NR 509 Study Guide
• The interviewing process
o This process generates the patient’s story that is fluid and draws on various
relational skills to respond effectively to patient cues, feelings, and concerns.
• Interviewing techniques
o Active or attentive listening
o Guided questioning
o Empathic responses
o Summarization
o Transitions
o Partnering
o Validation
o Empowering the patient
o Reassurance
o Appropriate verbal communication
o Appropriate nonverbal communication
• Setting the stage for the examination
o This is the relationship building stage with the patient
▪ Set the Stage
• Make sure the patient is comfortable in their own environment
• Reflect on any biases
▪ Adjust the environment
• Make the interview setting as private and comfortable as possible
• Making the environment as confidential as possible improves
communication
▪ Review the Clinical Record
• Before seeing the patient, review the clinical record
• Review data such as age, gender, address, and insurance
• Data may be incomplete or even disagree with what the patient
tells you
▪ Set your Agenda
• Before you talk to the patient, clarify goals for the interview
• As an advanced trainee or practicing clinician, your goals can
range from assessing a new concern, to treatment follow-up, to
completing forms.
▪ Greet the Patient and Establish Initial Rapport
• The initial moments of your encounter lay the foundation for your
ongoing relationship
• Welcome the patient by introducing self, giving first and last name.
• If this is the first time meeting the patient, explain role, your status
as a student or trainee, and how you will be involved in their
care
▪ Identifying Patient Title, Name, and Preferred Gender Pronoun
, • Let the patient dictate how they would like to be addressed
• Clinicians should ask all patients their preferred name and gender
pronouns – ideally at the beginning of the visit and/or intake
questionnaire
• Establishing rapport
o Newborns and Infants
▪ Congratulate family on the new baby if appropriate for the circumstances
▪ Encourage the caregivers to feed the baby while you are talking or before
the encounter begins to help keep the baby calm and relaxed
▪ Keep voice calm around newborns
▪ It is helpful to begin newborn or infant encounter by focusing on the
caregivers and asking about their well-being
o Young and School-Aged Children
▪ The school-aged years are characterized by increasing feelings of
autonomy, socialization, and curiosity
▪ Distraction and mood management are essential
▪ Beginning the encounter from a place of play is a great way to build
rapport with the child and parents
▪ Begin the encounter by introducing self and then to the family
▪ While the child is busy playing with toys, scribbling, etc., take the
opportunity to obtain health information from the caregiver
o Adolescents
▪ Generally want to be treated as adults and to be given respect and choices
▪ The most challenging for clinicians is balancing the needs of the family
and the autonomy of the adolescent
▪ Use open-ended questions
▪ Increase the amount of time spent with the adolescent alone without any
family members present
▪ Acknowledge trust and confidentiality in the space
o Older Adults
▪ Provide enough space in the exam room for the older adult to safely
navigate especially when navigating
▪ Allow for open-ended questions
▪ Include family members and caregivers
▪
• Gender pronouns
o Clinicians should ask all patients their preferred name and gender pronouns
o All patients regardless of gender have pronouns
o When asking about own pronouns, it can be helpful to share your own pronouns
with patients
o It’s important to use the title, name, and pronoun the patient provided, both with
the patient but also when talking about the patient to other clinicians and staff
o Referring the patient with the wrong name or pronoun, can make them feel
disrespected, invalidated, dismissed, alienated, or dysphoric
• Patient-centered medical care
o
, • The FIFE model
o Feelings, Ideas, effect on Function, and Expectations
▪ The patients Feelings, including fears or concerns about the problem
▪ The patients ideas about the nature and the cause of the problem
▪ The effect on the problem on the patient’s life and Function
▪ The patients Expectations of the disease, of the clinician, or of healthcare ,
often based on prior personal or family experiences
o Examples
▪ “What concerns you most about the pain?”
▪ “How has this been for you?”
▪ Why do you think you have this stomachache?
▪ “I’m glad the pain is gone, how specifically can I help you now?”
Chapter 2 Interviewing, Communication, and Interpersonal Skills
• Fundamentals of skilled interviewing
o
• Verbal and nonverbal communication
o Verbal
o Nonverbal
o Challenging patient situations and behaviors
▪ Sensitive topics
• Informed consent includes
o Communication process in which a clinician educates a patient about the risks,
benefits, and alternatives of a given procedure or intervention
o The following are required elements for documentation of the informed consent
discussion
▪ Nature of the procedure or treatment
▪ Risks and benefits of the procedure or treatment
▪ Reasonable alternatives
▪ Risks and benefits of alternatives
▪ Assessment of the patient’s understanding of the first four elements
o
• Interpreters
Chapter 3 Health History
• Focsued and comprehensive health includes
o Focused
o Comprehensive
• Determining the scope of the patient assessment
• The seven attributes of a patient’s principal symptoms
• Subjective versus objective data
• Modifying of the clinical interview for various clinical settings
• Components of the adult health history
• Suggested steps and documenting HPI
• The interviewing process
o This process generates the patient’s story that is fluid and draws on various
relational skills to respond effectively to patient cues, feelings, and concerns.
• Interviewing techniques
o Active or attentive listening
o Guided questioning
o Empathic responses
o Summarization
o Transitions
o Partnering
o Validation
o Empowering the patient
o Reassurance
o Appropriate verbal communication
o Appropriate nonverbal communication
• Setting the stage for the examination
o This is the relationship building stage with the patient
▪ Set the Stage
• Make sure the patient is comfortable in their own environment
• Reflect on any biases
▪ Adjust the environment
• Make the interview setting as private and comfortable as possible
• Making the environment as confidential as possible improves
communication
▪ Review the Clinical Record
• Before seeing the patient, review the clinical record
• Review data such as age, gender, address, and insurance
• Data may be incomplete or even disagree with what the patient
tells you
▪ Set your Agenda
• Before you talk to the patient, clarify goals for the interview
• As an advanced trainee or practicing clinician, your goals can
range from assessing a new concern, to treatment follow-up, to
completing forms.
▪ Greet the Patient and Establish Initial Rapport
• The initial moments of your encounter lay the foundation for your
ongoing relationship
• Welcome the patient by introducing self, giving first and last name.
• If this is the first time meeting the patient, explain role, your status
as a student or trainee, and how you will be involved in their
care
▪ Identifying Patient Title, Name, and Preferred Gender Pronoun
, • Let the patient dictate how they would like to be addressed
• Clinicians should ask all patients their preferred name and gender
pronouns – ideally at the beginning of the visit and/or intake
questionnaire
• Establishing rapport
o Newborns and Infants
▪ Congratulate family on the new baby if appropriate for the circumstances
▪ Encourage the caregivers to feed the baby while you are talking or before
the encounter begins to help keep the baby calm and relaxed
▪ Keep voice calm around newborns
▪ It is helpful to begin newborn or infant encounter by focusing on the
caregivers and asking about their well-being
o Young and School-Aged Children
▪ The school-aged years are characterized by increasing feelings of
autonomy, socialization, and curiosity
▪ Distraction and mood management are essential
▪ Beginning the encounter from a place of play is a great way to build
rapport with the child and parents
▪ Begin the encounter by introducing self and then to the family
▪ While the child is busy playing with toys, scribbling, etc., take the
opportunity to obtain health information from the caregiver
o Adolescents
▪ Generally want to be treated as adults and to be given respect and choices
▪ The most challenging for clinicians is balancing the needs of the family
and the autonomy of the adolescent
▪ Use open-ended questions
▪ Increase the amount of time spent with the adolescent alone without any
family members present
▪ Acknowledge trust and confidentiality in the space
o Older Adults
▪ Provide enough space in the exam room for the older adult to safely
navigate especially when navigating
▪ Allow for open-ended questions
▪ Include family members and caregivers
▪
• Gender pronouns
o Clinicians should ask all patients their preferred name and gender pronouns
o All patients regardless of gender have pronouns
o When asking about own pronouns, it can be helpful to share your own pronouns
with patients
o It’s important to use the title, name, and pronoun the patient provided, both with
the patient but also when talking about the patient to other clinicians and staff
o Referring the patient with the wrong name or pronoun, can make them feel
disrespected, invalidated, dismissed, alienated, or dysphoric
• Patient-centered medical care
o
, • The FIFE model
o Feelings, Ideas, effect on Function, and Expectations
▪ The patients Feelings, including fears or concerns about the problem
▪ The patients ideas about the nature and the cause of the problem
▪ The effect on the problem on the patient’s life and Function
▪ The patients Expectations of the disease, of the clinician, or of healthcare ,
often based on prior personal or family experiences
o Examples
▪ “What concerns you most about the pain?”
▪ “How has this been for you?”
▪ Why do you think you have this stomachache?
▪ “I’m glad the pain is gone, how specifically can I help you now?”
Chapter 2 Interviewing, Communication, and Interpersonal Skills
• Fundamentals of skilled interviewing
o
• Verbal and nonverbal communication
o Verbal
o Nonverbal
o Challenging patient situations and behaviors
▪ Sensitive topics
• Informed consent includes
o Communication process in which a clinician educates a patient about the risks,
benefits, and alternatives of a given procedure or intervention
o The following are required elements for documentation of the informed consent
discussion
▪ Nature of the procedure or treatment
▪ Risks and benefits of the procedure or treatment
▪ Reasonable alternatives
▪ Risks and benefits of alternatives
▪ Assessment of the patient’s understanding of the first four elements
o
• Interpreters
Chapter 3 Health History
• Focsued and comprehensive health includes
o Focused
o Comprehensive
• Determining the scope of the patient assessment
• The seven attributes of a patient’s principal symptoms
• Subjective versus objective data
• Modifying of the clinical interview for various clinical settings
• Components of the adult health history
• Suggested steps and documenting HPI
