115 Educating Patients: Creating Teaching Moments in Practice
CASE STUDY: MISS BROWN
Miss Brown is in the emergency department following a motor vehicle crash as a passenger not using a seatbelt. She is 17 years old, Caucasian, and registered as Robert Brown. Her history shows she was assigned male at birth and wants to transition to female. There is a suspected concussion and a left fractured clavicle noted on x-ray. Family is not at the bedside.
Question 1: What are some strategies that will promote building rapport and successful communication? What are some initial considerations when going in to meet the patient? Commentary on question 1 : It is important to ask the patient how they would like to be addressed. The emergency environment can be loud and busy at times, so any ability to decrease environmental stimulation should be done. A nonjudgmental demeanor with em- pathy can help create a good relationship. Respect can be shown with courtesy and respon- siveness. Plain language and use of open-ended questions are essential, as is encouraging participation through dialogue and questions. Sitting at the level of the patient, showing active listening, and speaking clearly are all necessary. An accident can be traumatic for patients and ending up in the emergency department can add to the stress and anxiety. Additionally, pain and a potential concussion may have negative effects on patient learning. Health literacy, culture, and learning style should all be assessed. Developmental level and lack of support systems present should also be explored. The patient states she identifies as female, and would like to be addressed as Miss Rachel Brown, with the pronouns of she/her/hers. She says she is very active in the LGBTQ commu- nity, and her parents are supportive of her. She lives at home with both of her parents. Miss Brown says her mother was working and will be arriving at the emergency department soon. Miss Brown states she would like to include her mother in teaching when she arrives. She also says she has a boyfriend, who was driving when the accident occurred and who is being evaluated in the emergency department for a shoulder injury. Miss Brown has been healthy and does not take any medications. She says she doesn’t like medications, even the use of over-the-counter medicine. She does not smoke cigarettes but does smoke marijuana on a weekly basis. Miss Brown just graduated from high school a few weeks ago and celebrated her 17th birthday two months ago. Assessment shows that Miss Brown has a basic understanding of words related to health literacy, with a score of 16 on the Short Assessment of Health Literacy tool. Her learning style is visual. She is pleasant and appropriate in her communications. Miss Brown considers herself tech savvy and uses multiple apps on her phone. In addition, she is active on many social media websites.
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