

In A Mass Disaster Situation


-ESCALATION of reaction/ stress reaction -Other social, politics and economy

involvement -The role of mass media (might worsening the


- The Visits of High Ranking Officials
situation)

more

often, make the job of medical professionals more difficult to perform.

PRESIDEN RI TIBA DI RS SANGLAH

COMMUNICATION STRATEGY

Critical Care Setting Information should be clear including : patients condition,


equipments, the time, date, familiar faces and names of doctors, nurses, medical technicians, repeated information, follow ups)

How to break bad news. How to tell Medical Mistakes, How to Make a Consultation (to a senior, to other
colleagues.

Awareness to possible psychological disturbances. The presence of Anxiety, Major Depression suicide , drugs and alcohol dependency, acute organic reaction The Need for Psychiatric Consultation.

ORGANIZATIONAL SKILLS IN
CRITICAL CARE.

Leadership Mature and good personality to take a decision The right time The ability in working together Honesty Consultation Techniques Patient Reassessment Communication with nurses Management (quick and accurate Dx/, treatment) Data collection Surgery/ non surgery : How to tell the patient/ family

More humane, with empathy, & sympathy in communication

Painful maybe, but a good supportive communication

Thank You