Intro & Interviewing

• 1. Biomedical "Medical" Model:
• Focus is the diagnosis & tx of disease.
• Assessment factors (signs & sx of disease)

• 2. Holistic Models (e.g., Nursing):
• Expanded focus: views the body, mind & spirit as interdependent & functioning as a whole within the environment.
• Individuals are considered active participants in their health care.
• Assessment factors (expanded to include culture & values, family & social roles, self care behaviors, environmental stress, developmental tasks, etc.)

• 1. Primary Prevention (promote optimum health prior to the onset of problems) - healthy diet, exercise, immunization, etc.
• 2. Secondary Prevention (early identification & tx of existing health problems) - PAP smear, mammogram, PPD, etc.
• 3. Tertiary Prevention (rehabilitation & restoration of health) cardiac rehab, etc. (Least desirable of all preventions)

• Collection of subjective and objective data
• Starts with the first pt contact.
• Forms the data base (the foundation for making a diagnosis)

• Subjective (statements by pt about their health) = symptoms
• Objective (observations, what you observe) = signs
• Inspection, Palpation, Percussion, Auscultation, Laboratory & diagnostic test results, Pt's medical records.

Assessment, Diagnosis, Outcomes Identification, Planning, Implementation, Evaluation

• MD - Treats problem or disease; diagnose disease
• MD - Treats the pt's response to disease/health problem

• Assessment Data:
• Subjective - "I have shortness of breath (SOB)
• Obj - Wheezing

• MD = asthma
• Plan - prescribe drug therapy
• ND = impaired gas exchange (pt's response to illness)
• Plan - Teach methods to improve gas exchange (e.g., smoking cessation, proper use of medications, etc.). Monitor pt's response to tx

• 1. Complete (health hx & pe) - 1st appointment in primary care, hospital admission
• 2. Episodic (mini data base concerning one problem) - acute illness (common cold)
• 3. Follow-up (to assess progress) - getting better or worse; data collected os focused & limited
• 4. Emergency (rapid & focused data collection) - rule in or out life threatening disorders quickly. The type to data collected may quickly increase/decrease the level of suspicion for a certain type of problem.

• 1. Allows for collection of subjective data
• 2. Assists the pt in identifying areas of concern & perceptions of health status
• 3. Identifies person's problems & strengths
• 4. Establishes rapport & trust for an ongoing working relationship
• 5. Provides a comfortable bridge to the pe
• 6. Provides an opportunity for education

• 1. Purpose (clarify) - Why are you here?
• 2. Time (set time limits in the beginning)
• 3. Presence of others (other care givers, family, friends, translator, etc.) - affects communication (+ or -)
• May be unalbe to speak freely about issues (abuse, sexual problems, etc.)
• May help w/info acquisitoin
• Interpreter e.g. violates confidentiality; risk of misinterpretation
• 4. Confidentiality (or limit of): Avoid conversations in public places; Don't discuss pt's w/friends/family; Don't refer to pt by name; Builds pt trust/decreases litigation

• Verbal - tone, words, speed, vocalizations, what your don't say
• Nonverbal - posture, gestures, facil expression, eye contact, body position, location in the room; sometimes conveys more than verbal (Smile)

Communication is a two-way street: The emotional impact of illness can affect interpretation of messages; may not be able to process info; pt teaching may have min impact in hospital setting (best to give written instructions)

• 1. Internal Factors:
• Acceptance of others (respect for pt's healthcare decisions): Tolerant for weaknesses, Convey warmth, caring & acceptance
• Empathy
• Active listening

• 2. External Factors:
• Environment: Attempt to achieve a comfortable setting, Control interruptions, Sit 4-5 ft from pt & slightly to the side (allows pt to avoid eye contact if desired by looking straight ahead), Avoid standing (implies haste & superiority)
• Professional Dress
• Ensure physical or psychological privacy (private room or pull curtain)

• Impedes eye contact
• Attention shifting
• Interrupts pt's narrative flow
• Impedes observation of nonverbal behavior
• Can be threatening

• Introduction - always intro yourself & your title; explain your role
• Address pt by surname (Mr, Mrs, Ms) - unless permission given to use 1st name

• Open ended quest:
• Requires narrative response
• Used to begin interview
• Allows for description, leads to more info

• Closed end quest:
• requires 1-2 word answers or yes/no responses
• Used to fill in omitted info or to get specific facts
• Ask only one quest at a time

• 1. Facilitation (encourages pt to say more) - "uh huh" or "go on"
• 2. Silence (gives the pt time to think , helps him/her focus)
• 3. Reflection (echoes the response; helps pt elaborate)
• 4. Empathy (show understanding & acceptance)
• 5. Clarification (describe what you mean by upset stomach?)
• 6. Confrontation (use this technique if the hx is inconsistent)
• 7. Interpretation (links events & associations; your impression of what pt has said)
• 8. Explanation (providing objective info)
• 9. Summary (final review of what pt has said; surveys what we perceive the health prob/concerns to be)

• 1. Providing false assurance - may lead to disappointment & lack of trust
• 2. Giving Advise
• 3. Using Authority
• 4. Avoiding Difficult Topics
• 5. Engaging in distancing
• 6. Using professional jargon
• 7. Using leading or biased questions
• 8. Talking too much
• 9. Interrupting
• 10. Asking "Why" questions

• 1. Physical appearance - ill, well, student/professional, well groomed/poor hygiene, etc)
• 2. Posture - relaxed/tensed
• 3. Gestures - agreement, anger, pain
• 4. Facial expression
• 5. Eye-contact
• 6. Voice
• 7. Touch

• 1. Hearing Impaired
• 2. Acutely ill
• 3. Substance abuse - may need to wait for them to sober up
• 4. Personal questions - redirect conversation to the pt
• 5. Sexually aggressive
• 6. Crying - allow expression of emotions
• 7. Anger - deal w/this emotion before going on w/interview
• 8. Those who threaten violence - be sure that you are safe and don't hesitate to seek assistance
• 9. Anxious

• The interview tks longer - has a long story to tell
• Tks longer to answer

• 1. Eye-to-eye contact
• 2. Hand shaking
• 3. Touch - may or may not be acceptable to pt
• 4. Personal space & interview distance

• 4 - 12 ft Social distance Interview range
• 1.5 - 4 ft Personal distance Dist for most pe
• 0 - 1.5 ft Intimate zone Some physical assessment