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The Radiographer 1996,43: 19-23

.Patient-radiographer interactionsDavid Kennedy

The subject of patient-radiographer interactions has rarely been specifically addressed since Goldin in 1979. This, paper describes the relevance of the subject today and how it impacts upon radiographers in their working life.The development and importance of patient-radiographer interactions, especially relating to circumstances where

__ ,special care is required, is analysed, ,and how diagnostic radiographers are and should be educated in this area isreviewed. The subjects"involvement'in the definition of radiography as a profession is also discussed. Researchersprovide many important points and valuable advice for radiographers; however, it was found that more quantita-tive research, a better definition of the subject, and a greater awareness of the subject's significance are required.

INTRODUCTIONIn 1979, Goldin discussed the importance of the radiogra-pher's contribution to both the physical.and mental healthof the patient. He suggested five techniques that radiogra-phers could use to reduce patient suffering. These are:1 reassurance;2 procedural explanation;3 listening to patient's feelings;4 displaying an empathic response to (3); and5 reducing patient's loss of identity. ,

Are these recommendations being followed today? Hasthe radiographer's role in maintaining th~ mental health ofpatients changed? Is it seen as important today? \Vith movestowards increased professionalism in radiography, what isthe importance of.radiographer-patient interactions? Howare students to be educated in radiographer-patient inter-actions? What, if any, 'are the special care needs of patientsin different examination situations?

HISTORY OF PATIENT-RADIOGRAPHERINTERACTIONSEver since the establishment of radiography as a profes-sion, correct and proper patient-radiographer interactionhas been a fundamental part of good professional prac-tice. In 1934, Cuthbert Andrews delivered a paper to theUK Society of Radiographers entitled 'The little old ladyin black: in which he discussed the importance of goodcommunication between radiographers and patients (citedin DeCann 1986). Fifteenyears later the UK Society ofRadiographers introduced psychology as a component ofradiographic education. Since then, psychology has beena part of radiography education in the UK and throughoutthe rest of the world in differing amounts (DeCann 1986).

There exists a substantial amount of literature debat-

David KennedyStudent radiographerCharles Sturt University, RiverinaCorrespondence: 57 Uki Road

~urwillumbah, NSW 2484

The Radiographer- vol. 43, no. 1, March 1996

ing the importance of patient-radiographer interactions,particularly in the UK (DeCann 1986; Hughes 1991;DeCann & Gratton 1984; Gratton 1990; Perrett & Mayes1989; Steves 1993; DeCann 1985; Dowd 1992). The re-sults of such debates and societal views ultimately deter-mines how much emphasis is given to ~he subject ofpatient-radiographer interaction in student education.

STUDENT EDUCATIONAccording to Hughes (1991), the most suitable title forpsychology in radiography would probably be 'human be-havioural studies and communication' rather than just sim-ply 'psychology'. Psychology subjects in radiographyeducation should not aim to create 'mini-psychologists'but rather to promote the development of good profes-sional practice in student radiographers. Hence, the ma-jority of such subjects aim to teach students to becomecaring professionals who display empathy and understand-ing towards patients. Good professional practice requiressue:h qualities.

DeCann and Gratton (1984) wrote of the need to in-corporate psychological aspects of p3;tient care into stu-dent education. They devised a program for students whichincludes: 'Role-play' situations. A student placed in a situation

acts out their reactions to that situation, with a groupof about eight evaluating the, results.

Simulations. An examination is performed by groupmembers on other members, and the results areevaluated with, the student 'patients' being askedabout their feelings and opinions.

Projects. Interviewing- of inpatients, and case studieson patients, incorporating all social. and culturalfactors.This' project work was assessed by Gratton in 1990.

After subjectively evaluating all of her former studentsshe believed, that they had gained an increase in empathywith patients as individuals, communications skills andthe awareness of .the role of patient care in good profes-sional practice.

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PATIENT-RADIOGRAPHER INTERACTIONS

The above techniques are described as experientialtechniques and are meant to be taught alongside traditionalstrategies (DeCann & Gratton 1984). In a study of all UKschools of diagnostic radiography, Hughes (1991) foundthat approximately half of the schools used experientialtechniques, despite these techniques providing the mostcompelling arguments for use in student education.

In contrast, Perrett and Mayes (1989) concluded thatpatient care is learnt through clinical experience ratherthan tuition. However, Steves (1993) believed that stu-dents can learn to care for patients by learning to thinkfrom an alternative point of view and improving commu-nication skills.

The combination'of e~periential techniques and tradi-tional teaching methods in preparing students for clinicalexperience would appear to be the best strategy for teach-ing good radiographer-patient interactions.

THE IMPORTANCE OF GOODPATIENT-RADIOGRAPHER INTERACTIONDeCann (1985) found that radiographers perceived a'good' radiographer as having:1 technical expertise;2 a good attitude;3 social skills (being able to work well with other

staff); and4 good patient care, which incorporates good radiog-

rapher-patient interactions and is most significant tothispaper.Since the radiographer has the dual responsibilities of

having good technical abilities and prOViding good pa-tient care, radiographers must be regarded as both schm-tists and carers (Dowd 1992). Patient care may be viewedas 'an art, a skill and a science within the sphere of radi-ography' (DeCann 1986).

Good patient care involves maintaining both the physi-cal and emotional needs of the patient. McKenna-Alder,as cited in Dowd (1992), identified that radiographers areprevented from giving good patient care by:1 a lack of time;2 poor education in exainining the critically of

terminally ill;3 the time needed to concentrate upon high-tech

equipment; and4 poor communication (McKenna-Alder-1990).

Dowd concluded' similar results in a 1990 paper, butadditional factors such as the personal life, self esteemand societal expectations of the individual radiographerwere also found.

THE PROFESSIONAL RADIOGRAPHER'A -pr.ofessiqn is a vocation requiring specialised educa-tion and training in a field of learning, art or science andhas certain moral codes and responsibilities which must

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be maint3ined' (Hornby 1989).- Nursing is now makinggreat steps to increase professionalism, but is radiogra-phy?

As DeCann (1986) pointed out, nurses have an imageof being caring and possessing an ability to communicatewell with patients, but in training student radiographers,there has been a concentration on the cognitive andpsychomotor domains rather than the affective domain oflearning. The cognitive domain relates to the acquisitionof knowledge, the psychomotor domain to performingtasks, and the affective domain concentrates on attitudes,feelings and values.

Patient care research in nursing has flourished, addingto its professional image. DeCann argued that in order to.move radiography forward as a profession,. research mustincorporate not only technical aspects of radiography, butmore importantly patient care. He proposed that radiog-raphers must decide if their profession should be machineand technically orientated or person orientated, as this willdecide whether radiographers are regarded as profession-als or merely 'button pushers'. Pack (1994) believed thatto survive in health systems that are changing to becomemore efficient and responsive to patient needs, radiogra-phers will need to focus mOre upon patient care.

SPECIAL CARE NEEDS OF PATIENTSThe terminally illIn a study by Drugay (1982) it was found that although alot of data existed on the subject of nurse-patient interac-tions, little data existed for radiographer-patient interac-tions. Many radiographers encounter terminally ill patientsfrequently and therefore they must lmow how to interactwith them effectively. In her small survey study, Drugayfound that radiographers did show interest in how to dealwith death and dying and in the communication techniquesthat could be applied. They also showed concern for thewelfare of such patients. However, radiographers lackedvital communication skills in this area. To remedy the situ-ation, Drugay recommended:1 radiography-based in-service education programs on

the topics of death and dying;2 workshops on therapeutic communication skills;3 peer group connselling;4 an increase in awareness of the importance of

programs that emphasise patient care withinradiology departments and hospital institutions;

5 incorporation of communication techniques with thetenninally ill in student education; and

6 further study in the area, and evaluation of programsthat aid the above' recommendations.Peteet et al. (1992) found in semi~structuredinterviews

of 79 cancer patients, that patients worried immenselyabout examination results. Patients had usually been givensome knowledge of their condition by consultants and

The Radiographer- vo!. 43, no. 1, March 1996

D.KENNEDY

wanted radiologists to give them the examination results.Special training was recommended for radiographers whofrequently examined cancer patients. This included mak-iug the radiographer a'ware of the need for: knowledge of the patient's religious beliefs and faith

to enable the opportunity for prayer, discussions onthe subject with the patient, the provision of adviceabout what facilities are available within-theinstitution to help the patient; and

techniques in meditation and visualisation used torelieve procedural anxiety and pain.Quirk et al. (1989) found in a small random sample,

that the above' exercises were more effective in reducingpatient anxiety than giving them patient information.

The elderlyA technically based radiographer would cringe at the ,ideaof examining an elderly hypochondriac; being only con-cerned with the physical aspects of their patient, theywould believe the exalnination to be a waste of time (Dowd1982). Dowd argued that if radiographers are to regardthemselves as truly professional then they should be con-cerned with the whole person and not just their physicalailments. From an objective stand-point a person's beliefsabout their health status may be more important than theiracmal health status.

The stress on people growing old may distort theirhealth beliefs or because they feel neglected by societyand unable to receive the concern they need from others,they play 'the sick role', but treating the patient as if thereis nothing wrong with them' may only exacerbate theirproblems. An empathic response showing an awarenessof the patient's feelings, anxieties and concerns must begiven by the radiographer (Dowd 1982).

Research performed by Dowd (1983) suggested thatknowledge about ,the aged is learnt mainly in the radiog-rapher's early clinical experiences. Integrated in patientcare subjects, Dowd argued that students should be in-structed in the basic issues of social gerontology as a prel-ude to such experiences.

Traumatic examinationsMarion' Ferguson (1988) described her traumatic experi-ences when undergoing a barium enema as due to:1 feeling a loss of dignity;2 being left alone;3 an incorrect procedure explanation;4 feeling vulnerable and of little consequence; and5 the lack of communication by the staff.

In a large survey ofradiographers DeCann (1990) foundthat the most commonly used techniques to reduce pa-tient suffering and anxiety dliring barium enema exami-nations included:1- explanation of the procedure;

The Radiographer- vo!. 43, no. 1, March 1996

2 patient reassurance by(a) talking to the patient,(b) answering patient questions,(c) touching by holding hands or stroking,(d) staying always with the patient,.and(e) encouragment and praise;

3 protection of modesty' and privacy; and4 taking time-

DeCann suggested that such methods and any othermethods found to be helpful in this area should be taughtto students and researched more effectively.

In a follow-up study, DeCann and Hegarty (1993) ob-served, whether staff used the techniques identified in thesmdy by DeCann. They found that staff generally did usethe identified techniques, even more than was indicatedin the previous survey. This study may have been biasedbecause staff knew they were being observed, however,many steps were taken to make a difficult study as validas possible. They also found that good staff team-workreduced stress more than was previously perceiVed.

Mammography patients will have high anxiety overtheir results, therefore results should be given to them assoon as possible (Bull & Campbell 1991). Gram andSlenker (1992) found ina large survey that nothing elsebefore or after the actual examination could be done toreduce patient anxiety, and that information regardingmammography was ineffective. Fox et al. (1990) believedotherwise and to reduce the anxiety of mammographicexamination suggested:I providing procedural explanation;2 having a friendly attitude; and3 allocating radiographers who are able to communi-

cate well to working with various ethic groups.After good examinations patients usually feel more

conlfortable about future examinations (Gram & Slenker1992).

Patient contact with advanced technologiesGeraldine O'Conner (1993) found in a higWy detailedstudy that patients perceived that attending staff possessedexcellent interpersonal skills, bu,t due to new technology,some patients still suffered many anxieties and stresses.Brennan et al. (1988) found in the case of MRI that, de-spite this modality being harmless, painless and non-in-vasive, patients had anxiety reactions and experiencedpsychological distress. Anxiety was caused by the lengthof the procedure, being positioned within the machine(claustrophobia), inability to move, and the size and com-plexity of the machinery.

These problems can be overcome in the followingways:1 By teaching students appropriate ways to understand

and deal with patients' feelings (O'Conner 1993).2- Through the availability of easy, comprehensive,

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PATIENT-RADIOGRAPHER INTERACTIONS

,pictorially based leaflets and videos explaining MRIprocedures (O'Conner 1993).

3 By allowing patients the option of company duringprocedures (especially for tenninally ill patients)(Ferrett & Mayes 1989).

4 By using proven systematic desensitisation tech-niques to offset sensory deprivation effects (Perrett& Mayes 1989).

5 Through further research upon patients and staff onthe MRI experience and on methods which make itless stressful (O'Conner 1993).Peteet et al. (1992) emphasised the importance of the

patient's first' examination because it is at that time theyhave the' most curiosity and concern about technology.Although booklets or 'videos on technology are helpful inreducing patient anxiety, good patient-radiographer inter-actions are most effective.

When Candace Kabler (1986) asked the question 'Cana radiographer survive _on technology alone?', the answerwas obviously, 'No',: To perform efficient and effectiveimaging procedures, the radiographer needs to build a goodrapport with the patient via good communication. Kablerargued that the radiographer must therefore concentratecareer development on communicative skills, as well ason the technical aspects of radiology.

CONCLUSIONToday more interest is being shown in radiographer-patientinteractions and patient-focused care. Ways to better servethe-mental healtll' of patients and to reduce their anxietiesin many situations are now documented. Further discus-sion and quantitativ.~ research is needed into the area ofradiographer to patient interactions. It.is still not clearwhat importance radiographers give to the subject and whatthey should give. Once the area is better defined, studentscan be educated to understand the radiographer's role insuch matters. Workirig radiographers will be able to im-plement strategies of patient to radiographer .interaction,and become better carers and professionals.

ACKNOWLEDGMENTSThe medical imaging staff of Charles Sturt University,Riverina, especially lecturers Mr M. Glisson and Dr H.Swann.- Thankyou also to Steven Kennedy and DebbieNickolas for proof-reading and suggestions..

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Peer reviewed.Submitted for publication: January 1995.Resubmitted: September 1995.Accepted: February 1996.

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