Health History I

Question 1

What is the purpose of history taking?

Answer 1

• gather subjective data from the patient/care partners to create a plan to maximize health
• to learn more about symptoms and patient perceptions
• to examine and further investigate
• to create treatment strategies
• to establish rapport and a therapeutic relationship
• simultaneously perform a general survey

Question 2

Types of Objective and Subjective Data

Answer 2

Objective (from nurse themself)- physical assessment, diagnostic testing (ie. blood pressure, heart rate)
Subjective (from patient, family, care partners)- feelings, perceptions, desires, ideals, values, symptoms, personal info

Question 3

What can a nurse do if they suspect the person is unreliable to collect info from?

Answer 3

• Always document WHO is giving the information so you can cross reference for discrepancies
• identify the sources (previous records) to confirm their history
• when the client is unable to provide info, the nurse may obtain it through a secondary source

Question 4

What are clues that a person is not able to provide RELIABLE history?

Answer 4

• Ie. A patient in a manic episode or having delusions is not a reliable source
• Ie. A patient having negative connotations regarding a certain condition/symptom due to religion/personal beliefs, so they may not report the condition entirely

Question 5

How do nurses build rapport?

Answer 5

• explain why info is being collected
• use silence
• communicate understanding (empathy)
• provide positive regard
• care for the unique patient (concerns)
• therapeutic touch (if appropriate)
• active listening (listen w/out judgement)

Question 6

Examples of what to say when building rapport?

Answer 6

• “That sounds like a very difficult time”
• “I am here to listen and support you, Feel free to ask me any q’s abt your care”
• “You are not alone in this. We will wor together toward you recovery”

Question 7

What is the purpose of unconditional positive regard?

Answer 7

• accepting another person without judgement (just bc they are a human)
• necessary to minimize the influence of guilt or shame while discussing taboo subjects
• caring for the client as a seperate person with permission to have their own feelings/experiences

Question 8

Who 1st described unconditional positive regard?

Answer 8

Carl Rogers - Humanistic Psychologist

Question 9

what is the difference between ‘hearing’ and ‘listening’?

Answer 9

Hearing - passive; process of perceiving sound
Listening - active; hearing with an intention to understand

Question 10

What is Presencing?

Answer 10

Deliberately focused attention, receptivity to the other person, and persistent awareness of the other
- encourages patents to be active contributors of their care

Question 11

Active listening is a dynamic process involving:

Answer 11

1) hearing a clients message
2) decode its meaning
3) provide feedback to the client regarding the nurse’s understanding of the message

Question 12

What is the goal of active listening?

Answer 12

To see of the words and behaviours match. If not, you need to find out what the essence (real meaning) is.

Question 13

Which characteristics are most important to listening?

Answer 13

• empathy
• silence
• attention to verbal and non-verbal communication
• ability to be nonjudgemental and accepting

Question 14

How to use silence effectively?

Answer 14

• respect clients silence without breaking the mood
• should only last bw 10-15 seconds
• long silences can be uncomfortable
• allows the client and nurse to reflect (esp useful when discussion is emotional)

Question 15

What are the 2 parts of empathy?

Answer 15

1) Pre-verbal: mental process where the nurse shifts from their world into the clients

2)Verbal: accurately and specifically reflect your understanding

Question 16

What is the difference between empathy, sympathy, and compassion?

Answer 16

Empathy - feeling WITH someone
- feeling with people
- a vulnerable choice
- affectionate response that understands a patients suffering through emotional resonance

Sympathy - feeling FOR someone
- drives disconnection
- distracts from the actual problem
- involves a pity-based response
- superficial acknowledgement of suffering
- not necessarily bad; used in specific situations
- can be a coping strategy for situational suffering

Compassion
- action-based
- seeks to address the patients’ suffering through understanding AND action

Question 17

What is the similarity between empathy and compassion?

Answer 17

• they share attributes of acknowledging, understanding, and emotionally resonating with a person who is suffering

Question 18

What is the difference between natural and clinical empathy?

Answer 18

Natural Empathy
- instinctive trait
- intrinsic ability to understand others’ feelings

Clinical Empathy
- a skill that is consciously and deliberately employed to achieve a therapeutic intervention and establish a helping relationship

Question 19

Verbal aspects of empathy?

Answer 19

• reflect to the client what you understand of their feelings and reactions
• be accurate; do not exaggerate
• dont just repeat what the client said
• be specific

Question 20

Non-Verbal aspects of empathy?

Answer 20

• genuineness
• warmth
• empathy is not feeling sorry for - it is value free

Question 21

What are things you should NOT say in an interview? (non-therapeutic)

Answer 21

• asking personal questions
• giving opinions
• generalizing/ stereotyping
• giving defensive responses
• arguing
• providing false reassurance
• asking “why” questions

Question 22

What are the 8 Communication Pitfalls?

Answer 22

1) Why Q’s - client may feel judges blamed, or get defensive

2) Leading Q’s - anticipate the answer when little is known
- if you give options to the client to answer, they will often just pick 1 of the options

3) Negative Phrasing - avoid asking a question in a format that downplays, minimizes, or negates the clients experience

4) Unfamiliar Language - (ie. medical technology, jargon)

5) Irrelevant or poorly times Q’s - impacts the flow of conversation

6) Too many Q’s - clients may feel that they are being interrogated

7) Inaccurate or false reassurance - client may distrust the nurse and discount the info given by the them

8) Defensiveness - justify an action that they know is insensitive, inappropriate, wrong, or covers up an error

Question 23

Why should we not use, ‘but’ statements?

Answer 23

• Using “but” in statement’s negates everything you said before that
• Ie. “you are making great progress, but I know you can improve”
• Instead, use “and”

Question 24

You should talk _______ the client, NOT _______ them.

Answer 24

Talk WITH the client, not ABOUT them.
- encourage client to tell their story
- give the client a voice and JOIN in with yours

Question 25

Common Interview Mistakes.

Answer 25

• Too many focused questions ​
• Ignoring the client’s emotions ​
• Refusing to return to the client for further information or clarifications ​
• No introductions, no regard for the client’s comfort, no relationship-building ​
• No open-ended questions ​
• Interruptions to the interview process

Question 26

Areas requiring additional sensitivity include:​

Answer 26

• Alcohol use, street/recreational drug use, prescription drug misuse​
• Intimate partner violence​
• Sexual activities, practices, and concerns​
• Physical and sexual abuse history​
• Suicidal and homicidal ideation​
• Mental health

Question 27

3 Factors that impact the reliability/validity of client self-report when asked sensitive q’s.

Answer 27

1) Your anxiety to discuss certain topics
2) The client’s anxiety to discuss certain topics
3) How you ask questions

Question 28

How to communicate sensitive topics?

Answer 28

To decrease anxiety​
- set the context​
- Careful, mindful wording of questions​ (illicit substances vs. street drugs)
- Use close-ended questions​
- Offer response choices​

To improve the quality and specificity of data shared​
- Asking for facts rather than judgments​
- Asking in specific rather than general terms​

Setting the stage​
- Normalizing​ (many ppl find this difficult)
- be transparent
- Ask permission​ (can I ask abt ur drug use)
- Addressing confidentiality concerns​

Question 29

Fact VS. Judgement

Answer 29

FACT: Is your mom healthy?

JUDGEMENT: Can you provide information about your mom’s current health status?

Question 30

How to get information from Caregivers?

Answer 30

• Important to consider families as recipients of care, not just the individual client (family centered vs. client centered nursing care)​
• Involve caregivers in a manner that respects a patient’s autonomy and right to privacy ​
• Seek consent from the client (to give caregivers appropriate information about the patient’s care and treatment)
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• Assure caregivers that their input is essential for providing comprehensive care to the client
• Listen attentively to the information shared by care partners​
• Validate and clarify the information provided ​
• Respect confidentiality of the information shared by care partners

Question 31

What is a family-minded lens?

Answer 31

• the nurse asks questions through a family filter, even if the family members are not present

Question 32

4 Categories of Interview Questions

Answer 32

1. Focused Q’s - specific, targeted, and get detail about an issue
2. Clarification Q’s - Used when the person has explained something that can lead to different explanations
3. Elaboration Q’s - Used to investigate an issue to provide more detail about an experience or situation
4. Circular Q’s - § Help people think and reflect on the meaning of their experiences