The Initial Interview Flashcards
The Initial Interview
entails the collection of subjective data
- optimal way to learn about the patient’s perceptions, understandings of, and reactions to their current health state
- helps to identify the patient’s health strengths, goals, problems and contextual influences
The Relational Approach
an approach to nursing that enables one to enter all situations as an inquirer: inquiring into the experiences of people (others and ourselves) = reflexivity
3 levels:
1. Intrapersonally
2. Interpersonally
3. Contextually
Reflexivity: Intrapersonal
Intra = within each person (the patient, yourself, the patient’s family)
- prompts you to consider what is going on within an individual patient (what does the patient think is important? what might they be overlooking?)
–> UNDERSTAND the patient - consider your own focus - what might you focus on in your assessment and why?
–> UNDERSTAND yourself
Reflexivity: Interpersonally
Inter = between and among people (the family, colleagues)
- focuses attention the experience being assessed (emotions, beliefs, concerns)
Reflexivity: Contextuality
levels of the health care system within society
- structures and conditions of our society that influence people’s health and well-being
- societal factors that influence interpersonal and intrapersonal experiences
Communication Skills (3)
- Unconditional Positive Regard
- Empathy
- Active Listening
Unconditional Positive Regard
approach patients with an attitude of unconditional acceptance, general optimism that they possess value and strengths, not just limitations
- unconditional acceptance even if you disagree with their behavior or decisions –> requires a high degree of reflexivity
Empathy
viewing the world from another person’s inner frame of reference while still remaining yourself
- recognize and accept another person’s feelings, actions, and perspectives without criticism –> feel WITH them NOT LIKE them
Active Listening
portraying active listening and complete attention to the patient using body language and verbal ques to signify interest
- encourage the patient to continue verbally “go on” or non verbally leaning in
- let the patient talk from with own perspective without interruption, not HOW a patient tells their story
Nonverbal Skills
- physical appearance - appear neat, clean and professional
- posture - maintain a relaxed, open posture to evoke trust and interest
- note the patient’s posture
- gestures - nodding and leaning in to show interest
- note the patient’s use of gestures to locate and/or describe pain
- facial expressions - convey a professional who is attenuative, sincere, and interested
- note patient’s facial expression when telling stories (full or flat?)
- eye contact - maintain eye contact without “staring down”
- voice - calm and steady tone of voice to indicate control and openness
- note patient’s tone and rate of voice
Practitioner Lead Verbal Responses
responses that involve the practitioner’s thoughts and feelings, only used when the situation requires it –> practitioner’s perspective
- Interpretation
- Explanation
- Summary
Verbal Response: Interpretation
practitioner lead response
practitioner creates inferences and conclusions about what the patient has said –> presents these inferences to patient who can correct or agree (prompts further discussion)
Verbal Response: Explanation
practitioner lead response
practitioner gives the patient factual and objective data –> lab results, next steps, care plan
Verbal Response: Summary
practitioner lead response
create a final summary of the practitioner’s understanding of what the patient has said –> patient can correct or contribute
Patient Lead Verbal Responses
involves the practitioner’s reactions to the facts or feelings that the patient has communicated –> patient’s perspective
- Facilitation
- Silence
- Reflection
- Empathy
- Clarification
Verbal Response: Facilitation
the practitioner responds in ways that encourage the patient to continue their story, indicates interest and a willingness to listen
–> “go on”, “mmhm?”
Verbal Response: Silence
allows the patient to collect their thoughts and continue their story without pressure to speed up or stop
–> allows the practitioner to observe patients’ nonverbal cues without interrupting
Verbal Response: Reflection
responses which echo the patient’s words, repeating part of what the patient has just said
–> creates an atmosphere of unconditional acceptance and encourages patients to elaborate
Verbal Response: Empathy
responses that relay recognition of a feeling, puts the feeling into words, and allows the patient to openly express the problem
–> patient feels understood by practitioner, eases the feelings of isolation brought on by the illness
Verbal Response: Clarification
can be used to seek clarification when the patient’s word choice is ambiguous or confusing
–> restating patient’s words or asking for further explanations allows for elaboration and correction of details
Interview Traps
- providing false assurance or reassurance
- using authority
- engaging in distancing
- using leading/ biased questions
- interrupting
- giving unwanted advice
- using avoidance language
- overusing professional jargon
- talking too much
- using “why” questions
Physical Environment Requirements
- ensure privacy
- minimize interruptions
- limit note taking to ensure active listening
- physical arrangements:
- never sit with patient’s back to the
door - sit at eye level to the patient
- sit at 90 degree angles
- never sit with patient’s back to the
Open-ended Questions
used when asking for narrative information –> when beginning an interview, to introduce a new section, and whenever the patient introduces a new topic
- silence can be used to encourage patients to elaborate
- patients can answer however they want
Closed/ Direct Questions
used when asking for specific information –> often to fill in gaps in information
- questions must be specific and asked one at a time
Health History
collects subjective data about the patient’s health history and reason for seeking care
- can be combined with objective data from the physical examination
Biographical Data
- Patient’s name, age, date of birth
- sex, gender identiy
- address and phone number
Reason for Seeking Care (Chief Complaint)
reason (using the patient’s own words) for vising, identifies most pressing concern
- signs (objective)
- symptoms (subjective)
Current Health/ Illness History - Pain Assessment
O - onset
P - pallitative/ provocative
Q - quality/ quantity
R - region/ radiation
S - severity on a scale of 1-10
T - timing
U - understanding the patient
Past Medical History (PmHx)
A - allergies
M - medications
P - past medical history
- surgeries, operations, procedures
- hospitalizations
- previous illnesses/ injuries
- last examination dates
- vaccinations
- obstetrical history (women)
L - last oral intake
E - events leading up to seeking care
Family History (FamHx)
- age and health status of immediate blood relatives (death + cause)
- family history of heart disease, high blood pressure, stroke, diabetes, blood disorders, cancer, etc
Review of Systems
evaluate the presence and/or absence of clinically relevant signs or symptoms for the body’s systems
1. General Overall Health State
2. Dermatology
3. HEENT
4. Respiratory
5. Cardiac
6. Gastrointestinal
7. Genital-Uro
8. Musculoskeletal
9. Neurological
10. anything else of relevance
Functional Assessment
continued ability to engage in AODL
The Nursing Process
- Assessment
- Nursing Diagnosis
- Planning
- Intervention
- Evaluation
Priority Setting Levels
Level 1 - immediately life threatening
Level 2 - require prompt intervention to prevent further deterioration
Level 3 - no imminent threat to health, can be left
Collaborative Problems - treatment requires collaboration of multiple disciplines
Priority Setting Level 1
immediately life-threatening (ABCs + V)
- airway problems
- breathing problems
- circulatory/ cardiac problems
- vital sign concerns (ex. high grade fever, high blood pressure, etc.)
Priority Setting Level 2
not immediately life-threatening but requires prompt intervention to prevent deterioration
- mental status change (LOC, following head trauma)
- acute pain (new or progressing issue)
- acute urinary elimination problems
- untreated medical problems
- abnormal laboratory values (something is deteriorating)
- risks of infections
- risks of safety or security (flight risk, suicidal ideations, homicidal ideations)
Priority Setting Level 3
important, but no threat of imminent harm or short-term deterioration
- broken bones
- cold and flu symptoms
- mobility issues
- excessive drinking (will destroy the liver eventually, but not right now)
- smoking (will destroy the lungs eventually, but not right now)
Collaborative Problems
health problems in which the approach to treatment requires the involvement of multiple disciplinaries
–> socioeconomic status, food security, clean water, housing, unemployment
ex: a patient experiencing illness might have barriers preventing them from accessing proper care, thus, we must collaborate with other resources to eliminate the barriers
