Istinye University introduction

• İstinye University was founded in 2015 by the 21st Century Anadolu Vakfı -It is an extension of the MLPCare Group's 25 years of knowledge, which unites three hospital brands: Liv Hospital, Medical Park, and VM Medical Park
• İstinye University aims to be among Turkey's and the world's leading universities by providing its students with strong equipment in their fields

İstinye University's Educational Approach

• Applies this approach in all its processes
• Aims to expand the boundaries of science through faculty research
• Aims to implement scientific developments for the welfare of society
• Aims to provide high-quality and accessible health services to the community
• Provides a learning and advancement environment that includes technology and art for students

Health Story Collection Lecture:

• Lecturer: Asst. Prof. Gizem Yağmur Yalçın
• Email: [email protected]
• Department: HSF/Nursing (English)
• Lecture: NUR111-Health Assessment
• Health story collection is the first step of patient assessment

Phases of the Interview Process

• Pre-interaction Phase
• Beginning Phase
• Working Phase
• Closing Phase

Pre-interaction Phase

• Before meeting with the patient, the nurse collects data from the medical record -Includes reviewing the patient’s history of medical illnesses/surgeries, current medication list, and problem list

Beginning Phase

• The nurse initially:
  • Introduces themself by name
  • States the purpose of the interview
  • Asks the patient their preferred name
• The beginning phase may continue with the discussion of neutral topics if the patient seems anxious
• Ensure privacy within the specific health care setting by :
  • Pulling drapes
  • Closing doors before proceeding
  • Considering confidentiality guidelines

Working Phase

• The nurse asks specific questions
  • This is done as each question has a purpose
  • The nurse then chooses to elicit appropriate responses
• Closed-ended (direct) questions
  • Give "yes" or "no" answers
  • Example: “Do you have a family history of heart disease?”
• Open-ended questions
  • Broad questions that give responses in the patient’s own words
  • Key to understanding symptoms, health practices, and areas requiring intervention
  • Example: "What is the reason to continue using cigarette?"
  • Example: "What do you think about your ... problems?"

Closing Phase

• The nurse ends the interview by summarizing
• States the two to three most important patterns or problems
• Asks patients if they would like to mention or need anything else
• Thank the patients and family members for taking the time to provide information

Summary of the Interview Process

• Ensure appropriate and efficient time management
• Ensure a suitable interview environment
  • Privacy
  • Seating arrangement
  • Lighting
  • Temperature of the room
• Nurse introducing themselves
• Explaining the purpose of the interview
• Good communication
• Getting an accurate and sufficient amount of history
• Keeping records after the interview, if possible

Establishing Trust & Communication

• During history taking and interviewing, the nurse establishes trust with patients
• Through therapeutic communication, the patient and the nurse work together to resolve problems through collaborative solutions
• As the nurse develops and refines interviewing capabilities, conversation with patients becomes more comfortable, with smooth transitions between questions

Therapeutic Communication Techniques

• Communication techniques make it easier to talk about feelings and thoughts
• These techniques keep communication open or therapeutic
• Active listening enables focusing on patients and their perspectives
• Encouraging elaboration/facilitation assists patients to describe problems more completely
  • Responses encourage patients to say more
  • Responses continue the conversation
  • Responses show patients that the nurse is interested

Practicing Empathy

• Empathy enables perceiving understanding of another person’s feelings without criticism
• Being able to see and feel the situation from the patient’s perspective, not the nurse’s
• It is important to practice empathy, not sympathy

Applying Communication Techniques

• It makes you sad that they don't give you a say in the family
• Example: You want them to value you and listen to you
• Use facilitation-support
• Use silence
• Confirm
• Clarify
• Explain

Question Types

• Open-ended questions
• Closed-ended questions

Considerations When Asking Questions

• Should be understandable
• The aim should be at clarifying the situation
• Questions should be asked in a way that reveals all the details
• Should not be intended to satisfy curiosity
• Do not ask more than one question at a time
• The answer to the question should not be in it

General Principles of Story Taking

• Start with open-ended questions
• Ask specific and narrow questions that eventually lead to a differential diagnosis
• Take your time
• When an individual stops talking, ask questions that will keep them talking
  • Example: "what else do you have"
• Maintain eye contact.
  • Show your openness with your body posture
• Show that you approve of it with your head gesture, when appropriate
• Give the patient the opportunity to express themself silently
• When a patient takes a break, briefly summarize what they are saying -Continue to listen actively, ensuring the accuracy of what is made sure true
• Generate a list by extracting complaints
• If there is confusion in the sequence of events, talk about the same topic again to clarify
• If the patient's feelings are obvious, "you look sad,....I understand that, it's annoying..."
  • Indicate that you understand it with phrases such as (empathy)
• If they have other complaints, ask them about them
• Communicate that all the patient's problems will be addressed and support her/him

Nonverbal Communication

• Emphasize that it’s not what you say but how you say it
• Nonverbal behaviors may be sending the real message through
• Includes:
  • Facial expressions -Gestures
  • Tone of voice
  • Emphasis on certain words
  • The manner in which a person paces
  • Eye contact
  • Physical appearance
  • Posture

Communication Percentages

• Facial expressions and tone of voice account for 93% of communication
• Words account for 7%

Health History: Subjective Data Collection

• Take health histories and collect subjective data
• Assess the patient’s health status and provide therapeutic communication
• The following sections contain the elements of a complete, comprehensive health history:
  • Sources
  • Components

Sources of Data

• The individual patient is considered the primary data source
• Charts and family members are considered secondary data sources

Health History Components

• Demographical Data
• Reason for Seeking Care
• History of Present Illness
• Past Health History
• Current Medications and Indications
• Family History
• Functional Health Assessment
• Review of Systems

Demographical Data

• Name, age, gender
• Educational status, marital status
• Address, employment, income and insurance details

Reason for Seeking Care

• Should be a brief statement, usually in the patient’s own words
• This establishes why they are making the visit
• Example: “Tell me why you came to the clinic today”
• Example: “What happened that brought you to the hospital?”

History of Present Illness

• The nurse begins with open-ended questions and asks patients to explain symptoms
• A complete description of the present illness is essential
• Questions about symptoms (subjective sensations or feelings of patients) in six to eight categories
  • Used to assist patients in being more specific and complete

Categories

• Location
• Intensity
• Duration
• Description
• Aggravating factors
• Pain goal
• Alleviating factors
• Functional impairment

Mnemonic Device for History of Present Illness

• OLDCARTS
  • Onset
  • Location
  • Duration
  • Character
  • Aggravating/ Relieving Factors
  • Timing
  • Severity

Past Health History

• Past health history should include the patient’s :
  • Medical and surgical problems
  • Treatment
  • Outcomes
• Some problems are acute, others resolve, and others are chronic

Current Medications/Indications

• The nurse should ask about current medications including:
  • Names
  • Purpose of each -Route of administration -Dosage
• If confusion about any medication exists, the nurse can ask patients/family to bring in pill bottles
• Hospitalized patients must reconcile all medication lists with those taken regularly at home - Ensure patients continue using the correct drugs
• The nurse verifies allergies with Legal documents and patient reports If there are findings, it should be noted
• The nurse notes the type of allergic response (rash, throat closing, anaphylaxis, etc) Distinguishes between allergies, side effects, and adverse reactions to medications

Family History

• Questions about the health of parents, grandparents, siblings, and children help identify disease risks
• Enables nurses to provide health teaching
• Important familial conditions should include: -High blood pressure
  • Coronary artery disease
  • High cholesterol -Stroke
  • Cancer
  • Diabetes mellitus -Obesity
  • Alcohol or drug addiction
  • Mental illness
    • Genetic conditions

Functional Health Assessment

• Functional health patterns are important to nursing -Focuses on the effects of health or illness on quality of life
• Using this approach, the nurse can assess the strengths of patients and areas needing improvement

Functional Health Patterns

1. Health perception/health management
2. Nutrition/metabolic
3. Elimination
4. Activitiy/exercise
5. Cognition/perception
6. Sleep/rest
7. Self perception/self-concept
8. Role/relationship
9. Sexuality/reproductive
10. Coping/stress tolerance
11. Values/beliefs

Review of Systems

• Series of questions about all body systems help to reveal concerns or problems
• Ask questions related to each body system (eg, cough in the respiratory system) systematically before proceeding to the physical assessment
• Integrate questions while physically examining each region (eg, chest pain when assessing the heart)

Areas to Review

• General Health State
• Skin, Hair, Nails
• Head and Neck (regional lymph nodes)
• Eyes
• Ear, nose, mouth and throat
• Thorax and Lungs
• Cardiovascular system
• Heart and Neck Vessels
• Peripheral Vascular
• Abdominal-Gastrointestinal
• Neurological

Cardiovascular System Questions

• Have you ever had any pain or pressure sensations in your chest, neck or arm? (myocardial ischemia)
• Do you have shortness of breath during exercise?
• Have you ever woken up at night with shortness of breath? (heart failure)
• Can you lie flat without shortness of breath?
• Do you have swelling in your ankles?
• Have you ever felt irregularities or stuttering in your heartbeat?
• Have you had a sudden blackout without any complaints?
• Have you felt tired in your legs during exercise?
• Have you had coldness and blueness in your hands or feet?
• Have you had a rheumatic fever or heart attack?
• Do you have high blood pressure (hypertension)?

System Review Sequencing & Setup

• Sequence and format vary with the nurse’s setting, urgency of the problem, and style