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
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
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)
Ensure physical or psychological privacy (private room or pull curtain)
What are the Challenges of Note Taking?
Impedes eye contact
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
10. Asking "Why" questions
What are some Non-Verbal Behaviors to look out for?