NR509 midterm exam
is the clinical encounter clinician-centered to patient-centered
both; needs to be a balance of the clinician meeting their needs of the interaction and
the patient feeling heard and create personal dimension
patient-centered approach
Interviewing technique empowering the patient to provide a candid and complete
medical history
recognizes importance of patient concerns, feelings and emotions and understands the
patients personal contact of the symptoms/disease
FIFE model
mnemonic for patients perspective on the illness
Feelings (fears and concerns about the problem)
Ideas (about nature and cause of problem)
Functioning (effect of illness on function)
Expectations
general structure of patient encounter (5 steps)
initiate the encounter
gather information
perform the physical examination
explaining and planning
closing the encounter
2 frameworks that continue throughout whole clinical encounter
relationship building
structuring the interview
what happens while initiating the encounter
greet the patient and set the stage/preparation
what does it mean to set the stage
prepare for the interview
check your appearance
make sure patient is comfortable and environment is conducive to private info being
shared
what happens during the gathering information stage
initiate information gathering
history of present illness
past medical history
social history
explore patients perspective of disease and relevant background information
what happens during explaining and planning
,provide correct amount and type of information
negotiate plan of action
shared decision making
when asking patient about there pronouns it may be helpful to....
share your own pronouns
"in an effort to promote an inclusive and respectful environment, we use pronouns that
are right for us. The pronouns I prefer are......how about you what pronouns do you
prefer?
the initial moments of your encounter lay the foundation for....
your ongoing relationship
how to establish rapport
introduce yourself, explain your role and how you will be a part of their care
3 dimensions of cultural humility
1) Self-awareness
2) Respectful communication
3) Collaborative partnerships
active listening
Closely listening to what the patient is communicating, connecting on an emotional state
to the patient.
use both verbal and nonverbal skills to encourage pt to expand on their
feelings/concerns
Empathetic responses
capacity to identify with a patient and feel patients pain as your own and respond in a
supportive manner
"That must have been difficult for you."
"I understand, you're worried."
Non-verbal: offering a tissue to a crying patient; reaching out and gently touching a
patient's hand.
Therapeutic use of self: "I've had surgery before, so I can relate to what you're going
through."
guided questioning
Helps to continue the patients story, shows sustained interest and allows clinician to
adapt questioning based on patient i.e.:
-moving from open ended to focused questions
-using questions that elicit a graded response
-asking a series of questions, ONE at a time
-clarifying what the patient means
-encouraging with continuers
-using echoing
guided questioning aka
adaptive questioning
nonverbal communication
, communication using body movements, gestures, and facial expressions rather than
speech
validation
affirm validity of patients emotional experience
"Your accident must have been terrifying. Car accidents are always unsettling because
they remind us how vulnerable we are. Perhaps that explains why you still feel upset,"
reassurance
first step is to identify and acknowledge the patients feelings
Helps pt feel that the problems have been fully understood and are being addressed
partnering
express commitment to an ongoing relationship
summarization
giving a summary of pts story to communicate that you have been listening
transitions
inform pt when you are changing directions to prepare them for what comes next
"now id like to ask some more questions about your past health"
empowering the patient
Empower pt to ask questions, express concerns, and probe your recommendations
people first language
seeing individuals as people first and not as being defined by their disorder/illness
i.e.: person with diabetes not diabetic, person with substance abuse not drug user
informed consent required elements
discuss nature of procedure or treatment
risks and benefits of the procedure or treatment
reasonable alternatives
risks and benefits of alternatives
assessment of the patients understanding go the first four elements
Protocol for delivering bad news?
S-set up meeting
P-perception (patients)
I-invitation (of conversation/questions)
K-knowledge
E-empathy
S-summarise and strategise
how to deal with a patient who is silent
remember silence can have many meanings and silence can be therapeutic
possibly the patient is having difficulty controlling emotions, deciding to open up, od
possibly you've offended them
"you are quiet, what are you thinking?"
how to deal with a patient who is talkative
is the clinical encounter clinician-centered to patient-centered
both; needs to be a balance of the clinician meeting their needs of the interaction and
the patient feeling heard and create personal dimension
patient-centered approach
Interviewing technique empowering the patient to provide a candid and complete
medical history
recognizes importance of patient concerns, feelings and emotions and understands the
patients personal contact of the symptoms/disease
FIFE model
mnemonic for patients perspective on the illness
Feelings (fears and concerns about the problem)
Ideas (about nature and cause of problem)
Functioning (effect of illness on function)
Expectations
general structure of patient encounter (5 steps)
initiate the encounter
gather information
perform the physical examination
explaining and planning
closing the encounter
2 frameworks that continue throughout whole clinical encounter
relationship building
structuring the interview
what happens while initiating the encounter
greet the patient and set the stage/preparation
what does it mean to set the stage
prepare for the interview
check your appearance
make sure patient is comfortable and environment is conducive to private info being
shared
what happens during the gathering information stage
initiate information gathering
history of present illness
past medical history
social history
explore patients perspective of disease and relevant background information
what happens during explaining and planning
,provide correct amount and type of information
negotiate plan of action
shared decision making
when asking patient about there pronouns it may be helpful to....
share your own pronouns
"in an effort to promote an inclusive and respectful environment, we use pronouns that
are right for us. The pronouns I prefer are......how about you what pronouns do you
prefer?
the initial moments of your encounter lay the foundation for....
your ongoing relationship
how to establish rapport
introduce yourself, explain your role and how you will be a part of their care
3 dimensions of cultural humility
1) Self-awareness
2) Respectful communication
3) Collaborative partnerships
active listening
Closely listening to what the patient is communicating, connecting on an emotional state
to the patient.
use both verbal and nonverbal skills to encourage pt to expand on their
feelings/concerns
Empathetic responses
capacity to identify with a patient and feel patients pain as your own and respond in a
supportive manner
"That must have been difficult for you."
"I understand, you're worried."
Non-verbal: offering a tissue to a crying patient; reaching out and gently touching a
patient's hand.
Therapeutic use of self: "I've had surgery before, so I can relate to what you're going
through."
guided questioning
Helps to continue the patients story, shows sustained interest and allows clinician to
adapt questioning based on patient i.e.:
-moving from open ended to focused questions
-using questions that elicit a graded response
-asking a series of questions, ONE at a time
-clarifying what the patient means
-encouraging with continuers
-using echoing
guided questioning aka
adaptive questioning
nonverbal communication
, communication using body movements, gestures, and facial expressions rather than
speech
validation
affirm validity of patients emotional experience
"Your accident must have been terrifying. Car accidents are always unsettling because
they remind us how vulnerable we are. Perhaps that explains why you still feel upset,"
reassurance
first step is to identify and acknowledge the patients feelings
Helps pt feel that the problems have been fully understood and are being addressed
partnering
express commitment to an ongoing relationship
summarization
giving a summary of pts story to communicate that you have been listening
transitions
inform pt when you are changing directions to prepare them for what comes next
"now id like to ask some more questions about your past health"
empowering the patient
Empower pt to ask questions, express concerns, and probe your recommendations
people first language
seeing individuals as people first and not as being defined by their disorder/illness
i.e.: person with diabetes not diabetic, person with substance abuse not drug user
informed consent required elements
discuss nature of procedure or treatment
risks and benefits of the procedure or treatment
reasonable alternatives
risks and benefits of alternatives
assessment of the patients understanding go the first four elements
Protocol for delivering bad news?
S-set up meeting
P-perception (patients)
I-invitation (of conversation/questions)
K-knowledge
E-empathy
S-summarise and strategise
how to deal with a patient who is silent
remember silence can have many meanings and silence can be therapeutic
possibly the patient is having difficulty controlling emotions, deciding to open up, od
possibly you've offended them
"you are quiet, what are you thinking?"
how to deal with a patient who is talkative
