Intro & Interviewing

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Author:
Karoly
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40873
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Intro & Interviewing
Updated:
2010-10-09 17:41:02
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N202
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Exam 1
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  1. 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.)
  2. 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)
  3. 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.
  4. What is the Nursing Process?
    Assessment, Diagnosis, Outcomes Identification, Planning, Implementation, Evaluation
  5. 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
  6. 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
  7. 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.
  8. 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
  9. 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
  10. 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)
  11. 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
    • Empathy
    • 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)
  12. 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
  13. 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
  14. 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)
  15. 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
  16. 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
  17. 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
  18. What special considerations you should tk for Older Pts?
    • The interview tks longer - has a long story to tell
    • Tks longer to answer
  19. 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
  20. 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

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