Nursing 202

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Nursing 202
2010-10-10 00:54:55
Nursing Interviewing

Introduction & Interviewing
Show Answers:

  1. What are the 2 concepts of health?
    • 1. Biomedical "Medical" Model
    • - focus is the diagnosis and treatment of disease
    • - assessment factors (signs and symptoms of disease)

    • 2. Holistic Models (e.g. Nursing)
    • - Expanded focus
    • - Individuals are considered active participants in their health care
    • - Assessment factors (expanded to include culture and values, family and social roles, self care behaviors, environmental stress, developmental tasks, etc. )
  2. What are the levels of Disease Prevention and give an example for each.
    Primary Prevention: (promote optimum health prior to the onset of problems)-healthy diet, exercise, immunization, etc.

    Secondary Prevention: (early identification and treatment of existing health problems)- PAP smear, mammogram, PPD, etc.

    Tertiary Prevention: (rehabilitation and restoration of health)- cardiac rehab, etc.
  3. What is a brief definition of assessment?
    A collection of subjective and objective data.
  4. What is subjective data?
    statements, symptoms (patient history)
  5. What is objective data?
    • the signs, observations
    • The methods include:
    • 1. Inspection
    • 2. Palpation
    • 3. Percussion
    • 4. Auscultation
    • 5. Laboratory and diagnostic test results
    • 6. Patient's medical records
  6. What is the Medical Diagnosis?
    Assessment data used to diagnose disease
  7. What is the Nursing Diagnosis?
    Assessment data (used to diagnose a patient's response to actual or potential health problems)- pain, altered skin integrity, ineffective coping, etc.
  8. Here is an example of the differences between Medical and Nursing Diagnosis.

    Assessment Data:
    - Subjective data: "I have shortness of breath (SOB)"
    - Objective data: wheezing

    Medical diagnoses?
    Nursing diagnoses?
    • Medical diagnoses: asthma
    • - Plan (prescribe drug therapy)
    • Nursing diagnoses: impaired gas exchange (the patient's response to illness)
    • - Plan: teach methods to improve gas exchange (e.g. smoking cessation, proper use of medications, etc.)
  9. What are the 4 types of data?
    • 1. Complete (health history and physical examination)
    • - e.g. 1st appointment in primary care, hospital admission

    • 2. Episodic (mini data base concerning one problem)
    • - e.g., acute illness [common cold]

    3. Follow-up (to assess progress)

    • 4. Emergency (rapid and focused data collection)
    • - e.g. chest pain (do you have a history of heart trouble, MI, PUD, hiatal hernia?)
    • - The type of data collection may quickly increase/decrease the level of suspicion for a certain type of problem.
  10. What are the purposes of the Interview?
    • 1) Allows for collection of subjective data (e.g. health history, symptoms)
    • 2) Assists the patient in identifying areas of concern and perceptions of health status.
    • 3) Identifies person's problems and strengths
    • 4) Establishes rapport and trust for an ongoing working relationship
    • 5) Provides a comfortable bridge to the physical examination
    • 6) Provides an opportunity for education
  11. What are the components of the interview?
    • 1) Purpose (clarify)- Why are you here?
    • - it may not always be apparent.

    2) Time (set time limits in the beginning)

    • 3) Presence of others (other caregivers, family, friends, translator, etc.)
    • - Affects communication (positive or negative effect)
    • - May be unable to speak freely about issues (abuse, sexual problems,etc.)
    • - May help with information acquisition.
    • - interpreter e.g. violates confidentiality; risk of misinterpretation.

    • 4) Confidentiality
    • - avoid conversations of public places
    • - don't discuss patients with friends/family; don't refer to patient by name
    • - builds patient trust/decreases litigation
  12. What is verbal and nonverbal communication?
    • Verbal:
    • - tone, words, speed, vocalizations, what you don't say

    • Nonverbal:
    • - posture, gestures, facial expression, eye contact, body position, location in the room)- sometimes conveys more than verbal communication (SMILE)
  13. What are the internal factors affecting the interview?
    • 1) Acceptance of others
    • - tolerance for weaknesses
    • - convey warmth, caring and acceptance
    • - respect for other's health care decisions (may be different from yours)
    • 2) empathy (to convey understanding for how the patient feels)
    • 3) active listening (give the patient full attention)
  14. What are the external factors affecting the interview?
    • 1) Environment
    • - attempt to achieve a comfortable setting (temperature, lighting, noise reduction, etc.)
    • - control interruptions
    • - sit 4-5 ft from pt and slightly to the side (allows pt to avoid eye contact if desired by looking straight ahead)
    • - avoid standing (implies haste and superiority)

    2) Professional Dress (e.g. good hygiene, keeping clothes and shoes neat and clean, and wearing a name tag)

    3) Ensure physical or psychological privacy (private room or pull curtain)
  15. What are the challenges of note taking?
    • 1) impedes eye contact
    • 2) attention shifting
    • 3) interrupts patient's narrative flow
    • 4) impedes observation of nonverbal behavior
    • 5) can be threatening
  16. What are some components for beginning the interview?
    - Introduction (Always introduce yourself and your title)- explain your role.

    - Address patient by surname (Mr./Mrs./Ms.)- unless permission given to use 1st name

    • - Open ended questions
    • - requires narrative responses
    • - used to begin interview
    • - allows for description, leads to more info

    • - Close ended questions
    • - requires 1-2 word answers or yes/no responses
    • - used to fill in omitted info or to get specific facts
    • - ask only one question at a time
  17. What are nine communication techniques?
    • 1) Facilitation (encourages patient to say more)- "uh huh" or "go on"
    • 2) Silence (gives the patient time to think, helps him/her focus)
    • 3) Reflection: (echoes the response; help patient elaborate)-'re telling me that it hurts when you cough
    • 4) Empathy (shows understanding and acceptance)- "I can understand why your test results would upset you"
    • 5) Clarification (describe what you mean by "upset stomach")
    • 6) Confrontation: (use this technique if the history is inconsistent)
    • - inconsistency may occur in one visit or over time
    • - situation: obese male over 300 lbs
    • - "before you told me that you rode your bike 10 miles/day, now you say you ride 25 miles/day"
    • 7) Interpretation: (links events and associations; your impression of what patient has said)- "It seems as though every time you have a deadline to meet at work, you develop stomach pain"
    • 8) Explanation (providing objective info)
    • 9) Summary(final review of what the patient has said; surveys what we perceive the health problems/concerns to be)
  18. What are 10 communication traps to avoid?
    • 1) Providing False Assurance (may lead to disappointment and lack of trust)- "I'm sure you will be all right"
    • 2) Giving Advice
    • - Don't shift accountability for decision making from the patient to you.
    • - present patient with the facts and allow him/her to make an informed decision.
    • 3) Using Authority "Your doctor knows best"
    • 4) Avoiding Difficult Topics
    • - Don't avoid discussion (allow the pt to discuss fears/dying etc.)
    • 5) Engaging in Distancing: e.g. saying "the breast" instead of "your breast"
    • 6) Using Professional Jargon (use language at the patient's level of understanding)
    • 7) Using Leading or Biased Questions (you may not get honest or objective response)- You don't smoke do you?
    • 8) Talking Too Much (you can't learn for yourself)
    • 9) Interrupting (breaks pt train of thought)- may miss important info
    • 10) Asking "Why" questions may put the pt on the defensive; too challenging; implies blame)
    • - "why did you wait so long to bring your child to the hospital?"
    • - It is better to teach regarding future behavior
  19. What are the seven characteristics of non-verbal behavior?
    • 1) Physical appearance (ill/well, student/professional, well groomed/poor hygiene, etc.)
    • 2) Posture (relaxed/tense)
    • 3) Gesture(agreement/anger/pain)
    • 4) Facial expression (alert/relaxed/anxious)
    • 5) Eye-contact (shy/withdrawn/depressed)
    • 6) Voice (anxious/hearing impaired/sarcasm)
    • 7) Touch
  20. What are nine special considerations affecting the interview?
    • 1) Hearing impaired- raising your voice increases the pitch and makes hearing worse
    • 2) Acutely ill
    • 3) Substance abuse
    • 4) Personal questions (redirect conversation to the pt) [not obligated to divulge personal info]
    • 5) Sexually aggressive (don't tolerate; confront) "your behavior makes me uncomfortable"
    • 6) Crying (allow expression of emotions; don't change the subject)
    • 7) Anger (deal with this emotion before going on with the interview)
    • 8) Those who threaten violence-be sure that you are safe and don't hesitate to seek assistance from others around you
    • 9) anxious
  21. What are four cross-cultural considerations
    • 1) eye-to-eye contact
    • 2) hand shaking
    • 3) touch (may or may not be acceptable to the pt)
    • 4) personal space and interview distance
  22. What are the three distance zones and their feet and when are they used?
    • 1) Social Distance: 4-12 feet, Interview range
    • 2) Personal Distance: 1.5-4 feet, Distance for most physical assessment
    • 3) Intimate Zone: 0-1.5 feet, Some physical assessment (e.g. HEENT exam)