Patient Centered Care Flashcards
Define clinician centered care
The balance of power was centered on the preferences and values of the doctor. The patient’s experience of illness was often ignored or discouraged. A detached perspective developed .. find the broken part and fix it
Define patient centered care
Encourages patients to express what is important to them and to recognize the importance of patient’s expressions of personal concerns, feelings and emotions
Define relationship centered care
An expansion of patient-centered care. It takes into consideration that all illness, care and healing processes occur in the setting of relationships (with self and with others)
Describe the sequence of a full patient assessment
-Preparation
- Health History
- Physical Examination
- Assessment
- Plan
- Documentation
- Presentation
What are examples of positive nonverbal communication?
Rotary hand gestures, make eye contact, direct body orientation, uncross arms and legs, sit level with patient, expectation nod, lean forward with expression of interest, “I see”, “Uh-huh”, “Yes”, “Mmm”
What are examples of negative nonverbal communication?
Backward lean, stare, frequent touch, write/type notes while patient is emotionally engaged, fidgeting, glancing at watch or phone frequently
Why is the medical interview important?
It helps establish meaningful caring relationships with your patients and allows you to be a rigorous diagnostician who carefully collects data.
Why is the patient centered component of the medical interview particularly important?
- Allowing patients to tell their symptom story is diagnostically helpful. - Associated with increased patient and clinical satisfaction
- Leads to improved health outcomes
- Associated with less malpractice suits
Describe the core skills of patient centered interviewing
Core Skills: open ended skills, emotion seeking skills. and empathizing skills.
Describe steps 1-5 of the Smith’s Patient Centered Interview
- Set the stage
- Chief Concern/ Agenda Setting
- Open ended non-focusing HPI (listen to patient story)
- Focus on story, obtain emotional and personal context, open ended skills/emotion seeking skills/empathy skills
- Summarize & Transition
Identify the components of the “Preparation” aspect of patient assessment
Patient’s name, chief concern, past & current medical history, tools, special accommodations
Identify the components of the “Health History” aspect of patient assessment sequence
Identify data, source/reliability, chief concern, history of present illness, past medical history, social history, family history, review of systems
Identify the components of the “Physical Examination” aspect of patient assessment sequence
General survey, vital signs, skin, HEENT, neck, back, posterior & anterior thorax and lungs, breasts/axillae and lymph nodes, cardiovascular system, abdomen, lower extremities, nervous system, genital and rectal exam
Identify the components of the “Assessment” aspect of patient assessment sequence
Analyze findings and use clinical reasoning to identify problems
Identify the components of the “Plan” aspect of patient assessment sequence
Specify next steps
Identify the components of the “Documentation” aspect of patient assessment sequence
Accurate, thorough and clear documents for the clinical reasoning behind medical assessment and plan
Identify the components of the “Presentation” aspect of patient assessment sequence
Demonstrates ability to elicit and synthesize large amounts of data, skills in communication and the way you see and understand the patient as a person
Describe Open Ended Skills in patient centered interviewing
Goal: get patient to tell their story in their own words in the way they want
- Nonfocusing: encourage patient to talk freely (silence, nonverbal encouragement, neutral utterances)
- Focusing: invite patient to talk more about topics they already mentioned (echoing, open ended requests, summarizing)
Describe Emotion Seeking Skills in patient centered interviewing
Goal: build a relationship, understand personal and emotional context of symptoms
- Direct Inquiry (First): elicits the initial feeling/emotion. “How does this make you feel?”
- Indirect Inquiry (Second): when patient doesn’t respond to direct inquiry. Impact, eliciting beliefs, self disclosure, triggers
Describe Empathizing Skills in patient centered interviewing
Goal: build a relationship, understand personal and emotional context of symptoms, empathize
-NURS: Name, Understanding, Respect, Support
What are examples of N in NURS
Naming the emotion. “It seems as though you are frustrated”, “It made you sad”, “You sound worried”
What are examples of U in NURS
Understanding the emotion. “I can understand why you feel this way”, “I can’t imagine how hard this must be for you”, “This helps me understand what you have been thinking”
What are examples of R in NURS
Respecting the emotions. “Thanks for sharing this with me”, “It seems like you have remained really strong through all of this”
What are examples of S in NURS
Support. “I am here to help anyway I can”, “If it is okay with you, I would like to discuss these concerns with your physician and see who can best help you”, “I will be with you the whole way”
