Reflective Case Study

Introduction
During the placement, the importance of effective communication was highlighted as an integral
part of patient-centered care in radiography. Upon reflection and research, it is evident that
effective communication involves three main components- verbal communication, non-verbal
communication and active listening. ("Communication | Radiology Key", 2016) During Week
3, boundaries to communication were present with a 90-year-old patient. He presented with a
recent onset of Lower Respiratory Tract Infection with effusion and required a chest x-ray. The
department protocol for a chest x-ray includes PA and lateral. Initially this patient was
approached like any other patient, going through standard protocols such as patient detail
confirmation and procedure explanation. However, in the midst of procedure explanation, the
patient notably became anxious and distressed. He lacked focus and was unresponsive after
verbal explanation. After asking him if he understood the procedure, the patient gestured to his
right ear that contained his hearing aid and responded by communicating that he had difficulties
hearing. His gesture clearly communicated that verbal communication was not sufficient and to
effectively communicate with this patient, strategies were needed to overcome this barrier.

What needs to be communicated & its importance, the barriers to effective

communication that are present
Effective communication is vital to aid in the diagnosis and the treatment of the patient. (Code
of Ethics, 2003) The AIDET (Acknowledge, Introduce, Duration, Explanation, Thanks) tool is
enforced in many facilities to ensure that effective communication between radiographers and
patients are implemented at all times. (Ehrlich & Daly, 2009; Scott 2012). During the
interaction with the described patient, acknowledgement of the patient was conducted by
greeting their title, full name, and asking the patient how are you? This simple
acknowledgment displays respect for the patient, makes them feel at ease and establishes the
foundations of patient rapport, which is vital for patient-centered care. (Bramhall, 2014)
Following acknowledgement, the patient was led into the x-ray room, where an introduction of
the radiographer was given to the patient. By leading the patient into the room first, it provided
him with a sense of privacy and comfort. The use of an introduction is shown to reduce patient
anxiety, as patients tend to stress when waiting for their diagnosis. ("AIDET Patient
Communication", 2016; Neuman, 2015) This will therefore establish a sense of trust in the
radiographer-patient relationship, encouraging the patient to be more cooperative and voice
their concerns. Subsequently, an explanation of the duration of the examination was given, the
explanation was limited with this particular patient as it was a general chest x-ray. Because the
patient was an elderly patient, considerations of his decreased mobility was taken into account
and the patient was told to take their time. The considerations and verbal communication would
ultimately make the patient feel not rushed, which will ease the stress levels of the patient. The
explanation of the procedure is the most crucial part during patient communication as vital
information that can aid in the management, diagnosis and treatment of the patient is revealed.
(Lam, Egan, & Baird, 2004). During this process, the patient revealed that he had a hearing

impairment, revealing that verbal communication on its own is not sufficient to effectively
communicate with the patient. Finally, thanking the patient once the procedure is done
demonstrates gratitude for the patient and helps them feel appreciated. The AIDET tool is used
to ensure that all the vital information is communicated and received, however, the approach to
each patient needs to be altered accordingly to deliver a patient-centered care.
Strategies implemented to effectively communicate
There are many strategies that can be implemented to overcome barriers of effective
communication. Effective communication does not only involve verbal communication, the
incorporation of non-verbal communication such as body language and gesturing is of high
value, especially with patients that have a hearing impairment. Talking to the patient, facing the
patient and maintaining eye contact are vital to ensure the patient is focused and understands
the verbal explanation. (Guglielmi, Peh, & Guermazi, 2013) The tone and the pitch of the voice
is an important factor to ensure effective communication, as hearing loss is frequently in the
upper register, speaking in a lower pitch and louder will increase the chances of the patient
hearing the explanation. (Barnett, 2002) One of the strategies that was implemented for the 90
year old patient included speaking directly to the right side of the patient which contained his
hearing aid, this strategy will greatly increase the chances of the patient being able to listen and
understand the instructions. Gesturing is another form of communication that creates a mental
representation, which aids in communication for both speakers and listeners. (Grace & Alman,
2007; Law 2005; Goldin-Meadow 1999) As the patient was unresponsive when explained that
he needed to stand close to the board, gesturing to the board helped the patient understand the
verbal explanation. This action and response highlighted the importance of gesturing as a form
of non-verbal communication. A demonstration was given to the patient, the patient maintained
eye contact and focus on the movements needed to ensure the patient would follow and be in
the correct position for a diagnostically acceptable image. Another important non-verbal
strategy for effective communication and patient-centred care is body language. Body language
aids in building a rapport with the patient, which builds a professional relationship which
allows communication to easily flow (Mackenzie, Farah, & Savage, 2002). As the encountered
patient had hearing impairment, strategies were needed as verbal communication was not
sufficient to overcome the barrier to effectively communicate with this patient.
Reflection- what was learnt, what will be done differently next time
A key learning aspect from this placement concerned the importance of effective
communication. Effective communication will result in patient centered care that makes patients
feel comfortable and at ease and ultimately, success in radiographic examinations.
(Chingarande, Estina, Mukwasi, Majonga, & Karera, 2013) The effect of efficient
communication made me realize that radiographers cannot simply approach every patient
systematically and changes to the approach of communication towards different patients is
always needed. The changes that are made are based on the different circumstances and
situations each patient presents to us. In my scenario, at the time of meeting the 90-year-old
patient, I did not realize the importance of non-verbal communication; there was a lack of
response from the patient and progress. I instructed the patient to move and stand closer to the
board, however the patient was unresponsive. The patient then gestured to his right ear and
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stated that he could not hear me. This response made me realise that I had to adjust my
communication approach to this patient. After my encounter with this patient, I realise that
effective communication with patients involves a radiographer to observe and understand the
different situations and circumstances presented by each patient. This involves implementing a
wide variety of communication skills as well as awareness of the patients actions and reactions.
This reflection task highlights the importance of gestures and body language in communicating
with patients that lack or have a limited ability to engage in verbal interactions. (Lund 2007) It
has also made me understand that a skilled radiographer needs to be able to read and
understand the patients body language correctly as well as aware of their own. I believe a
skilled radiographer is not only able to communicate with a patient, but are able to build rapport
to deliver patient centred care. Sommers article (Sommer & Sommer, 2002) on patients with
hearing impairment has highlighted the impact of body language on a hard-hearing patient.
Patients with hearing impairment will tend to observe the facial expressions and body language
of the speaker to interpret what is being said. Although at that time, I mainly focused on my
verbal explanation, and was unaware of my facial expressions. It is known that facial
expressions are a vital part of non-verbal communication as it helps convey the speakers
emotions. (Iannucci & Howerton, 2012 p.120).Upon my reflection, I will remember to carefully
take into account my facial expressions, conveying positive and comfortable emotions towards
patients such as smiling. (Ghom & Ghom 2008) Another factor that I failed to take into account
was confirming whether or not the patient understood my verbal explanation. Implementing
effective communication should include the patient summarizing what was said to ensure that
the patient has completed understood the procedure (Barnett, 2002). The importance of
maintaining eye contact and being in view of the patient at all times was overlooked and was
only carried out to ensure the patient was in focus. However, Lezzonis article (Iezzoni, 2004)
contained an interview with a hard-hearing patient in which the patient felt discomfort and fear
during procedures. Eye contact is also generally perceived as positive behaviour to show
express interest, concern [and] honesty (Ehrlich & Daly p.97, 2009). To build a patient
rapport, the patient should be able to trust the health professional and be at ease. This is an
important point to take into account to for future patients with hearing impairment to provide a
patient-centered care.

Conclusion
Through reflection, it is evident that effective communication in radiography is essential for any
diagnosis. Effective communication aids in achieving accurate diagnosis. However, sometimes
difficult situations arise and present barriers preventing us from communicating effectively. To
overcome these adversities, radiographers need to always be ready to adapt their
communication techniques. The encounter of this 90-year-old patient with a hearing impairment
posed many obstacles and made it difficult to effectively communicate, this resulted in applying
strategies such as demonstrations to the patient and using other means of non-verbal
communication. Effective communication will develop a rapport with the patient to provide a
patient-centred care.
Reference List
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Book
Ehrlich, R. & Daly, J. (2009). Patient care in radiography. (p. 97-104) St. Louis, Mo.: Mosby Elsevier.
Ghom, A. & Ghom, S. (2008) Textbook of oral medicine.
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Ebook/PDF
Code of Ethics. (2003) (1st ed.). Retrieved from https://www.asrt.org/docs/default-source/practicestandards/codeofethics.pdf

Journal/Articles
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Representation of Spatial Information.
Iezzoni, L. (2004). Communicating about Health Care: Observations from Persons Who Are Deaf or
Hard of Hearing. Annals Of Internal Medicine, 140(5), 356.
Lam, D., Egan, I., & Baird, M. (2004). The Radiographer's impact on improving Clinical Decisionmaking, Patient Care and Patient Diagnosis: A pilot study. Journal Of Medical Radiation
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Scott, J. (2012). Utilizing AIDET and other tools to increase patient satisfaction scores.American
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Website
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