NR 509 Midterm Study Guide
Chapter 1 Approach to the Clinical Encounter
The interviewing process
o Stage 1: Initiating the encounter
Set the stage
Adjust the environment
Review the clinical record
Set your agenda
Greet the patient and establish initial rapport
Identify patient title, name, and preferred gender pronoun
o Stage 2: Gathering information
Initiate information gathering
Establish the agenda for the patient encounter
Invite the patient’s story
Gather information about the patient’s perspective of illness
Identify and respond to the patient’s emotional cues
o Stage 3: Performing the physical exam
o Stage 4: Explaining and Planning
Provide useful information and verify patient understanding
Negotiate the plan of action through shared decision making
o Stage 5: Closing the encounter
Interviewing techniques
o Teach-back method
Setting the stage for the examination
o Check your appearance
o Make sure the patient is comfortable, and the environment is conductive to the very
personal information soon to be shared
o Reflect on any biases you have
Establishing rapport
o Newborns and infants:
Calm voice
Encourage parents to feed right before or during the start of the encounter
Begin by focusing on caregivers and asking about their well-being
o Young (1-4 years) and school-aged children (5-10 years)
Young: Distraction and mood management
Begin from a place of play
School-aged
Ask age-appropriate questions
Brush up on “kid culture” and identify a character on a piece of clothing
or backpack
o Adolescents
Treat like adults and give respect and choices
Aim questions at the patient
Acknowledge the confidentiality and trust
, o Older adults
Elicit preferred way of being addresses
Gender pronouns
o Ask patient preference, and give example if needed
Patient-centered medical care
o Recognizes the importance of patient’s expressions of personal concerns, feelings, and
emotions
o Evokes “the personal context of the patient’s symptoms and disease”
The FIFE model: To explore the patient’s perspective, using different types of questions
o F: Feelings
o I: Ideas
o F: Function
o E: Expectations
Chapter 2 Interviewing, Communication, and Interpersonal Skills
Fundamentals of skilled interviewing
o Active or attentive listening
o Guided questioning
Avoid yes of no questions
Instead of asking “Is the pain sharp?”
Ask: “Please describe your pain?”
o Empathetic responses
For a response to be empathetic, it must convey that you feel what the patient
is feeling
o Summarization
o Transitions: Tell patients that you are changing directions during the interview
o Partnering: Express commitment to an ongoing relationship
o Validation: Validate the legitimacy of his or her emotional experience
o Empowering the patient
o Reassurance
o Appropriate verbal communication
o Appropriate nonverbal communication
Verbal and nonverbal communication
o Verbal
Use understandable language
Use nonstigmatizing language
o Nonverbal
Seem calm and unhurried
Challenging patient situations and behaviors
o Even if a patient is challenging, always remember the importance of listening to the
patient and clarifying his or her concerns
o Patient with altered state or cognition
Some patients can provide a history but cannot make informed health care
decisions
Need to then determine whether a patient has “decision-making
capacity”, which is the ability to understand information related to
, health, weigh choices and their consequences, reason through the
options, and communicate a choice
Chapter 3 Health History
Focused and comprehensive health histories
o Comprehensive: For new patients
o Focused or problem-oriented history: For patient’s seeking care for specific concerns
Determining the scope of the patient assessment
o Adjust the scope of your history and PE to the situation at hand, keeping several factors
in mind:
The magnitude and severity of the patient’s problems
The need for thoroughness
The clinical setting- inpatient or outpatient, primary or subspecialty
The time available
The seven attributes of a patient’s principal symptoms
o Location: Area of body
o Quality: Dull, sharp, throbbing, constant, etc.
o Quantity or severity
o Timing: Onset, duration, frequency
o Setting in which it occurs: Ex: worse when standing, improved with sitting, during a
football game
o Modifying factors: Ex: relieved with Tylenol, feels better/worse with…
o Associated manifestations
Ex: The abdominal pain is accompanied by N/V
Subjective versus objective data
o Subjective: What the patient tells you
o Objective: Labs and diagnostic tests, PE signs you detect during the examination
Modifying of the clinical interview for various clinical settings
o Ambulatory care clinic
Conducting a health history, especially for beginning clinicians as exam rooms
are quiet, private, and have minimal distractions
Focus on not only the CC (if there is one) but also chronic health issues and any
changes to them since their last visit
Also ask about routine health care maintenance
o Emergency care
Ensure patient is clinically stable before initiating a detailed but focused
interview
Ask about symptoms related to possible cause of the problem to quickly rule out
life-threatening illnesses
May need to obtain hx from family, caregivers, other clinicians, or patient health
records if available
o ICU
Often need to get medical history from others
If first time meeting the patient in the hospital: should perform a
comprehensive health history focused on the course of events that led to ICU
care
Chapter 1 Approach to the Clinical Encounter
The interviewing process
o Stage 1: Initiating the encounter
Set the stage
Adjust the environment
Review the clinical record
Set your agenda
Greet the patient and establish initial rapport
Identify patient title, name, and preferred gender pronoun
o Stage 2: Gathering information
Initiate information gathering
Establish the agenda for the patient encounter
Invite the patient’s story
Gather information about the patient’s perspective of illness
Identify and respond to the patient’s emotional cues
o Stage 3: Performing the physical exam
o Stage 4: Explaining and Planning
Provide useful information and verify patient understanding
Negotiate the plan of action through shared decision making
o Stage 5: Closing the encounter
Interviewing techniques
o Teach-back method
Setting the stage for the examination
o Check your appearance
o Make sure the patient is comfortable, and the environment is conductive to the very
personal information soon to be shared
o Reflect on any biases you have
Establishing rapport
o Newborns and infants:
Calm voice
Encourage parents to feed right before or during the start of the encounter
Begin by focusing on caregivers and asking about their well-being
o Young (1-4 years) and school-aged children (5-10 years)
Young: Distraction and mood management
Begin from a place of play
School-aged
Ask age-appropriate questions
Brush up on “kid culture” and identify a character on a piece of clothing
or backpack
o Adolescents
Treat like adults and give respect and choices
Aim questions at the patient
Acknowledge the confidentiality and trust
, o Older adults
Elicit preferred way of being addresses
Gender pronouns
o Ask patient preference, and give example if needed
Patient-centered medical care
o Recognizes the importance of patient’s expressions of personal concerns, feelings, and
emotions
o Evokes “the personal context of the patient’s symptoms and disease”
The FIFE model: To explore the patient’s perspective, using different types of questions
o F: Feelings
o I: Ideas
o F: Function
o E: Expectations
Chapter 2 Interviewing, Communication, and Interpersonal Skills
Fundamentals of skilled interviewing
o Active or attentive listening
o Guided questioning
Avoid yes of no questions
Instead of asking “Is the pain sharp?”
Ask: “Please describe your pain?”
o Empathetic responses
For a response to be empathetic, it must convey that you feel what the patient
is feeling
o Summarization
o Transitions: Tell patients that you are changing directions during the interview
o Partnering: Express commitment to an ongoing relationship
o Validation: Validate the legitimacy of his or her emotional experience
o Empowering the patient
o Reassurance
o Appropriate verbal communication
o Appropriate nonverbal communication
Verbal and nonverbal communication
o Verbal
Use understandable language
Use nonstigmatizing language
o Nonverbal
Seem calm and unhurried
Challenging patient situations and behaviors
o Even if a patient is challenging, always remember the importance of listening to the
patient and clarifying his or her concerns
o Patient with altered state or cognition
Some patients can provide a history but cannot make informed health care
decisions
Need to then determine whether a patient has “decision-making
capacity”, which is the ability to understand information related to
, health, weigh choices and their consequences, reason through the
options, and communicate a choice
Chapter 3 Health History
Focused and comprehensive health histories
o Comprehensive: For new patients
o Focused or problem-oriented history: For patient’s seeking care for specific concerns
Determining the scope of the patient assessment
o Adjust the scope of your history and PE to the situation at hand, keeping several factors
in mind:
The magnitude and severity of the patient’s problems
The need for thoroughness
The clinical setting- inpatient or outpatient, primary or subspecialty
The time available
The seven attributes of a patient’s principal symptoms
o Location: Area of body
o Quality: Dull, sharp, throbbing, constant, etc.
o Quantity or severity
o Timing: Onset, duration, frequency
o Setting in which it occurs: Ex: worse when standing, improved with sitting, during a
football game
o Modifying factors: Ex: relieved with Tylenol, feels better/worse with…
o Associated manifestations
Ex: The abdominal pain is accompanied by N/V
Subjective versus objective data
o Subjective: What the patient tells you
o Objective: Labs and diagnostic tests, PE signs you detect during the examination
Modifying of the clinical interview for various clinical settings
o Ambulatory care clinic
Conducting a health history, especially for beginning clinicians as exam rooms
are quiet, private, and have minimal distractions
Focus on not only the CC (if there is one) but also chronic health issues and any
changes to them since their last visit
Also ask about routine health care maintenance
o Emergency care
Ensure patient is clinically stable before initiating a detailed but focused
interview
Ask about symptoms related to possible cause of the problem to quickly rule out
life-threatening illnesses
May need to obtain hx from family, caregivers, other clinicians, or patient health
records if available
o ICU
Often need to get medical history from others
If first time meeting the patient in the hospital: should perform a
comprehensive health history focused on the course of events that led to ICU
care
