The Initial Interview

Question 1

The Initial Interview

Answer 1

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

Question 2

The Relational Approach

Answer 2

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

Question 3

Reflexivity: Intrapersonal

Answer 3

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

Question 4

Reflexivity: Interpersonally

Answer 4

Inter = between and among people (the family, colleagues)

• focuses attention the experience being assessed (emotions, beliefs, concerns)

Question 5

Reflexivity: Contextuality

Answer 5

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

Question 6

Communication Skills (3)

Answer 6

1. Unconditional Positive Regard
2. Empathy
3. Active Listening

Question 7

Unconditional Positive Regard

Answer 7

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

Question 8

Empathy

Answer 8

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

Question 9

Active Listening

Answer 9

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

Question 10

Nonverbal Skills

Answer 10

1. physical appearance - appear neat, clean and professional
2. posture - maintain a relaxed, open posture to evoke trust and interest
   
   • note the patient’s posture
3. gestures - nodding and leaning in to show interest
   
   • note the patient’s use of gestures to locate and/or describe pain
4. facial expressions - convey a professional who is attenuative, sincere, and interested
   
   • note patient’s facial expression when telling stories (full or flat?)
5. eye contact - maintain eye contact without “staring down”
6. voice - calm and steady tone of voice to indicate control and openness
   
   • note patient’s tone and rate of voice

Question 11

Practitioner Lead Verbal Responses

Answer 11

responses that involve the practitioner’s thoughts and feelings, only used when the situation requires it –> practitioner’s perspective

1. Interpretation
2. Explanation
3. Summary

Question 12

Verbal Response: Interpretation

Answer 12

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)

Question 13

Verbal Response: Explanation

Answer 13

practitioner lead response

practitioner gives the patient factual and objective data –> lab results, next steps, care plan

Question 14

Verbal Response: Summary

Answer 14

practitioner lead response

create a final summary of the practitioner’s understanding of what the patient has said –> patient can correct or contribute

Question 15

Patient Lead Verbal Responses

Answer 15

involves the practitioner’s reactions to the facts or feelings that the patient has communicated –> patient’s perspective

1. Facilitation
2. Silence
3. Reflection
4. Empathy
5. Clarification

Question 16

Verbal Response: Facilitation

Answer 16

the practitioner responds in ways that encourage the patient to continue their story, indicates interest and a willingness to listen

–> “go on”, “mmhm?”

Question 17

Verbal Response: Silence

Answer 17

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

Question 18

Verbal Response: Reflection

Answer 18

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

Question 19

Verbal Response: Empathy

Answer 19

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

Question 20

Verbal Response: Clarification

Answer 20

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

Question 21

Interview Traps

Answer 21

1. providing false assurance or reassurance
2. using authority
3. engaging in distancing
4. using leading/ biased questions
5. interrupting
6. giving unwanted advice
7. using avoidance language
8. overusing professional jargon
9. talking too much
10. using “why” questions

Question 22

Physical Environment Requirements

Answer 22

1. ensure privacy
2. minimize interruptions
3. limit note taking to ensure active listening
4. physical arrangements:
   
   • never sit with patient’s back to the
     door
   • sit at eye level to the patient
   • sit at 90 degree angles

Question 23

Open-ended Questions

Answer 23

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

Question 24

Closed/ Direct Questions

Answer 24

used when asking for specific information –> often to fill in gaps in information

• questions must be specific and asked one at a time

Question 25

Health History

Answer 25

collects subjective data about the patient’s health history and reason for seeking care

• can be combined with objective data from the physical examination

Question 26

Biographical Data

Answer 26

• Patient’s name, age, date of birth
• sex, gender identiy
• address and phone number

Question 27

Reason for Seeking Care (Chief Complaint)

Answer 27

reason (using the patient’s own words) for vising, identifies most pressing concern

• signs (objective)
• symptoms (subjective)

Question 28

Current Health/ Illness History - Pain Assessment

Answer 28

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

Question 29

Past Medical History (PmHx)

Answer 29

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

Question 30

Family History (FamHx)

Answer 30

• age and health status of immediate blood relatives (death + cause)
• family history of heart disease, high blood pressure, stroke, diabetes, blood disorders, cancer, etc

Question 31

Review of Systems

Answer 31

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

Question 32

Functional Assessment

Answer 32

continued ability to engage in AODL

Question 33

The Nursing Process

Answer 33

1. Assessment
2. Nursing Diagnosis
3. Planning
4. Intervention
5. Evaluation

Question 34

Priority Setting Levels

Answer 34

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

Question 35

Priority Setting Level 1

Answer 35

immediately life-threatening (ABCs + V)

• airway problems
• breathing problems
• circulatory/ cardiac problems
• vital sign concerns (ex. high grade fever, high blood pressure, etc.)

Question 36

Priority Setting Level 2

Answer 36

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)

Question 37

Priority Setting Level 3

Answer 37

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)

Question 38

Collaborative Problems

Answer 38

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