In this chapter, you will learn about professional responsibilities. The text will cover some of the duties required of a CPCT, including the use of appropriate medical terminology and therapeutic communication. The chapter concludes with a six-question self-assessment drill.

Obtain and Maintain Basic Cardiac Life Support (BCLS) Certification for Health Caregivers

You can obtain a CPR card from any properly authorized health educator. The American Heart Association certifies instructors to train health care workers in this procedure. Following the completion of this course, students will be issued a CPR card.  You must renew this card every 2 years, and in order to work in the health care field it must be current at all times. 

In 2021, new guidelines for CPR went into effect. 

• D- Danger

        •Check for danger.

• R- Respond

        •Check for response of the victim.

• C - Compressions

        •Deliver 30 compressions hard and fast - this is 100 beats per minute, followed by 2 rescue breaths.

• A- Airway

        •Open the airway using chin lift or jaw thrust.

• B - Breathing

        •Check for breathing. Do not deliver rescue breathing.

After following these steps, direct rescuers to attach the automated external defibrillator (AED) as soon as it is available and to follow the prompts. Then continue 30 compressions to 2 breaths cycles until help arrives.

For all individuals over the age of 1, a 2-inch compression of the chest is recommended. For infants less than 1 year, a depth of 11h inch is recommended. For a lone rescuer (regardless of the patient's age) the rate is a 30:2 compression-to-breath ratio. Two or more rescuers caring for an adult should use a 30:2 ratio. Two or more rescuers caring for an infant should use a 15:2 ratio.

It has been proven by evidence-based practice that the compressions are the most effective part of CPR. Fast but effective compressions with recoil of the chest between compressions correlate with the highest survival rate.

Although there are renewal classes available online, most facilities and health businesses do not allow them. Instead, they prefer hands-on demonstrations in front of instructors.

Adhere to HIPAA Regulations Regarding Protected Health Information

The Health Insurance Portability and Accountability Act (HIPAA) law was enacted in 1996. The law became effective in 2001, and it allowed facilities 2 years to comply. As of 2003, all those handling health care information must abide by the law or suffer stiff, monetary penalties. Violation of the law can result in civil and criminal penalties including:

• Fines of up to $25,000 for multiple violations of the same standard in a calendar year; or

• Fines up to $250,000 and/or imprisonment up to 10 years for knowing misuse of individually identifiable health information. 

Patients have a right to keep their information confidential. Minimal information should be given. Disclosure of information - either written or verbal - about a patient must be accompanied by a consent form signed by that patient. Giving such information without a patient's consent is a violation of the HIPAA law. This can result in dismissal from your job, criminal charges, civil charges, and the removal of your certification.

More recently, congress passed the Health Information Technology for Economic and Clinical Health (HITECH) act of 2009. This act brought forward the technology for health care facilities to electronically record information of patient care - including computerized charts. All facilities and clinics were required to comply by 2011. By 2015, penalties will be given if a facility is not in compliance.

By using the Electronic Health Record (EHR) software, clinicians are able to retrieve information about a patient's condition more easily. With this new technology comes the possibility for lack of confidentiality. That is why HIPAA regulations are so strictly enforced.

Some hospitals offer patients the ability to look at their own records. Because these records are not available to unauthorized persons, only employees with access to the system can get this information. Should a breach occur, these actions can be traced. If a person accessed these records illegally, he or she can be reprimanded, counseled, fired, fined or otherwise penalized per HIPAA.

Recently, such information was leaked through the website Facebook where a nursing student discussed 'a patient's confidential information. The nursing student was dismissed from the nursing program and faces penalties from HIPAA. All health care and personal information about a patient needs to stay in the facility. This is an ethical issue, because medical personnel are present when a patient is the most vulnerable.

Communicate with Other Health Care Professionals Using Appropriate

Medical Terminology

In today's health care arena, a patient may come into contact with 50 medical personnel during any given hospital stay. As technology advances, these health care workers may not even see each other. Communication is at the center of safe patient care. Lack of communication can cause medical errors that may result in severe injury or death. In 2005, The Joint Commission (TJC) reported communication failures as the leading cause of medication errors, delays in treatment, and wrong-site surgeries. Remember that

communication and team collaboration are important aspects of good patient care.

You must communicate professionally with other health care workers. Layperson's terminology is not acceptable. Remember you are a professional and will work with many types of patients in your daily activities. You must display professional language. Some rules to follow are:

• Do not use profanity or vulgar language.

• Never use slang.

• Always speak clearly, so you are not misunderstood.

• Use a soft tone and speak gently.

• When caring for a patient who is deaf or hard of hearing, drop the tone of your voice to a lower register (higher tones usually hardest to hear), speak clearly, and face the person.

• Never shout or yell.

• Never argue or fight with patients or their families. Always maintain a soft voice. If the patient or a family member begins getting upset maintain a soft voice.

When communicating with professional staff (nurses, doctors), always use medical terminology. If you do so, you will get more respect from the nurses and doctors.

Always dress professionally. If your uniform is dirty and wrinkled, you may be seen as an unprofessional person. Most facilities have a dress code, so be sure to follow it. Shoes should be clean and polished. Long hair should be tied back. Most facilities do not allow excessive body jewelry or visible tattoos. Seek out the advice of a professional on these issues before applying for a job.

Observe the Chain of Command in a Health Care Setting

In any organizational structure, a chain of command is meant to create a clear line of responsibility from the bottom to the top of the organization.  A good organizational structure lets everyone know to whom to report and what their responsibilities are.

If an employee has a complaint, this chain of command gives him or her a direction to turn for assistance. 

Furthermore, some employees do not report problems for fear of retaliation. Doctors are usually the boss or the one giving orders; an employee of the hospital may not agree with the order or there may be a conflict with hospital policy. 

If this occurs, the employee can go to their supervisor report the offense. 

If a patient's life is at stake, there are a number of steps you must take:

1. First, call the nurse. If he or she does not respond, go to the charge nurse. The charge nurse has the power to get a response from the physician or whoever needs to be involved.

2. Should this action fail (or there is no charge nurse), move on to the Unit Director or Director of Nursing. These individuals are always on call.

3. If there is still a problem, contact the Medical Director or the Chief Executive Officer (CEO).

4. As always, document every move and why it was made. Complete incident reports if possible.

5. Finally, if the problem persists, involve the state's Department of Welfare.

Remember, it is not a weakness to ask for help. Solving problems is what the chain of command is designed to do. Many careers have been ruined and many patients have been harmed because the chain of command was not used. You should always be your patient's advocate.

Use Therapeutic Communication When Talking to Patients

To effectively communicate with a patient, a CPCT should ask open-ended questions that require more than a "yes" or "no" answer. Furthermore, the CPCT should focus on the patient's feelings, restate the patient's comments, and make sure that all responses are neutral. Remember that effective communication is appropriate, simple, adaptive, concise, and credible.

There are a variety of interpersonal communication techniques that a CPCT can use.

These include the following:

1. Offering self - Express interest and concern.

2. Active listening - Pay close attention to verbal and nonverbal cues.

3. Exploring - Ask questions related to comments made by the patient.

4. Giving broad openings - Begin conversations with open-ended questions.

5. Silence- Pause during verbal comments to allow for introspection.

6. Stating the observed - Verbalize the patient's comments, allowing for validation and discussion.

7. Encouraging comparisons - Find similarities and differences between feelings and events.

8. Identifying themes - Ask the patient to identify repeated thoughts and behaviors.

9. Summarizing - Reiterate the discussion and draw conclusions.

10. Placing the event in time or sequence - Ask the patient to describe the relationship between events.

11. Voicing doubt- Express any uncertainty about the patient's comments.

12. Encouraging descriptions of perceptions - Have the patient describe his or her opinions.

13. Presenting reality or confronting - Express the reality of any situation.

14. Seeking clarification - Ask the patient to reiterate any unclear statements.

15. Verbalizing the implied- Rephrase the patient's comments for clarification.

16. Reflecting - Present the patient's statement in the form of a question.

17. Restating- Repeat the patient's words.

18. General leads- Use neutral expressions (such as "Go on").

19. Asking questions- Use open-ended questions to allow for discussion.

20. Empathy - Acknowledge the patient's feelings.

21. Focusing - Pursue any relevant topic.

22. Interpreting - Offer a new point of view to provide clarity.

23. Encouraging evaluation- Ask patients about the importance of various subjects.

24. Suggesting collaboration - Offer help to patients.

25.Encouraging goal setting- Ask patients to determine needed changes.

26. Encouraging formulation of a plan of action - Invite the patient to determine are needed.

27. Encouraging decisions - Have the patient choose among options.

28.Encouraging consideration of options- Have patients weigh the pros and cons of any action.

29. Giving information - Provide all the information needed.

30. Limit setting - Discourage nonproductive actions.

31. Supportive confrontation- Push for action, while acknowledging any difficulty.

32. Role playing - Practice specific situations.

33. Rehearsing- Have the patient verbally describe upcoming situations.

34. Feedback - Point out specific behaviors.

35. Encouraging evaluation- Invite the patient to appraise their actions.

36. Reinforce!I!,ent - Offer positive feedback.