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What are the 2 Concepts of Health and what are they?
- 1. Biomedical "Medical" Model:
- Focus is the diagnosis & tx of disease.
- Assessment factors (signs & sx of disease)
- 2. Holistic Models (e.g., Nursing):
- Expanded focus: views the body, mind & spirit as interdependent & functioning as a whole within the environment.
- Individuals are considered active participants in their health care.
- Assessment factors (expanded to include culture & values, family & social roles, self care behaviors, environmental stress, developmental tasks, etc.)
What are the 3 major focuses on "Health Promotion/Disease Prevention" that forms the core of nursing practice?
- 1. Primary Prevention (promote optimum health prior to the onset of problems) - healthy diet, exercise, immunization, etc.
- 2. Secondary Prevention (early identification & tx of existing health problems) - PAP smear, mammogram, PPD, etc.
- 3. Tertiary Prevention (rehabilitation & restoration of health) cardiac rehab, etc. (Least desirable of all preventions)
What information is collected during an Assessment and how does it start and form?
- Collection of subjective and objective data
- Starts with the first pt contact.
- Forms the data base (the foundation for making a diagnosis)
- Subjective (statements by pt about their health) = symptoms
- Objective (observations, what you observe) = signs
- Inspection, Palpation, Percussion, Auscultation, Laboratory & diagnostic test results, Pt's medical records.
What is the Nursing Process?
Assessment, Diagnosis, Outcomes Identification, Planning, Implementation, Evaluation
What is the difference between Medical Diagnosis & Nursing Diagnosis?
- MD - Treats problem or disease; diagnose disease
- MD - Treats the pt's response to disease/health problem
Example of comparing/contrasting Medical and Nursing Dx
- Assessment Data:
- Subjective - "I have shortness of breath (SOB)
- Obj - Wheezing
- MD = asthma
- Plan - prescribe drug therapy
- ND = impaired gas exchange (pt's response to illness)
- Plan - Teach methods to improve gas exchange (e.g., smoking cessation, proper use of medications, etc.). Monitor pt's response to tx
What are the 4 types of Data?
- 1. Complete (health hx & pe) - 1st appointment in primary care, hospital admission
- 2. Episodic (mini data base concerning one problem) - acute illness (common cold)
- 3. Follow-up (to assess progress) - getting better or worse; data collected os focused & limited
- 4. Emergency (rapid & focused data collection) - rule in or out life threatening disorders quickly. The type to data collected may quickly increase/decrease the level of suspicion for a certain type of problem.
What are the purposes of having and Interview?
- 1. Allows for collection of subjective data
- 2. Assists the pt in identifying areas of concern & perceptions of health status
- 3. Identifies person's problems & strengths
- 4. Establishes rapport & trust for an ongoing working relationship
- 5. Provides a comfortable bridge to the pe
- 6. Provides an opportunity for education
What are the Terms of the Interview?
- 1. Purpose (clarify) - Why are you here?
- 2. Time (set time limits in the beginning)
- 3. Presence of others (other care givers, family, friends, translator, etc.) - affects communication (+ or -)
- May be unalbe to speak freely about issues (abuse, sexual problems, etc.)
- May help w/info acquisitoin
- Interpreter e.g. violates confidentiality; risk of misinterpretation
- 4. Confidentiality (or limit of): Avoid conversations in public places; Don't discuss pt's w/friends/family; Don't refer to pt by name; Builds pt trust/decreases litigation
Communication (all behaviors): observable and process in an Interview?
- Verbal - tone, words, speed, vocalizations, what your don't say
- Nonverbal - posture, gestures, facil expression, eye contact, body position, location in the room; sometimes conveys more than verbal (Smile)
Communication is a two-way street: The emotional impact of illness can affect interpretation of messages; may not be able to process info; pt teaching may have min impact in hospital setting (best to give written instructions)
What are the 2 Factors Affecting the Interview?
- 1. Internal Factors:
- Acceptance of others (respect for pt's healthcare decisions): Tolerant for weaknesses, Convey warmth, caring & acceptance
- Active listening
- 2. External Factors:
- Environment: Attempt to achieve a comfortable setting, Control interruptions, Sit 4-5 ft from pt & slightly to the side (allows pt to avoid eye contact if desired by looking straight ahead), Avoid standing (implies haste & superiority)
- Professional Dress
- Ensure physical or psychological privacy (private room or pull curtain)
What are the Challenges of Note Taking?
- Impedes eye contact
- Attention shifting
- Interrupts pt's narrative flow
- Impedes observation of nonverbal behavior
- Can be threatening
How should you Begin the Interview and keep it flowing?
- Introduction - always intro yourself & your title; explain your role
- Address pt by surname (Mr, Mrs, Ms) - unless permission given to use 1st name
- Open ended quest:
- Requires narrative response
- Used to begin interview
- Allows for description, leads to more info
- Closed end quest:
- requires 1-2 word answers or yes/no responses
- Used to fill in omitted info or to get specific facts
- Ask only one quest at a time
What are the 9 Communication Techniques?
- 1. Facilitation (encourages pt to say more) - "uh huh" or "go on"
- 2. Silence (gives the pt time to think , helps him/her focus)
- 3. Reflection (echoes the response; helps pt elaborate)
- 4. Empathy (show understanding & acceptance)
- 5. Clarification (describe what you mean by upset stomach?)
- 6. Confrontation (use this technique if the hx is inconsistent)
- 7. Interpretation (links events & associations; your impression of what pt has said)
- 8. Explanation (providing objective info)
- 9. Summary (final review of what pt has said; surveys what we perceive the health prob/concerns to be)
What are the 10 Traps to Avoid in an Interview?
- 1. Providing false assurance - may lead to disappointment & lack of trust
- 2. Giving Advise
- 3. Using Authority
- 4. Avoiding Difficult Topics
- 5. Engaging in distancing
- 6. Using professional jargon
- 7. Using leading or biased questions
- 8. Talking too much
- 9. Interrupting
- 10. Asking "Why" questions
What are some Non-Verbal Behaviors to look out for?
- 1. Physical appearance - ill, well, student/professional, well groomed/poor hygiene, etc)
- 2. Posture - relaxed/tensed
- 3. Gestures - agreement, anger, pain
- 4. Facial expression
- 5. Eye-contact
- 6. Voice
- 7. Touch
What are some Special Considerations Affecting the Interview?
- 1. Hearing Impaired
- 2. Acutely ill
- 3. Substance abuse - may need to wait for them to sober up
- 4. Personal questions - redirect conversation to the pt
- 5. Sexually aggressive
- 6. Crying - allow expression of emotions
- 7. Anger - deal w/this emotion before going on w/interview
- 8. Those who threaten violence - be sure that you are safe and don't hesitate to seek assistance
- 9. Anxious
What special considerations you should tk for Older Pts?
- The interview tks longer - has a long story to tell
- Tks longer to answer
What are some Cross Cultural Considerations?
- 1. Eye-to-eye contact
- 2. Hand shaking
- 3. Touch - may or may not be acceptable to pt
- 4. Personal space & interview distance
What are the appropriate Space & Distances to observe?
- 4 - 12 ft Social distance Interview range
- 1.5 - 4 ft Personal distance Dist for most pe
- 0 - 1.5 ft Intimate zone Some physical assessment