Week 2 - Health Assessment

What type of data is mainly collected during the health interview?

primarily subjective data, but some objective data is also gathered through nonverbal cues (appearance, posture, behavior)

What does a successful health interview allow the nurse to gather?

• patient’s feelings about their health and past medical care

• build trust and rapport

  • provide health teaching about health and illness

Why is it important to explain the interview to the patient?

to inform them about what the interview involves and to understand what the patient expects from healthcare

How should the interview be viewed by the nurse?

as a contract between the nurse and patient

What information should be explained before starting the interview?

• time and place of the interview and physical exam

• introduction of yourself and your role

• purpose of the interview

• how long it will take

• expectations for participation

• presence of others (family, students, providers)

• confidentiality and its limits

  • any cost to the patient

what are internal factors that affect the interview?

factors within the nurse that influence communication with the patient

why is awareness of internal factors important?

because verbal and nonverbal messages sent by the nurse affect the interview

what attitudes support effective interviewing?

• liking others: respecting and accepting patients unconditionally

• empathy: feeling with the patient

• being a good listener: keep the focus on the patient

• self-awareness

what is the key external factor affecting the interview?

privacy - ensure the patient is comfortable and space is used functionally

What is the intimate zone and when is it used?

0-1 ½ feet. visual distortion occurs. best for assessing breath and body odor

what is personal distance and what happens at this range?

1 ½ -4 ft. considered an extension of self (like a bubble). Voice is moderate, body odors are unapparent, no visual distortion.

• much of the physical assessment occurs here

What is social distance used for?

4-12 feet. used for impersonal business interactions.

• perceptual information is less detailed

  • much of the interview occurs at this distance

what is public distance and how does communication change?

12+ feet. interactions are impersonal.

• speaker must project voice and subtle facial expressions are hard to see

why is note-taking during interviews sometimes unavoidable?

because documentation is necessary, but it should be as specific as possible

what terms should be avoided in documentation?

avoid vague terms like normal, usual, fine, better, or worse

how can note-taking interferer with the interview?

it can act as a buffer between nurse and patient

what are disadvantages of excessive note-taking?

• breaks eye contact too often

• shifts focus away from patient

• diminishes patient’s sense of importance

• disrupts natural flow of expression

• impedes observation of nonverbal behavior

• can feel threatening during sensitive discussions (substance use, sexual history, abuse)

what is an important communication consideration when using EMRs?

maintain regular eye contact to continue building a relationship with the patient

How should the computer be positioned during the interview?

position it so the patient can see their chart and what is being entered, rather than the nurse turning away behind the computer

What should you do at the start of the interview?

introduce yourself and your role and provide the reason for the interview

Why should you review the patient’s chart before interviewing?

many healthcare providers ask the same questions, which can cause patient fustration

how many types of verbal responses are there?

9 types

what are the first five types of verbal responses?

• facilitation

• silence

• reflection

• empathy

• clarification

these focus on responding to the patient’s facts and feelings

What are the last four types of verbal response?

• confrontation

• interpretation

• explanation

• summary

these involve expressing your own thoughts and feelings

who leads the interview during the first 5 responses vs the last 4?

• first five: patient leads

• last four: nurse leads

How do interview skills improve over time?

they improve with practice

when will you practice therapeutic response more in depth?

during clinical experiences, with a strong focus in mental health next semester

what is one of the easiest interview traps to fall into?

providing false reassurance - avoid doing this

why is false reassurance important to recognize?

it is one of the easiest traps to identify and correct in future interactions

• we are not God and cannot promise everything will be okay

what is a good rule for every interviewer?

listen more than you talk

why are nonverbal skills important during the interview?

they influence how the patient feels and how information is communicated

what nonverbal behaviors should you be aware of?

• eye contact

• tone of voice

• touch

how should you close an interview?

end with an open-ended question and a quick summary to help bring closure

What does developmental competence in interviewing involve?

interacting with multiple age groups, sometimes interviewing both a parent/guardian and child, and adjusting techniques based on the child’s developmental stage

Why are Piaget’s stages important for interviewing?

they guide how to communicate with different age groups and help understand age-appropriate language and thinking

What is the sensorimotor stage?

• occurs in infancy

• infant learns by manipulating objects

• communication is reflexive at birth

• progresses through 6 stages to reach true thinking

What characterizes the preoperational stage?

• beginning use of symbolic thinking

• imaginative play

• begins to master reversibility

What defines the concrete operations stage?

• logical thinking

• mastery of numbers

• understanding classification and conservation

  • thinking is based on concrete ideas

what is the formal operations stage?

• abstract thinking

• futuristic and theoretical thinking

• takes a broader perspective

What interviewing consideration is important for infants? (birth- 12 months)

they may develop stranger anxiety later in this stage. allow caregiver to hold or stay close to the infant

what changes occur in toddlers’ communication? (12-36 months)

language beings to increase

• frequent “why, why, why” questions

How should you communicate with toddlers?

• give simple explanations

• allow simple choices when possible

How does language develop in preschoolers? (3-6 years)

language continues to develop, and grammar is well developed near the end of this stage

what is meant by preschoolers being “egocentric'“?

they see the world from their own point of view

what beliefs might preschoolers have during medical encounters?

they may believe inanimate objects can come to life and hurt them

how should you explain medical equipment to preschoolers?

use brief explanations, play, and dress-up activities to reduce fear and improve understanding

How does a school-aged child think during an interview? (7-12 years)

they become objective and realistic

what type of information can school-aged children provide?

they can give factual information, consider information, and form conclusions

why is caregiver help still important for school-aged children?

their abstract thinking is still underdeveloped, so caregiver input may be needed

why are adolescents considered a challenging age group?

they often think they are adults and may resist authority

how should healthcare providers approach adolescents?

by using communication techniques that build rapport and trust

how may the adolescent view the nurse or provider?

as “the adult”, which may reflect struggles they have with adults in their personal life

What communication strategies should be used with asolescents?

• validate the adolescent

• always give the truth with rationale

• stay professional

• keep questions short, simple, and well explained

• delay emotionally charged or high-risk behavior questions

How does Erikson’s theory relate to older adults>

they are working toward finding purpose and meaning while adjusting to the inevitability of death

What are key communication principles when interviewing older adults?

• show respect

• use proper surnames (Mr. Mrs.)

• recognize they have a long life story

• allow extra time for processing questions

• ensure you face the patient when speaking

What is the first step when communicating with a patient who has hearing impairment?

find out their preferred method of communication

how should you communicate with hard-of-hearing (HOH) patients?

• face them

• ensure hearing aids are on

• do not distort your voice

• sometimes speaking directly into the ear helps

How may communication differ for a deaf patient?

they may:

• read lips

• need an interpreter

• prefer written communication

why is subjective data sometimes limited in acutely ill patients?

because in emergencies, the patient may be unable to communicate

where can information be obtained if the acutely ill patient cannot respond?

from family members, friends, or bystanders/onlookers

how should questions be asked to an acutely ill patient who can respond?

ask short, direct questions

how does assessment change for people under the influence?

it depends on which substances were consumed

what are CNS depressants and their effects?

• example: alcohol, heroin, oxycodone

• effects: slowed judgment and impaired motor coordination

what are CNS stimulants and their effects?

• examples: cocaine, amphetamines

• effects: agitation, paranoia

how should questions be asked to patients under the influence?

use simple, direct questions

when is it best to obtain a full health history from these patients?

when the patient is sober, especially if detoxification is needed

what safety precautions should be taken with patients under the influence?

remain alert and safe; have security measures or personnel available

How should a nurse respond to sexually aggressive behavior?

clearly state that you are a professional and that the behavior is not appropriate

What may sexually aggressive behavior reflect?

it may be a response to illness, threatening the person’s self-esteem or sexual adequacy

what may crying indicate during an interview?

it may be elicited by topics discussed or emotional distress

what does anger often represent in patients?

a way of coping with stressors or disease

How should the nurse act during threats or potential violence?

remain calm and non-confrontational

what is the goal during a threatening situation?

to de-escalate and diffuse the situation if possible

what is the key principle when considering culture and gender?

understanding and respect

what does sexual orientation and gender identity encompass?

includes LGBTQ+, sexual orientation, and gender identity

What attitude should healthcare providers maintain?

• do not judge

• do not marginalize

  • show respect to all patients

what is appropriate to ask regarding gender identity?

you may ask a patient’s preferred pronouns respectfully

why is sensitivity important when asking questions in this area?

to promote trust, inclusivity, and patient comfort

Why are family members not ideal interpreters?

• confidentiality concerns

• may not fully understand medical information

  • may edit or leave out information

What interpreter characteristics should you be aware of?

possible age or gender differences that may affect comfort or communication

How common is low health literacy?

about 9 out of 10 people do not have adequate health literacy

What difficulties are associated with low health literacy?

• difficulty navigating the healthcare system

• trouble reading

• difficulty understanding numbers

  • difficulty following verbal instructions

How should oral instructions be given?

• keep it simple

• use 2 syllable words or less

What is the teach-back method?

having the patient repeat or demonstrate what they learned to confirm understanding

what reading level should written health materials be?

at about a 5th-grade reading level

What is the basic sequence of a complete health history?

• biographic data

• reason for seeking care

• present health/history of present illness

• past history

• review of systems

• functional assessment/ ADLs

What is included in biographic data?

basic identifying information such as DOB, address, and other demographic data

Why is source and reliability important?

to determine who is giving the information and whether the answers remain consistent throughout the interview

How should the reason for seeking care be recorded?

in the patient’s own words

What is the difference between a symptom and a sign?

a symptom is subjective sensation the person feels and a sign is objective abnormality detected on exam or lab

What does the health history focus on?

• present health or history

• chronological record of problems

  • use of the eight critical characteristics

What are the eight critical characteristics of a symptom?

• location

• character or quality

• quantity or severity

• timing

• setting

• aggravating or relieving factors

• associated factors

• patient’s perception

What tools helps remember the critical characteristics?

PQRSTU

What does the P stand for in PQRSTU

Provocative or palliative

• what were you doing when you first noticed it

What does Q stand for in PQRSTU?

Quality or quantity

• how does it look, feel, or sound

What does R stand for in PQRSTU

Region or radiation

• where is it, does it spend anywhere

What does S stand for in PQRSTU?

Severity

• how bad is it, pain scale 0-10

What does T stand for in PQRSTU?

Timing

• onset - when did it first occur

What does U stand for in PQRSTU?

Understanding the patient’s perception

• what do you think this problem means

What is included in past history?

• childhood illness

• accidents or injuries

• serious or chronic illnesses

• hospitalizations

• operations/surgeries

• obstetric history (pregnancies)

• immunizations

• last examination date

• allergies

• current medications