HIP Final Exam 2023 with verified questions and answers

Therapeutic communication Verbal and nonverbal communication techniques that encourage patients to express their feelings and to achieve a positive relationship. message the idea or information we wish to convey sender initiates and transmits the message channel the means by which a message is communicated: verbal, nonverbal, written receiver the person for whom the message is intended feedback a response indicating whether the message was received and understood; may provide verification or ask for clarification HIPAA (Health Insurance Portability and Accountability Act) Federal law that protects patient health information (PHI) and upholds patient-provider confidentiality. Patients must authorize for disclosure of health information and the minimum PHI should be used for patient care. Verbal Communication includes oral and written communication; avoid medical jargon and informal speech nonverbal communication -body language -paralanguage: sighing, humming, volume, pitch, tone -incongruence -proxemics: spatial awareness -kinesics: body movements, facial expression Introductory/Orientation Phase -introduce patient and nurse to each other -help form a mutual agreement to exchange info -classifies roles and establishes tones/guidelines for relationship -provide patient with orientation to health care systems Working Phase -keep conversation focused on task at hand -control the flow of the conversation -work together to meet patient's needs -provide assistance needed to achieve each goal -provide teaching and counseling Termination phase -both parties are satisfied -goals for patient's needs have been achieved -examine goals of the helping relationship -make suggestions for future efforts -encourage patients to express emotions about termination -if appropriate, help patient establish a helping relationship with another nurse -assist patient transferring from one agency to another Empathy -Experiencing the same feelings as another -Drives compassion: taking action to reduce the patient's distress Patient Interview interaction with a patient for the purpose of obtaining in-depth information about: -Chief complaint -Medical history -Medications -Family history -Review of systems (ROS) Subjective Information experienced by the individual -chief complaint: pt's most significant or serious reason for concern •Onset of problem •Location of the complaint •Duration of the problem -Pain: •Measured on pain scale •Quality of pain - sharp, dull, throbbing Objective Information observed and measurable -no room for interpretation -Ex: Bloodwork, labs, heart rate, BP open-ended questions -responder must give a longer, freeform answer: gain more information -ask "how" or "what" questions, avoid "why" questions to avoid judgement -can not be answered with yes or no closed-ended questions a question with a limited set of possible answers, used to clarify Leading questions and Cuing *avoid both leading question: Encourages or expects a certain answer; ex: "You never had unprotected sex, did you?" cuing: inadvertently eliciting an answer by giving positive or negative feedback that signals what the questioner expects or wants to hear Algorithm -A series or path of questions to follow that changes based on the pt's response at each step; solve problem using logical progression Acronym Ex: MDVISIT -Medications - What medicines do you take, how much -Diet - Daily diet, recent weight gain or loss -Visits - Any recent trips to ER since last visit? -Injuries - Any recent injuries, slips, falls -Symptoms - Any new symptoms, problems -Information - Any questions about medical treatment? -Treatments - Following provider prescribed treatment? Reflective Response a statement confirming that you received the message but leaving room for the patient to complete their thought or explore it further: allow patient to supply more information Active Listening -the full attention of the listener to comprehend, respond to, and remember what the speaker is communicating -Requires recognizing verbal, nonverbal cues Steps in Patient Education 1.Assessment 2.Planning 3.Implementation 4.Evaluation 5.Documentation Assessment -should define health care needs -Determine the patient's readiness to learn -Evaluate the patient's learning needs -Assess the patient's learning style Readiness to Learn can be influenced by: -Medical language and terms -Patient is (still) sick: readiness increases as patient recovers -Hospital room may be a poor setting for learning -Patient doesn't speak language and no interpreter Health Literacy the degree in which individuals have the capacity to understand basic health information and services needed to make appropriate health decisions -low health literacy affects the quality of communication Learning Styles 1. cognitive: to acquire knowledge based on reading and learning info 2. affective: to grow emotionally and change attitudes 3. psychomotor: to acquire a skill, learn hands-on Learning Goals broad statements about the long-term expectation of a desired result Learning Objectives statements that describe the desired results and how they will be achieved; usually multiple objectives to achieve one goal Implementation -Puts the process in motion using a variety of tools -ex: lecture, roleplay, demonstration, discussion, patient education material, Understanding Medication Administration -Which medication, dosage, frequency is individualized based on weight, health history, other medications -How: the procedure, including injection site -When: how often or at what time of day -Why: why did the provider prescribe this medicine Evaluation -the making of a judgment about the amount, number, or value of something; assessment. -ex: teach back method Patient Adherence The degree to which the patient's behavior corresponds with the agreed provider recommendation and can be influenced by: -patient cannot afford medication or stops taking -Misunderstanding between provider and patient -Lifestyle changes and treatment is too difficult Documentation -for legal reasons and to ensure quality of care -needed for continuity of care -No documentation=HCP assume it was not done Cultural imposition -when a person or group believes others should adhere to their beliefs -When HCP impose personal beliefs on patient's, they decrease the chance of a successful interaction -leads to health disparities Cultural Bias Cultural beliefs affect how patient's perceive health care: -How they relate to pain, illness and injuries -Traditional medicine versus natural healers -Whether to follow health care directives Language Barriers -Limited English Proficiency: are more likely to be misdiagnosed, have difficulty providing medical history, issues adhering to instructions -Use certified interpreters: remote or in person -Ad hoc interpreters: any untrained interpreter present during clinical encounter Sensory Barriers any impairment of one or more of the senses, sight, hearing, smell, touch, taste -visual impairments (anopia) -auditory impairments (anacusis): Otosclerosis, Sensorineural, Mixed deafness: presbycusis Patient Stress HCP must try to relieve stress from patient -Create relaxing environment -Sit face-to-face, speak slow and calmly -Help patient adjust priorities and be more realistic -Be available for questions -Stay positive and encourage laughter Intimate Partner Violence physical, sexual, or psychological harm by a current or former partner or spouse -Look for signs: injuries, trauma, Ask questions when pt is alone, S.A.F.E. method of questioning -Safe, Afraid, Friends/family?, Emergency plan? Mandatory Reporters states require HCPs and others to report suspected child abuse Acute vs. Chronic Illness Acute: a rapid onset, short duration Chronic: develop gradually, long term -Knowing timeline of illness can be comforting -Knowing the illness is progressive or debilitating can lead to poor compliance and poor results Informed Consent Patient authorizes treatment -Needed unless emergency situation -Pt must be told diagnosis, treatments options, risks Advanced Directive a legal document completed to provide HCP with guidance on interventions durable power of attorney allows patient to legally delegate another person to make decisions Physician Order of Life-Sustaining Treatment Medical order made by patient directing HCPs in event of a medical crisis in future situations Grief our normal emotional response to actual or perceived loss of something we value Actual Loss more tangible and able to be identified by others: loss of loved one, job, health, etc. Perceived Loss Perceived loss - internal and identified only by the person experiencing it. Anticipatory Grief preparing for eventual loss and grief is easier when spread over time Complicated Grief persistent, intense grief with chronic sadness and constant thoughts of the loss; interferes with daily life Mourning outward, personal expression of grief: -influenced by spiritual and cultural beliefs -Actions, symbolism, ceremonies, rituals Bereavement The state after losing a loved one- occurs after the death during the period of both grief and mourning Palliative Care focuses on comfort and pain relief rather than curing patients; used to improve the quality of remaining life Freud's Grief Work -face grief head on to avoid long term depression -individuals must work through strong feelings to reduce stress Kubler-Ross's Stages 1. Denial 2. Acceptance 3. Bargaining 4. Depression 5. Acceptance William Worden Task Model Four fluid, non-linear tasks the bereaved must work through Attachment Theory Feelings experiences when the infant-caregiver bond is involuntarily severed Dual-process model says a grieving person must cope with less on one hand and adjust lifestyle on the other -rest from both type of stressors at times -oscillates processing loss and avoiding loss Chaplain Trained to provide emotional support and spiritual care to patients Respite -short interval of rest -Volunteers can be trained to provide respite care: Allows caregivers valuable time away -respite and palliative care often used in hospice Professionalism skills, judgements, behaviors expected in workplace: -Showing respect for others -Being polite and dependable -Safeguarding pt privacy -Following ethical guidelines -Maintaining accurate and timely health records Covered entities any organizations that obtain and manage health information - in the way health information is held, stored or transmitted -Health care providers -Insurance health plans -Health care clearinghouses Business associates vendors who contract with covered entities, use health information while providing a service interdisciplinary communication combination of two or more specialties working together towards a specific goal: -Each specialty lends a unique viewpoint -Promotes teamwork, improving productivity -Improves patient care environment -Meets requirements of regulatory agencies -Helps to formulate policies and procedures Referral a formal contract between two or more HCP to provide patient services that goes over the type of service needed, date it should begin, duration or goals of service, specific instructions -requires a release of information (ROI) from the patient Agenda -Lists what will be discussed or take place -Promotes focus and efficiency of meeting Minutes a summary record of what took place -Allow absent invitees to read what happened -Aid in subsequent meetings -Record for any auditing, accrediting, regulation Triage process of determining degree of sickness and placing patient into appropriate level of care: -Emergent: must act very quickly -Urgent: must act within a reasonable time-frame -Nonurgent: not a time-dependent situation -STAT: a situation requiring immediate attention Accreditation and Regulatory Agencies 1. CDC - Center for Disease Control 2. CMS - Center for Medicare and Medicaid 3. DPH - Department of Public Health 4. FDA - U.S. Food and Drug Administration 5. TJC - The Joint Commission 6. OSHA - Occupational Safety Heath Administration Communicating with Agencies A: Answer the investigators questions G: Give only appropriate data or information E: Encourage open dialogue N: Never hide or conceal any information C: Confidentiality - what information and to whom• Y: Your attention and full participation in important Communicate with Staff B: Behavior O: Objective S: Spreads S: Suggest/Search Work through Staff Conflicts P: Present the problem E: Explain your feelings E: Effect the problem has on ability to work R: Resolve - express you want to resolve the problem Telephone Communication -Phone calls should be answered by third ring -Refilling prescriptions, scheduling appointments, labs -Test/Labs: Do not share results with patient until provider says so -Billing: handled in-house or by a third party; good estimate of potential cost -Ensure patient understands information discussed: Repeat key material, avoid jargon Email Communication -If message is complex, phone may be better -Should be accurate, clear and timely -Most important points at the top of the message -Carbon Copy (cc) - including another person -Bling carbon copy (bcc) - identity is not shared Business letters written forms of communication with pts, colleagues and other professionals -Should include seven key pieces, in order: 1. Business Address - if not on letterhead, facility address should be in top left corner 2. Date of Letter - spelled out below address 3. Recipient Address - one line below date 4. Greeting - two lines below date 5. Main Body - gracious opening clarifying purpose followed by paragraphs that support 6. Closing - "Sincerely" 7. Signature - leave four blank spaces where sender will sign, typed named, title under Health Record -the primary means by which HCPs communicate info about patient care to one another: Providers to nurses, nurses to providers, providers to payers -Consists of all the information from the initial patient interview, findings and orders of the provider, and all instructions given to the patient over course of care Uses: -continuity of care, billing, legal matters, risk management, management/administration, quality improvement, Research and Public Policy (patient's diagnosis- show health data and health of a population) Clinical Content of Health Record 1. Operative Reports: Findings during surgical procedure, pre-operative assessment and post-operative instructions 2. Patient Education 3. Discharge Summary Notice of Privacy Practices (NPP) details a health care organizations policies on privacy; required to be clearly written Electronic Health Record digital version of patient's paper chart -Sharing patient data with other providers from other health care facilities or networks -Record viewed/shared with by multiple parties -Data recorded in real-time -Send prescriptions directly to pharmacies -Standardized data input -Using drop-down menus instead of freely typing -Alerts for allergies/contraindications -Secure messaging (interoperable software) -Record completion reminders and other tools for compliance Documenting Guidelines -Military time -Approved abbreviations and Symbols from TJC -Correct punctuation, spelling, and active voice -Be concise and specific -Document corrections, late entries -Stick to facts -emergency care -patient noncompliance Computer-assisted physician order entry (CPOE) allows providers to select and digitally transmit orders/meds: Reduces errors Clinical decision support (CDS) system evidence-based approaches and treatments Children/Adolescents and Grief -shielding children from death may prevent coping skills from developing -Adolescents are better able to conceptualize death than children and may be more withdrawn or private in their grief -child life specialists are pediatric HCP who provide age-appropriate preparation for illness and recovery -Families know better if they know what to expect, calm acceptance help soothe child and family Adults and Grief -young adults: sudden death magnifies grief response -middle adults: more realistic view of life -older adults: see acceleration of loss around them and are more likely to accept their own death Communication and Depression -be aware of verbal and nonverbal cues -patient may be seeking care for another reason -use open ended questions -practice active listening -accept the way the patient feels -encourage medication adherence: antidepressants take time to work Communication and Anxiety Disorders -your manner can ease stress of anxious patients -be calm, patient, accepting, and summarize -normalize patient feelings -interview to obtain history, duration, and severity of anxiety Communication and Cancer -your compassionate approach is critical -accept patient without judgement or pity -most treatments weaken patient immune system -wearing PPE may be necessary -acknowledge the overall impact of a cancer diagnosis on the patient and their loved ones -don't try to be an expert, just give support, always use patients name Communication and Eating Disorders -many patients will hide or deny problem and resist -ask clarifying questions using active listening -interdisciplinary care -hospitalization may be required if patient is not responding Communication and Dementia -patient centered care: sustain patient identity, include in decisions -do not assume all dementia presents similarly -engage patient in life review of happy memories -approach from the front, address and eye level -communicate in distraction-free setting -do not talk about patient in the 3rd person -be patient and never correct or argue your patient -Rule of 5's Communication and Autism -communication is difficult and should be tailored individually -keep environment quiet and dim light to alleviate anxiety -use realistic, clear language spoken softly and slowly Communication and Somatic Symptom Disorder -can cause disruption in daily life -6 months or longer, preoccupied with symptoms -consistently unwell despite medical care -may be aware they drift to different illnesses -anxiety dominates patients life -patient becomes angry when studies do not validate feelings -stress can cause illness- symptoms usually pass when stressor disappears