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Patient Assessment > Patient Centered Care > Flashcards

Patient Centered Care Flashcards

1
Q

Problems with Clinician Centered Care

A

Balance of power to the Doc

Doc took charge and focused on Sx to determine Dx

Too closed ended - Pt interrogation

Pt experience was ignored/discouraged; prevented pertinent information

Detached perspective

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2
Q

Biopsychosocial Model

A

Bio medicine to narrow.

Illness is a complex interaction of biological, psychological, social factors

-George Engal

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3
Q

Picker’s Eight

A

Respect

Coordination/Integration of care

Information and Education

Physical Comfort

Emotional Support

Involvment of Fam/Friends

Continuity and Transition

Access to Care

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4
Q

Patient centered care

A

Patients want to be seen as individuals, to understand their concerns, emotions, and life challenges.

This models encourages expression of what is important to them and to recognize the importance of the patient’s expressions of personal concerns, feelings and emotions.

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5
Q

Relationship-centered Care

A

Expansion of Pt Centered Care and biopsychosocial model

Considers all illness, care, and healing occurs in the setting of relationships - with self and others.

Emphasizes nature and quality of these relationships are central to healthcare.

Includes relationship b/w caregivers and the patient’s families, relationship among the healthcare team, relationship with self.

REspectful and responsive care with Pt pref, values, needs ensures that Pt values guides all clinical desicions

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6
Q

Patient Assessment Overview

A

Prep

Hx taking

PE

Assessment

Plan

Documentation and presentation

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7
Q

Preperation

A

Pt name

CC

Review past/current medical Hx

Tool

Special accomdations

ID Accomodations

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8
Q

Health Hx

A

ID Data

Reliable Source

CC

HPI

PMH

Social Hx

Fam Hx

ROS

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9
Q

PE Components

A

General Survey

VS

Skin

HEENT

Neck

Back

P./A. Thorax and Lungs

Breast, Axillae, Lymph nodes

CV

Abd.

Lower Extremities

NS

Genital`/Rectal Exam PRN

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10
Q

Assessment

A

Analyze Findings

Use sound reasoning to ID problems.

Requires DDx

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11
Q

Plan

A

For each problem, specify next steps.

ABX? Tests? FUV?

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12
Q

Documentation

A

A clear, well organized record is #1 in providing excellent care.,

Be accurate, thorough, and clearly express reasoning for your assessment and plan.

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13
Q

Oral Presentation

A

Demonstrate ability to synthesize lg amounts of data, communication skills, and how you see the Pt as a person.

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14
Q

Medical interview Intro

A

Most important and difficult skill.

Over 200,000 interviews.

Defined as the process of gathering and sharing info in the context of a Trustworthy Relationship

Interview is one of the most effective diagnostic tools.

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15
Q

Medical interview - Goal #1

A

Establish a meaningful and caring Relationship with the Pt

Make sure that they feel head, understood, and cared for

Ensure what they are hoping to achieve is acknowledged

Respond to their Emotions

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16
Q

Medical interview - Goal #2

A

Be a rigorous Diagnostician - Carefully collect data

Thoroughly collect all data necessary to generate an accurate medical assessment and plan.

Ensure Collected Data is correct and pertinent.

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17
Q

Smith’s Steps Summary

A

1, 2 - Create Rapport and Set the Adgenda

3,4, 5 - Patient -Centered Hx and Interview:
Which includes listening to Story, Eliciting and responding to emotions, and summary and transition.

6, 7, 8, 9, 10 - Clinician-Directed Hx interviewing skills (HPI, PMH, SH, FH, ROS)

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18
Q

Interview - Patient-Centered

A

Complements Clinician-centered interview.

Encourages Pt to express what is most important, including Sx

Helps to recognizes the importance of the Pt’s expressions of personal concerns, feelings and emotions.

Helps synthesize a Biopsychosocial description of the Pt.

19
Q

Interview - Clinician-Centered

A

Clinician lead interview to gather more information to develop an accurate Dx and Plan.

20
Q

Why is the Patient-centered interview so important? #1

A

1 Allowing the patient to tell their story is diagnostically helpful

Helps to arrive at the correct Dx more often and more quickly.

Adds physical Sx information not elicited at all in the clinician-centered approaches.

“if you listen to the Pt, they are telling you the Dx”

21
Q

Why is the Patient-centered interview so important? #2

A

Associated with increased Pt and clinician satisfaction!

Therapeutic, and helps the Pt feel like they have been heard and understood.

Provider is given the chance to understand context of Sx

And an opportunity to express empathy and respond to the Pt’s emotions.

More meaningful relationships

22
Q

Why is the Patient-centered interview so important? #3

A

Leads to improved Healthcare Outcomes.

IE better cancer outcomes, more compliance in Tx, and better postop or perinatal coutcomes

23
Q

Why is the Patient-centered interview so important? #4

A

Associated with less malpractice suits

24
Q

Clinician Centered Interview - Biomedical Model :(

A

Concerns treated as non medical data, and ignored.

Without that personal information, feelings, and emotional component, the ability to form a relationship is limited.

Leads to poor Pt satisfaction, physician frustration, and worse health outcomes overall.

25
Q

Core Skills of the Patient-Centered Interview - Open Ended Skills

A

Goal is to get the Pt to tell their story in their own words in the way that they want!

Non-focusing (listening) - Silence, neutral utterances, Nonverbal Encouragement

Focusing - Echoing, Requesting More Information, Paraphrasing

26
Q

Core Skills of the Patient-Centered Interview - Open Ended Nonfocusing

A

Encouraging the Pt to talk Freely;

Silence: attentive posture, but longer than 5 seconds.

Nonverbal Encouragement: Gestures, nods, expression of interest

Neutral Utterances: Iss, Yes, uhhuh, Mmm

  • If the Pt is giving a coherent and non-repetitive story, this is all you may need.

*More accurately reflects the feeling state of the person than the verbal message; so be careful not to go too long as this can shut down the conversation as well as enhance it.

27
Q

Core Skills of the Patient-Centered Interview - Open Ended Focusing

A

Invites the Pt to talk more about the topics that they already mentioned.

Echoing a word/phrase

Requests - “tell me more about…” or “Go on”

Summarizing or Paraphrasing - inviting to the Pt to focus on the material summarized

These skills help the provider to actively develop a coherent narrative in the Pt’s words and take control of the interview if necessary.

It is okay to ask for more about what the Pt has already put on the table but try not to add topics for discussion yourself.

28
Q

Core Skills of the Patient-Centered Interview - Emotion Seeking Skills Goal

A

Goal Build a relationship, understand the personal and emotional context of the Sx

Use emotion seeking skills when emotions are hinted at or not fully expressed; then subsequently employ empathy skills

29
Q

Core Skills of the Patient-Centered Interview - Emotion Seeking Skills Direct and Indirect Inquiry

A

Direct Inquiry (1st): elicits the initial feeling or emotion - “How does that make you feel?”

Indirect Inquiry (2nd): When the Pt doesn’t respond to the Direct inquiry

Impact- how has you back pain affected your life?

Eliciting Beliefs - What do you think is causing your HTN?

Self Disclosure - If that happened to me, I think I would feel upset.

TRiggers - What made you decide to come in today?

30
Q

Empathy

A

The capacity to share/resonate others’ emotional state.

Sharing the suffering can be challenging for ppl in HC professions and for this reason it is important to respond to the suffering with compassion.

31
Q

Compassion

A

Does not mean sharing in suffering

Characterized by feelings of warmth, concern and care, and strong motivation to improve the other’s well being

To help.

32
Q

Core Skills of the Patient-Centered Interview - NURS: Naming

A

Signals to the Pt that you have heard or Observed the emotion and that it is okay for them to express it.

“you seem frustrated”

“it made you sad”

“you sound worried

33
Q

Core Skills of the Patient-Centered Interview - NURS: Understanding

A

Acknowledging that the Pt’s emotional reaction is reasonable.

“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”

34
Q

Core Skills of the Patient-Centered Interview - NURS: Respecting

A

Saying something positive; find something they have done well.

“Thank you for sharing this with me”

“It seems like you have remained strong through all of this”

“Thanks for being so open”

35
Q

Core Skills of the Patient-Centered Interview - NURS: Support

A

Signaling the Pt that you are Ready to work together as a team.

“I am here to help in anyway that I can”

“If it is okay with you, I would like to discuss this further”

“I will be here with you the whole way”

36
Q

Patient-Centered Interview - Step 1

A

Setting the Stage

Welcoming the Pt, being respectful and Authentic

Address formally at first and asking how they would like to be addressed.

Introduce yourself and your Role (Student!!!)

Ensure Pt privacy and readiness

Make Appropriate Space for Communication

Ensure comfort and put the Pt at Ease

Start with Small Talk!!!

First impressions can be based almost entirely on nonverbal communication. Can shut down a conversation or enhance it

37
Q

Patient-Centered Interview - Step 1: nonverbal communication

A

Do:

Lean fwd, make eye contact, direct body orientation, uncross legs and arms, maintain arm symmetry, nod, sit level with the Pt

Don’t:

Lean backwards, stare, touch freq, write/type notes while the Pt is emotionally engaged, be fidgety, or glance at your phone.

38
Q

Patient-Centered Interview - Step 2 CC and Agenda

A

first, discuss what the you want to address.

Then, Obtain a list of what the Pt wants to address (Sx, forms, meds).

Make sure to clarify CC

Summarize an Agenda and confirm Pt agreement

39
Q

Patient-Centered Interview - Step 2: Importance of setting the agenda

A

Increases Clinical Efficiency:
Prevents errors of investigating the wrong CC
Give opportunity to prioritize Concerns
Avoids door knob questions

Improves Pt satisfaction:
Assures that all items the Pt has are acknowledged
Ensures that the Patient is Hear and Understood.

40
Q

Patient-Centered Interview - Step 3: All Ears!

A

Open Ended Skills - Non-focusing, Focusing

Emotion Seeking Skills - Direct and Indirect

NURS - Name, Understanding, Respect, Support

Get the Pt to tell their story in their own words in the way they want.

Build a relationship, understand personal and emotional context of Sx; Empathize

41
Q

Patient-Centered Interview - Step 3: Begin with open ended question.

A

Begin with open ended question.

Encourage Pt to tell story in their own words in their own way using non-focusing open-ended skills.

Do not introduce new topics, just observe.

and obtain additional data from nonverbal sources

42
Q

Patient-Centered Interview - Step 4: Focusing the Story, obtaining the emotional and personal context.

A

Focusing the Story, obtaining the emotional and personal context.

Encourage elaboration of the Sx story using the Focusing skills.

Eliciting Emotional context - directly and indirectly

Responding to the feelings and emotion; NURS

43
Q

Patient-Centered Interview - Step 5 Summarize and Transition

A

Summarize

Check accuracy

Indicate Transition “ I would like to switch gears now”

Patient Assessment (11 decks)

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