This week for my blog, I am going to look at considerations that need to be taken into account when imaging a patient with special needs (Easton, 2014). This is one of the very first Intermediate Diagnostic Imaging lectures that I attended in my second year; I find the topic extremely interesting as I have a lot of experience when dealing with patients with special needs as I worked as a support worker within this field before attending university. I feel that a lot of the time patients and their needs are not completely understood, so I have decided to do a bit of research around this subject and along with the reflections of my own personal experience produce this week’s blog. It was very thought provoking to see the range of patients that are classed under the special needs ‘umbrella’, the young, the elderly, individuals under the influence of drugs and/alcohol, individuals with a disability, learning disorder, individuals with mental health problems or anyone who may need additional aid to undergo their examination. The specific type of patient with special needs that I am going to look at in this week’s blog is the elderly patient.
Whilst in the lecture I discovered that there are four main types of patient’s needs, which are communication needs, physical needs, behavioural needs and cognitive needs. I believe that from my own experience in my career and clinical placement that when encountering elderly patients a lot of the time the certain aspects from one or more of these four of these needs need to be met.
Currently the life expectancy of the population is increasing, it is now stated the within the United Kingdom the average life expectancy age for men is 86 and for females is 89 (Office for National Statistics, 2013). This increasing life expectancy is resulting in individuals developing health problems and being in need of diagnosis, as elderly patients present a wide range of symptoms for numerous conditions it is essential that a correct diagnosis is made so the correct route of care can be decided upon and followed. It is discussed that elderly patients can be distinguished into three categories:
- Patients in good general health.
- Vulnerable patients.
- Frail Patients. (Monfardini & Vecchi, 2013)
Based on these three categories it can be assumed that the treatment of elderly patients in good general health should not really differ much from the treatment of a normal adult patient, although there may be physical needs that may need to be met, for example mobility issues. It can also be assumed that the treatment of vulnerable and frail patients may differ from the treatment of a normal adult patient, as there may be cognitive, behavioural, communication and physical needs that the radiographer may need to comprehend before the patients examination takes place, for example extra staff members to assist with transfers, but then if transfers needed to be made then under the Manual Handling Operation Regulations 1992 (Health and Safety Executive, 1992) all staff involved need to be manual handling trained.
Whilst on clinical placement, at first when encountering individuals with special needs I found it quite difficult when dealing with them, be it knowing how to talk and interact efficiently with them or how to assist them and instruct them without sounding rude. As I got further into my placement I realised quite quickly that if I was polite and tried to understand the patient’s situation before I encountered them then this eased the situation along with showing empathy and patience. Imaging an elderly patient who is classed as vulnerable or frail can be quite challenging especially with the multitude of examinations that a patient can undergo for symptoms that may present. Whilst on clinical placement I encountered a patient who was elderly and required neuro-imaging, this patient was diagnosed with dementia. The patient was to undergo a Computed Tomography (CT) scan of the brain. This CT scan requires the patient to be placed on a bed and be cranially moved into the scanner, the bed is raised quite highly from the floor. This presented to be a challenge as the patient kept trying to get up off the bed, as the individual did not understand the instruction of ‘lie down’. To combat this, the radiographer placed a thin foam pad under the patients head and placed a sheet over the body – to give the impression of lying in bed. Personally I thought that this was a very good technique. Once the patient was lying down and positioned within the scanner the patient was instructed to keep very still, this also presented a problem as the patient could not keep their head still – this presented with movement artefact on the resultant images. It is stated that the problems that a confused patient may present should not preclude the use of imaging or interventional examinations that they may be required to undergo (O’Brien, et al., 2009).
It is important to note that all patients no matter how they present themselves should be treated with dignity and respect as stated by Article 8 of The Human Rights Act 1998 (Equality and Human Rights Commission, 1998). The Society of Radiographers Code of Conduct and ethics also states that Radiographers should demonstrate respect for individual dignity, belief, culture and autonomy through a commitment to the principles of consent and confidentiality (Society of Radiographers, 2008).
It is the role of the radiographer to provide a high standard of care to every patient, also to access the needs of a patient prior to the examination. When challenging patients present the radiographer should be calm and act patiently. Explaining the procedure thoroughly and also what is happening at each step throughout the examination. It is very important that the radiographer completes a three point identification check on each patient as this is a legal requirement under the Ionising Radiation (Medical Exposure) Regulations 2000, this may be hard to obtain with an elderly patient as there may be communication issues – for example the patient may be hard of hearing or may not understand what is being asked of them. In instances like this there may be an identification bangle around the patient’s wrist and there may also be a nurse accompanying them to the department. It is essential that the radiographer checks that this is the correct patient for the correct examination.
It is paramount that every patient be treated as an individual, receiving the best standard of care that is achievable. Good communication skills are an essential part of being a radiographer, this was proved by a study that was carried out in 2007 entitled ‘Effectiveness of Communication between Radiographers and Patients at C W M H Radiology Department, Fiji’ (Kaushal, 2007) where the patients were given questionnaires, interviews were conducted and patient – radiographer consultations were observed, this study showed that in this particular hospital radiographer were lacking in communication skills and patients felt that the standard of care that they received was poor, leading on from this study changes were made and communication training was implemented to improve service user experiences. The Society of Radiographers Code of conduct and ethics discussed communication with elderly patients and they state that good communication with vulnerable people such as the elderly or special needs patients is imperative; Radiographers must always listen carefully to them and respect their views, also being able to identify individuals with communication difficulties and make adjustments to accommodate their particular problems (Society of Radiographers, 2008). I believe that from my own experiences good and effective communication can quickly put a patient at ease, especially with and elderly individual.
In conclusion as mentioned earlier, each patient – regardless of their situation or how they present themselves should be treated with dignity and respect and as an individual. Individuals who are classed as a ‘special needs’ patient are still an individual within their own right – and entitled to the best patient centred care that can be provided to them, even though special considerations may need to be made by the radiographer, adapting techniques and good communication skills are key to tackling patients who may be difficult to image – which as described by the Society of Radiographers is indefinitely the role of a radiographer.
Easton, S., 2014. Imaging the Patient with Special Needs. [Sound Recording] (University of the West of England).
Equality and Human Rights Commission, 1998. The Human Rights Act, London: Equality and Human Rights Comission.
Health and Safety Executive, 1992. Manual Handling Operation Regulations. [Online] Available at: http://www.hse.gov.uk/msd/pushpull/regulations.htm [Accessed 21 October 2014].
Kaushal, K., 2007. Effectivness of Communication between Radiographers and Patients at CWMH Radiology Department, Fiji. Biomedical Imaging and Intervention Journal, 3(12), p. 225.
Monfardini, L. & Vecchi, V., 2013. Limitations of Diagnostic Radiology for Frail and Vulnerable Elderly Cancer Patients. Aging Health, 9(3), pp. 283-285.
O’Brien, J., Baerlocher, M. & Myers, A., 2009. Role of Radiology in Geriatric Care. [Online] Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628843/ [Accessed 22 October 2014].
Office for National Statistics, 2013. National Life Tables – United Kingdoms, London: Office for National Statistics.
Society of Radiographers, 2008. Code of Conduct and Ethics, London: Society of Radiographers.