Introduction to N1037

1
Introduction to N1037

• Course Outline
• Topic Outline

2
Intro to N1037

• Handouts
• Schedule
• Assignment
• Marking scheme

3
Schedule for Lab Groups

• Group 1 Mondays 1630-1930
• Group 2 Thursdays 1430-1730
• Group 3 Thursdays 1730-1930
• Group 4 Friday 1630-1930

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Definitions

• Assessment
• Critical Thinking
• Critical Reasoning

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Assessment definition

• Assessment is the hallmark of the health
  profession. It is the ability to distinguish
  normal functioning of the human organism from the
  abnormal, and if the latter is discovered to
  determine the gravity of the abnormality. It does
  not mean pinpointing the precise pathological
  process underlying the findings garnered at the
  examination the ultimate expertise for this
  function belongs to the physician. Assessment ,
  however belongs to all the healing professions.
  Sorting out the healthy from the unhealthy and
  grading the significance of any threat to the
  human person is an activity common to the health
  professional of whatever type. Furthermore it is
  the prime characteristic that sets us apart from
  the nonprofessional.

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Critical Thinking - definition

• - is purposeful, goal-directed thinking process
  that strives to problem solve patient care issues
  through the use of clinical reasoning. It
  combines logic, intuition, and creativity.

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Critical Reasoning - definition

• - is a disciplined, creative and reflective
  approach used together with critical thinking, is
  purpose is to establish potential strategies to
  assist patients in reaching their desired health
  goals.

8
Nursing Process and Critical ThinkingComponents
of Critical thinking

• Interpretation
• Analysis
• Inference
• Explanation
• Evaluation
• Self-regulation

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Assessment

• Whats the problem?
• Collect data
• Review of the clinical record
• Interview
• Health history
• Physical examination
• Functional assessment
• Consultation
• Review of the literature

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Diagnosis

• Interpret data
• Identify clusters of cues
• Compare clusters of cues with definition and
  defining characteristics
• Identify related factors
• Document the diagnosis

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Outcomes/Goals

• Identify expected outcomes
• Individualize to the person
• Realistic and measurable
• Include a time frame

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Planning

• What are we going to do about it?
• Establish priorities
• Develop outcomes
• Set time frames for outcomes
• Identify interventions
• Document plan of care

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Implementation

• Move into action!
• Do it!
• Review the planned interventions
• Schedule and coordinate the person's total health
  care
• Collaborate with other team members

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Evaluation

• Did it work?
• How did it go?
• Refer to established outcomes
• Evaluate the individual's condition and compare
  actual outcomes with expected outcomes
• Summarize the results of the evaluation

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Evaluation

• Identify reasons for the person's failure, if
  indicated, to achieve expected outcomes stated in
  the plan of care
• Take corrective action to modify the plan of care
  as necessary
• Document the evaluation of the person's
  achievement of outcomes and the modifications, if
  any, in the plan of care

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Interviewing

• Purpose
• How to begin
• Environment
• Confidentiality
• Note taking

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Stages in Interview Process

• Stage 1 - Joining stage
• Stage 2 Working stage
• Stage 3 Termination stage

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Communication

• PROCESS OF COMMUNICATION
• SENDING RECEIVING
• The sender needs to be aware of verbal
  nonverbal communication
• Receiver will interpret your V NV
• Communication is a basic skill (tool) which can
  be learned and must be practiced/re-evaluated on
  a regular basis.

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Factors affecting Communication

• Listening
• Non verbal cues
• Distance
• Personal space

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Communication

• INTERNAL FACTORS
• Liking others (optimistic view of the person)
• Empathy
• The ability to listen actively to the client

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Communication

• EXTERNAL FACTORS
• Ensure privacy
• Refuse interruptions
• Physical environment comfortable temperature,
  good lighting, reduced noise, no distractions,
  comfortable distance (4 to 5 feet), eye
  level-face to face seating, do not stand.
• Dress professionally

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Techniques of Communication

• Listening techniques
• Questioning techniques
• Sending messages techniques

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INTRODUCING THE INTERVIEW

• Use clients last name.
• Introduce yourself and your role.
• Give the reason for the interview.

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WORKING PHASE (data gathering phase)

• OPEN ENDED QUESTIONS to request narrative
  information, to begin the interview, introduce a
  new area of questioning or topic.
• CLOSED OR DIRECT QUESTIONS to illicit a yes or
  no answer, to request specific information.
• USING RESPONSES facilitation (go on, uh-huh),
  silence, reflection, summary.

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10 TRAPS OF INTERVIEWING

• OFFERING FALSE ASSURANCES OR REASSURANCES
• ADVISING
• USING AUTHORITY
• USING PROBLEMATIC QUESTIONING
• ENGAGING IN DISTANCING

• USING PROFESSIONAL JARGON
• USING LEADING OR BIASED QUESTIONS
• TAKING TOO MUCH TIME
• INTERRUPTING
• DEFENDING

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NONVERBAL SKILLS/BEHAVIOURS OF THE INTERVIEWER

• POSITIVE
• Eye contact
• Open posture, relaxed
• Leaning forward
• Tone of voice moderate
• Appropriate touch
• Professional appearance

• NEGATIVE
• Standing
• Bland expression
• High pitch tone
• Speech slow or fast
• Sitting far away, behind a desk
• Inappropriate dress

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DEVELOPMENTAL CONSIDERATIONS

• Parent/infant greet both by name,interview
  together, allow toys for the child, ask about toy
  to make contact.
• School-age child parent/child together, child
  will have valuable information at times, ask
  child about symptoms first then parent later.
• Adolescent be respectful, dont judge, give
  truth with rationale, keep it short and simple.
• Older adult greet by last name, allow more time
  for interview, shorter segments may be necessary.
• You must be able to develop a rapport with people
  at different stages of life.

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INTERVIEWING PEOPLE WITH SPECIAL NEEDS

1. Hearing-impaired
2. Acutely ill people
3. Crying
4. Anger
5. Threat of violence

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CROSS CULTURAL COMMUNICATION

1. Etiquette formal/respectful/polite, name and
   title.
2. Space and distance 2-4 feet with all.

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OVERCOMING COMMUNICATION BARRIERS

• Language
• Divers backgrounds
• Behaviours
• Eye contact

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The Complete Health History

• What is the purpose of the complete health hx?
• Subjective data what the person says about
  himself/herself.
• Objective data physical examination and lab
  studies.
• Both form the data base which is used to make a
  diagnosis about the health status of the
  individual.

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The health history

• complete picture of the person's past and present
  health
• describes the individual as a whole how the
  person interacts with the environment
• records health strengths coping skills

• for the well person - hx used to assess lifestyle
  e.g. exercise, diet, risk
  reduction, health promotion behaviour
• for the ill person - hx includes a detailed
  chronological record of the health problem

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Health History Forms

• biographical data
• reason for seeking care (previously chief
  complaint)
• present health or history of present illness
• past history
• family history
• review of systems
• functional assessment or activities of daily
  living (ADLs)

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Health History (Adult)
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A-Health Hx

• Biographical data
• Name
• Age
• Address
• Phone number
• Birth date
• Sex
• Marital status

• Source of history
• Who provided the information?
• Are they a reliable source?
• Was there an interpreter present?

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Health Hx

• Reason for seeking
• care
• Brief statement of why the client is seeking
  health care.
• It states one or two symptoms and their duration.
• Use quotation marks.

• Present health/history
• of present illness
• Chronological record of the reason for seeking
  health care.
• Tell me aboutfrom the time it started
• Should include the 8 critical characteristics.

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Health HxSymptoms- 8 Critical Characteristics

• location
• character or quality (burning, sharp, dull, etc.)
• quantity or severity (scale, how many?)
• Timing (onset, duration, frequency)
• Setting
• aggravating or relieving factors (better, worse)
• associated factors
• patient's perception (what do you think it means?)

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B-Past Health

• Childhood illnesses MMR, chickenpox, pertussis,
  strep throat, polio.
• Accidents/injuries auto, fractures, head
  injuries, burns.
• Serious/chronic illnesses diabetes, BP, heart
  disease, cancer, seizures.
• Hospitalizations cause, name of.., how was it
  treated, how long, physician.

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B-Past Health

• Operations type, date, surgeon, name of
  hospital, how they recovered.
• Obstetric hx Grav___Term___Preterm___Ab___Living
  __
• Immunizations MMR, polio, DpT, Hep B, Tb
  immunization and skin test, last flu shot.
• Last examination date MD, dental, vision,
  hearing, ECG, chest x-ray.

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B-Past Health

• Allergies allergen and reaction.
• Current medication Rx OTC. Note name dose
  and schedule. How often do they take it? What
  is it for? How long have they been taking it?

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C-Family History

• Include a Genogram
• Include age and health of the parents,
  grand-parents and siblings.
• or age and cause of death.

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D-Review of Systems

• The purpose of this review is to evaluate
  past/present health states, to evaluate health
  promotion strategies and to identify if any
  information was missed.
• Review each system in the lab as well as
  corresponding health promotion(HP) strategies.

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D-Review of Systems (listed only)

• Skin
• Hair
• Head
• Eyes
• Ears
• Nose and Sinuses
• Mouth and Throat

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Review of Systems

• Neck
• Breast
• Axilla
• Respiratory
• Cardiovascular
• Peripheral Vascular
• Gastrointestinal

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Review of Systems

• Urinary
• Male Genital
• Female Genital
• Sexual Health
• Musculoskeletal
• Neurological
• Hematological

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E-Functional Assessment

• This is a measure of the persons self-care
  abilities with respect to
• ADLs bathing, dressing, toileting, eating,
  walking.
• IADLs housekeeping, shopping, cooking, doing
  laundry, using phone, managing finances,
  nutrition, social relationships/resources,
  self-concept/coping, home environment.

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E-Functional Assessment

• Self-esteem/Self-concept education,
  financial status, value-belief system.
• Activity/Exercise
• Sleep/Rest
• Nutrition/Elimination
• Interpersonal Relationships/Resources social
  roles and support persons.
• Coping/Stress Management

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Functional AssessmentIncluding ADLS

• Personal habits
• Tobacco
• Alcohol
• Street drugs
• Environmental hazards
• Occupational health

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F-Perception of Health

• How do you define health?
• What are your health goals?
• What do you expect from your health care
  providers?

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Developmental Considerations

• Children include prenatal/perinatal hx, parent
  description of problem, developmental overview
  nutritional hx.
• Older adults ADLs and IADLs very important.
  Explore changes to ADLs caused by aging process
  or chronic illnesses. Note if the impact of
  disease is more important than the disease
  itself. Note the reason for the person seeking
  health care not the HCPs assumption of the
  problem.

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THE GENERAL SURVEY

• Follows the health history
• This is subjective not objective
• Study of the whole person

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THE GENERAL SURVEY

• The GENERAL SURVEY is split up into 4 different
  components
• Physical appearance
• Body structure
• Mobility
• Behaviour

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1. Physical Appearance

• Age
• Sex
• Level of Consciousness

• Skin Colour
• Facial Features

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2. Body Structure

• Stature
• Nutrition
• Symmetry

• Posture
• Position
• Body build, Contour

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3. Mobility

• Gait
• Range of Motion

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4. Behaviour

• Facial expression
• Mood and affect
• Speech

• Dress
• Personal Hygiene

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Developmental Considerations

• Infants/children
• Physical appearance, body structure, mobility
  note same but with consideration to age and
  development.
• Behaviour note response to stimuli according to
  developmental age
• Parental bonding

• Aging Adult
• physical appearance 8th to 9th decade contour is
  sharper and facial features more angular and a
  change to body proportions.
• Posturegeneral flexion by 8th to 9th decade.
• Gait wider base due to poor balance, arms out,
  smaller steps.