NR 509 Midterm Study Guide
Week 3
Ch. 1
● Basic and Advanced Interviewing Techniques
Basic Interviewing Techniques
● Active listening: Active listening means closely attending to what the
patient is communicating, connecting to the patient's emotional state, and
using verbal and nonverbal skills to encourage the patient to expand on
his or her feelings and concerns.
● Empathic responses: Empathy has been described as the capacity to
identify with the patient and feel the patient's pain as your own, then
respond in a supportive manner.
● Guided questioning: Guided questions show your sustained interest in
the patient's feelings and deepest disclosures and allows the interviewer
to facilitate full communication, in the patient's own words, without
interruption.
● Nonverbal communication: Nonverbal communication includes eye
contact, facial expression, posture, head position and movement such as
shaking or nodding, interpersonal distance, and placement of the arms or
legs—crossed, neutral, or open.
● Validation: Validation helps to affirm the legitimacy of the patient's
emotional experience.
● Reassurance: Reassurance is an appropriate way to help the patient feel
that problems have been fully understood and are being addressed.
● Partnering: When building rapport with patients, express your
commitment to an ongoing relationship.
● Summarization: Giving a capsule summary of the patient's story during
the course of the interview to communicate that you have been listening
carefully.
● Transitions: Inform your patient when you are changing directions during
the interview.
● Empowering the patient: Empower patients to ask questions, express
their concerns, and probe your recommendations in order to encourage
them to adopt your advice, make lifestyle changes, or take medications as
prescribed.
Advanced Interview Techniques
, 2
○ Determine scope of assessment: Focused vs. Comprehensive:
■ Comprehensive: Used patients you are seeing for the first
time in the office or hospital. Includes all the elements of
the health history and complete physical examination.
● Is appropriate for new patients in the office or
hospital
● Provides fundamental and personalized knowledge
about the patient
● Strengthens the clinician–patient relationship
● Helps identify or rule out physical causes related to
patient concerns
● Provides a baseline for future assessments
● Creates a platform for health promotion through
education and counseling
● Develops proficiency in the essential skills of physical
examination
■ Focused: For patients you know well returning for routine
care, or those with specific “urgent care” concerns like sore
throat or knee pain. You will adjust the scope of your
history and physical examination to the situation at hand,
keeping several factors in mind: the magnitude and severity
of the patient’s prob- lems; the need for thoroughness; the
clinical setting—inpatient or outpatient, primary or
subspecialty care; and the time available.
● Is appropriate for established patients, especially
during routine or urgent care visits
● Addresses focused concerns or symptoms
● Assesses symptoms restricted to a specific body
system
● Applies examination methods relevant to assessing
the concern or problem as thoroughly and carefully as
possible
○ Being aware of your reactions helps develop your clinical skills.
○ Your success in eliciting the history from different types of patients
grows with experience, but take into account your own stressors,
such as fatigue, mood, and overwork.
○ Self-care is also important in caring for others. Even if a patient is
challenging, always remember the importance of listening to the
patient and clarifying his or her concerns.
● Components of the Health History
● Initial information
■ Date and time of history-time is especially important in emergent
, 3
situations
■ Identifying data-age, gender, marital status, occupation-identify
source of history ie: family member, friend etc.
■ Reliability-usually documented at end of interview ie: “patient is
vague when describing symptoms”.
○ Chief Complaint(s)
■ Try to quote the patients words
○ Present Illness
■ Complete, clear and chronological description of the problem
prompting the patient visit
■ Onset, setting in which it occurred, manifestations and any treatments
■ Should include 7 attributes of a symptom:
● Location
● Quality
● Quantity or severity
● Timing, onset, duration, frequency
● Setting in which it occurs
● Aggravating or relieving factors
● Associated manifestations
Differential diagnosis is derived from the “pertinent positives” and “pertinent negatives”
when doing Review of Systems that are relevant to the chief complaint.
Present illness should reveal patient’s responses to his or her symptoms and what effect this
has on their life.
Each symptom needs its own paragraph and a full description.
Medication should be documented, name, dose, route, and frequency. Home remedies, non-
prescriptions drugs, vitamins, mineral or herbal supplements, oral contraceptives, or
borrowed medications.
Allergies-foods, insects, or environmental, including specific reaction
Tobacco use, including the type. If someone has quit, note for how long
Alcohol and drug use should always be investigated and is often pertinent to the Presenting
Illness.
○ Past history
■ Childhood Illness: measles, rubella, mumps, whooping cough,
, 4
chickenpox, rheumatic fever, scarlet fever, and polio. Also include any
chronic childhood illness
■ Adult illnesses: Provide information in each of the 4 areas:
● Medical: diabetes, hypertension, hepatitis, asthma and HIV;
hospitaliations; number and gender of sexual partners; and
risk taking sexual practices.
● Surgical: dates, indications, and types of operations
● Obstetric/gynecologic: Obstetric history, menstrual history,
methods of contraception, and sexual function.
● Psychiatric: Illness and time frame, diagnoses, hospitalizations,
and treatments.
Health Maintenance: Find out if they are up to date on immunizations
and screening tests.
○ Family history
■ Outlines or diagrams age and health, or age and cause of
death, of siblings, parents, and grandparents
■ Documents presence or absence of specific illnesses in
family, such as hypertension, coronary artery disease,
elevated cholesterol levels, stroke, diabetes, thyroid or
renal disease, arthritis, tuberculosis, asthma or lung
disease, headache, seizure disorder, mental illness, suicide,
substance abuse, and allergies, and symtoms reported by
patient.
■ Ask about history of breast, ovarian, colon, or prostate
cancer
■ Ask about Genetically transmitted diseases
Personal or social history
■ Describes educational level, occupation, family of origin,
current household, personal interests, and lifestyle
■ Capture the patients personality and interests, sources of
support, coping style, strengths, and concerns
■ Includes lifestyle habits that promote health or create risk,
such as exercise and diet, safety measures, sexual
practices, and use of alcohol, drugs, and tobacco
■ Expanded personal and social history personalizes your
relationship with the patient and builds a rapport
○ Review of systems
Week 3
Ch. 1
● Basic and Advanced Interviewing Techniques
Basic Interviewing Techniques
● Active listening: Active listening means closely attending to what the
patient is communicating, connecting to the patient's emotional state, and
using verbal and nonverbal skills to encourage the patient to expand on
his or her feelings and concerns.
● Empathic responses: Empathy has been described as the capacity to
identify with the patient and feel the patient's pain as your own, then
respond in a supportive manner.
● Guided questioning: Guided questions show your sustained interest in
the patient's feelings and deepest disclosures and allows the interviewer
to facilitate full communication, in the patient's own words, without
interruption.
● Nonverbal communication: Nonverbal communication includes eye
contact, facial expression, posture, head position and movement such as
shaking or nodding, interpersonal distance, and placement of the arms or
legs—crossed, neutral, or open.
● Validation: Validation helps to affirm the legitimacy of the patient's
emotional experience.
● Reassurance: Reassurance is an appropriate way to help the patient feel
that problems have been fully understood and are being addressed.
● Partnering: When building rapport with patients, express your
commitment to an ongoing relationship.
● Summarization: Giving a capsule summary of the patient's story during
the course of the interview to communicate that you have been listening
carefully.
● Transitions: Inform your patient when you are changing directions during
the interview.
● Empowering the patient: Empower patients to ask questions, express
their concerns, and probe your recommendations in order to encourage
them to adopt your advice, make lifestyle changes, or take medications as
prescribed.
Advanced Interview Techniques
, 2
○ Determine scope of assessment: Focused vs. Comprehensive:
■ Comprehensive: Used patients you are seeing for the first
time in the office or hospital. Includes all the elements of
the health history and complete physical examination.
● Is appropriate for new patients in the office or
hospital
● Provides fundamental and personalized knowledge
about the patient
● Strengthens the clinician–patient relationship
● Helps identify or rule out physical causes related to
patient concerns
● Provides a baseline for future assessments
● Creates a platform for health promotion through
education and counseling
● Develops proficiency in the essential skills of physical
examination
■ Focused: For patients you know well returning for routine
care, or those with specific “urgent care” concerns like sore
throat or knee pain. You will adjust the scope of your
history and physical examination to the situation at hand,
keeping several factors in mind: the magnitude and severity
of the patient’s prob- lems; the need for thoroughness; the
clinical setting—inpatient or outpatient, primary or
subspecialty care; and the time available.
● Is appropriate for established patients, especially
during routine or urgent care visits
● Addresses focused concerns or symptoms
● Assesses symptoms restricted to a specific body
system
● Applies examination methods relevant to assessing
the concern or problem as thoroughly and carefully as
possible
○ Being aware of your reactions helps develop your clinical skills.
○ Your success in eliciting the history from different types of patients
grows with experience, but take into account your own stressors,
such as fatigue, mood, and overwork.
○ Self-care is also important in caring for others. Even if a patient is
challenging, always remember the importance of listening to the
patient and clarifying his or her concerns.
● Components of the Health History
● Initial information
■ Date and time of history-time is especially important in emergent
, 3
situations
■ Identifying data-age, gender, marital status, occupation-identify
source of history ie: family member, friend etc.
■ Reliability-usually documented at end of interview ie: “patient is
vague when describing symptoms”.
○ Chief Complaint(s)
■ Try to quote the patients words
○ Present Illness
■ Complete, clear and chronological description of the problem
prompting the patient visit
■ Onset, setting in which it occurred, manifestations and any treatments
■ Should include 7 attributes of a symptom:
● Location
● Quality
● Quantity or severity
● Timing, onset, duration, frequency
● Setting in which it occurs
● Aggravating or relieving factors
● Associated manifestations
Differential diagnosis is derived from the “pertinent positives” and “pertinent negatives”
when doing Review of Systems that are relevant to the chief complaint.
Present illness should reveal patient’s responses to his or her symptoms and what effect this
has on their life.
Each symptom needs its own paragraph and a full description.
Medication should be documented, name, dose, route, and frequency. Home remedies, non-
prescriptions drugs, vitamins, mineral or herbal supplements, oral contraceptives, or
borrowed medications.
Allergies-foods, insects, or environmental, including specific reaction
Tobacco use, including the type. If someone has quit, note for how long
Alcohol and drug use should always be investigated and is often pertinent to the Presenting
Illness.
○ Past history
■ Childhood Illness: measles, rubella, mumps, whooping cough,
, 4
chickenpox, rheumatic fever, scarlet fever, and polio. Also include any
chronic childhood illness
■ Adult illnesses: Provide information in each of the 4 areas:
● Medical: diabetes, hypertension, hepatitis, asthma and HIV;
hospitaliations; number and gender of sexual partners; and
risk taking sexual practices.
● Surgical: dates, indications, and types of operations
● Obstetric/gynecologic: Obstetric history, menstrual history,
methods of contraception, and sexual function.
● Psychiatric: Illness and time frame, diagnoses, hospitalizations,
and treatments.
Health Maintenance: Find out if they are up to date on immunizations
and screening tests.
○ Family history
■ Outlines or diagrams age and health, or age and cause of
death, of siblings, parents, and grandparents
■ Documents presence or absence of specific illnesses in
family, such as hypertension, coronary artery disease,
elevated cholesterol levels, stroke, diabetes, thyroid or
renal disease, arthritis, tuberculosis, asthma or lung
disease, headache, seizure disorder, mental illness, suicide,
substance abuse, and allergies, and symtoms reported by
patient.
■ Ask about history of breast, ovarian, colon, or prostate
cancer
■ Ask about Genetically transmitted diseases
Personal or social history
■ Describes educational level, occupation, family of origin,
current household, personal interests, and lifestyle
■ Capture the patients personality and interests, sources of
support, coping style, strengths, and concerns
■ Includes lifestyle habits that promote health or create risk,
such as exercise and diet, safety measures, sexual
practices, and use of alcohol, drugs, and tobacco
■ Expanded personal and social history personalizes your
relationship with the patient and builds a rapport
○ Review of systems
