Introduction to N1037Introduction to N1037

Course OutlineCourse Outline

Topic OutlineTopic Outline

Intro to N1037Intro to N1037

HandoutsHandoutsScheduleSchedule

Assignment Assignment Marking schemeMarking scheme

Schedule for Lab GroupsSchedule for Lab Groups

• Group #1 Mondays 1630-1930Group #1 Mondays 1630-1930

• Group #2 Thursdays 1430-1730Group #2 Thursdays 1430-1730

• Group #3 Thursdays 1730-1930Group #3 Thursdays 1730-1930

• Group #4 Friday 1630-1930Group #4 Friday 1630-1930

DefinitionsDefinitions

• AssessmentAssessment

• Critical ThinkingCritical Thinking

• Critical ReasoningCritical Reasoning

Assessment definitionAssessment definition

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

Critical Thinking - definitionCritical Thinking - definition

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

Critical Reasoning - Critical Reasoning - definitiondefinition

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

Nursing Process and Critical Nursing Process and Critical ThinkingThinking

Components of Critical thinkingComponents of Critical thinking

• InterpretationInterpretation

• AnalysisAnalysis

• InferenceInference

• ExplanationExplanation

• EvaluationEvaluation

• Self-regulationSelf-regulation

AssessmentAssessment

• What’s the problem? What’s the problem? • Collect data Collect data • Review of the clinical recordReview of the clinical record• InterviewInterview• Health historyHealth history• Physical examinationPhysical examination• Functional assessmentFunctional assessment• ConsultationConsultation• Review of the literatureReview of the literature

DiagnosisDiagnosis

• Interpret dataInterpret data

• Identify clusters of cuesIdentify clusters of cues

• Compare clusters of cues with Compare clusters of cues with definition and defining characteristicsdefinition and defining characteristics

• Identify related factorsIdentify related factors

• Document the diagnosis Document the diagnosis

Outcomes/GoalsOutcomes/Goals

• Identify expected outcomesIdentify expected outcomes

• Individualize to the personIndividualize to the person

• Realistic and measurableRealistic and measurable

• Include a time frameInclude a time frame

PlanningPlanning

• What are we going to do about What are we going to do about it?it?

• Establish prioritiesEstablish priorities

• Develop outcomesDevelop outcomes

• Set time frames for outcomesSet time frames for outcomes

• Identify interventionsIdentify interventions

• Document plan of careDocument plan of care

ImplementationImplementation

• Move into action! Move into action!

• Do it!Do it!

• Review the planned Review the planned interventionsinterventions

• Schedule and coordinate the Schedule and coordinate the person's total health careperson's total health care

• Collaborate with other team Collaborate with other team membersmembers

EvaluationEvaluation

• Did it work? Did it work?

• How did it go?How did it go?

• Refer to established outcomesRefer to established outcomes

• Evaluate the individual's condition Evaluate the individual's condition and compare actual outcomes and compare actual outcomes with expected outcomeswith expected outcomes

• Summarize the results of the Summarize the results of the evaluationevaluation

EvaluationEvaluation• Identify reasons for the person's failure, Identify reasons for the person's failure,

if indicated, to achieve expected if indicated, to achieve expected outcomes stated in the plan of careoutcomes stated in the plan of care

• Take corrective action to modify the plan Take corrective action to modify the plan of care as necessaryof care as necessary

• Document the evaluation of the person's Document the evaluation of the person's achievement of outcomes and the achievement of outcomes and the modifications, if any, in the plan of caremodifications, if any, in the plan of care

InterviewingInterviewing

• PurposePurpose

• How to begin How to begin

• EnvironmentEnvironment

• ConfidentialityConfidentiality

• Note takingNote taking

Stages in Interview ProcessStages in Interview Process

• Stage 1 - Joining stageStage 1 - Joining stage

• Stage 2 – Working stageStage 2 – Working stage

• Stage 3 – Termination stageStage 3 – Termination stage

CommunicationCommunication

PROCESS OF COMMUNICATIONPROCESS OF COMMUNICATION

SENDING & RECEIVINGSENDING & RECEIVINGThe sender needs to be aware of verbal & The sender needs to be aware of verbal &

nonverbal communicationnonverbal communicationReceiver will interpret your V &NVReceiver will interpret your V &NVCommunication is a basic skill (tool) which Communication is a basic skill (tool) which

can be learned and must be practiced/re-can be learned and must be practiced/re-evaluated on a regular basis.evaluated on a regular basis.

Factors affecting Factors affecting CommunicationCommunication

• ListeningListening

• Non verbal cuesNon verbal cues

• DistanceDistance

• Personal spacePersonal space

CommunicationCommunication

INTERNAL FACTORSINTERNAL FACTORSLiking others (optimistic view of the Liking others (optimistic view of the

person)person)EmpathyEmpathyThe ability to listen actively to the The ability to listen actively to the

clientclient

CommunicationCommunication

EXTERNAL FACTORSEXTERNAL FACTORSEnsure privacyEnsure privacyRefuse interruptionsRefuse interruptionsPhysical environment: Physical environment: comfortable comfortable

temperature, good lighting, reduced noise, temperature, good lighting, reduced noise, no distractions, comfortable distance (4 to no distractions, comfortable distance (4 to 5 feet), eye level-face to face seating, do 5 feet), eye level-face to face seating, do not stand.not stand.

Dress professionallyDress professionally

Techniques of Techniques of CommunicationCommunication

• Listening techniquesListening techniques

• Questioning techniquesQuestioning techniques

• Sending messages techniquesSending messages techniques

INTRODUCING THE INTRODUCING THE INTERVIEWINTERVIEW

• Use client’s last name.Use client’s last name.

• Introduce yourself and your role.Introduce yourself and your role.

• Give the reason for the interview.Give the reason for the interview.

WORKING PHASE WORKING PHASE (data gathering phase)(data gathering phase)

• OPEN ENDED QUESTIONSOPEN ENDED QUESTIONS: to request : to request narrative information, to begin the narrative information, to begin the interview, introduce a new area of interview, introduce a new area of questioning or topic.questioning or topic.

• CLOSED OR DIRECT QUESTIONS:CLOSED OR DIRECT QUESTIONS: to to illicit a yes or no answer, to request illicit a yes or no answer, to request specific information.specific information.

• USING RESPONSES:USING RESPONSES: facilitation (go on, facilitation (go on, uh-huh), silence, reflection, summary.uh-huh), silence, reflection, summary.

10 TRAPS OF 10 TRAPS OF INTERVIEWINGINTERVIEWING• OFFERING FALSE OFFERING FALSE

ASSURANCES OR ASSURANCES OR REASSURANCESREASSURANCES

• ADVISINGADVISING• USING AUTHORITYUSING AUTHORITY• USING USING

PROBLEMATIC PROBLEMATIC QUESTIONINGQUESTIONING

• ENGAGING IN ENGAGING IN DISTANCINGDISTANCING

• USING USING PROFESSIONAL PROFESSIONAL JARGONJARGON

• USING LEADING OR USING LEADING OR BIASED QUESTIONSBIASED QUESTIONS

• TAKING TOO MUCH TAKING TOO MUCH TIMETIME

• INTERRUPTINGINTERRUPTING• DEFENDINGDEFENDING

NONVERBAL NONVERBAL SKILLS/BEHAVIOURS OF THE SKILLS/BEHAVIOURS OF THE INTERVIEWERINTERVIEWERPOSITIVE POSITIVE Eye contactEye contactOpen posture, relaxedOpen posture, relaxedLeaning forwardLeaning forwardTone of voice Tone of voice

moderatemoderateAppropriate touchAppropriate touchProfessional Professional

appearanceappearance

NEGATIVENEGATIVEStandingStandingBland expressionBland expressionHigh pitch toneHigh pitch toneSpeech slow or fastSpeech slow or fastSitting far away, Sitting far away,

behind a deskbehind a deskInappropriate dressInappropriate dress

DEVELOPMENTAL DEVELOPMENTAL CONSIDERATIONSCONSIDERATIONS1)1) Parent/infantParent/infant: greet both by name,interview together, : greet both by name,interview together,

allow toys for the child, ask about toy to make allow toys for the child, ask about toy to make contact.contact.

2)2) School-age childSchool-age child: parent/child together, child will have : parent/child together, child will have valuable information at times, ask child about valuable information at times, ask child about symptoms first then parent later.symptoms first then parent later.

3)3) AdolescentAdolescent: be respectful, don’t judge, give truth with : be respectful, don’t judge, give truth with rationale, keep it short and simple.rationale, keep it short and simple.

4)4) Older adultOlder adult: greet by last name, allow more time for : greet by last name, allow more time for interview, shorter segments may be necessary.interview, shorter segments may be necessary.

You must be able to develop a rapport with people at You must be able to develop a rapport with people at different stages of life.different stages of life.

INTERVIEWING PEOPLE WITH INTERVIEWING PEOPLE WITH SPECIAL NEEDSSPECIAL NEEDS

1)1)Hearing-impairedHearing-impaired

2)2)Acutely ill peopleAcutely ill people

3)3)CryingCrying

4)4)AngerAnger

5)5)Threat of violenceThreat of violence

CROSS CULTURAL CROSS CULTURAL COMMUNICATIONCOMMUNICATION

1)1)EtiquetteEtiquette: formal/respectful/polite, : formal/respectful/polite, name and title.name and title.

2)2)Space and distance:Space and distance: 2-4 feet with 2-4 feet with all.all.

OVERCOMING OVERCOMING COMMUNICATION BARRIERS…COMMUNICATION BARRIERS…

• LanguageLanguage

• Divers backgroundsDivers backgrounds

• BehavioursBehaviours

• Eye contactEye contact

The Complete Health The Complete Health HistoryHistory• What is the purpose of the complete health hx?What is the purpose of the complete health hx?

• Subjective dataSubjective data: what the person says about : what the person says about himself/herself.himself/herself.

• Objective dataObjective data: physical examination and lab : physical examination and lab studies.studies.

Both form the data base which is used to Both form the data base which is used to make a diagnosis about the health status make a diagnosis about the health status

of the individual.of the individual.

The health history:The health history:

• complete picture of complete picture of the person's past and the person's past and present healthpresent health

• describes the describes the individual as a whole individual as a whole & how the person & how the person interacts with the interacts with the environmentenvironment

• records health records health strengths & coping strengths & coping skillsskills

• for the for the well personwell person - - hx used to assess hx used to assess lifestyle lifestyle e.g.e.g. exercise, diet, exercise, diet, risk reduction, health risk reduction, health promotion behaviourpromotion behaviour

• for the for the ill personill person - hx - hx includes a detailed & includes a detailed & chronological record chronological record of the health problemof the health problem

Health History FormsHealth History Forms

• biographical databiographical data

• reason for seeking care (previously chief reason for seeking care (previously chief complaint)complaint)

• present health or history of present illnesspresent health or history of present illness

• past historypast history

• family historyfamily history

• review of systemsreview of systems

• functional assessment or activities of daily functional assessment or activities of daily living (ADLs)living (ADLs)

Health History (Adult)Health History (Adult)

A-Health Hx A-Health Hx

Biographical dataBiographical data

• Name Name

• AgeAge

• AddressAddress

• Phone numberPhone number

• Birth dateBirth date

• SexSex

• Marital statusMarital status

Source of historySource of history

• Who provided the Who provided the information?information?

• Are they a reliable Are they a reliable source?source?

• Was there an Was there an interpreter interpreter present?present?

Health HxHealth Hx

Reason for seekingReason for seeking

care care

• Brief statement of Brief statement of why the client is why the client is seeking health care.seeking health care.

• It states one or two It states one or two symptoms and their symptoms and their duration.duration.

• Use quotation marks.Use quotation marks.

Present health/historyPresent health/history

of present illnessof present illness

• Chronological record of Chronological record of the reason for seeking the reason for seeking health care.health care.

• ““Tell me about…from Tell me about…from the time it started”the time it started”

• Should include the 8 Should include the 8 critical characteristics.critical characteristics.

Health HxHealth HxSymptoms- 8 Critical Symptoms- 8 Critical CharacteristicsCharacteristics• locationlocation• character or quality character or quality (burning, sharp, dull, etc.)(burning, sharp, dull, etc.)• quantity or severity quantity or severity (scale, how many?)(scale, how many?)• Timing Timing (onset, duration, frequency)(onset, duration, frequency)• SettingSetting • aggravating or relieving factorsaggravating or relieving factors (better, (better,

worse)worse)• associated factorsassociated factors • patient's perceptionpatient's perception (what do you think it (what do you think it

means?)means?)

B-Past HealthB-Past Health

• Childhood illnesses:Childhood illnesses: MMR, chickenpox, MMR, chickenpox, pertussis, strep throat, polio.pertussis, strep throat, polio.

• Accidents/injuries:Accidents/injuries: auto, fractures, head auto, fractures, head injuries, burns.injuries, burns.

• Serious/chronic illnesses:Serious/chronic illnesses: diabetes, BP, heart diabetes, BP, heart disease, cancer, seizures.disease, cancer, seizures.

• Hospitalizations:Hospitalizations: cause, name of.., how was it cause, name of.., how was it treated, how long…, physician.treated, how long…, physician.

B-Past HealthB-Past Health

• Operations:Operations: type, date, surgeon, name of type, date, surgeon, name of hospital, how they recovered.hospital, how they recovered.

• Obstetric hx:Obstetric hx: Grav___Term___Preterm___Ab___Living__Grav___Term___Preterm___Ab___Living__

• Immunizations:Immunizations: MMR, polio, DpT, Hep B, Tb MMR, polio, DpT, Hep B, Tb immunization and skin test, last flu shot.immunization and skin test, last flu shot.

• Last examination date:Last examination date: MD, dental, vision, MD, dental, vision, hearing, ECG, chest x-ray.hearing, ECG, chest x-ray.

B-Past HealthB-Past Health

• Allergies:Allergies: allergen and reaction.allergen and reaction.

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

C-Family HistoryC-Family History

• Include a Include a GenogramGenogram

• Include age and health of the Include age and health of the parents, grand-parents and parents, grand-parents and siblings.siblings.

• ……or age and cause of death.or age and cause of death.

D-Review of Systems D-Review of Systems

The purpose of this review is to evaluate The purpose of this review is to evaluate past/present health states, to evaluate past/present health states, to evaluate health promotion strategies and to health promotion strategies and to identify if any information was missed.identify if any information was missed.

Review each system in the lab as well Review each system in the lab as well as corresponding health as corresponding health promotion(HP) strategies.promotion(HP) strategies.

D-Review of Systems (listed D-Review of Systems (listed only)only)

• SkinSkin

• HairHair

• HeadHead

• EyesEyes

• EarsEars

• Nose and SinusesNose and Sinuses

• Mouth and ThroatMouth and Throat

Review of SystemsReview of Systems

• NeckNeck

• BreastBreast

• AxillaAxilla

• Respiratory Respiratory

• CardiovascularCardiovascular

• Peripheral VascularPeripheral Vascular

• GastrointestinalGastrointestinal

Review of SystemsReview of Systems

• Urinary Urinary

• Male GenitalMale Genital

• Female GenitalFemale Genital

• Sexual HealthSexual Health

• MusculoskeletalMusculoskeletal

• NeurologicalNeurological

• HematologicalHematological

E-Functional AssessmentE-Functional Assessment

This is a measure of the person’s self-care This is a measure of the person’s self-care abilities with respect to:abilities with respect to:

1)1) ADLs: bathing, dressing, toileting, eating, ADLs: bathing, dressing, toileting, eating, walking.walking.

2)2) IADLs: housekeeping, shopping, cooking, doing IADLs: housekeeping, shopping, cooking, doing laundry, using phone, managing finances, laundry, using phone, managing finances, nutrition, social relationships/resources, self-nutrition, social relationships/resources, self-concept/coping, home environment.concept/coping, home environment.

E-Functional AssessmentE-Functional Assessment

• Self-esteem/Self-conceptSelf-esteem/Self-concept:: education, financialeducation, financialstatus, value-belief system.status, value-belief system.

• Activity/ExerciseActivity/Exercise

• Sleep/RestSleep/Rest

• Nutrition/EliminationNutrition/Elimination• Interpersonal Relationships/ResourcesInterpersonal Relationships/Resources: : social social

roles and support persons.roles and support persons.

• Coping/Stress ManagementCoping/Stress Management

Functional AssessmentFunctional AssessmentIncluding ADLSIncluding ADLS

• Personal habitsPersonal habits

1.1. TobaccoTobacco

2.2. AlcoholAlcohol

3.3. Street drugsStreet drugs

• Environmental hazardsEnvironmental hazards

• Occupational healthOccupational health

F-Perception of HealthF-Perception of Health

• How do you define health?How do you define health?

• What are your health goals?What are your health goals?

• What do you expect from your health What do you expect from your health care providers?care providers?

Developmental Developmental ConsiderationsConsiderations• ChildrenChildren: include prenatal/perinatal hx, : include prenatal/perinatal hx,

parent description of problem, developmental parent description of problem, developmental overview & nutritional hx.overview & nutritional hx.

• Older adultsOlder adults: ADLs and IADLs very : ADLs and IADLs very important. Explore changes to ADLs caused important. Explore changes to ADLs caused by aging process or chronic illnesses. Note if by aging process or chronic illnesses. Note if the impact of disease is more important than the impact of disease is more important than the disease itself. Note the reason for the the disease itself. Note the reason for the person seeking health care not the HCP’s person seeking health care not the HCP’s assumption of the problem. assumption of the problem.

THE GENERAL SURVEYTHE GENERAL SURVEY

Follows the health historyFollows the health history

This is subjective not objectiveThis is subjective not objective

Study of the whole personStudy of the whole person

THE GENERAL SURVEYTHE GENERAL SURVEY

The GENERAL SURVEY is split up The GENERAL SURVEY is split up into 4 different components:into 4 different components:

1.1. Physical appearancePhysical appearance

2.2. Body structureBody structure

3.3. MobilityMobility

4.4. BehaviourBehaviour

1. Physical Appearance1. Physical Appearance

• AgeAge

• SexSex

• Level of Level of ConsciousnessConsciousness

• Skin ColourSkin Colour

• Facial FeaturesFacial Features

2. Body Structure2. Body Structure

• StatureStature

• NutritionNutrition

• SymmetrySymmetry

• PosturePosture

• PositionPosition

• Body build, Body build, ContourContour

3. Mobility3. Mobility

• GaitGait

• Range of MotionRange of Motion

4. Behaviour4. Behaviour

• Facial expressionFacial expression

• Mood and affectMood and affect

• Speech Speech

• DressDress

• Personal HygienePersonal Hygiene

Developmental Developmental ConsiderationsConsiderationsInfants/childrenInfants/children Physical appearance, Physical appearance,

body structure, body structure, mobility: note same but mobility: note same but with consideration to with consideration to age and development.age and development.

Behaviour: note Behaviour: note response to stimuli response to stimuli according to according to developmental agedevelopmental age

Parental bondingParental bonding

Aging AdultAging Adult physical appearance: 8physical appearance: 8thth

to 9to 9thth decade contour is decade contour is sharper and facial sharper and facial features more angular features more angular and a change to body and a change to body proportions.proportions.

Posture:general flexion Posture:general flexion by 8by 8thth to 9 to 9thth decade. decade.

Gait: wider base due to Gait: wider base due to poor balance, arms out, poor balance, arms out, smaller steps.smaller steps.