NUR246 TOPIC 1 LECTURE

Primary Health Care – Interviewing and Assessment Skills

Primary Health Care

Definition and Philosophy

  • Primary Health Care refers to:

    • A philosophy or approach to providing care that incorporates:

    • Equity

    • Access

    • Social justice

    • The social model of health

Levels of Prevention in Health Care

  1. Primary Prevention:

    • Activities aimed at preventing the onset of disease (e.g., vaccinations, health education).

  2. Secondary Prevention:

    • Early detection and treatment to prevent progression (e.g., screening tests).

  3. Tertiary Prevention:

    • Focused on managing disease and preventing complications (e.g., rehabilitation).

Contextual Areas in Primary Health Care

  • Public Health

  • Community Health

  • Intervention and Treatment

  • Rehabilitation Services

Key Terminology in Community Nursing

  • Patient vs. Client:

    • ‘Patient’ is utilized in hospital/clinical contexts.

    • ‘Client’ is primarily used in community settings.

Defining Rural and Remote Areas

  1. Rural:

    • Defined as having a medical officer and a 24-hour healthcare facility with inpatient capabilities.

  2. Remote:

    • Marked by the absence of a medical officer; typically includes health centers operational during office hours with on-call services after hours.

Challenges in Rural and Remote Healthcare

  • Distance and geographical obstructions.

  • Small or dispersed populations.

  • Poor overall health status of populations.

  • Climate and rugged environmental conditions.

  • Limited transportation and infrastructure.

  • Higher prevalence of Indigenous populations.

  • Low socioeconomic status leading to inflated prices for essential goods.

  • Seasonal fluctuations affecting service availability.

Cross-Cultural Dynamics in Rural & Remote Nursing

Demographic Characteristics

  • Higher Indigenous populations present in these areas.

  • A variety of cultural backgrounds beyond Anglo-Saxon.

  • Presence of migrant and refugee populations.

  • Diverse cultures due to the mining industry.

Rural Area Nursing

  • Nurses operate in regional centers serving wide geographic areas.

  • Health services available are limited compared to urban centers; often lacking specialist services.

  • Duties may include emergency care, rehabilitation, and primary health care, depending on available health professionals.

Remote Area Nursing

Scope of Practice

  • Determined by the absence of other healthcare professionals.

  • Reliance on telehealth services to connect with medical specialists.

  • Common services include fly-in, fly-out practices for various health services.

  • Limited inpatient facilities necessitate opening health centers during office hours, with backup services.

  • Notable example includes the Flying Doctor Service in Australia.

Services Provided

  • Trauma and emergency care

  • Advanced and extended generalist practice

  • Wellness check-ups appropriate for all age groups

  • Acute and non-urgent care throughout the lifespan

  • Detection and ongoing management of chronic diseases

  • Mental health services

  • End-of-life care

  • Implementation of public health initiatives

Characteristics of Remote and Rural Nursing

  • Lack of clear boundaries between professional and personal life due to job nature.

  • Frequent on-call demands and high exposure to traumatic incidents.

  • Employment offers considerable autonomy and flexibility.

  • Environments often require cross-cultural communication skills.

Rewards of Rural and Remote Nursing

  • Opportunity to provide impactful healthcare.

  • Integration into tightly-knit community settings.

  • Short commuting times to workplaces.

  • Engaging and challenging roles.

  • Enhanced community relationships and connections.

Interviewing and Assessment Skills

Influencing Factors

  • Physical environment of the interview setting.

  • Nurse's behavioral and interpersonal skills.

  • Types of questions framed during the interview.

  • Manner of questions posed.

  • Patient's personality and behavior traits.

  • Emotional state and current feelings of the patient during the interview.

  • Nature of the issues or information being addressed.

Nurse's Patient's Physical Setting for Interviews

  • Importance of a private, quiet, and comfortable room devoid of distractions.

  • Privacy is crucial for discussions of sensitive issues, encouraging openness and honesty.

  • Arrangement and comfort should minimise interruptions; for example, asking to turn off disruptive devices.

  • Suggested distance of 4-5 feet between nurse and patient to ensure comfort.

Note-Taking Considerations

  • While documentation is necessary, it may have drawbacks, including:

    • Disrupting eye contact.

    • Diverting attention from the patient to the paperwork.

    • Interrupting the flow of narrative.

    • Obscuring nonverbal communication from the patient.

    • Potentially intimidating to the patient during sensitive discussions.

  • Recommendation to take shorthand notes for later documentation.

Phases of the Interview

  1. Introduction Phase:

    • Prepare the patient for what to expect during the interview.

  2. Discussion Phase (Working Phase):

    • Facilitate, collect, and record health history and patient data.

    • Maintain a patient-centered approach allowing the patient to share personal concerns in their own words.

  3. Summary Phase:

    • Review and validate collected information; provides closure and allows for clarification of any misunderstood data.

Professional Nursing Behaviours

  • First impressions rest on the nurse's appearance and welcoming demeanor.

  • Essential interpersonal skills include active listening, showing interest, and conveying understanding.

  • It is crucial to communicate acceptance and build respect towards the patient.

  • Careful choice of words and attentiveness to patient interpretations is important.

  • Avoid extreme negative nonverbal reactions that might discourage patient openness.

Patient-Related Variables

  • Consideration of patient demographics, including age and their physical, mental, and emotional well-being.

  • Ensure that patients are capable of responding effectively (alert and comfortable) before extensive questioning takes place.

  • In cases of patient distress, limit inquiries and allow time before following up with additional questions.

The Art of Asking Questions

Questioning Techniques

  • Clarity and simplicity should dominate spoken questions; avoid technical jargon.

  • Definitions should be clear, unique slang usage is to be avoided unless necessary.

  • Questions should be tailored to the patient's understanding levels.

  • Encourage patients for specificity and clarification on their responses.

  • Single questions should be posed, allowing time for the patient to respond.

  • Attentiveness to the patient’s emotions can cue the nurse in on the need for more data collection.

patient'spatient'sSensitive Questioning

  • It's vital to prepare patients for sensitive inquiries by explaining the nature of the questions.

  • Employ permission-giving techniques, allowing patients to feel safe to discuss uncomfortable topics.

  • Use clarifying prompts like, "Tell me more about what you're thinking" to further explore issues.

Types of Questions Used in Assessment

  1. Open-Ended Questions:

    • Initial inquiries should encourage free-flow, descriptive responses, focusing on the patient’s health.

  2. Close-Ended Questions:

    • Gather specific data and direct responses, presenting patients with multiple choices.

  3. Directive Questions:

    • Lead a patient to a particular line of thinking, often utilized in system reviews and functional evaluations.

Techniques Enhancing Data Collection

  • Active Listening:

    • Concentrate on patient replies without preparing the next question during their responses.

    • Avoid making assumptions.

  • Facilitation:

    • Use verbal and nonverbal cues to encourage patient dialogue.

  • Clarification:

    • Invoke further information for a clearer understanding.

  • Restatement:

    • Paraphrase the patient’s comments to confirm interpretations.

  • Reflection:

    • Reinstate comments as a means to cultivate elaboration or deeper information.

  • Confrontation:

    • Tackle inconsistencies between patient reports and nurse observations sensitively.

  • Interpretation:

    • Share deductive conclusions from data to invite patient confirmations or corrections.

  • Summary:

    • Organize and condense information to reveal the series of events and highlights relevant to health issues.

Techniques That Hinder Data Collection

  • Usage of medical jargon can confuse patients, leading to misunderstood responses.

  • Value judgments can bias a patient, reducing honesty.

  • Interruptions during patient dialogue can destroy narrative flow and discourage communication.

  • An authoritarian demeanor or posing “Why” questions can render patients defensive.

““Managing Awkward Moments in Interviews

Personal Questions

  • Provide a succinct, direct answer when a patient questions your personal experiences.

  • Facilitate rapport through relatable experiences without over-disclosing.

Handling Silence

  • Recognize silence as an opportunity for patient contemplation.

  • Maintain comfort with silence for deeper issue exploration.

Addressing Emotional Displays

  • Be prepared for emotions such as crying, allowing time before further probing.

  • Address anger constructively by identifying its source and discussing feelings.

Challenges in the Interview

Managing Talkative Patients

  • Refocus overly detailed subjects back to significant present events, utilizing closed-ended questions for redirection.

Assessing Others Present

  • Clarify relationships of individuals present to ensure appropriate interviewing.

Language Barriers

  • Utilize objective interpreters who share gender alignment with the patient for data collection efficiency.

Interviewing and Assessment Quick Poll

Best Question for Culturally Safe Health Assessment:

  • C - "In order to care for you, what is important for me to know about your culture?"

““Components of the Comprehensive Health History

  1. Biographic data (initial visit).

  2. Reason for seeking care (document in patient's own words).

  3. Present health status.

  4. Past medical history.

  5. Family history.

  6. Personal and psychosocial history.

  7. Comprehensive review of all body systems.

patient'sHistory of Present Illness/Complaint

Chief Complaint or Presenting Problem

  • A succinct declaration pertaining to the purpose of the visit, ideally articulated in the patient's own words.

  • Procedures for recording multiple reasons include listing and prioritizing them based on urgencies.

  • Symptoms should detail onset, location, duration, alleviating factors, and self-treatment attempts.

patient'sInstitutional Support

  • Commitment to inclusivity for diverse gender identities and sexual orientations, including LGBTIQA+ community.

  • Prohibition of homophobia, transphobia, racism, and ableism.

  • Emphasis on the importance of addressing systemic barriers to support collective community safety and acceptance.

  • From Holly Clegg, Unit Coordinator NUR246

  • All communications should occur through LMS discussion platform.