NURS 612 Chapter 1 Notes

Chapter 1: The History and Interviewing Process

Developing a Relationship with the Patient
 You and your patient may come from very different backgrounds without any shared experiences.
 If you are to prevent misinterpretations and misperceptions, you must make every effort to sense the
world of the individual patient as that patient senses it.
o “Unique,” Originally Derived from Latin “Unus,” Meaning “One”
 We use “unique” in that sense of being the only one. Each of us is unique, incomparably
different from anyone in the past, present, or future. No relationship, then, has an exact
counterpart. Each moment is unique, different from the time before with the same patient.
 The first meeting with the patient sets the tone for a successful partnership as you inform the patient that
you really want to know all that is needed and that you will be open, flexible, and eager to deal with
questions and explanations. You can also explain the boundaries of your practice and the degree of your
availability in any situation. Trust evolves from honesty and candor.
 A primary objective is to discover the details about a patient’s concern, explore expectations for the
encounter, and display genuine interest, curiosity, and partnership.
 Identifying underlying worries, believing them, and trying to address them optimizes your ability to be
of help. You need to understand what is expected of you.
o The patient relationship
 You will, in the course of your career, have numerous relationships with patient. Never
forget that each time they are having an experience with you, it is important to them.
 Appropriate care satisfies a need that can be fully met only by a human touch, intimate conversation,
and the “laying on of hands.”
 Personal interactions and physical examination play an integral role in developing a meaningful and
therapeutic relationships with patients.
 This actual realization of relationships with patients, particularly when illness compounds vulnerability,
cannot be replaced.
 At a first meeting, you are in a position of strength and your patients are vulnerable. You may not have
similar perspectives but you need to understand the patient’s if you are to establish a meaningful
partnership. This partnership has been conceptualized as patient-centered care, identified by the Institute
of Medicine (IOM) as an important element of high-quality care
 The IOM report defined patient-centered care as “respecting and responding to patients’ wants, needs
and preferences, so that they can make choices in their care that best fit their individual circumstances”.
o You own beliefs, attitudes, and values cannot be discarded, but you do have to discipline them.
You have to be aware of your cultural beliefs, faith, and conscience so that they do not
inappropriately intrude as you discuss with patients a variety of issues.
o Patient-Centered Questions
 How would you like to be addressed?
 How are you feeling today?
 What would like for us to do today?
 What do you think is causing your symptoms?
 What is your understanding of your diagnosis? Its importance? Its need for management?
 How do you feel about your illness? Frightened? Threatened? Angry? As a wage earner?
As a family member? (Be sure, however, to allow a response without putting words in the
patient’s mouth)
 Do you believe treatment will help?
 How are you coping with your illness? Crying? Drinking more? Tranquilizers? Talking
more? Less? Changing lifestyles?
 Do you want to know all the details about your diagnosis and its effect on your future?
 How important to you is “doing everything possible”?
 How important to you is “quality of life”?

,  Have you prepared advance directives?
 Do you have people you can talk with about your illness? Where do you get your
strength?
 Is there anyone else we should contact about your illness or hospitalization? Family
members? Friends? Employer? Religious advisor? Attorney?
 Do you want or expect emotional support from the healthcare team?
 Are you troubled by financial questions about your medical care? Insurance coverage?
Tests of treatment you may not be able to afford? Timing of payment required from you?
 If you have had previous hospitalizations, does it bother you to be seen by teams of
physicians, nurses, and students on rounds?
 How private a person are you?
 Are you concerned about the confidentiality of your medical records?
 Would you prefer to talk to an older/younger, male/female healthcare provider?
 Are there medical matters you do not wish to have disclosed to others?
 Effective Communication
o Establishing a positive patient relationship depends on communication built on courtesy,
comfort, connection, and confirmation.
 Courtesy
 Knock before entering a room
 Address, first, the patient formally (e.g., Miss., Ms., Mrs., Mr.) it is all right to
shake hands
 Meet and acknowledge others in the room and establish their roles and degree of
participation
 Learn their names
 Ensure confidentiality
 Be in the room, sitting, with no effort to reach too soon for the doorknob
 If taking notes, take notes sparingly; not key words as reminders but do not let
note-taking distract from your observing and listening
 If typing in the electronic medical record, type briefly and maintain eye contact
with patient, if possible
 Respect the need for modesty
 Allow the patient time to be dressed and comfortably settled after the
examination. Follow-up discussion with the patient still ‘on the table” is often
discomforting.
 Comfort
 Ensure physical comfort for all, including yourself
 Try to have a minimum of furniture separating you and the patient
 Maintain privacy, using available curtains and shades
 Ensure a comfortable room temperature or provide a blanket – a cold room will
make a patient want to cover up
 Ensure good lighting
 Ensure necessary quiet. Turn off the television set
 Try not to overtire the patient. It is not always necessary to do it all at one visit.
 Connection
 Look at the patient; maintain good eye contact if cultural practices allow
 Watch your language. Avoid professional jargon. Do not patronize with what you
say.
 Do not dominate the discussion. Listen alertly. Let the patient order priorities if
several issues are raised
 Do not accept a previous diagnosis as a chief concern. Do not too readily follow a
predetermined path.