NR 509 Midterm Study Guide Week 3 (Preview)

Ch. 1

  • Basic and Advanced Interviewing Techniques

Basic Interviewing Techniques

  • Active listening: Active listening means closely attending to what the patient is communicating, connecting to the patient’s emotional state, and using verbal and nonverbal skills to encourage the patient to expand on his or her feelings and concerns.
  • Empathic responses: Empathy has been described as the capacity to identify with the patient and feel the patient’s pain as your own, then respond in a supportive manner.
  • Guided questioning: Guided questions show your sustained interest in the patient’s feelings and deepest disclosures and allows the interviewer to facilitate full communication, in the patient’s own words, without interruption.
  • Nonverbal communication: Nonverbal communication includes eye contact, facial expression, posture, head position and movement such as shaking or nodding, interpersonal distance, and placement of the arms or legs—crossed, neutral, or open.
  • Validation: Validation helps to affirm the legitimacy of the patient’s emotional experience.
  • Reassurance: Reassurance is an appropriate way to help the patient feel that problems have been fully understood and are being addressed.
  • Partnering: When building rapport with patients, express your commitment to an ongoing relationship.
  • Summarization: Giving a capsule summary of the patient’s story during the course of the interview to communicate that you have been listening carefully.
  • Transitions: Inform your patient when you are changing directions during the interview.
  • Empowering the patient: Empower patients to ask questions, express their concerns, and probe your recommendations in order to encourage them to adopt your advice, make lifestyle changes, or take medications as prescribed.

Advanced Interview Techniques

  • Determine scope of assessment: Focused vs. Comprehensive:
    • Comprehensive: Used patients you are seeing for the first time in the office or hospital. Includes all the elements of the health history and complete physical examination.
      • Is appropriate for new patients in the office or hospital
      • Provides fundamental and personalized knowledge about the patient
      • Strengthens the clinician–patient relationship
      •  Helps identify or rule out physical causes related to patient concerns
      • Provides a baseline for future assessments
      • Creates a platform for health promotion through education and counseling
      • Develops proficiency in the essential skills of physical examination
    • Focused: For patients you know well returning for routine care, or those with specific “urgent care” concerns like sore throat or knee pain. You will adjust the scope of your history and physical examination to the situation at hand, keeping several factors in mind: the magnitude and severity of the patient’s prob- lems; the need for thoroughness; the clinical setting—inpatient or outpatient, primary or subspecialty care; and the time available.
      • Is appropriate for established patients, especially during routine or urgent care visits
      • Addresses focused concerns or symptoms
      • Assesses symptoms restricted to a specific body system
      • Applies examination methods relevant to assessing the concern or problem as thoroughly and carefully as possible
    • Being aware of your reactions helps develop your clinical skills.
    • Your success in eliciting the history from different types of patients grows with experience, but take into account your own stressors, such as fatigue, mood, and overwork.
    • Self-care is also important in caring for others. Even if a patient is challenging, always remember the importance of listening to the patient and clarifying his or her concerns.
  • Adaptive Questioning ( pg. 69-71)
  • Adaptive questioning also known as guided questioning
  • Techniques of Guided Questioning
  • ●Moving from open-ended to focused questions
  • Using questioning that elicits a graded response
  • ●Asking a series of questions, one at a time
  •  ●Offering multiple choices for answers ●Clarifying what the patient means
  •  ●Encouraging with continuers
  •  ●Using echoing

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