PART I

2. PART I Assessment of Respiratory Disease

3. Section I Clinical Data Obtained at the Patient’s Bedside

4. Chapter 1 The Patient Interview

5. Patient History • Biographic data • Age, gender, occupation • Chief complaint • Present health 5

6. Patient History (Cont’d) • Past health • Family history • Review of body systems • Functional assessment 6

7. Patient Interview • Patient’s impression of his or her health • Establish rapport and trust • Understanding of patient’s health • Facilitates future assessments 7

8. Internal Factors • What the practitioner brings to the interview • Genuine concern for others • Empathy • The ability to listen 8

9. Internal Factors (Cont’d) • During the interview the examiner should: • Observe the patient’s body language • For example, note • Facial expressions • Eye movement • Pain grimaces • Restlessness • Sighing 9

10. Internal Factors (Cont’d) • The examiner should listen to the way things are said • For example: • Is the tone of the patient’s voice? • Does the patient’s voice quiver? • Are there pitch breaks in the patient’s voice? • Does the patient say only a few words and then take a breath?

11. External Factors • A good physical setting • Ensures privacy • Prevents interruptions • Secures a comfortable physical environment 11

12. Techniques of Communication

13. Open-Ended Questions • This type of question asks the patient to provide narrative information. • For example: • “What brings you to the hospital today?” • “How has your breathing been getting along?” 13

14. Closed or Direct Questions • This type of question asks the patient for specific information—a short one- or two-word answer, a yes or no, or a forced choice. • For example: • “Have you ever had this chest pain before?” 14

15. Responses—Assisting the Narrative • Facilitation • “Mm-hmm,” “Go on,” “Continue” • “Uh-huh” 15

16. Responses—Assisting the Narrative (Cont’d) • Silence • Effective after an open-ended question 16

17. Responses—Assisting the Narrative (Cont’d) • Reflection • Patient: “My breathing is blocked.” • Examiner: “It’s blocked?” • Patient: “Yes, every time I try to exhale, something blocks my breath and prevents me from getting all my air out.” 17

18. Responses—Assisting the Narrative (Cont’d) • Empathy • Patient: “This is just great! I used to work out every day, and now I don’t have enough breath to walk up the stairs!” • Examiner: “It must be hard—you used to exercise every day, and now you can’t do a fraction of what you used to do.” 18

19. Responses—Assisting the Narrative (Cont’d) • Clarification • “Tell me what you mean by bad air.” 19

20. Responses—Assisting the Narrative (Cont’d) • Confrontation • “You look depressed today.” 20

21. Responses—Assisting the Narrative (Cont’d) • Interpretation • “It seems that every time you have a serious asthma attack, you have had some kind of stress in your life.” 21

22. Responses—Assisting the Narrative (Cont’d) • Explanation • “It is very common for your heart rate to increase a bit after a bronchodilator treatment.” 22

23. Responses—Assisting the Narrative (Cont’d) • Summary • The final overview of the examiner’s understanding of the patient’s statements. • It condenses the facts and presents an outline of the way the examiner perceives the patient’s statements. • The patient can agree or disagree with the examiner’s summary. 23

24. Nonproductive Verbal Messages • Providing assurance or reassurance • Giving advice • Using authority • Using avoidance language • Distancing 24

25. Nonproductive Verbal Messages (Cont’d) • Professional jargon • Asking leading or biased questions • Talking too much • Interrupting and anticipating • Using “why” questions 25

26. Nonverbal Skills Professional appearance vs. Unprofessional appearance

27. Nonverbal Skills (Cont’d) Sitting next to the patient vs. Sitting behind a desk

28. Nonverbal Skills (Cont’d) Proximity to patient vs. Far away from patient

29. Nonverbal Skills (Cont’d) Turned toward patient vs. Turned away from patient

30. Nonverbal Skills (Cont’d) Relaxed, open posture vs. Tense, closed posture

31. Nonverbal Skills (Cont’d) Leaning toward patient vs. Slouched away from patient

32. Nonverbal Skills (Cont’d) Facilitating gestures(e.g., nodding the head) vs. Nonfacilitating gestures(e.g., looking at watch)

33. Nonverbal Skills (Cont’d) Positive facial expressions vs. Negative facial expressions

34. Nonverbal Skills (Cont’d) Good eye contact vs. Poor eye contact

35. Nonverbal Skills (Cont’d) Moderate tone of voice vs. Strident, high-pitched voice

36. Nonverbal Skills (Cont’d) Moderate rate of speech vs. Speech too fast or too slow

37. Nonverbal Skills (Cont’d) Appropriate touch vs. Too frequent or inappropriate touch

38. Closing the Interview • The interview should end gracefully. • “Is there anything else that you would like to talk about?” • “Do you have any questions you would like to ask me?” • “Are there any other problems that I should have asked you about?” 38

39. Closing the Interview (Cont’d) Finally, Thank the patient for the time and cooperation provided during the interview. 39