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Crisis Intervention
Week Four
The Elderly / The Trauma Patient
Responding to all equally


Effective Communication
      Many of you have mentioned either in class the goal of improving your skills in some form of communication. During the third week of class there have been references to some of these components, like the use of humor and listening. I would like to highlight a few aspects of communication this week as we look at the elderly person who is seeking health care and the trauma patient.


Characteristics of an Effective Listener:
  1. Seek to understand the person / who is this person / what can we tell about their life in our short time with them / what do we need to understand to best help them
  2. Active listening / we use our whole self / we use open ended conversation to clarify / not that we have to agree with them but that we can try to understand from the road they travel
  3. Recognizing body language / helps us to pick up clues about the person we are listening to / can key us in to things not being said / or safety issues
  4. Don't rush with opinions & judgments / people may have very different values than what you practice in your private life but it's not our place to judge / we crowd out the concept of really listening when we offer opinions too quickly
  5. Speak with clear understanding / when people are in crisis they don't need to be overwhelmed with words / speaking slowly, in less words & clearly doesn't mean speaking down to them / try very hard to honor each person you work with
Some Common Blocks of Successful Communication:
  1. Placing our value on to the other person / we know intellectually about the 'providing unbiased care' but it really isn't always easy / most of the time the differing value isn't bad or good - it just is!
  2. Language / this can be as simple as using technical - medical terms / we live in a world with lots of languages and we can't be proficient in them all
  3. Comfort of individuals / do we know what the other person considers important to feel comfort? / does touch provide comfort or unease?
  4. Power / who has the power / how is it being used / does the patient feel that they have any power?
  5. Cultural differences / perceptions and values can really vary
  6. Use of perceptions, assumptions / we discussed this in class / realize that your perception may not be the same from another's eyes

Listen --- A poem by Anonymous
    When I ask you to listen to me
      and you start giving advice
      you have not done what I asked.
    When I ask you to listen to me
      and you being to tell me why I shouldn't feel that way,
      you are trampling on my 'feelings'.
    When I ask you to listen to me
      and you feel you have to do something to solve my problem,
      you have failed me, strange as that may seem.
    Listen! All I asked, was that you listen,
      not talk or do -- just hear me. Advice is cheap: 25 cents will get you both Dear Abby and Billy Graham in the same newspaper. And I can do for myself: I'm not helpless, maybe discouraged and faltering, but not helpless.
    When you do something for me that I can and need to do
      for myself, you contribute to my fear and weakness.
    But, when you accept as a simple fact that I do feel what I feel,
      no matter how irrational, then I can quit trying to convince you and can get about the business of understanding what's behind this irrational feeling. And when that's clear, the answers are obvious and I don't need advice. Irrational feelings make sense when we understand what's behind them.
    Perhaps that's why prayer works, sometimes, for some people
      because God is mute and he doesn't give advice or try to fix things. "They" just listen and let you work it out for yourself.
    So, please listen and just hear me. And, if you want to
      talk, wait a minute for your turn; and I'll listen to you.


    The use of silence:
    1. Silence can be a very helpful tool if you demonstrate a comfort level with it
    2. Can you sit in silence with someone and not feel that you need to fill the space?
    3. When working with some people (especially with cognitive functioning problems) / they need processing time / for example: an elder may need time to think about the question before giving a valid answer and when we rush them they will just say yes or no to be done with it
    Pain:
          Pain is now considered a valid vital sign to be evaluated on each person we assess in all aspects of the health care system. Pain can represent loss, uncertainty or crisis in the physical, emotional or spiritual realm of a person. In the chapters that you have been reading, pain is referenced in those that are seeking help and those that are giving the help. This is one resource that you can use when identifying various types of pain. We are limiting our response to others until we can think very broadly about the concept of pain.

          Let's have a little competition. In your Discussion Groups see how many different types of pain that you can identify and/or describe. Your instructor holds the right to be the judge of duplication and the final accounting of numbers. Those individuals who participate in the group that wins will get a bonus of 5 participation points for the week.

    Activities for Week Four
    • Reading:
      • Chapters 3 and 5 from the text

    • Participation:
      • There are many ways that people find to relax and allow the concerns of the day or week to melt away. Some people utilize music to help them unwind and relax. I personally enjoy a tape that has the sounds of the forest; water / wind / loons. There are many other technics as well; exercising, gardening, wilderness trekking etc. Report a few of the ways and means that help you relax.
        Post this in your tree conference Week #4 Activity #1 -
        due Wed (10/18/06)
      • Discussion Group assignment: refer back to section on Pain Ð how many different types of pain can your group identify? Remember the extra points!!! Post this in your specific - Discussion Group - under the topic listed as "Types of Pain" - this will be closed Sat PM.

    • Project # 1:
          (To see a summary of this project, click here or on Project 1 in menu)
      • In the first two weeks you have interviewed a seasoned provider and written up their viewpoint of the job and job stressors.
      • The Personal Inventory, you have written your self reflections. This paper should be a minimum of 2 pages but what I'm really looking for is some substance.
      • After watching the movie, Patch Adams, you have typed your response to the questions.
      • Project One is due in your Personal Conference on the Web Board (your name conference) by 10/21/2006 at Midnight. Please no emails or hard copies.

  • Worksheets:
    • Place yourself in a public setting where you will be able to observe a significant number of persons over 60 years old.
      1. What signs of illness or deterioration did you observe that could be considered part of the normal aging process?
      2. Go to at least one of the Web Sites listed in the back of the chapter 3 and find some clues about the aging process and how that might affect our care to the elders.
      3. How might these observations manifest themselves in a need for health care? What are some key issues about communication that might be pertinent with each of these people? (example: the person was walking with a cane and had a ground level fall, when you are working with them they say, "I am so clumsy, I should just stay home." Your response might include ---what would you say?
      4. Write up your experience and observations identifying some specific aspects of communication.
        Post this under conference Week #4 Activity #2 - Due Sat 10/21/2006
Email Gail at: saxg@chemeketa.edu