2022-01-30T00:36:56+03:00[Europe/Moscow] en true The Interview, Contract, Sending, receiving, Internal Factors, External factors, Intimate zone, personal distance, social distance, public distance, equal-status seating, dress, Electronic Health Record, introducing the interview, The Working Phase, Open-ended questions, closed or direct questions, assisting the narrative, facilitation, silence, Reflection, Empathy, clarification, confrontation, interpretation, Explanation, summary, Ten Traps of Interviewing, nonverbal skills, closing the interview, Interviewing the parent or caregiver, Stages of Cognitive Development, sensorimotor, presymbolic, preoperatinal, symbolic speech, concrete operational stage, formal operational stage, communicating with infants, communicating with toddlers, communicating with the preschooler, Communicating with the school-age child, communicating with the adolescent, communicating with the older adult, interviewing hearing impaired, Interviewing Acutely Ill People, People Under the Influence of Street Drugs or Alcohol, Personal Questions, Interviewing sexually aggressive people, Cultural Considerations in Assessment, health literacy, interprofessional communication, language barrier, SBAR flashcards
Health Assessment Chapter 3

Health Assessment Chapter 3

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  • The Interview
    First point of contact with a client and the most important part of data collection
  • Contract
    concerns what the client needs and expects from health care and what you as a clinician have to offer. Your mutual goal is optimal health for the client. The terms include: • Time and place of the interview and succeeding physical examination. • Introduction of yourself and a brief explanation of your role. • The purpose of the interview. • How long it will take. • Expectation of participation for each person. • Presence of any other people (e.g., family, other health professionals, students). • Confidentiality and to what extent it may be limited. • Any costs to the client.
  • Sending
    Verbal commnication, words you speak, vocalizaiton, the tone of voice. Nonverbal- body language- posture, gestures, facial expression, eye contact foot tapping, touch, where you place your chair.
  • receiving
    interpretations of your words. These interpretations are based on past experiences, culture, and self-concept. Physical and emotional states also play a role in a person's interpretation.
  • Internal Factors
    liking others, empathy, ability to listen, self-awareness
  • External factors
    ensure privacy, refuse interruptions, physical environment
  • Intimate zone
    0-18 inches
  • personal distance
    18 inches to 4 feet
  • social distance
    4-12 feet
  • public distance
    (12 to 25 feet) the distance used for public ceremonies such as lectures and performances
  • equal-status seating
    Both you and the patient should be comfortably seated at eye level, about 4-5 feet apart. Avoid standing which communicates haste and superiority
  • dress
    client in street clothes you professional
  • Electronic Health Record
    Systematic collection of a patient's health care and treatment in a digital format
  • introducing the interview
    1.address the patient using his or her surname 2.shake hands if comfortable do not use the first name for adults except if they are children or adolescence 3. introduce yourself 4. state your role in the agency 5. give the reason of the interview 6 ask an open ended question RAPPORT IS BUILT DURING THE INTRODUCTION
  • The Working Phase
    the data-gathering phase, includes two question types: open and closed
  • Open-ended questions
    questions that allow respondents to answer however they want
  • closed or direct questions
    asks for specific information, usually illicit a short 1 or 2 word answer, limits the patient's answer, use to fill in details after open ended questions
  • assisting the narrative
    facilitation, silence, reflection, empathy, clarification, confrontation, interpretation, explanation, summary
  • facilitation
    encourages client to say more, shows person you are interested
  • silence
    communicates that client has time to think
  • Reflection
    echoes client's words by repeating part of what person has just said. Can help express feelings behind words. Mirroring clients words can help person elaborate on problem
  • Empathy
    names a feeling and allows its expression. Allows person to feel accepted and strengthens rapport. Useful in instances when client hasn't identified the feeling or isn't ready to discuss it
  • clarification
    useful when person's word choice is ambiguous or confusing. Summarize person's words, simplify the statement, and ensure that you are on the right track
  • confrontation
    clarifying inconsistent information. Focusing client's attention on an observed behavior, action, or feeling
  • interpretation
    links events, makes associations, and implies cause. Not based direct observations but instead on inference or conclusion. Your interpretation may be incorrect but helps prompt further discussion
  • Explanation
    informing person. Sharing factual and objective information
  • summary
    condenses facts and validates what was discussed during the interview. Signals that termination of interview is imminent. Both client and examiner should be active partcipants.
  • Ten Traps of Interviewing
    1. Providing false assurance or reassurance 2. Giving unwanted advice 3. Using authority 4. Using avoidance language 5. Engaging in distancing 6. Using professional jargon 7. Using leading or biased questions 8. Talking too much 9. Interrupting 10. Using "why" questions
  • nonverbal skills
    congruent with verbal message. physical appearance, good posture, minimize gestures, facial expressions, eye contact, voice, touch when necessary
  • closing the interview
    -Ending should be gradual thereby allowing for adequate closure to allow for final expression. -No new topics introduced -Summary provided as final statement
  • Interviewing the parent or caregiver
    - build rapport with child and caregiver - children less than 6 years old focus more on parent - provide toys for children - most communication with caregiver
  • Stages of Cognitive Development
    sensorimotor, preoperational, concrete operational, formal operational
  • sensorimotor
    describes Piaget's stage in which the child explores the world through interaction of his mouth and hands with the environment
  • presymbolic
    communication largely nonverbal.
  • preoperatinal
    2-6 years. Beginning use of symbolic thinking. Imaginative play.
  • symbolic speech
    actual use of structured grammar and language to communicate
  • concrete operational stage
    7-11 years logical thinking. Masters use of numbers and other concrete ideas such as classification and conservation
  • formal operational stage
    abstract thinking. Futuristic; takes borader, more theoretical perspective
  • communicating with infants
    -Nonverbal, but crying as communication -Use soothing and calming town when talking to infant
  • communicating with toddlers
    -12 to 36 months -give one direction at a time and provide simple explanations
  • communicating with the preschooler
    (3-6) use short simple sentences, take time and give short explanations
  • Communicating with the school-age child
    interview caregiver and child together. when a presenting a symptom or sign exists, ask the child about it first and then gather data from the caregiver
  • communicating with the adolescent
    Must have an attitude of respect. Second communication must be totally honest. Stay in character. Focus first on the adolescent not the problem. Talk about the patient first. Show interest. Don't ask about family. Give direction. Silence is best avoided. Develop rapport. Know when to ask caregiver for privacy. Positive reinforcement is key.
  • communicating with the older adult
    -address by proper surname - older adults have longer stories to tell so plan accordingly - important to adjust pace of interview with older adults - allow periods of silence during times (some adults need time to interpret the question and process the answer - avoid hurrying - consider physical limitations (hearing loss, etc) - touch is non verbal skill that is very important to older adults
  • interviewing hearing impaired
    Ask for preferred way of communication. For lip reading have good lighting. Always talk normal and use hand gestures. Use nonverbal cues and written communication.
  • Interviewing Acutely Ill People
    focus on making him or comfortable.
  • People Under the Influence of Street Drugs or Alcohol
    alcohol and opioids slow brain activity and impair judgment, memory, intellectual performance, and motor coordination. Stimulants cause intense high, agitation, and paranoid behavior. Hallucinogens cause bizarre, inappropriate, sometimes violent behavior accompanied by superhuman strength and insensitivity to pain. Ask simple direct questions. Be nonthreatening. avoid confrontation. Find out the last time they drank or took drugs, how much, and the name of everything taken.
  • Personal Questions
    -Where you live, what you do, who you do it with, when you do it, what you say, where you are now -Same for your children, partners, friends, family, and other people you care about
  • Interviewing sexually aggressive people
    Make clear you're a health professional and that maintain a professional relationship. Communicate that you accept the person and understand his or her need to be self-assertive
  • Cultural Considerations in Assessment
    affects perception of health, illness, and death. Affects belief of causes of diseases. Affects patients perception of health promotions. Maintain cultural norms. Use proper pronouns.
  • health literacy
    ability to understand instructions, navigate the health care system, and communicate concerns with the health care provider.
  • interprofessional communication
    collaboration, mutual respect, ineffective communication among healthcare professional is one of the leading causes of medical errors and patient harm.
  • language barrier
    use an interpreter, verbal and non verbal cues in communication patter, bilingual team member or trained medical interpreter, ask for verbatim account of the conversation. Speak to the patient not the interpreter. Plan for longer time period.
  • SBAR
    S: Situation B: Background A: Assessment R: Recommendation