Istinye University: Health Story Collection

• Istinye University was established in 2015 by the 21st Century Anadolu Foundation
• It is associated with the MLPCare Group which includes "Liv Hospital”, “Medical Park " and "VM Medical Park" hospitals
• The goal is to be among the prominent universities in both Turkey and the world, by creating new information through education and research.
• Istinye adopts a student-centered education approach and aims to contribute to society by delivering high-quality and accessible healthcare services
• It offers a learning atmosphere that encompasses technology and art and delivers universal standards in teaching, research and community service

Health Story Collection

• Health story collection is the first step for patient assessment
• It requires careful consideration of patient confidentiality

Phases of the Interview Process

• There are five phases in the interview process: pre-interaction, beginning, working, and closing

Pre-interaction Phase

• Before meeting the patient, data is collected from the medical record
• The patients medical history, surgeries, current medications, and problem lists, are all reviewed

Beginning Phase

• Initially introduce oneself by name, state the purpose of the interview
• The patients preferred name is requested
• Neutral topics such as the weather may be discussed if the patient seems anxious.
• Ensuring privacy in the specific health care setting by pulling drapes or closing doors before proceeding is critical

Working Phase

• Specific questions with a purpose chosen to elicit appropriate responses are asked
• Closed-ended questions that can be answered with "yes" or "no" and may include "Do you have a family history of heart disease?"
• Open-ended questions provide broader responses from the patient in their own words
• Understanding symptoms, health practices, and intervention areas is key
• Examples of open ended questions are "What is the reason to continue using cigarette?" and "What do you think about your … problems?"

Closing Phase

• Summarize to end an interview by summarizing and stating the two or three most important patterns or problems
• Patinets are asked if they would like to mention or need anything else
• The nurse thanks patients and family members for their time and information.

Summary: The Interview Process

• Appropriate time management is key
• A suitable interview environment with privacy, seating arrangement, lighting, and temperature
• Involves both a good nurse and good communication
• Accurately and sufficiently document history and keep records, if possible, after the interview

Therapeutic Communication

• It makes it easier for the individual to talk about their feelings and thoughts
• It keeps communication open

Active Listening

• Focus on patients and their perspectives

Encouraging Elaboration (Facilitation)

• Assists patients to more completely describe problems
• Encourages the patient to say more, continue the conversation, and show patients that the nurse is interested

Empathy

• Understand another person’s feelings without criticism
• See and feel the situation from the patient’s perspective, not the nurse’s

Facilitation-Support

• Use silence, confirm questions, and ask for calrification
• Summarizing by saying "I’m not sure I understand” or "You seem to be saying…”
• Try to provide an example

Question Types

• Open-ended questions
• Closed-ended questions

Considerations When Asking Questions

• Must be understandable
• Aimed at a clarifying the situation
• Asked in a way that reveals details
• Should not intend to satisfy curiosity
• Ask one questions at a time
• The answer to the question should not be in the question

General Principles of Story Taking

• Start with open-ended questions
• Ask specific and narrow questions that will lead to a differential diagnosis
• Take your time
• When an individual stops talking, ask questions that will keep them talking, such as “what else do you have”
• Maintain eye contact and show your openness with body posture
• Show that approve with head gestures
• Give the patient the opportunity to express themselves and stay silent
• Briefly summarize what they say when they take a break and make sure it is the truth
• Generate a list by extracting complaints
• Talk again in sequence if confusing, and clarify events
• If the patients feelings look obvious, Indicate understanding with "you look sad,....I understand that, it's annoying..." with empathy
• If they have other complaints, ask them about them
• Communicate that all of the patents problems will be addressed and supported

Nonverbal Communication

• "It’s not what you say but how you say it.”
• Nonverbal behaviors send messages

Communication Process

• Facial expressions and tone of voice %93, and words %7

Health History: Subjective Data Collection

• Reviewing the elements of a complete comprehensive health history starts with histories
• Data is gathered subjectively to assess the patient’s health status and to provide communication

Sources

• Primary data such as a patients history
• Secondary data such as family reports and charts

Components

• All important information is considered
• Demographical data
• Reasons for seeking care
• Present and past health history
• Current medications
• Family history’s
• A functional health assessment
• System reviews

Demographical Data

• Name, age, gender
• Marital and eduction status
• Contact details

Reason for Seeking Care

• Make a brief statement with the patient’s own words for why they are coming to the hospital today
• Ask “Tell me why you came to the clinic today" and “What happened that brought you to the hospital?”

History of Present Illness

• Always use open ended questions and ask to explan the illness
• Provide complete description of the present illness, as its essential
• Be more specific with the assessment of symptoms, such as locating them, noting duration, description, factors aggravating the issue

Past Health History (Background)

• Includes the patient's history of medical and surgical problems, treatments and outcomes
• Note if history is acute, resolved, are chronic

Current Medications and Indications

• Ask the patient what current medications are included, as well as their names, dosage and purpose
• Clarify the purpose and indication of the drugs taken

Family History

• Identify potential diseases that patients risk with the help of their family’s background and information
• Ask relevant questions about their siblings, parents, grandparents, and children to provide health teaching skills
• Important familial conditions are high blood pressure, coronary artery disease, high cholesterol, stroke, cancer, diabetes mellitus, obesity, alcohol or drug addiction, mental illness, and genetic conditions

Functional Health Assessment

• Functional health patterns are important to nursing as they effect quality of life
• The nurse can assess the strengths and areas needing improvement with this approach

Functional Health Patterns

• Health perception/health management
• Nutrition/metabolic
• Elimination
• Activity/exercise
• Cognition/perception
• Sleep/rest
• Self perception/self-concept
• Role/relationship
• Sexuality/reproductive
• Coping/stress tolerance
• Values/beliefs

Functional Health Assessment Questions

• How was your general health been?
• What things do you do to stay healthy?
• With your patterns of bowel or bladder habits, how does it affect activities?
• Do you have enough energy?
• Describe yourself - are you happy?
• How would you define your feelings about yourself?
• How has your illness affected your family?
• Are you happy as you are with your sexual relations?
• What gives you hope, and how do you deal with problems?

Review of Systems

• A series of questions about all body systems that helps to reveal concerns or problems
• Ask related questions to systems, like if they regularly couugh
• In order to get a better understanding of the problem, one has to assess the physical condition and how the heart feels
• Also do and thoraks and lungs
• Be aware of different components such as: general health, skin, neurological states, hearts, head, and eyes

Cardiovascular System Questions

• Any chest pains or pressure problems in your chest?
• Having a hard time breaking during exersize - are you waking with shortness of breath?
• Problems swelling
• Any irregularities?