Istinye University: Patient Interview Process

• İstinye University was established in 2015 by the 21st Century Anadolu Foundation.
• The university is an extension of the MLPCare Group's 25 years of knowledge, uniting hospital brands like "Liv Hospital," "Medical Park," and "VM Medical Park."
• İstinye University aims to be among the world's and Türkiye's top universities through quality education and research.
• Its educational approach is student-centered.
• İstinye University aims to broaden the boundaries of science, translate scientific findings into community welfare, and offer quality health care.
• It provides a learning environment that integrates technology and art, maintaining universal standards.
• Health story collecting is the first step of patient assessment.

Interview Process Phases

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

Pre-interaction Phase

• Prior to meeting the patient, the nurse gets data from the medical record.
• The patient's medical history, current medications, and problem list are reviewed.

Beginning Phase

• The nurse introduces themselves by name.

• The interview's purpose gets stated.

• The patient's preferred name gets asked.

• The beginning phase may continue with neutral topics if the patient seems anxious.

• Privacy gets ensured by pulling drapes or closing doors.

• Considering confidentiality guidelines is essential.

Working Phase

• The nurse asks specific questions, each with a purpose to elicit appropriate responses.

• Closed-ended questions elicit "yes" or "no" answers, for example: "Do you have a family history of heart disease?"

• Open-ended questions elicit broad responses and understanding of the patient’s symptoms, health practices, and areas requiring intervention.

• Examples include: “What is the reason to continue using cigarettes?” and “What do you think about your … problems?”

Closing Phase

• The nurse ends the interview by summarizing.
• The two to three most important patterns of problems get stated.
• Patients get asked if they would like to mention anything else.
• Patients and family members are thanked for their time and information.

Interview Process Summary

• Allocate appropriate time.
• The environment should be suitable, including privacy, seating, lighting, and temperature.
• The nurse introduce themselves.
• The nurse explain the purpose of the interview.
• Good communication should happen.
• Acquire an accurate and sufficient amount of history
• Records should get kept when possible.
• Establish trust during history taking and interviewing.
• Through therapeutic communication, the patient and nurse work to resolve problems via collaborative solutions.
• As the nurse develops interviewing capabilities, conversations with patients becomes more comfortable with smooth transitions between questions.

Therapeutic Communication Techniques

• Therapeutic techniques makes it easier for individuals to share thoughts and feelings, thus keeping communication open.

• Active listening focuses on patients and their perspectives.

• Encouraging elaboration assists patients to describe problems better.

• Responses encourages patients to say more, continue the conversation, and show that the nurse is interested

• Empathy means understanding another person’s feelings without criticism.

• See and feel the situation from the patient’s perspective, not the nurse’s “It makes you sad that they don't give you a say in the family, you want them to value you and listen to you." is empathetic

Other Therapeutic Communication Techniques

• Facilitation-Support
• Using silence
• Confirming
• Clarification
• Explanation

Types of Questions

• Open-ended questions.
• Closed-ended questions.

Asking Questions Considerations

• Questions should be understandable.
• Questions should be aimed at clarifying the situation.
• Questions should reveal the details.
• Questions 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 - 1

• Start with open-ended questions.
• Ask specific and narrow questions that will eventually lead to a differential diagnosis
• Take your time.
• When an individual stops talking, ask questions that will keep them talking, like "what else do you have?"
• Maintain eye contact and show openness with body posture.

General Principles of Story Taking - 2

• Show approval with head gestures.

• Give the patient opportunity to express themselves (stay silent).

• Briefly summarize what the patient is saying and actively listen to ensure accuracy.

• Generate a list by extracting any complaints.

• If confused about the sequence of events, talk about the same topic again and clarify the sequence of events

• If the patient’s feelings are obvious, acknowledge them .

• Acknowledge them with phrases that express empathy.

• Ask patient if they have other complaints.

• Communicate that all the patient’s problems will be addressed and support them

• Nonverbal communication encompasses the tone of voice, facial expressions, hand gestures, eye contact, body posture, and physical appearance.

• It is not about what gets said, but how it gets said.

• It's the nonverbal behaviors may be sending the real message through.

• Facial expressions and tone of voice account for 93% of communication, while words account for 7%.

• Health histories are subjective data collection.

• The following section reviews the elements of a complete comprehensive health history.

Sources for Data Collection

• Individual patients get considered the primary data source.
• Charts and family members get 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 Componenets

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

Seeking Care Components

• This brief statement, in patient's own words, establishes why he or she is making the visit.
• The nurse might say: “Tell me why you came to the clinic today”, or “What happened that brought you to the hospital?”

Present Illness Components

• The nurse should begin with open-ended questions and asks patients to explain symptoms.

• Complete description of the present illness is essential

• Questions about symptoms (subjective sensations or feelings of patients) in six to eight categories assist patients to be more specific and complete:

• Aspects of Present Illness include Location, Intensity, Duration, Description, Aggravating factors, Pain Goal, Alleviating factors, and Functional Impairment.

• The Pneumonic OLDCARTS (Onset, Location, Duration, Character, Aggravating/Relieving Factors, Timing and Severity) may be of use.

Past Health History (Background)

• Includes the patient’s history of medical and surgical problems including treatments and outcomes.
• Some problems are acute, others resolve, and others are chronic.

Current Medications and Indications

• The nurse should ask about current medications including: names, purpose of each medication, dosages and routes

• If confused, ask patients or family to bring in pill bottles,.

• If hospitalized, reconcile medication lists to make sure the person is still using the correct drugs.

• Evaluate/verify for current allergies and compare against legal records.

• Notes the type of allergic response which includes rash, throat swelling, anaphylaxis.

• Allergies should get differentiated from side effects or adverse reactions.

Family History

• Questions about the health of the patient's parents, grandparents, siblings, and children helps reveal diseases that the patient may be at risk of, thus enable nurses to provide health teaching.

• Important familial conditions include: high blood pressure, coronary artery disease, high cholesterol, stroke, cancer, diabetes mellitus, obesity, alcohol or drug addiction, mental illness, and genetic conditions.

Functional Health Assessments

• Functional health patterns are used, especially important to nursing, because it focus on effect of health and or illness on quality of life.
• Using this approach allows the nurse to assess the strengths of patients as well as areas needing improvement.

Functional Health Patterns Include

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

Additional Info Regarding the Patterns

• Health perception/health management patterns concerns perceived health and well-being and how health is managed.
• Nutrition and Metabolic patterns concern food to metabolic need and indicators of local nutrient supply.
• Question to ask include “How was your general health? What do you do to stay healthy? How does your nutrition influence your health?”
• Elimination patterns concern excretory function- bowel, bladder, and skin.
• Ask “Do your patterns of bowel/bladder habits affect your activities?
• Do you have sufficient energy to compete desired activities?"

Questions to Ask for Cognition/Perception Patterns

• How would you describe yourself?
• Are there any changes in the way that you feel about yourself/your body?
• Are there any family problems that you have difficulty handling?

Questions To ask for Role/Relationship

• How was your illness affected your family?

Questions To ask for Sexuality/Reproductive

• Have you had changes in sexual relations that you are concerned about?
• How has this illness affected your sexual relationship?
• Have you had any major changes in the past year?

Questions To ask for Coping/stress tolerance

• How do you usually deal with stress? Is it effective?

Questions To ask for Values/Beliefs

• the most important things to you in life?
• What gives you hope when times are troubled?

Components of Review of Systems

• The review of systems are questions about all body systems that helps to reveal concerns or problems.
• Asking questions related to each body system systematically before moving onto the physical assessment.
• The interviewer integrates questions while examining each region.
• Common points to review include review of systems, general health state, skin hair and nails, head and neck lymph nodes, eyes, ear nose mouth and throat, thorax and lungs, cardiovascular system (heart neck vessels or peripheral vascular), abdominal -gastrointestinal or neurological review of systems.
• Sequence and format vary on the nurse style, urgency of the problem, and setting