Ch 2: Health History And Interview

Question 1

What is the purpose of a health history

Answer 1

To provide description of patients symptoms and how they developed

Question 2

What does a complete health history identify

Answer 2

Potential/underlying disease states

Question 3

What is another commonly used word for health history?

what are very broad components of a health history

Answer 3

An interview

Review of past history and a review of systems where the patient disclose his private information during open communication

Question 4

Describe the communication process and relationship

Answer 4

The communication process is used in caring relationships with patients focused on patient emotion

Question 5

What are two essential components (people) of the communication process

Answer 5

Verbal and nonverbal communication between a sender and a receiver (decoder)

Question 6

What are the two types of therapeutic communication and describe them

Answer 6

1. Caring : respect, valuing patient, non-judge mental

2. Empathy: putting yourself in their shoes , compassion, sensitivity

Question 7

 What is therapeutic communication used for

Answer 7

To create a relationship with the patient of trust and rapport

Question 8

What is nonverbal communication considered as almost more important than verbal communication

Answer 8

It is most accurate a demonstrating feelings

Question 9

List the important components of nonverbal communication

Answer 9

• Physical appearance/ facial expression
  : (1st impression)

-Posture
: crossing arms closed communication

• Gestures/ eye contact
  : gestures should be purposeful and iContact must be maintained at patient level such as a CHAIR (do not stand over them as it signals a power position)
• Tone and use of touch
  : speak at a moderate tone, always ask permission for touch

Question 10

Why is it essential to always ask permission for touch

Answer 10

It may not always be culturally appropriate so clarify with patient
As well as eye contact

Question 11

 Why is nonverbal communication and physical appearance vital

Answer 11

Nonverbal communication and physical appearance is vital so the line of communication stays open between patient and nurse

Question 12

How is verbal communication developed

Answer 12

Is learned by practice and repetition

Question 13

What are appropriate speech patterns for verbal communication

Normal hearing v hearing problems

Answer 13

Nurses speak in a moderate tone that is not too fast as the patient will lose trust in a barrier will be formed

                         V 

Project voice for those with hearing problems, speak slower

Question 14

What are key components you can use for a patient with limited English

Answer 14

• USE SIMPLE CLEAR LANG AT NORM VOLUME*
• Use simple 1 to 2 word phrases
• Use pauses
• Use a normal volume
• let patient speak so you can get an understanding
• facilitate trust, respect and caring

Question 15

Do’s and don’ts of a complete language barrier

Answer 15

DO: get a hospital interpreter
- is standard of care

DONT: don’t use family

Question 16

If there is a complete language barrier why is it important to not use family

Answer 16

You may violate HIPPA

medical terms may not be known

family member may give incomplete information

Question 17

How would you actively listen to a patient

Answer 17

Use both verbal and nonverbal actions to focus on a patient and their perspective

Question 18

How can you actively listen that helps a patient heal?

Answer 18

Let’s patient Talk about difficult feelings, concerns, anxieties, and fears

Question 19

What is a good skill to use in patients who’s emotions cannot be diffused such as anger

Answer 19

Redirect patient to the purpose of your communication

Question 20

What are other techniques of communication (list 4)

Answer 20

1. Restatement
2. Reflection
3. Elaboration (facilitation) 
4. Silence

Question 21

Define restatement

Answer 21

RESTATE = Elaborate

Restatement is the repeating of what the patient said FOR ELABORATION

Question 22

Define reflection and give an example of how you as a nurse can state it

Answer 22

Reflection is summarizing the main themes said by your patient

Ex: “you sound very scared” and boom communication is open

Question 23

Define elaboration (facilitation) and how would you tell the patient to elaborate

Answer 23

Get patient to more completely describe the issues

done by showing interesting conversation

“Go on” “how would you describe that”

Question 24

How to silence aid in communication

Answer 24

Silence shows both caring and thinking

Question 25

Define empathy

Answer 25

Putting yourself in your patients shoes | Compassion

Question 26

What is focusing and how would you get a patient to focus

Answer 26

Focusing= redirecting Keeping conversation on track “ we were talking about”

Question 27

How would you ask a patient to clarify

Answer 27

” tell me what you mean by”

Question 28

What is summarizing and when is it used

Answer 28

Summarizing is reviewing and condensing information stating the most important things Done at the end of the closing phase of an interview

Question 29

Give examples of non-therapeutic responses (greatest ones)

Answer 29

- False reassurance: A casual response the diminishes the patients concerns We truly don’t know -Sympathy: having pity on patient, feeling what patient feels -unwanted advice: It’s best to refer to provider and family -biased questions Hold judgment, guide patient to acceptable response -Interrupting: listen to patient> speaking

Question 30

What is a very essential non-therapeutic way to ask a question and why

Answer 30

Asking why questions they are often accusatory and close communication

Question 31

What is non-professional involvement and some examples (2)

Answer 31

Non-professional involvement is crossing boundaries / relationships with patients 1. Social media: Out of hospital 2. Violation of sexual boundaries

Question 32

How would you describe intercultural communication

Answer 32

Intercultural communication is what we learn from culture on how to be healthy and or Ill

Question 33

What is proper communication etiquette when under inter-cultural communication circumstances

Answer 33

Show respect and be sensitive to patient by asking how they want to be addressed

Question 34

What are issues that can ride with limited English during intercultural communication

Answer 34

There can be a decrease in quality of care that can be fixed with a hospital interpreter DO NOT USE FAMILY

Question 35

How do you address gender and sexual orientation issues

Answer 35

Address patient as what they identify but clearly state they must be treated as their biological aspects

Question 36

What are phases of the interview process and give brief description + post interview

Answer 36

1.Pre-interaction phase :preparing for interview by looking at medical records, demographic data (pt info) 2. Beginning phase : introduction, stating purpose, opening line of communication 3. Working phase : gathering of data through direct and open ended questions as well as chart 4. Closing phase : “reflecting” summarizing and stating the most important issues Post interview “ is there anything else you need to tell me” And think patient

Question 37

Expand on the pre-interaction phase

Answer 37

The preinteraction phase is preparing for the interview where you gather patient information (demographic data), medical records !!! Is used to determine historian (PT) reliability!!!

Question 38

Elaborate on the beginning phase

Answer 38

The beginning phase is where you introduce yourself, address the patient, say the purpose of the interview, and establish an open line of communication

Question 39

Elaborate on the working phase

Answer 39

The working phase is the gathering of the bulk of data asking both closed, direct questions (Y/N) and open ended questions Avoiding “why” questions Information can come from the primary source (pt) or the secondary source (fam, doc, emt)

Question 40

Elaborate on the closing phase and mention the post interview 

Answer 40

The closing phase is essentially reflecting: summarizing the main ideas about 2 to 3 important issues of the interview You are obligated to report any information by law (I.E: abuse) POST INTERVIEW “ is there anything else you need to tell me” Thank the patient

Question 41

What is the nurses main Focus of the interview | 4 things

Answer 41

- gather info - assess patient status - risk behaviors - strengths

Question 42

Differentiate primary and secondary data sources

Answer 42

Primary : AKA historian is pt Secondary: fam, doc, emt

Question 43

What is an important action to do during the pre-interaction phase in regards to the historian and the historians information

Answer 43

Determine the historians reliability between the information you get pre-interaction and during the interview

Question 44

What are you obtaining as you get a patient’s history

Answer 44

Your obtaining the patients database

Question 45

Give initial components of health history

Answer 45

• Demographic data : id pt and history - any illnesses (adult and childhood) - surg, immunizations, injury, transfusions - med lists and reasons (including herbal) * Reason for seeking care * history of present illness ``` O-nset L-ocation D-uration C-haracteristic A-ggregating/ alleviating R-adiations T-iming S-everity ```

Question 46

Define genogram

Answer 46

GENE- ogram Shows family health patterns and genetic genes

Question 47

Define functional health assessment

Answer 47

Assess patient strengths and needed improvements such as in activities of daily living

Question 48

What is the purpose of the review of systems and are you physically touching the patient

Answer 48

Purpose: to identify current and past health of systems where we touch base on systems and assess all areas No touching

Question 49

What area of the health assessment is done until the end of the interview and why

Answer 49

The psychosocial and lifestyle factors are done at the end of the interview because trust must be established first

Question 50

What is discussed during the psychosocial and lifestyle factors

Answer 50

Any social, cultural, spiritual assessments -coping and stress tolerance A mental health assessment -self-medicating is assessed  Human violence assessment -look for possible abuse such as different color bruising Sexual history and orientation -establish a need for education

Question 51

What are a few special situation’s in interviews and their solutions

Answer 51

Low levels of consciousness/ cognitive impairments -Establish other sources, direct questions Anger - Avoid becoming defensive DO NOT YELL Mental illness -have patient focus (redirect) away from distractions to interview