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Introduction to N1037

Introduction to N1037. Course Outline Topic Outline. Intro to N1037. Handouts Schedule Assignment Marking scheme. Schedule for Lab Groups. Group #1 Mondays 1630-1930 Group #2 Thursdays 1430-1730 Group #3 Thursdays 1730-1930 Group #4 Friday 1630-1930. Definitions. Assessment

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Introduction to N1037

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  1. Introduction to N1037 Course Outline Topic Outline

  2. Intro to N1037 Handouts Schedule Assignment Marking scheme

  3. Schedule for Lab Groups • Group #1 Mondays 1630-1930 • Group #2 Thursdays 1430-1730 • Group #3 Thursdays 1730-1930 • Group #4 Friday 1630-1930

  4. Definitions • Assessment • Critical Thinking • Critical Reasoning

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

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

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

  8. Interpretation Analysis Inference Explanation Evaluation Self-regulation Nursing Process and Critical ThinkingComponents of Critical thinking

  9. Assessment • What’s the problem? • Collect data • Review of the clinical record • Interview • Health history • Physical examination • Functional assessment • Consultation • Review of the literature

  10. Diagnosis • Interpret data • Identify clusters of cues • Compare clusters of cues with definition and defining characteristics • Identify related factors • Document the diagnosis

  11. Outcomes/Goals • Identify expected outcomes • Individualize to the person • Realistic and measurable • Include a time frame

  12. Planning • What are we going to do about it? • Establish priorities • Develop outcomes • Set time frames for outcomes • Identify interventions • Document plan of care

  13. Implementation • Move into action! • Do it! • Review the planned interventions • Schedule and coordinate the person's total health care • Collaborate with other team members

  14. Evaluation • Did it work? • How did it go? • Refer to established outcomes • Evaluate the individual's condition and compare actual outcomes with expected outcomes • Summarize the results of the evaluation

  15. Evaluation • Identify reasons for the person's failure, if indicated, to achieve expected outcomes stated in the plan of care • Take corrective action to modify the plan of care as necessary • Document the evaluation of the person's achievement of outcomes and the modifications, if any, in the plan of care

  16. Interviewing • Purpose • How to begin • Environment • Confidentiality • Note taking

  17. Stages in Interview Process • Stage 1 - Joining stage • Stage 2 – Working stage • Stage 3 – Termination stage

  18. Communication PROCESS OF COMMUNICATION • SENDING & RECEIVING • The sender needs to be aware of verbal & nonverbal communication • Receiver will interpret your V &NV • Communication is a basic skill (tool) which can be learned and must be practiced/re-evaluated on a regular basis.

  19. Factors affecting Communication • Listening • Non verbal cues • Distance • Personal space

  20. Communication INTERNAL FACTORS • Liking others (optimistic view of the person) • Empathy • The ability to listen actively to the client

  21. Communication EXTERNAL FACTORS • Ensure privacy • Refuse interruptions • Physical environment: comfortable temperature, good lighting, reduced noise, no distractions, comfortable distance (4 to 5 feet), eye level-face to face seating, do not stand. • Dress professionally

  22. Techniques of Communication • Listening techniques • Questioning techniques • Sending messages techniques

  23. INTRODUCING THE INTERVIEW • Use client’s last name. • Introduce yourself and your role. • Give the reason for the interview.

  24. WORKING PHASE (data gathering phase) • OPEN ENDED QUESTIONS: to request narrative information, to begin the interview, introduce a new area of questioning or topic. • CLOSED OR DIRECT QUESTIONS: to illicit a yes or no answer, to request specific information. • USING RESPONSES: facilitation (go on, uh-huh), silence, reflection, summary.

  25. OFFERING FALSE ASSURANCES OR REASSURANCES ADVISING USING AUTHORITY USING PROBLEMATIC QUESTIONING ENGAGING IN DISTANCING USING PROFESSIONAL JARGON USING LEADING OR BIASED QUESTIONS TAKING TOO MUCH TIME INTERRUPTING DEFENDING 10 TRAPS OF INTERVIEWING

  26. POSITIVE Eye contact Open posture, relaxed Leaning forward Tone of voice moderate Appropriate touch Professional appearance NEGATIVE Standing Bland expression High pitch tone Speech slow or fast Sitting far away, behind a desk Inappropriate dress NONVERBAL SKILLS/BEHAVIOURS OF THE INTERVIEWER

  27. DEVELOPMENTAL CONSIDERATIONS • Parent/infant: greet both by name,interview together, allow toys for the child, ask about toy to make contact. • School-age child: parent/child together, child will have valuable information at times, ask child about symptoms first then parent later. • Adolescent: be respectful, don’t judge, give truth with rationale, keep it short and simple. • Older adult: greet by last name, allow more time for interview, shorter segments may be necessary. You must be able to develop a rapport with people at different stages of life.

  28. INTERVIEWING PEOPLE WITH SPECIAL NEEDS • Hearing-impaired • Acutely ill people • Crying • Anger • Threat of violence

  29. CROSS CULTURAL COMMUNICATION • Etiquette: formal/respectful/polite, name and title. • Space and distance: 2-4 feet with all.

  30. OVERCOMING COMMUNICATION BARRIERS… • Language • Divers backgrounds • Behaviours • Eye contact

  31. The Complete Health History • What is the purpose of the complete health hx? • Subjective data: what the person says about himself/herself. • Objective data: physical examination and lab studies. Both form the data base which is used to make a diagnosis about the health status of the individual.

  32. complete picture of the person's past and present health describes the individual as a whole & how the person interacts with the environment records health strengths & coping skills for the well person - hx used to assess lifestyle e.g. exercise, diet, risk reduction, health promotion behaviour for the ill person - hx includes a detailed & chronological record of the health problem The health history:

  33. Health History Forms • biographical data • reason for seeking care (previously chief complaint) • present health or history of present illness • past history • family history • review of systems • functional assessment or activities of daily living (ADLs)

  34. Health History (Adult)

  35. Biographical data Name Age Address Phone number Birth date Sex Marital status Source of history Who provided the information? Are they a reliable source? Was there an interpreter present? A-Health Hx

  36. Reason for seeking care Brief statement of why the client is seeking health care. It states one or two symptoms and their duration. Use quotation marks. Present health/history of present illness Chronological record of the reason for seeking health care. “Tell me about…from the time it started” Should include the 8 critical characteristics. Health Hx

  37. Health HxSymptoms- 8 Critical Characteristics • location • character or quality (burning, sharp, dull, etc.) • quantity or severity (scale, how many?) • Timing (onset, duration, frequency) • Setting • aggravating or relieving factors (better, worse) • associated factors • patient's perception (what do you think it means?)

  38. B-Past Health • Childhood illnesses:MMR, chickenpox, pertussis, strep throat, polio. • Accidents/injuries:auto, fractures, head injuries, burns. • Serious/chronic illnesses:diabetes, BP, heart disease, cancer, seizures. • Hospitalizations:cause, name of.., how was it treated, how long…, physician.

  39. B-Past Health • Operations:type, date, surgeon, name of hospital, how they recovered. • Obstetric hx:Grav___Term___Preterm___Ab___Living__ • Immunizations:MMR, polio, DpT, Hep B, Tb immunization and skin test, last flu shot. • Last examination date:MD, dental, vision, hearing, ECG, chest x-ray.

  40. B-Past Health • Allergies:allergen and reaction. • Current medication:Rx & OTC. Note name dose and schedule. How often do they take it? What is it for? How long have they been taking it?

  41. C-Family History • Include a Genogram • Include age and health of the parents, grand-parents and siblings. • …or age and cause of death.

  42. D-Review of Systems The purpose of this review is to evaluate past/present health states, to evaluate health promotion strategies and to identify if any information was missed. Review each system in the lab as well as corresponding health promotion(HP) strategies.

  43. D-Review of Systems (listed only) • Skin • Hair • Head • Eyes • Ears • Nose and Sinuses • Mouth and Throat

  44. Review of Systems • Neck • Breast • Axilla • Respiratory • Cardiovascular • Peripheral Vascular • Gastrointestinal

  45. Review of Systems • Urinary • Male Genital • Female Genital • Sexual Health • Musculoskeletal • Neurological • Hematological

  46. E-Functional Assessment This is a measure of the person’s self-care abilities with respect to: • ADLs: bathing, dressing, toileting, eating, walking. • IADLs: housekeeping, shopping, cooking, doing laundry, using phone, managing finances, nutrition, social relationships/resources, self-concept/coping, home environment.

  47. E-Functional Assessment • Self-esteem/Self-concept:education, financial status, value-belief system. • Activity/Exercise • Sleep/Rest • Nutrition/Elimination • Interpersonal Relationships/Resources: social roles and support persons. • Coping/Stress Management

  48. Functional AssessmentIncluding ADLS • Personal habits • Tobacco • Alcohol • Street drugs • Environmental hazards • Occupational health

  49. F-Perception of Health • How do you define health? • What are your health goals? • What do you expect from your health care providers?

  50. Developmental Considerations • Children: include prenatal/perinatal hx, parent description of problem, developmental overview & nutritional hx. • Older adults: ADLs and IADLs very important. Explore changes to ADLs caused by aging process or chronic illnesses. Note if the impact of disease is more important than the disease itself. Note the reason for the person seeking health care not the HCP’s assumption of the problem.

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