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Adv. Health Assessment- Interviewing & Health Hx (Ch 3)
Terms in this set (46)
Generates the patients story. It is "open-ended" drawing on a range of techniques that affirm and empower the patient. Involves:
-non verbal affirmations
Health history format
Structured framework for organizing patient information in written and verbal form. "Clinician centered" used closed-ended "yes-no" questions in Past Medical history, Family history, and personal and social history and the Review of systems
Integration of which two approaches provides the best outcome for the patient
"Patient centered" and "clinician-centered"
Skilled Interviewing Techniques
- Active listening
-Empowering the patient
Is the process of closely attending to what the patient is communicating, being aware of the patients emotional state, and using verbal and non-verbal skills to encourage the speaker to continue and expand upon important concerns
The capacity of the clinician to identify with the patient and feel the patients pain as the clinicians own
Must convey that you "feel" what the patient is expressing
-"How do you feel about that?"
-"That must have been difficult for you"
-Non verbal gestures like comforting gesture or handing tissues to a crying patient
Helps to continue the patients story
-moving from open ended to focused questions
-using questions that elicit a graded response
-asking a series of questions, ONE at a time
-clarifying what the patient means
-encouraging with continuers
Continuous process throughout the interview. Pay attention to facial expression,posture, eye contact or lack of.
-helps you read the patient
A way to AFFIRM the patient or acknowledge the legitimacy of his/her feelings
First step is identiying and acknowledging the patients feelings. Avoid over stepping with promises
"Don't worry, everything will be fine" --> not appropriate
Reassure patient of one going support.
-Make patient feel that regardless of what happens with their illness, "you" envision continuing their care
Qualities of speech such as pacing, tone and volume to increase rapport
A summary of the HPI during the course of gathering the information. Conveys careful listening: allows for addition information or correction, can also serve as a transition or allow a break to organize next step
Helps patients to relax as you move from one segment to the next.
-"Now I'd like to go over your medications"
-"Now I'd like to give you privacy as you change into this gown
Empowering the Patient
-Evoke the patients perspcetive
-convey interest in the person, not just the problem
-follow the patients lead
-Elicit and validate emotional conflicts
-share info with the patient, Especially at transition points during the visit
- make your clinical reasoning transparent to the patient
reveal the limits of knowledge
Preparation (4 items in category)
1. review medical records
2. Setting Goals for the interview
3. Reviewing your clinical behavior and appearence
4. Adjusting the environment
The Sequence of the Interview
-Greeting the patient and establishing rapport
-Establishing the agenda
-Inviting the patient's story
-Exploring the patient's perspective
-Identifying and responding to the patient's emotional cues
-Expanding and clarifying the patient's story
-Generating and testing diagnostic hypotheses
-Sharing the treatment plan
-Closing the interview and the visit
Disease- Explanation that the clinician brings to the symptoms being described.. that is then organized and leads to diagnosis
Illness- how the patient experiences the disease, including its effects on relationships, function, and sense of well-being
the patients Feelings, including concerns and fears
the patients Ideas about the nature or cause of symptoms
Effects of the problem on patients life and Function
Expectations - of the disease, of clinician of setting based on past experience
A Mnemonic for responding to emotional cues is NURes
N- Naming- " that sounds like a scary situation"
U-understanding and legitimization- "it's understandable that you feel that way"
R-Respect - "You've done better then most people would with this"
S-Support- "I will continue to work with you on this"
E-Explore- "How else were you feeling about it?"
Expanding and clarifying the patients story using the 7 attributes of a system
OLDCARTS or OPQRST
-Quality "what is it like"
-Quantity and Severity " how bad is it - pain scale
-Setting in which it occurs
-Remitting an Exacerbating factors
-Associated manifestations- "have you noticed anything else that accompanies it?"
big 4 lifestyle habits
-lack of exercise
The guiding style of motivational interviewing
-Ask open ended questions
-listen to capture their account
-inform by asking permission to provide info and then asking what the implications might be for the patient
the 3 dimensions of cultural humility
Values and Biases
Learn about different cultures
Communication built on respect, trust and mutually acceptable plans
The silent patient
patients fall silent to collect their thoughts, remember details, or decide if they can trust you with certain information.
in the confusing patient
It may be the patient's style, and by using your skills of guided questions, clarification, and summarizating, you can put together a coherent story.
consider delirium- in acutely ill and or intoxicated and
dementia- in the elderly
clinical designation and can be assessed by clinicians
a legal designation and can only be decided by the court
Elements of decision-making capacity
-understand the relevant information about proposed diagnostic tests or treatment
-appreciate their situation
-use reason to make a decision
-communicate their choice
Patient with language barrier*
make every effort to find a trained interpreter
make your questions clear, short, and simple
Working with an Interpreter: "INTERPRET"
-Introductions- introduce everyone in the room and include information as to the roles the individuals will play
-Note Goals- notes the goals of the interview
-Transparency- Let the patient know that everything said will be interpreted throughout the session
-Ethics- Use qualified interpreters to allow the patient to maintain autonomy and make informed decisions about their care
-Respect Beliefs- The interpreter may be able to serve as a cultural broker and help explain any cultural beliefs that may exist
-Patient Focus- Providers should interact with the patient and not the interpreter.
-Retain Control- Remain in control and not let the patient or the interpreter take over the conversation
-Explain- Use simple language and short sentences. This will ensure that comparable words can be found in the second language and that all information can be conveyed clearly
-Thanks- Thanks the interpreter and the patient for their time
Guidelines for broaching sensitive topics
- the single most important rule is to be nonjudgemental
- Explain why you need to know certain information
-Find opening questions for sensistive topics and learn the specific kinds of information needed for your shared assessment and plan
-Consciously acknowledge whatever discomfort you are feeling.
A state of adaption in which exposure to a drug induces changes that result in a diminution of one or more of the drugs effects over time
A state of adaptation that is manifested by a drug class-specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug and or admin of antagonist
A primary, chronic, neurobiologic disease with genetic, psychosocial and environmental factors influencing its development and manifestation
A- annoyance when criticized
( postive responses to 2 - suspicious for drinking problem)
men should have __ drinks per week and __ drinks on 1 occasion
< or equal to 14
women should have ___ drinks per week and __ drinks on one occasion
< or equal to 7
1 drink= _____ ounces of beer, _____ ounces of wine, or ______ 1.5 ounces of spirits
NIAAA recommends __ drink per day for people 65 and older
5 stages to loss, grief
1.denial and isolation
4.depression or sadness
-Rights- people have a right to health and health care
-Balance-care of the individual patient is central, but the health of populations is also our concern
-Comprehensivesness- we have an obligation to ease suffering, minimize disability, prevent disease, and promote health
-Cooperation- Health care succeeds only if we cooperate with those we serve, each other, and those in other sectors
-Improvement- Improving health care is a serious and continuing responsibily
-Safety- Do no harm
-Openness- Being open, honest, and trustworthy is vital in health care
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