NUR111 Health Assessment: Interview Process

• İstinye University was founded in 2015 by the 21st Century Anadolu Foundation
• It happened as a continuation of the 25-year knowledge and experience of the MLPCare Group, uniting three separate hospital brands, Liv Hospital, Medical Park, and VM Medical Park, under one roof.
• The goal is to be among the distinguished universities in worldwide.
• The university aims to expand science’s boundaries, implement findings from scientific developments for society's welfare, and provide quality healthcare.
• It offers a learning and advancement environment covering technology and art.
• Gizem Yağmur Yalçın is the lecturer, who can be contacted at [email protected]
• The department is HSF/Nursing (English), the lecture to reference is NUR111-Health Assessment

Interview Process

• The health story collection is the first step for patient assessment
• The phases are:
  • Pre-interaction Phase
  • Beginning Phase
  • Working Phase
  • Closing Phase

Pre-Interaction Phase

• Prior to meeting the patient, nurses gather data from the medical record.
• Nurses review the patient’s history of medical illnesses/surgeries, current medication list, and problem list.

Beginning Phase

• The nurse initially introduces themselves by name
• The nurse shares the purpose of the interview
• The nurse asks the patient for their preferred name
• Beginning phase can include discussing neutral topics if the patient seems anxious
• Ensuring privacy by pulling drapes or closing doors is essential.
• Ensuring privacy within the specific healthcare setting is important

Working Phase

• Specific questions with a purpose help elicit appropriate patient responses.
• Closed-ended questions include "yes" or "no" answers, such as "“Do you have a family history of heart disease?”
• Open-ended questions provide broad responses in the patient’s own words
• Open ended questions are key to understanding symptoms, health practices, and intervention areas.
  • Examples include “What is the reason to continue using cigarette?" and “What do you think about your … problems?”

Closing Phase

• The nurse summarizes the interview, stating the two to three most important patterns or problems
• The nurse gives the opportunity for patients to mention or need anything else.
• The nurse thanks patients and family for their time and information.

Summary: The Interview Process

• Allocate appropriate time
• Ensure a suitable interview environment, including privacy, seating arrangement, lighting, and temperature
• What a nurse should do:
  • Introduce themselves
  • Explain the interview's purpose
  • Establish solid communication
  • Get sufficient and accurate current/past health data
  • If possible, Keep records after the interview

Best Practice

• During history taking and interviewing, nurses must establish trust with patients.
• Therapeutic communication helps patients and nurses work together to resolve problems through collaborative solutions
• Nurses refine interviewing skills through practice, that can make patients comfortable, with smooth transitions between questions

Therapeutic Communication and How To Action

• Eliciting feelings and thoughts through tailored communication is considered a therapeutic technique to keep communication open.
• Active listening means focusing on the patient's perspective
• Encouraging elaboration helps patients describe problems more completely by encouraging them to say more and show the nurse is interested.
• Empathy means the ability to understand another person’s feelings without criticism
• The approach is to see and feel the situation from the patient’s perspective, not the nurse’s.

Therapeutic Communication Techniques

• Support and facilitate
• Use silence
• Confirm
• Clarify
• Explain

Question Types

• Open-ended questions
• Closed-ended questions

Considerations for Asking Questions

• Ensure questions are understandable
• Ensure questions are aimed at clarifying the situation
• Ensure the wording of questions reveals all the details
• Ensure the intent of questions isn't simply to satisfy curiosity
• Do not ask more than one question at a time
• Do not put the answer within the question

General Principles of Story Taking

• Start with open-ended questions
• Ask specific and narrow questions to eventual differential diagnosis
• Take your time
• If an individual stops talking, ask questions to engage them such as "What else do you have?”
• Maintain eye contact to show openness using body posture
• Show approval with head gestures
• Give the patient the opportunity to express themselves, remain silent and listen
• When the patient takes a break, briefly summarize the details.
• Continuously listen to ensure what is said is true
• Create a list by noting and extracting complaints
• If details are confusing, talk about the same topic again and clarify the sequence of events

Empathy Actions

• Empathy is showing an understanding through phrases
• Ask about other complaints
• Communicate that the patient's problems is important and will be addressed and supported with care.
• Key elements of Nonverbal Communication:
  • Facial expressions
  • Hand gestures
  • Eye contact
  • Body posture
  • Tone of voice
  • Emphasis on certain words
  • The manner in which a person paces speech

Communication Considerations

• 93% of communication is facial expressions and tone of voice
• Only 7% is the words used

Health History and Why Is It Important

• Subjective data collected
• Assess the patient’s health status to provide therapeutic communication
• There needs to be an analysis of data
• These elements comprise a complete comprehensive health history:
  • Sources
  • Components

Data Sources

• The patient is the primary data source
• Charts and family members are 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

Demographic Data Key Details

• Name, age, gender
• Educational status, marital status, who they live with
• Address, employment, income, and insurance details

Reason for Seeking Care Explained

• It is a brief statement, with the patients’s word of what happened and why they are visiting the hospital
• "What is all bringing you in today" or "What happened to bring you to the hospital" can be asked

How To Assess the "History of Present Illness"

• The nurse starts begins with questions to encourage them explaining their symptoms
• It must be a complete description of the present illness is essential
• There should be questions about symptoms in six to eight categories to assist patients be more specific and complete
• Pain should be assessed by:
  • Location
  • Intensity
  • Duration
  • Description
  • Aggravating facto
  • Pain goal, Alleviating factors
  • Functional impairment

Past Health History Considerations

• The history includes the patient's medical and surgical problems along with treatments and outcomes.
• Some problems are acute, some resolve, and others are chronic

Current Medications and Indications

• Nurses need to ask about current medications including:
  • Names, purpose of each, and doses,
  • Routes of administration

Considerations For Medications

• The nurse has patients and family members bring in pill bottles if there is confusion about current medication
• For hospitalized patients, nurses must reconcile all medication lists with medications taken regularly at home so that patients continue to use the correct drugs.
• Allergies need to be verified with patients and compare findings against legal records
• When documenting medication allergies, the nurse needs to notes the type of allergic response, differentiating between side effects or adverse reactions.

When to Ask Questions About Family History

• Family history is important in determining questions about the health of parents, grandparents, siblings, and children
• It is important to identify diseases for which patients are at risk.
• 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

Details For A Functional Health Assessment

• Functional health patterns especially for nursing, help focus on the effects of health or illness
• Nursing focuses on what it has done to a patient’s quality of life
• The nurses need to assess the patient's strengths as well as areas where they need improvement.
• Functional health patterns include:
  • 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

Health perception/health management

• How would you describe your health in general
• What do you do to stay healthy?

Nutrition/metabolic

• What is your history with:
  • Food Allergies/lactose intolerance
  • Diabetes
  • Swallowing difficulties
  • Problems obtaining/preparing food due to finances/physical limitations/lack of knowledge

Elimination

• How do you assess elimination problems:
  • Current bowel/bladder patterns
  • Artificial orifices, ostomies.
  • Problems that affect elimination (restricted activity, medications)

Activitiy / Exercise

• Assessing patients and their needs and abilities
• Is energy sufficient for completing required and desired activities or are activities limited by:
  • Cardiovascular/respiratory problems
  • Musculoskeletal problems
  • Neuromuscular problems

Cognition/Perception

• Assessing patients and their history with the following issues:
  • Sensory alterations
  • Pain
  • Communication

How to handle Sleep/Rest

• How would you assess if the patient is getting enough sleep
  • History of sleep disturbances, medications, routines that promote or disturb sleep
  • Note interventions the patient has tired

Self-Perception/Self-Concept

• What are the 3 key things to ask about:
  • Body comfort
  • Body image
  • Feeling state

Role/Relationship

• How would a nurse learn about your patients history with:
  • Family
  • Social
  • Work

Questions To Ask About Sexuality/Reproductive

• Are you concerned about the relationship you have with your partner?
• What affect has this illness had on your ability to have a relationship?
• Do you have any questions or concerns?

Questions About Coping/Stress Tolerance

• What effect has this illness has on your life?
• What do you do in your daily life to lower stress?
• What do you do to relax?

Question Ideas For Assessing Values / Beliefs

• What do you like to do?
• Is illness interfering with goals, and plans?
• Will illness affect beliefs, spirituality?

Review of Systems

• It is a systematic series of questions about all body systems to assess concerns or problems
• Specific questions related to each body system are asked before the physical assessment, such as coughing for the respiratory system
• Questions are integrated while physically examining each region, such as chest pain when assessing the heart.
• The sequence and format vary with setting, urgency of the problem, and style of the nurse

Systems To Inquire About

• General Health State
• Skin Hair and Nails
• Head Neck regional lymph nodes
• Eyes, ears, nose, throat
• General health, Thorax and lungs Cardio vascular system abdominal Review of Systems

Samples Questions Cardiovascular system:

• Have you ever had any pain or pressure sensations in your chest, neck or arm?
• Do you have shortness of breath with exercise
• Do you have swelling in your ankles