EEG in the Intensive Care Setting —
Training activity: 3

Details

Adapt and explain EEG procedures to patients and carers to ensure cooperation with the diagnostic testing

Type

Entrustable training activity (ETA)

Evidence requirements

Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion. ​

Reflection at multiple timepoints on the trainee learning journey for this activity.

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

What does success look like?

• Identify what is expected of you in relation to effectively adapting and explaining EEG procedures to patients and carers to ensure their cooperation.
• Consider how the learning outcomes apply, specifically in relation to demonstrating effective and compassionate communication skills with all stakeholders, including patients and carers.
• Discuss with your training officer to gain clarity of what is expected of you in relation to adapting your explanation for different patient needs e.g., explaining procedural discomfort to an anxious carer or simplifying technical details for an unconscious patient’s relative.

What is your prior experience of this activity?

• Think about what you already know about explaining medical procedures or adapting communication based on the audience.
• Consider possible challenges you might face during the activity, such as dealing with patient or carer anxiety, potential communication barriers, or needing to explain complex information simply, and think about how you might handle them.
• Recognise the scope of your own practice for this activity i.e. know when you will need to seek advice or help, and from whom. You will need to seek advice from your Training Officer when required, for example:
  • When a specific communication need e.g., severe cognitive impairment or language barrier requires specialist communication support outside standard practice
  • If there is ambiguity regarding capacity to consent or refusal of procedures from an appropriate legal proxy
• Acknowledge how you feel about undertaking the task of explaining a procedure in the intensive care setting, potentially to distressed patients or anxious carers.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as tailoring communication strategies for clinical procedures in the intensive care environment to secure cooperation.
• Identify the specific insights you hope to gain into the most effective language or approaches for explaining sensitive procedures to stakeholders in a high-stress setting.

What additional considerations do you need to make?

• Consult actions identified following previous experiences of procedures where clear communication was important for a successful outcome.
• Identify important information you need to consider before embarking on the activity, such as the patient’s current conscious state, any documented language or cognitive impairments, or the carer’s emotional state and level of understanding.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst explaining the EEG procedure to the patient and/or carer in the intensive care setting?
• Are you encountering situations such as:
  • The patient or carer reacts in a way you didn’t expect during your explanation e.g., showed unexpected anxiety, or seemed to misunderstand a key point?
  • An unforeseen interruption or change in the environment (e.g., noise, arrival of other healthcare staff, a change in the patient’s clinical state) makes the explanation more challenging than anticipated?
  • You encounter a specific communication barrier e.g., language, cognitive impairment, emotional distress that you hadn’t fully anticipated?

How are you reacting to the unexpected development?

• How is this impacting your actions? For example, are you responding to the situation appropriately? Are you adapting or changing your approach to explanation strategy or language in that specific moment?
• Consider the steps you are taking in the moment, such as pausing, rephrasing, using different examples, or seeking clarification from the patient/carer to address the unexpected reaction or situation.
• How are you feeling in that moment? For instance, are you finding it difficult to adapt your communication strategy dynamically? Is it affecting your confidence in continuing the explanation smoothly or independently?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, were you able to successfully adapt your explanation to ensure understanding and secure cooperation? Or are you needing support because the patient’s clinical state changed suddenly, requiring immediate medical consultation?
• What are you learning as a result of the unexpected development? For example, are you mastering a more effective technique for adapting your communication dynamically? Or gaining insight into responding to unexpected patient/carer emotional needs during a procedure explanation?

On action

What happened?

• Begin by summarising the key steps you took when explaining the EEG procedure to the patient and/or carer.
• Consider specific events, actions, or interactions which felt important, such as how you tailored your language to address unexpected anxiety or emotional distress shown by the carer, or how you ensured the patient/carer understood the procedural discomfort.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately changing your explanation strategy (e.g., simplifying technical details or pausing due to environmental interruption) when the patient’s clinical state changed or the carer showed misunderstanding.
• How did you feel during this experience, e.g., did you feel stressed or confident in your ability to adapt your communication?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding effective and compassionate communication. What strengths did you demonstrate, e.g., ability to rephrase complex information simply to secure comprehension?
• What skills and/or knowledge gaps were evident, e.g., unfamiliarity with specialist communication techniques required for patients with severe cognitive impairment?
• Compare this experience against previous engagement with similar activities – Has your practice improved in handling unexpected patient/carer anxiety or verifying comprehension of the procedure?
• Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding ambiguity concerning the patient’s capacity to consent or the refusal of the procedure by a legal proxy, and how you reacted to this.

What will you take from the experience moving forward?

• Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt, including from any feedback you have received, with regards to dynamically adapting communication strategies for complex ICU patients and stakeholders.
• What will you do differently next time you approach explaining a procedure in the ICU, for instance, by proactively seeking out specific communication resources or support (e.g., interpreter, specialist nurse) when anticipating barriers?
• Do you need to practise any aspect of the activity further, such as rehearsing clear, compassionate responses to ethical questions (e.g., consent/capacity) or adapting communication effectively?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences explaining procedures or gaining consent to patients or carers, particularly encountering unexpected ethical or emotional challenges, since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how a subsequent instance where a patient had highly specific legal/ethical queries regarding data sharing forced you to re-evaluate the brevity of your explanation regarding post-procedure reporting during your first attempt at this training activity.
• Considering what you understand about effective communication, procedural adaptation, and ethical requirements now, were the actions or considerations you identified after your initial reflection on this training activity sufficient? How have you since implemented or adapted improvements in your communication technique and procedural explanations based on further learning and experiences? For example, how you proactively reviewed and implemented a structured communication technique (e.g., ‘teach-back’) to confirm capacity and understanding with relatives, demonstrating you have adapted improvements based on further learning.
• Has discussing challenging interactions or the impact of miscommunication on patient cooperation with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how professional storytelling with a senior colleague about a patient who became distressed due to an unclear explanation of the stimulus phase refined your understanding of the critical nature of compassionate communication in high-stress settings.

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent experiences of explaining procedures, contributed to your overall confidence and competence in adapting and explaining EEG procedures, particularly in preparing for assessments like Observed Communication Events (OCEs)? For example, how your accumulated ability in clearly outlining procedural steps and managing complex questions now enables you to confidently present procedural details during an OCE assessment.
• How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to explaining procedures and ensuring cooperation? How does this evolved understanding help you identify when something is beyond your scope of practice or requires escalation? For example, how your evolved approach means you now routinely seek advice from the Training Officer or Clinical Governance Lead immediately when a request involves highly unusual ethical constraints or legal capacity issues in obtaining consent.
• Looking holistically at your training journey, how has this initial communication and adaptation experience, revisited with your current perspective, contributed to your development in demonstrating effective communication and preparing the patient/environment? For example, how this foundational experience in securing patient cooperation directly supports your ability to successfully perform the subsequent recording activities by minimising movement artefact and distress.

Relevant learning outcomes

#	Outcome
# 2	Outcome Prepare patients and environments for testing, maintaining safety and patient dignity.
# 4	Outcome Demonstrate effective and compassionate communication skills with all stakeholders including patients and the multidisciplinary team.