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PART I
Assessment of
Respiratory Disease
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Section I
Clinical Data Obtained at
the Patient’s Bedside
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Chapter 1
The Patient Interview
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Patient History

Biographic data



Age, gender, occupation
Chief complaint
Present health
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Patient History (Cont’d)




Past health
Family history
Review of body systems
Functional assessment
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Patient Interview




Patient’s impression of his or her health
Establish rapport and trust
Understanding of patient’s health
Facilitates future assessments
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Internal Factors

What the practitioner brings to the interview


Genuine concern for others
Empathy
 The ability to listen
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Internal Factors (Cont’d)

During the interview the examiner should:


Observe the patient’s body language
For example, note
• Facial expressions
• Eye movement
• Pain grimaces
• Restlessness
• Sighing
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Internal Factors (Cont’d)


The examiner should listen to the way things
are said
For example:




Is the tone of the patient’s voice?
Does the patient’s voice quiver?
Are there pitch breaks in the patient’s voice?
Does the patient say only a few words and then
take a breath?
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External Factors

A good physical setting


Ensures privacy
Prevents interruptions
 Secures a comfortable physical environment
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Techniques of Communication
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Open-Ended Questions


This type of question asks the patient to
provide narrative information.
For example:
“What brings you to the hospital today?”
 “How has your breathing been getting along?”

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Closed or Direct Questions


This type of question asks the patient for
specific information—a short one- or twoword answer, a yes or no, or a forced choice.
For example:

“Have you ever had this chest pain before?”
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Responses—Assisting the Narrative

Facilitation


“Mm-hmm,” “Go on,” “Continue”
“Uh-huh”
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Responses—Assisting the Narrative
(Cont’d)

Silence

Effective after an open-ended question
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Responses—Assisting the Narrative
(Cont’d)

Reflection
Patient: “My breathing is blocked.”
Examiner: “It’s blocked?”
 Patient: “Yes, every time I try to exhale, something
blocks my breath and prevents me from getting all
my air out.”


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Responses—Assisting the Narrative
(Cont’d)

Empathy


Patient: “This is just great! I used to work out every
day, and now I don’t have enough breath to walk
up the stairs!”
Examiner: “It must be hard—you used to exercise
every day, and now you can’t do a fraction of what
you used to do.”
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Responses—Assisting the Narrative
(Cont’d)

Clarification

“Tell me what you mean by bad air.”
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Responses—Assisting the Narrative
(Cont’d)

Confrontation

“You look depressed today.”
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Responses—Assisting the Narrative
(Cont’d)

Interpretation

“It seems that every time you have a serious
asthma attack, you have had some kind of stress
in your life.”
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Responses—Assisting the Narrative
(Cont’d)

Explanation

“It is very common for your heart rate to increase a
bit after a bronchodilator treatment.”
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Responses—Assisting the Narrative
(Cont’d)

Summary
The final overview of the examiner’s
understanding of the patient’s statements.
 It condenses the facts and presents an outline of
the way the examiner perceives the patient’s
statements.
 The patient can agree or disagree with the
examiner’s summary.

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Nonproductive Verbal Messages





Providing assurance or reassurance
Giving advice
Using authority
Using avoidance language
Distancing
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Nonproductive Verbal Messages
(Cont’d)





Professional jargon
Asking leading or biased questions
Talking too much
Interrupting and anticipating
Using “why” questions
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Nonverbal Skills
Professional appearance
vs.
Unprofessional appearance
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Nonverbal Skills (Cont’d)
Sitting next to the patient
vs.
Sitting behind a desk
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Nonverbal Skills (Cont’d)
Proximity to patient
vs.
Far away from patient
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Nonverbal Skills (Cont’d)
Turned toward patient
vs.
Turned away from patient
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Nonverbal Skills (Cont’d)
Relaxed, open posture
vs.
Tense, closed posture
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Nonverbal Skills (Cont’d)
Leaning toward patient
vs.
Slouched away from patient
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Nonverbal Skills (Cont’d)
Facilitating gestures
(e.g., nodding the head)
vs.
Nonfacilitating gestures
(e.g., looking at watch)
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Nonverbal Skills (Cont’d)
Positive facial expressions
vs.
Negative facial expressions
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Nonverbal Skills (Cont’d)
Good eye contact
vs.
Poor eye contact
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Nonverbal Skills (Cont’d)
Moderate tone of voice
vs.
Strident, high-pitched voice
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Nonverbal Skills (Cont’d)
Moderate rate of speech
vs.
Speech too fast or too slow
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Nonverbal Skills (Cont’d)
Appropriate touch
vs.
Too frequent or inappropriate touch
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Closing the Interview

The interview should end gracefully.
“Is there anything else that you would like to talk
about?”
 “Do you have any questions you would like to ask
me?”
 “Are there any other problems that I should have
asked you about?”

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Closing the Interview (Cont’d)
Finally,
Thank the patient for the time and
cooperation provided during the interview.
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