NR509 midterm exam

NR509 midterm exam is the clinical encounter clinician-centered to patient-centered both; needs to be a balance of the clinician meeting their needs of the interaction and the patient feeling heard and create personal dimension patient-centered approach Interviewing technique empowering the patient to provide a candid and complete medical history recognizes importance of patient concerns, feelings and emotions and understands the patients personal contact of the symptoms/disease FIFE model mnemonic for patients perspective on the illness Feelings (fears and concerns about the problem) Ideas (about nature and cause of problem) Functioning (effect of illness on function) Expectations general structure of patient encounter (5 steps) initiate the encounter gather information perform the physical examination explaining and planning closing the encounter 2 frameworks that continue throughout whole clinical encounter relationship building structuring the interview what happens while initiating the encounter greet the patient and set the stage/preparation what does it mean to set the stage prepare for the interview check your appearance make sure patient is comfortable and environment is conducive to private info being shared what happens during the gathering information stage initiate information gathering history of present illness past medical history social history explore patients perspective of disease and relevant background information what happens during explaining and planning provide correct amount and type of information negotiate plan of action shared decision making when asking patient about there pronouns it may be helpful to.... share your own pronouns "in an effort to promote an inclusive and respectful environment, we use pronouns that are right for us. The pronouns I prefer are......how about you what pronouns do you prefer? the initial moments of your encounter lay the foundation for.... your ongoing relationship how to establish rapport introduce yourself, explain your role and how you will be a part of their care 3 dimensions of cultural humility 1) Self-awareness 2) Respectful communication 3) Collaborative partnerships active listening Closely listening to what the patient is communicating, connecting on an emotional state to the patient. use both verbal and nonverbal skills to encourage pt to expand on their feelings/concerns Empathetic responses capacity to identify with a patient and feel patients pain as your own and respond in a supportive manner "That must have been difficult for you." "I understand, you're worried." Non-verbal: offering a tissue to a crying patient; reaching out and gently touching a patient's hand. Therapeutic use of self: "I've had surgery before, so I can relate to what you're going through." guided questioning Helps to continue the patients story, shows sustained interest and allows clinician to adapt questioning based on patient i.e.: -moving from open ended to focused questions -using questions that elicit a graded response -asking a series of questions, ONE at a time -clarifying what the patient means -encouraging with continuers -using echoing guided questioning aka adaptive questioning nonverbal communication communication using body movements, gestures, and facial expressions rather than speech validation affirm validity of patients emotional experience "Your accident must have been terrifying. Car accidents are always unsettling because they remind us how vulnerable we are. Perhaps that explains why you still feel upset," reassurance first step is to identify and acknowledge the patients feelings Helps pt feel that the problems have been fully understood and are being addressed partnering express commitment to an ongoing relationship summarization giving a summary of pts story to communicate that you have been listening transitions inform pt when you are changing directions to prepare them for what comes next "now id like to ask some more questions about your past health" empowering the patient Empower pt to ask questions, express concerns, and probe your recommendations people first language seeing individuals as people first and not as being defined by their disorder/illness i.e.: person with diabetes not diabetic, person with substance abuse not drug user informed consent required elements discuss nature of procedure or treatment risks and benefits of the procedure or treatment reasonable alternatives risks and benefits of alternatives assessment of the patients understanding go the first four elements Protocol for delivering bad news? S-set up meeting P-perception (patients) I-invitation (of conversation/questions) K-knowledge E-empathy S-summarise and strategise how to deal with a patient who is silent remember silence can have many meanings and silence can be therapeutic possibly the patient is having difficulty controlling emotions, deciding to open up, od possibly you've offended them "you are quiet, what are you thinking?" how to deal with a patient who is talkative give pt free reign of first 5-10 minutes while listening carefully focus on what seems most important to the patient and ask questions in those areas brief summary may help you change subject yet validate any concerns "let me make sure I understand, you have brought up many concerns, I heard 2 different types of pain. lets focus on the pain...." dealing with a patient giving a confusing narrative assess why its confusing (pts style vs underlying communication issue) guide interview into psychosocial assessment how to deal with patient with altered state of cognition obtain hx from other sources (family, caregiver) while obtains info do not give out info about patient unless they are the patients healthcare proxy dealing with a patient with emotional lability pausing, gentle probing, respond with empathy, offer a tissue supportive remark "im glad you were able to express your feelings" dealing with an angry or aggressive patient stay clam do not be confrontational, acknowledge situation, make amends, validate patients feelings without agreeing to their reasons for beings upset alert security staff dealing with flirtatious pt calmly and firmly set boundaries about your relationship being professional not personal maybe get a chaperone if needed dealing with a discriminatory patient assess illness acuity of patient cultivate a therapeutic alliance with help of supervisor supportive environment from healthcare team dealing with a patient with hearing loss or deaf ask preferred method of communication use normal volume rate of talking allow lip reading utilize touchback method to determine if they heard/understood you dealing with nonadherant patient assess factors that may cause nonadherance like socioeconomic factors, cognition, cultural beliefs give informative handouts, cues, emails simplify dosing schedules/disease monitoring Format of Health History initial information chief complaint history of present illness past medical history family history personal and social history review of systems Comprehensive Health History- when to do new patient establishment-first encounter