NR 509 Midterm Exam 2024 is the clinical encounter clinician-centered to patient-centered - Correct Answers both; needs to be a balance of the clinician meeting their needs of the interaction and the patient feeling heard and create personal dimension patient-centered approach - Correct Answers Interviewing technique empowering the patient to provide a candid and complete medical history recognizes importance of patient concerns, feelings and emotions and understands the patients personal contact of the symptoms/disease FIFE model - Correct Answers mnemonic for patients perspective on the illness Feelings (fears and concerns about the problem) Ideas (about nature and cause of problem) Functioning (effect of illness on function) Expectations general structure of patient encounter (5 steps) - Correct Answers initiate the encounter gather information perform the physical examination explaining and planning closing the encounter
- frameworks that continue throughout whole clinical encounter - Correct Answers relationship
building structuring the interview what happens while initiating the encounter - Correct Answers greet the patient and set the stage/preparation what does it mean to set the stage - Correct Answers prepare for the interview 1 / 3
check your appearance make sure patient is comfortable and environment is conducive to private info being shared what happens during the gathering information stage - Correct Answers initiate information gathering history of present illness past medical history social history explore patients perspective of disease and relevant background information what happens during explaining and planning - Correct Answers provide correct amount and type of information negotiate plan of action shared decision making when asking patient about there pronouns it may be helpful to.... - Correct Answers share your own pronouns
"in an effort to promote an inclusive and respectful environment, we use pronouns that are right for us. The pronouns I prefer are......how about you what pronouns do you prefer?the initial moments of your encounter lay the foundation for.... - Correct Answers your ongoing relationship how to establish rapport - Correct Answers introduce yourself, explain your role and how you will be a part of their care
- dimensions of cultural humility - Correct Answers 1) Self-awareness
2) Respectful communication 3) Collaborative partnerships active listening - Correct Answers Closely listening to what the patient is communicating, connecting on an emotional state to the patient. 2 / 3
use both verbal and nonverbal skills to encourage pt to expand on their feelings/concerns Empathetic responses - Correct Answers capacity to identify with a patient and feel patients pain as your own and respond in a supportive manner "That must have been difficult for you." "I understand, you're worried." Non-verbal: offering a tissue to a crying patient; reaching out and gently touching a patient's hand.Therapeutic use of self: "I've had surgery before, so I can relate to what you're going through." guided questioning - Correct Answers Helps to continue the patients story, shows sustained interest
and allows clinician to adapt questioning based on patient i.e.:
-moving from open ended to focused questions -using questions that elicit a graded response -asking a series of questions, ONE at a time -clarifying what the patient means -encouraging with continuers -using echoing guided questioning aka - Correct Answers adaptive questioning nonverbal communication - Correct Answers communication using body movements, gestures, and facial expressions rather than speech validation - Correct Answers affirm validity of patients emotional experience "Your accident must have been terrifying. Car accidents are always unsettling because they remind us how vulnerable we are. Perhaps that explains why you still feel upset," reassurance - Correct Answers first step is to identify and acknowledge the patients feelings
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