aNR 509 Midterm Study Guide
General Study Tips and Recommendations
o Topics and content on guides are intended to focus student attention when reading/studying and
some topics may be repeated in multiple chapters.
o Multiple test items are derived from the same topic areas to encourage deeper comprehension.
o Students must have a broad understanding of content and not simply memorize passages in
textbooks or articles.
o Information in red letters in the chapters as well as tables and appendices at the end of the
chapters may include test items.
o Exam questions represent various levels of cognitive learning. You are expected to analyze,
synthesis, and evaluate patient scenarios in order to answer the questions.
o Read all of the answers BEFORE reading the stem of the question. This will help you focus on the
key content and not get distracted by extraneous information.
o Be familiar with “Techniques of Examination” and “Recording Your Findings” for all body
system chapters in the textbook.
Chapter 1 Approach to the Clinical Encounter
The interviewing process
o Stage 1: initiating the encounter
Set the stage, adjust the environment, review the clinical record, set your
agenda, greet patient and establish raport, ID patient title/pronouns,
o Stage 2: Gathering information
Initiate info gathering- “chief complaint”, establish agenda for encounter
(begin with open ended questions), invite patients story (“tell me more
about…”), gather info about pts perspective of illness (FIFE), idenfity and
respond to emotional cues (illness accompanied by emotional distress-
30-40% pts have anxiety and depression in primary care practices),
gather info by exploring the biomedical perspective, gather background
info and context
o Stage 3: Performing the physical examination
o Stage 4: Explaining and planning - asses and respond to the patients need for
information – establish shared understanding
Verify patient understanding
Negotiated the plan of action with shared decision making
o Stage 5: closing the encounter-
Allow time for final questions
Follow-up plans
Taking time for self-reflection
Interviewing techniques
o Gather info about patients understanding of illness
FIFE
Feelings, ideas, effect on function, experience
o Respond to emotional cues
Name: “That sounds like a scary experience”
Understand or legitimize: “It’s understandable that you feel that way”
Respect: “You’ve done better than most people would with this”
Support: “I will continue to work with you on this”
Explore: “How else were you feeling about it?”
, o Gather information by exploring the biomedical perspective
Health history format
o Gather important background information and context
Medical, family, and personal/social history
Setting the stage for the examination
o Set the stage, adjust the environment, review the clinical record, set your
agenda(balance patient centered goals and provider goals), greet patient and
establish rapport, identify patient name and gender pronoun
o
Establishing rapport
o Patient clinician relationship is crucial in the beginning stages so the clinical
encounter can be pursued in an optimal manner
o Initial moments lay foundation of relationship,-introduce self, explain role, and
involvement in care
Gender pronouns
o Let the patient dictate how they want to be addressed.
o Ask all patients preferred name and gender pronouns
Patient-centered medical care
o Recognize the importance of patient expressions of personal concerns, feelings,
and emotions. Evokes personal context of pts symptoms and disease. Follows
the patients lead to understanding their perspective vs the clinicians perspective
The FIFE model
o Mnemonic for pts perspective on the illness
Feelings, Ideas, effect on Function, and Expectations
This combo of concerns and expectations influence pts decision to seek
help from clinician
· Clinician centered-condition takes charge of a reaction to meet his or her own
need to acquire the symptoms, their details, and other data that will help identify
the disease. Emphasizes features of disease
· Disease/illness distinction model-uses the disease to organize symptoms that
lead to the diagnosis. Illness is the construct that explains how the patient
experiences the disease
, · Patient may withhold true concerns in 75% of visits/while giving emotional
/nonverbal/ indirect cues
o -use NURSE to respond to emotional cues
-Name: (“that sounds like a scary experience”), Understand or
legitimize, Respect (“You’ve done better than most people would
with this”), Support, Explore
· Explaining and planning: provide useful info and very pt understanding (teach
back method), negotiate the plan of action through shared decision making
(Three step process: introducing choices and describing options using pt
decision support tools, exploring pt preferences, moving to a decision, checking
the pt is ready to make a decision and offering more time if needed)’
· Social determinants of health include: economic stability, neighborhood and
build environment, healthcare and health, education, social and community
context
· Elements of decisional capacity: patients must have the ability to understand
the relevant information about proposed diagnostic tests or treatments,
appreciate their situation including underlying values and current clinical
situation, use reason to make a decision, and communicate their choice
Chapter 2 Interviewing, Communication, and Interpersonal Skills
Fundamentals of skilled interviewing
o Active or attentive listening
o Guided questioning
o Empathic responses
o Summarization
o Transitions
o Partnering
o Validation
o Empowering the patient
o Reassurance
Verbal and nonverbal communication
o Verbal
Use understandable language
Ask/tell me 3: encourages pt to ask clinician or clinician to ask pt “what is
my main problem?; what do I need to do?, Why is it important for me to
do this?”
Teach back is a test of how well you explained things to the pt in a
manner they can understand, NOT a test of pts knowledge
Use nonstigmatizing language \
Use people first language “a person with..”
o Nonverbal
Body orientation/gaze
Head nodding with facial animation/gestures
Posture
Tone and sue of voice/silence
Touch
Challenging patient situations and behaviors
General Study Tips and Recommendations
o Topics and content on guides are intended to focus student attention when reading/studying and
some topics may be repeated in multiple chapters.
o Multiple test items are derived from the same topic areas to encourage deeper comprehension.
o Students must have a broad understanding of content and not simply memorize passages in
textbooks or articles.
o Information in red letters in the chapters as well as tables and appendices at the end of the
chapters may include test items.
o Exam questions represent various levels of cognitive learning. You are expected to analyze,
synthesis, and evaluate patient scenarios in order to answer the questions.
o Read all of the answers BEFORE reading the stem of the question. This will help you focus on the
key content and not get distracted by extraneous information.
o Be familiar with “Techniques of Examination” and “Recording Your Findings” for all body
system chapters in the textbook.
Chapter 1 Approach to the Clinical Encounter
The interviewing process
o Stage 1: initiating the encounter
Set the stage, adjust the environment, review the clinical record, set your
agenda, greet patient and establish raport, ID patient title/pronouns,
o Stage 2: Gathering information
Initiate info gathering- “chief complaint”, establish agenda for encounter
(begin with open ended questions), invite patients story (“tell me more
about…”), gather info about pts perspective of illness (FIFE), idenfity and
respond to emotional cues (illness accompanied by emotional distress-
30-40% pts have anxiety and depression in primary care practices),
gather info by exploring the biomedical perspective, gather background
info and context
o Stage 3: Performing the physical examination
o Stage 4: Explaining and planning - asses and respond to the patients need for
information – establish shared understanding
Verify patient understanding
Negotiated the plan of action with shared decision making
o Stage 5: closing the encounter-
Allow time for final questions
Follow-up plans
Taking time for self-reflection
Interviewing techniques
o Gather info about patients understanding of illness
FIFE
Feelings, ideas, effect on function, experience
o Respond to emotional cues
Name: “That sounds like a scary experience”
Understand or legitimize: “It’s understandable that you feel that way”
Respect: “You’ve done better than most people would with this”
Support: “I will continue to work with you on this”
Explore: “How else were you feeling about it?”
, o Gather information by exploring the biomedical perspective
Health history format
o Gather important background information and context
Medical, family, and personal/social history
Setting the stage for the examination
o Set the stage, adjust the environment, review the clinical record, set your
agenda(balance patient centered goals and provider goals), greet patient and
establish rapport, identify patient name and gender pronoun
o
Establishing rapport
o Patient clinician relationship is crucial in the beginning stages so the clinical
encounter can be pursued in an optimal manner
o Initial moments lay foundation of relationship,-introduce self, explain role, and
involvement in care
Gender pronouns
o Let the patient dictate how they want to be addressed.
o Ask all patients preferred name and gender pronouns
Patient-centered medical care
o Recognize the importance of patient expressions of personal concerns, feelings,
and emotions. Evokes personal context of pts symptoms and disease. Follows
the patients lead to understanding their perspective vs the clinicians perspective
The FIFE model
o Mnemonic for pts perspective on the illness
Feelings, Ideas, effect on Function, and Expectations
This combo of concerns and expectations influence pts decision to seek
help from clinician
· Clinician centered-condition takes charge of a reaction to meet his or her own
need to acquire the symptoms, their details, and other data that will help identify
the disease. Emphasizes features of disease
· Disease/illness distinction model-uses the disease to organize symptoms that
lead to the diagnosis. Illness is the construct that explains how the patient
experiences the disease
, · Patient may withhold true concerns in 75% of visits/while giving emotional
/nonverbal/ indirect cues
o -use NURSE to respond to emotional cues
-Name: (“that sounds like a scary experience”), Understand or
legitimize, Respect (“You’ve done better than most people would
with this”), Support, Explore
· Explaining and planning: provide useful info and very pt understanding (teach
back method), negotiate the plan of action through shared decision making
(Three step process: introducing choices and describing options using pt
decision support tools, exploring pt preferences, moving to a decision, checking
the pt is ready to make a decision and offering more time if needed)’
· Social determinants of health include: economic stability, neighborhood and
build environment, healthcare and health, education, social and community
context
· Elements of decisional capacity: patients must have the ability to understand
the relevant information about proposed diagnostic tests or treatments,
appreciate their situation including underlying values and current clinical
situation, use reason to make a decision, and communicate their choice
Chapter 2 Interviewing, Communication, and Interpersonal Skills
Fundamentals of skilled interviewing
o Active or attentive listening
o Guided questioning
o Empathic responses
o Summarization
o Transitions
o Partnering
o Validation
o Empowering the patient
o Reassurance
Verbal and nonverbal communication
o Verbal
Use understandable language
Ask/tell me 3: encourages pt to ask clinician or clinician to ask pt “what is
my main problem?; what do I need to do?, Why is it important for me to
do this?”
Teach back is a test of how well you explained things to the pt in a
manner they can understand, NOT a test of pts knowledge
Use nonstigmatizing language \
Use people first language “a person with..”
o Nonverbal
Body orientation/gaze
Head nodding with facial animation/gestures
Posture
Tone and sue of voice/silence
Touch
Challenging patient situations and behaviors
