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nursing manual torrent

Study Guide for Fundamentals of Nursing The Art and Science of Nursing Care. Pages·· MB·28, Downloads. authors of the seventh edition of. Lab Manual to Accompany. Health Assessment in Nursing. JANET WEBER, RN, MSN, EdD. Professor. Department of Nursing. Southeast Missouri State University. Learn about STERIS's Torrent Irrigation System which provides an intraprocedural irrigation solution for both capital equipment and consumable products. AGREGAR LIBRERIAS KONTAKT 5 TORRENT A XMLPatch section of the physical if it is. Fifth: Check file. With Cloud, which his other major with fun trucks popularly identified by could end up before the upgrade.

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The app has the information of the book in a larger font and lighter weight, and is easier to use. To start your 30 day trial you have to subscribe and after its 22 euro per year Get lost. Nurse's Pocket Drug Guide Nursing Drug Handbook.

Mosby's Nursing Drug Reference. NurseBrain: Nurse Report Sheet. This love is silent. Louis St. As nurses provide more care in a variety of settings—acute care agencies, clinics, family homes, rehabilitation centers, and long-term care facilities—they need to be more prepared than ever before to perform accurate, timely health assessments.

No matter where a nurse practices, two components are essential for accurate collection of client data: a comprehensive knowledge base and expert nursing assessment skills. This textbook teaches students to use critical thinking skills to analyze the data they collect. This information is highlighted with this icon. Family and Community, highlighted in Chapters 33 and 34, contain the theories of family function, family commu- nication styles, nursing interview techniques for families, internal and external family structuring, and family development stages and tasks.

The types of communities families and individuals live in and how the community enhances health or presents a barrier to effective, healthful functioning is also explored. Chapter 10 assists the student in assessing the use of violence in families. Special Features of the Fifth Edition New art program includes new photos of nurses demon- strating how to correctly perform each step of the physical examination. Chapter 6, Assessing Mental Status and Substance Abuse, includes information about assessing risk for substance abuse.

These chapters explain and illustrate the uniqueness of these differences in regard to body structures and functions, interview techniques, growth and development, and physical examination techniques. Hospital-acquired MSRA occurs in individuals who are hospitalized, have been hospitalized within the past year, receive care in same-day surgery centers or ambulatory outpatient care clinics, or are residents of long-term care facilities. HAIs are associated with invasive medical devices—including urinary catheters—as well as surgical incisions, pneumonia, and bloodstream infections.

Community-acquired MRSA occurs in individuals who have not been in the hospital within the past year, have not had recent medical procedures, and may otherwise be healthy. HAIs are a growing concern to health care professionals. Healthy People Goal Prevent, reduce, and ultimately eliminate health care—associated infections. Wash your hands.

Safety Tips alert the student to key information to ensure safe practice. Clinical Tips are included to help highlight critical content necessary for a thorough assessment. Older Adult Considerations and Cultural Considerations call attention to vital considerations for special populations. Case Study, threaded throughout the chapter, teaches the student how to apply the COLDSPA mnemonic, with inter- The Teaching-Learning Package view questions, physical assessment, and analysis of data, to a particular client.

It looks like a bad case of acne. Assessment Guides teach students about essential equip- ment and techniques. Ask the client to bend the head slightly toward the side being palpated to relax the muscles in that area. Compare lymph nodes that occur bilaterally.

Choose a particular palpation sequence. This chapter presents a sequence that proceeds in a superior to inferior order from 1 to This helps to guard against skipping a group of nodes. While palpating the lymph nodes, note the following: s Size and shape s Delimitation s Mobility s Consistency s Tenderness and location Size and Shape Normally lymph nodes, which are round and smaller than 1 cm, are not palpable. When lymph node enlargement exceeds 1 cm, the client is said to have lymphadenopathy, which may be caused by acute or chronic infection, an autoimmune disorder, or metastatic disease.

If one or two lymphatic groups enlarge, the client is said to have regional lymphadenopathy. Enlargement of three or more groups is generalized lymphadenopathy. In acute infection, they remain discrete. Mobility Typical lymph nodes are mobile both from side to side and up and down. Tenderness and Location Tender, enlarged nodes suggest acute infections; normally lymph nodes are not sore or tender.

Of course, you need to document the location of the lymph node being assessed. And this is the perfect practice. Michael Bennett, Curt Casteel, and Dr. Gutierrez, age 52, arrives at the clinic for diabetic teaching. She appears distracted and sad, uninterested in the teaching. She is unable to focus, and paces back and forth in the clinic wringing her hands. The nurse suspects that Mrs. Gutierrez is upset by her diagnosis of diabetes. As a professional nurse, you will constantly observe situations and collect information to make nursing judgments.

This occurs no matter what the setting: hospital, clinic, home, community, or long-term care. You conduct many informal assessments every day. For example, when you get up in the morning, you check the weather and determine what would be the most appropriate clothing to wear. You assess whether you are hungry. Do you need a light or heavy breakfast? When will you be able to eat next?

You may even assess the physical condition of your skin. Do you need moisturizing lotion? What are your family members doing today? Are there special events occurring in your community? The role of the nurse in assessment and diagnosis is more prevalent today than ever before in the history of nursing.

Nurses from numerous countries are expanding their assessment and nursing diagnosis skills Lunney, ; Baid, The rapidly evolving roles of nursing e. Current focus on managed care and internal case management has had a dramatic impact on the assessment role of the nurse.

Ambulatory care nurses assess and screen clients to determine the need for physician referrals. Home health nurses make independent nursing diagnoses and referrals for collaborative problems as needed. Public health nurses assess the needs of communities, school nurses monitor the growth and health of children, and hospice nurses assess the needs of the terminally ill clients and their families. Nursing health assessment courses with informatics content are becoming the norm in baccalaureate programs.

As the scope and environment for nursing assessment diversify, nurses must be prepared to assess populations of clients not only across FIGURE The acute care nurse performs a focused assessment, then incorporates assessment findings with a multidisciplinary team to develop a comprehensive plan of care.

The nurse can then discuss and demonstrate assessments with other health care professionals as clearly and quickly as if they were in the same room. The future will see increased specialization and diversity of assessment skills for nurses. While client acuity increases and technology advances, bedside nurses are challenged to make in-depth physiologic and psychosocial assessments while correlating clinical data from multiple technical monitoring devices.

The communication of health assessment and clinical data will span a myriad of electronic interactivities and research possibilities. Health care networks already comprise a large hospital or medical center with referrals from smaller community hospitals; subacute, rehabilitation, and extended-care units; HMOs; and home health services. These structures provide diverse settings and levels of care in which nurses will assess clients and facilitate their progress.

There is tremendous growth of the nursing role in the managed care environment. The most marketable nurses will continue to be those with strong assessment and client teaching abilities as well as those who are technologically savvy.

Some examples reported in the American Journal of Nursing — include gastrointestinal palpation, testing eighth cranial nerve function, and examination of children in school systems. If data collection is inadequate or inaccurate, incorrect nursing judgments may be made that adversely affect the remaining phases of the process: diagnosis, planning, implementation, and evaluation Table Each nurse was autonomous in making comprehensive initial assessments from which individualized plans of care were established.

In turn, there was a demand for documentation of client assessments by all health care providers to justify health care services. Health assessment is more than just gathering information about the health status of the client. It is analyzing and synthesizing that data, making judgments about the effectiveness of nursing interventions, and evaluating client care outcomes AACN, The nursing process should be thought of as circular, not linear Fig.

The steps overlap because you may have to move more quickly for some problems than others. While Evaluation involves examining all the previous steps, it especially focuses on achieving desired outcomes. The arrow between Assessment and Evaluation goes in both directions because assessment and evaluation are ongoing processes as well as separate phases. When the outcomes are not as anticipated, the nurse needs to revisit reassess all the steps, collect new data, and formulate adjustments to the plan of care.

Adapted from Alfaro, R. Applying nursing process: a tool for critical thinking 6th ed. A comprehensive health assessment consists of both a health history and physical examination. However, the purpose of a nursing health history and physical examination differs greatly from that of a medical or other type of health care examination e. The nurse collects physiologic, psychological, sociocultural, developmental, and spiritual data about the client.

Thus the nurse performs holistic data collection. For example, a client with asthma may have to avoid extreme temperatures and may not be able to enjoy recreational camping. For example, a diabetic client may not be able to eat the same foods that the rest of the family enjoys. If this client develops complications of diabetes and has an amputation, the client may not be able to carry out the family responsibility of maintaining the yard. The client may no longer be able to work in the community as a bus driver.

The community may or may not have a diabetic support group for the client and the family. Less focus may be placed on psychological, sociocultural, or spiritual well-being. A nursing framework helps to organize information and promotes the collection of holistic data.

This, in turn, provides clues that help to determine human responses. Because there are so many nursing health assessment frameworks available for organizing data, using one assessment framework would limit the use of this text and ignore many other valid nursing assessment framework methods. Therefore, the objective of this textbook is to provide the reader with the essential information necessary to perform a comprehensive nursing health assessment.

Readers can take the information in this book and adapt it to the nursing assessment framework of their choice. The book is organized around a head-to-toe assessment of body parts and systems. There are many models used to analyze health promotion and disease prevention.

The Pender Health Promotion Model is also focused on behavioral outcomes. The progress towards this goal is evaluated every 10 years, resulting in the development of new goals. These are referred to in related chapters. The nurse typically collects subjective data and objective data in many settings hospital, community, clinic, or home.

Depending on the setting, other members of the health care team may also participate in various parts of the data collection. In this setting, the nurse continues to assess the client as needed to monitor progress and client outcomes. A physical therapist may perform a musculoskeletal examination, as in the case of a stroke patient, and a dietitian may take anthropometric measurements in addition to a subjective nutritional assessment.

In a community clinic, a nurse practitioner may perform the entire physical examination. In the home setting, the nurse is usually responsible for performing most of the physical examination Fig. Ongoing or Partial Assessment An ongoing or partial assessment of the client consists of data collection that occurs after the comprehensive database is established. This type of assessment is usually performed whenever the nurse or another health care professional has an encounter with the client.

This type of assessment may be performed in the hospital, community, or home setting. The frequency of this type of assessment is determined by the acuity of the client. For example, a client admitted to the hospital with lung cancer requires frequent assessment of lung sounds. A total assessment of skin would be performed less frequently, with the nurse focusing on the color and temperature of the extremities to determine level of oxygenation.

Focused or Problem-Oriented Assessment A focused or problem-oriented assessment does not replace the comprehensive health assessment. A focused assessment consists of a thorough assessment of a particular client problem and does not cover areas not related to the problem. For example, if your client, John P. However, asking questions about his sexual functioning or his normal bowel habits would be unnecessary and inappropriate. The physical examination should focus on his ears, nose, mouth, and throat.

At this time, it would not be appropriate to perform a comprehensive assessment by repeating all system examinations such as the heart and neck vessel or abdominal assessment. Emergency Assessment An emergency assessment is a very rapid assessment performed in life-threatening situations Fig. In such situations choking, cardiac arrest, drowning , an immediate assessment is needed to provide prompt treatment.

Collection of subjective data 2. Collection of objective data 3. Validation of data 4. Documentation of data Although there are four steps, they tend to overlap and you may perform two or three steps concurrently.

For example, you may ask your client, Jane Q. However, Chapters 2, 3, and 4 provide an in-depth explanation of each of the four assessment steps. In addition, the four steps of the assessment process format are carried throughout this text. All of the physical assessment chapters contain the following sections: Collecting Subjective Data, Collecting Objective Data, and a combined Validation and Documentation section. FIGURE A comfortable, relaxed atmosphere and an attentive interviewer are essential for a successful clinical interview.

For example, do not assume that a year-old female client who happens to be a nurse knows everything regarding hospital routine and medical care or that a yearold male client with diabetes mellitus needs client teaching regarding diet.

Validate information with the client and be prepared to collect additional data. The client may have a medical diagnosis that you have never heard of or that you have not dealt with in the past. For example, the client may be a year-old with a drug addiction. If you are 22 years old and a very health-conscious person who does not drink, smoke, take illegal drugs, or drink caffeine, you need to take time to examine your own feelings in order to avoid biases, judgment, and the possibility of projecting those judgments.

You must be as objective and open as possible. Remember to obtain and organize materials that you will need for the assessment. The materials may be assessment tools such as a guide to interview questions or forms on which to record data collected during the health history interview and physical examination. Most primary care settings use electronic health records EHRs for recording data.

Also, gather any equipment e. To elicit accurate subjective data, learn to use effective interviewing skills with a variety of clients in different settings. Gutierrez that she has no appetite and no energy. She feels as though she wants to stay in bed all day. She misses her sisters in Mexico, and cannot do her normal housekeeping or cooking.

The nurse thinks that Mrs. Gutierrez is probably suffering from depression. But when the nurse asks Mrs. Gutierrez what she believes is causing her lack of appetite and low energy, Mrs. Gutierrez says she was shocked when her husband was hit by a car. He could not work for a month. The skills of interviewing and the complete health history are discussed in Chapter 2.

See Table for a comparison of objective and subjective data. It serves to ensure that the assessment process is not ended before all relevant data have been collected, and helps to prevent documentation of inaccurate data. What types of assessment data should be validated, the different ways to validate data, and identifying areas where data are missing are all parts of the process.

Validation of data is discussed in detail in Chapter 4 Fig. Chapter 5 provides information about nursing diagnoses, collaborative problems, and referrals. Thorough and accurate documentation is vital to ensure that valid conclusions are made when the data are analyzed in the second step of the nursing process.

Chapter 4 discusses the types of documentation, purpose of documentation, what to document, guidelines for documentation, and different types of documentation forms Fig. Analysis of the collected data goes hand in hand with the rationale for performing a nursing assessment. To arrive at conclusions, the nurse must analyze the assessment data.

Indeed, nurses often begin to analyze the data in their minds while performing assessment. To achieve the goal or anticipated outcome of the assessment, the nurse makes sure that the data collected are as accurate and thorough as possible.

During this phase, you analyze and synthesize data to determine whether the data reveal a nursing concern nursing diagnosis , a collaborative concern collaborative problem , or a concern that needs to be referred to another discipline referral. A nursing diagnosis provides the basis for selecting nursing interventions to achieve outcomes for which the nurse is accountable. Nurses manage collaborative problems by implementing both physician- and nurse-prescribed interventions to reduce further complications.

This process requires diagnostic reasoning skills, often called critical thinking. The process can be divided into seven major steps: 1. Identify abnormal data and strengths. Cluster the data. Draw inferences and identify problems. Propose possible nursing diagnoses. Document conclusions. Each of these steps is explained in detail in Chapter 5. Factors Affecting Health Assessment In the past, health assessment has focused solely on the individual client.

But there is a need to place individuals in the contexts that affect their health. Understanding or being aware of the client in context is essential to performing an effective health assessment. Case Study Consider Mrs. Gutierrez, introduced at the beginning of the chapter, to help illustrate the reason for seeing the client in context. The nurse continues to listen to Mrs. Gutierrez states that a few days in bed will help her recover her soul and her health.

The nurse decides to reschedule the diabetic teaching for a later time and provide only essential information to Mrs. Gutierrez at this visit. Many systems are operating to create the context in which the client exists and functions. The nurse sees an individual client, but accurate interpretation of what the nurse sees depends on perceiving the client in context.

Culture, family, and community operate as systems interacting to form the context. This text must be supported by knowledge or concurrent instruction in medical—surgical and psychosocial nursing and, of course, anatomy and physiology. In this text, we can provide only a review of key concepts of these subjects.

As with anatomy and physiology, medical—surgical nursing, and psychosocial nursing content, a health assessment textbook can only provide key concepts related to culture, family, spirituality, and community. Many texts on transcultural nursing, family nursing, family therapy, social work, community nursing, and spiritual care exist to provide the knowledge base, concurrent instruction, or resources needed for exhaustive information.

This assessment text emphasizes the need to consider the client in context for best practice in health assessment. For basic concepts of cultural, spiritual, family, and community assessment, see Chapters 11, 12, 33, and Summary Nursing health assessment differs in purpose, framework, and end result from all other types of professional health care assessment.

The role of the nurse in health assessment has expanded drastically from the days of Florence Nightingale, when the nurse used the senses of sight, touch, and hearing to assess clients. In addition, advances in technology have expanded the role of assessment and the development of managed care has increased the necessity of assessment skills.

Expert clinical assessment and informatics skills are absolute necessities for the future as nurses from all countries continue to expand their roles in all health care settings. Health assessment can be divided into four steps: collecting subjective data, collecting objective data, validation of data, and documentation of data.

There are four types of nursing assessment: initial comprehensive, ongoing or partial, focused or problem-oriented, and emergency. Data analysis is the second step of the nursing process and the end result of nursing assessment.

These conclusions are in the form of nursing diagnoses, collaborative problems, or a need for referral. To arrive at conclusions, the nurse must go through seven steps of diagnostic reasoning or critical thinking. Maintaining a focus on the clients in the contexts of their culture, family, and community is emphasized in this text. Want to know more? A wide variety of resources to enhance your learning and understanding of this chapter are available on. Nursing: Scope and standards of practice.

Silver Springs, MD: Author. Alfaro-LeFevre, R. Applying the nursing process: A tool for critical thinking 7th ed. Baid, H. The process of conducting a physical assessment: A nursing perspective. British Journal of Nursing, 15 13 , — Becker, M.

Comparing social learning theory and the health belief model. In: Ward, E. Bews, D. Pre-placement health screening by nurses. Journal of Public Health, 12 59 , — Bullough, B. American Journal of Nursing, 9 76 , — Carpenito, L. Nursing diagnosis: Application to clinical practice 14th ed. Cipolla, J. Nurse clinicians in industry. American Journal of Nursing, 8 71 , — Coombs, M. Physical assessment skills: A developing dimension of clinical nursing practice.

Intensive and Critical Care Nursing, 18 4 , — Darbyshire, P. User-friendliness of computerized information systems. Computers in Nursing, 18 2 , 93— Eastman, P. New Institute of Medicine report calls for transformation of nursing, increased empowerment and responsibility. Oncology Times, 32 20 , 42— Fagin, C. Baccalaureate preparation for primary care. Nursing Outlook, 4 20 , — Fitzsimmons, V. Physical assessment skills: A historical perspective.

Nursing Forum, 4 17 , — Health promotion model. Oxford: Wiley-Blackwell. Holzemer, W. A program evaluation of four workshops designed to prepare nurse faculty in health assessment. Journal of Nursing Education, 4 19 , 7— Institute of Medicine IOM The future of nursing: Leading change, advancing health. Architecture of an image capable, web-based, electronic medical record. Journal of Digital Imaging, 13 2 , 82— Lee, M. Building a personal health record from a nursing perspective.

International Journal of Medical Informatics, 4. Ludwig-Beymer, P. Williams, P. Journal of Nursing Care Quality, The need for international nursing diagnosis research and a theoretical framework. An abstr act for action. New York: McGraw-Hill. McManus, B. A move to electronic patient records in the community: A qualitative case study of a clinical data collection system.

Topics in Health Information Management, 20 4 , 23— Moorhead, S. Louis, MO: Mosby. Newbold, S. Advance for Nurses. Role expansion of role extension. Nursing Forum, 4 9 , — Health promotion in nursing practice. Pender, N. Health promotion in nursing practice 3rd ed. Purnell, L. Transcultural health care: a culturally competent approach 3rd ed.

Philadelphia: F. Rosenstock, I. Why people use health services. Milbank Memorial Fund Quarterly, 44 3 , 94— Rushforth, H. Nurse-led preoperative assessment: A study of appropriateness. Pediatric Nursing, 12 5 , 15— Simpson, R. Global informing: Impact and implications of technology in a global marketplace.

Nursing Informatics, 28 2 , — Stricklin, M. Home Healthcare Nurse, 18 1 , 53— Sturt, G. Theories of health behavior. Gutierrez, age 52, was introduced in Chapter 1. Recall that she arrived at the clinic for diabetic teaching but appeared distracted and sad, uninterested in the teaching. She was unable to focus, pacing back and forth in the clinic wringing her hands. The nurse suspected that Mrs. Gutierrez was upset by her diagnosis of diabetes.

However, through the interview, the nurse learned additional information that changed her thoughts about the client. In this chapter you will learn how to use the nursing interview to collect additional data to better understand what is really happening with Mrs. Interviewing Obtaining a valid nursing health history requires professional, interpersonal, and interviewing skills.

The nursing interview is a communication process that has two focuses: 1. Establishing rapport and a trusting relationship with the client to elicit accurate and meaningful information Fig. Subjective data provide clues to possible physiologic, psychological, and sociologic problems. The information is obtained through interviewing. Therefore, effective interviewing skills are vital for accurate and thorough collection of subjective data.

Preintroductory Phase The nurse reviews the medical record before meeting with the client Fig. If the client has been in the system for some time, it may reveal additional information. This information will guide the nurse as to which side of the client would be best to conduct the interview.

However, there may not be a medical record established in some instances. These types of communication are discussed later in the chapter. Case Study The nurse reviewed Mrs. The report states that she does not routinely monitor and record her blood sugar. Her weight 6 weeks ago was pounds. The nurse also makes sure that the client is comfortable physically and emotionally and has privacy. It is also essential for the nurse to develop trust and rapport at this point in the interview.

This can begin by conveying a sense of priority and interest in the client. Developing rapport depends heavily The nurse introduces herself to Mrs. Gutierrez and explains that she will be asking questions in order to better assist her with control of her diabetes. The nurse then sits down with Mrs. At that point the nurse asks her if she has any questions to verify that client is following and understanding the interview process. The nurse observes and listens to Mrs. Gutierrez to determine her level of comprehending and speaking English.

The nurse then listens, observes cues, and uses critical thinking skills to interpret and validate information received from the client. Gutierrez speaks and comprehends English, the nurse then begins enters the working phase with Mrs. Gutierrez, asking questions about her biographical data, reasons for seeking care, history of present health concern, past health history, family history, review of body systems for current health problems, lifestyle and health practices, and developmental level.

The nurse asks Mrs. During the summary and closing, the nurse summarizes information obtained during the working phase and validates problems and goals with the client see Chapter 4. Finally, the nurse makes sure to ask if anything else concerns the client and if there are any further questions. She shares with Mrs. She discusses a plan for Mrs. Gutierrez to return to see her primary physician for her anxiety, a plan for her to modify her diet and caffeine intake, and to engage in a daily exercise walking routine.

Her collaborative problems may be risk for hypoglycemia related to poor intake at this time. Several special techniques and certain general considerations will improve both types of communication as well as promote an effective and productive interview. Nonverbal Communication Nonverbal communication is as important as verbal communication. Never overlook this type of communication or take it for granted.

Appearance First take care to ensure that your appearance is professional. The client is expecting to see a health professional; therefore, you should look the part. Your hair should be neat and not in any extreme style; some nurses like to wear long hair pulled back. Fingernails should be short and neat; jewelry should be minimal.

Demeanor Your demeanor should also be professional. When you enter a room to interview a client, display poise. This appears unprofessional to the client and will have an effect on the entire interview process. It is best to maintain a professional distance. No matter what you think about a client or what kind of day you are having, keep your expression neutral and friendly.

If your face shows anger or anxiety, the client will sense it and may think it is directed toward him or her. If you cannot effectively hide your emotions, you may want to explain that you are angry or upset about a personal situation. Admitting this to the client may also help in developing a trusting relationship and genuine rapport. It means using the right expression at the right time.

If the client looks upset, you should appear and be understanding and concerned. Conversely, smiling when the client is on the verge of tears will cause the client to believe that you do not care about his or her problem. Attitude One of the most important nonverbal skills to develop as a health care professional is a nonjudgmental attitude. These attitudes will cause the client to feel uncomfortable opening up to you and important data concerning his or her health status could be withheld.

Focus on health care and how you can best help the client to achieve the highest possible level of health. For example, if you are interviewing a client who smokes, avoid lecturing condescendingly about the dangers of smoking. Also, avoid telling the client that he or she is foolish and avoid projecting an attitude of disgust. The client is, no doubt, already aware of the dangers of smoking.

Forcing guilt on him is unhelpful. This does not mean you should not encourage the client to quit; it means that how you approach the situation makes a difference. Let the client know you understand that it is hard to quit smoking, support efforts to quit, and offer suggestions on the latest methods available to help kick the smoking habit. Listening Listening is the most important skill to learn and develop fully in order to collect complete and valid data from your client.

To listen effectively, you need to maintain good eye contact, smile or display an open, appropriate facial expression, maintain an open body position open arms and hands, and lean forward. Avoid preconceived ideas or biases about your client. To listen effectively, you must keep an open mind. In addition, several nonverbal affects or attitudes may hinder effective communication.

Some clients feel very uncomfortable with too much eye contact; others believe that you are hiding something from them if you do not look them in the eye. Therefore, it is best to use a moderate amount of eye contact. For example, establish eye contact when the client is speaking to you but look down at your notes from time to time.

Biased or Leading Questions Avoid using biased or leading questions. These cause the client to provide answers that may not be true. The way you phrase a question may actually lead the client to think you want her to answer in a certain way. Distraction and Distance Avoid being occupied with something else while you are asking questions during the interview.

This behavior makes the client believe that the interview may be unimportant to you. Avoid appearing mentally distant as well. The client will sense your distance and will be less likely to answer your questions thoroughly. Also try to avoid physical distance exceeding 2 to 3 feet during the interview. Physical distance may portray a noncaring attitude or a desire to avoid close contact with the client. Standing Avoid standing while the client is seated during the interview.

Standing puts you and the client at different levels. You may be perceived as the superior, making the client feel inferior. If the client is made to feel inferior, he or she will not feel empowered to be an equal partner and the potential for optimal health may be lost. In addition, vital information may not be revealed if the client believes that the interviewer is untrustworthy, judgmental, or disinterested.

Verbal Communication Effective verbal communication is essential to a client interview. Several types of questions and techniques to use during the interview are discussed in the following sections. The following example shows how open-ended questions work. The client can respond with one or two Rushing Through the Interview Avoid rushing the client. If you ask questions on top of questions, several things may occur. With this type of interview technique, the client may believe that his individual situation is of little concern to the nurse.

Taking time with clients shows that you are concerned about their health and helps them to open up. Finally, rushing someone through the interview process undoubtedly causes important information to be left out of the health history. A client will usually sense that you are rushed and may try to help hurry the interview by providing abbreviated or incomplete answers to questions. Reading the Questions Avoid reading questions from the history form.

This deflects attention from the client and results in an impersonal interview process. As a result, the client may feel ill at ease opening up to formatted questions. They can also be used to clarify or obtain more accurate information about issues disclosed in response to open-ended questions. Rephrasing Rephrasing information the client has provided is an effective way to communicate during the interview.

For example, your client, Mr. For example, if the client is in the middle of explaining a symptom or feeling and believes that you are not paying attention, you may fail to get all the necessary information. An example of inferring information follows: Your client, Mrs. This technique, if used properly, helps to elicit the most accurate data possible from the client.

FIGURE Establish and maintain trust, privacy, and partnership with older adults to set the tone for effectively collecting data and sharing concerns. Three variations in communication must be considered as you interview clients: gerontologic, cultural, and emotional. These variations affect the nonverbal and verbal techniques you use during the interview. Imagine, for example, that you are interviewing an year-old woman and you ask her to describe how she has been feeling.

She does not answer you and she looks confused. This older client may have some hearing loss. In such a case, you may need to modify the verbal technique of asking open-ended questions by following the guidelines provided. Older clients may have more health concerns than younger clients and may seek health care more often. Many times, older adult clients with health problems feel vulnerable and scared. They need to believe that they can trust you before they will open up to you about what is bothering them.

Thus establishing and maintaining trust, privacy, and partnership with the older client is particularly important Fig. It is not unusual for older adult clients to be taken for granted and their health complaints ignored, causing them to become fearful of complaining.

It is often disturbing to the older client that their health problems may be discussed openly among many health care providers and family members. Assure your older adult clients that you are concerned, that you see them as equal partners in health care, and that what is discussed will be between you, their health care provider, and them. Speak clearly and use straightforward language during the interview with the older adult client. Ask questions in simple terms.

Avoid medical jargon and modern slang. Showing respect is very important. Gerontologic Variations in Communication Cultural Variations in Communication Age affects and commonly slows all body systems to varying degrees. However, normal aspects of aging do not necessarily equate with a health problem, so it is important not to approach an interview with an elderly client assuming that there is a health problem.

Older clients have the potential to be as healthy as younger clients. Make sure that you answer every question as thoroughly as you can. The more clients know about their own health, the more likely they are to become equal participants in caring for their health. Use of slang with nonnative speakers is discouraged as well. Keep in mind that it is hard enough to learn proper language, let alone the idiom vernacular. The nonnative speaker will likely have no idea what you are trying to convey.

For example, direct eye contact may be perceived as rude, aggressive, or immodest by some cultures but lack of eye contact may be perceived as evasive, insecure, or inattentive by other cultures. You may have to interview a client who does not speak your language. Consider the relationship of the interpreter to the client. Also keep in mind that communication through use of pictures may be helpful when working with some clients.

Emotional Variations in Communication Not every client you encounter will be calm, friendly, and eager to participate in the interview process. They may be scared or anxious about their health or about disclosing personal information, angry that they are sick or about having to have an examination, depressed about their health or other life events, or they may have an ulterior motive for having an assessment performed. Clients may also have some sensitive issues with which they are grappling and may turn to you for help.

A few minutes of preparation may save a lot of time and help communication flow more smoothly in the long run. U Be patient. It often takes longer to say in some languages what has already been said in English; therefore, plan for more time than you normally would. U Speak slowly and clearly.

Avoid jargon. Use short sentences and be concise. Avoid interrupting the interpreter. U Pause every few sentences so the interpreter can translate your information. After 30 seconds of speaking, stop and let the interpreter express the information. Talk directly to the family, not the interpreter.

U Give the family and the interpreter a break. U Express the information in two or three different ways if needed. There may be cultural barriers as well as language and dialect differences that interfere with understanding. Interpreters may often know the correct communication protocols for the family. U Use an interpreter to help ensure that the family can read and understand translated written materials.

The interpreter can also help answer questions and evaluate learning. U Avoid side conversations during sessions. These can be uncomfortable for the family and jeopardize client— provider relationships and trust.

An interpreter who has no medical background may not understand or interpret correctly, no matter how good his or her language skills are. U Do not use children as interpreters. Doing so can affect family relationships, proper understanding, and compliance with health care issues. Adapted from Weech, W. Tips for using interpreters. Department of State.

Complete Health History The health history is an excellent way to begin the assessment process because it lays the groundwork for identifying nursing problems and provides a focus for the physical examination. At this point, these areas may be more intensely examined during the physical assessment. When a client is having a complete, head-to-toe physical assessment, collection of subjective data usually requires that the nurse take a complete health history.

However, if the client is out of control, do not argue with or touch the client. This will not help the depressed client. See Assessment Tool for a summary of the components of a complete client health history.

This can be used as a guide for collecting subjective data from the client. The name of the person providing the information needs to be included, however, to assist in determining its accuracy. In any event, validation of the information by a secondary source may be helpful. However, if the client was educated in another language from kindergarten on, that may be the primary language and the birth language would be secondary. In addition, this information can help to identify possible client strengths and limitations affecting health status.

For example, if the client was recently downsized from a high-power, high-salary position, the effects of overwhelming stress may play a large part in his or her health status. Onset When did it begin; is it better, worse, or the same since it began? Location Where is it? Does it radiate? Duration How long does it last?

Does it recur? Severity How bad is it on a scale of 1 [barely noticeable] to 10 [worst pain ever experienced]? Pattern What makes it better? What makes it worse? Associated factors What other symptoms do you have with it? Will you be able to continue doing your work or other activities [leisure or exercise]? Past Health History Problems at birth Childhood illnesses Immunizations to date Adult illnesses physical, emotional, mental Surgeries Accidents Prolonged pain or pain patterns Allergies Physical, emotional, social, or spiritual weaknesses Physical, emotional, social, or spiritual strengths Family Health History Age of parents Living?

Deceased date? She was born in Mexico City. Her daughter has dropped her off at the clinic while she runs some errands. Gutierrez lives with her husband and three daughters ages 12, 14 and She has two older sons who are married and live in Mexico. She shares a cell phone and car with her daughter. She completed high school in Mexico. This question may also draw out descriptions of previous experiences—both positive and negative—with other health care providers. BOX Mrs. First, encourage the client to explain the health problem or symptom in as much detail as possible by focusing on the onset, progression, and duration of the problem; signs and symptoms and related problems; and what the client perceives as causing the problem.

Mneumonic Question Character Describe the sign or symptom feeling, appearance, sound, smell, or taste if applicable. Does it occur anywhere else? Does it radiate or go to any other part of your body?

Does it come and go or is it constant? How much does it bother you? Rate it on a scale of 1 to How does it affect you? Do you have any other problems that seem related to your back pain? How does this pain affect your life and daily activities?

Case Study The nurse further explores Mrs. I only sleep for 4—5 hours a night. Once I fall asleep, about 12 midnight, I wake up about 2 PM and cannot go back to sleep. I do not take naps during the day. I eat cereal in the morning but am not able to eat much the rest of the day. I eat less than one half of what I use to eat.

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