Health Assessment Interview:Rapport PDF

Preview

Summary

Health Assessment Interview for Assessment Task 1 ...

Description

!1 Establishment of Rapport in the Health Assessment Interview ! ! Introduction The initial and most important step in communication between the nurse and the patient is the establishment of rapport as it creates a foundation of trust and a common ground for further management (Bramhall, 2014). Rapport is an essential component of high quality health care as it involves the ability to understand the patient and communicate well with them (Crisp et al., 2017). It increases accurate diagnosis, builds trust between the patient and the healthcare provider which in turn improves the patients compliance to treatment, their satisfaction and overall health outcome (Boykins, 2014). In order to demonstrate the application of rapport in the clinical setting, I have facilitated a health assessment interview which will outline the considerations, techniques and questioning styles used to establish and maintain rapport. ! The Health Assessment Interview !

The health Assessment Interview was conducted on a 61 year old male, who due to confidentiality reasons will be referred to as “Mr John Smith”. Mr Smith’s main health concern was his newly diagnosed diabetes and elevated blood pressure. In order to address his concerns, I adopted the Roper-Logan-Tierney model in order to provide a more holistic approach to the interview (Holland et al., 2019).! ! Considerations used to establish and maintain rapport According to O’Toole (2016), effective communication plays a critical role in successful patient outcomes as studies have proven that effective communication increases recovery

!2 rates and decreases the likeness of ongoing medical issues for those experiencing a health condition (Boykins, 2014). Therefore, it is important to consider what constitutes effective communication when establishing and maintaining rapport (O’Toole, 2016). Effective communication in the healthcare setting goes beyond verbal, auditory, visual and non verbal messages; rather it involves mutual understanding (Forbes & Watt, 2016). Therefore, it is important that while conducting the health assessment interview I was able to establish a mutual understanding between myself and Mr Smith. Having mutual understanding allows the nurse to understand the experiences and needs of the patient and value their opinions when forming clinical decisions (Forbes & Watt, 2016). It places the patient at the centre of care as communication is patient centred and it initiates communication based on trust and sympathy (O’Toole, 2016). This allows the nurse and patient to work together towards a common goal and harnesses a harmonious relationship built on understanding (Forbes & Watt, 2016). Similarly, it is was also vital that I was able to obtain an optimistic view of Mr Smith as it allowed me to create an atmosphere of warmth and care which allowed him to feel accepted unconditionally (Eberts, 2019). Having the ability to listen, recognise and accept Mr Smiths feelings without criticism also played an important part when establishing rapport as it gave him an opportunity to be comfortable enough to express his concerns (Eberts, 2019). While it is important to carry out a positive and non judgmental approach to healthcare when establishing and maintaining rapport, it is also important to consider the setting in which the health assessment interview is being conducted (Forbes & Watt, 2016). According to Forbes and Watt (2016), the physical environment can influence the flow of communication in a variety of ways, therefore I conducted the interview in quiet and private room. This not only respected the confidentiality of Mr Smith, however it also minimised disruptions which can greatly reduce my ability to communicate well with him (Forbes &

!

!3 Watt, 2016). In addition, seating was set up face to face as it prevented myself from standing over Mr Smith and this position allowed me demonstrate an interest and care, which further encouraged communication (Forbes & Watt, 2016). Furthermore, I ensured that I was at eye level with Mr Smith as having a stance over or above a patient has been shown to insinuate authority which can leave the patient feeling uncomfortable or overwhelmed, thus diminishing rapport instantly (O’Toole, 2016). During the interview I also considered the language in which I used to engage with Mr Smith by avoiding complicated medical terminology as this can create confusion and error (Bramhall, 2014). Rather, I ensured that my discussion was simple enough that it was transferable to him. ! During this time I also reflected on my own qualities and the qualities that a nurse should possess such as moral conduct, integrity, open mindfulness, personal awareness and motivation to ensure the best possible care and rapport with a patient (Gallagher, 2012). Obtaining these qualities meant that I was able to provide a professional approach to the health assessment interview and a commitment to the care of the patient (Gallagher, 2012). Therefore it is important to consider these qualities when forming the health assessment interview as our ability to establish rapport is important, howether following up on that relationship and really committing to the patients health experience and outcome is just as important (Gallagher, 2012). Hence, I ensured that I continually upheld and valued the human dignity of Mr Smith by treating him equally and advocating for him despite his cultural and religious differences (Gallagher, 2012). This allowed me to develop a more accepting and understanding relationship with him. ! Techniques used to establish and maintain rapport

!4 There are many techniques that can be used throughout the health assessment interview to establish and maintain rapport (Forbes & Watt, 2016). Before conducting the interview I ensured that I made a verbal introduction about myself, my associated role and the purpose of the assessment (O’Toole, 2016). This aims to initiate the conversation and control the direction of the interview (Forbes & Watt, 2016). During the interview I ensured that I was actively listening to Mr Smith through the use of eye contact, probing and nodding (O’Toole, 2016). This allowed me to exhibit a sense of value for Mr Smith and encourage free expression from him (Crsip et al., 2017). Similarly, I adopted a tone of voice and a posture that conveyed openness and a willingness to listen, thus reinforcing this idea as it allows Mr Smith to feel comfortable enough to express his concerns (Forbes & Watt, 2016). In addition, the use of non verbal techniques such as touch was also adopted in the interview, as it displays a level of empathy which is essential when establishing and maintain rapport (Forbes & Watt, 2016). Forbes and Watt (2016), suggests placing one hand on the patients shoulder as it conveys the message that the nurse is sharing and understanding the feelings of the patient. This creates a strong sense of connection and trust which are crucial elements when building and maintaining rapport (Forbes & Watt, 2016). The use of communication techniques such as observing, restating, reflecting or clarifying were also used, specifically when closing the interview as it allowed Mr Smith to have a final opportunity to express any other concerns (O’Toole, 2016). This is supported by Forbes & Watt who suggest that the nurse should state “is there anything else you would like to mention?” before closing the interview (2016, p. 67). In addition, I summarised what I learnt during the interview such as health aspects and problems and then explained the plans for action to Mr Smith. This ensures that the interview is goal orientated and enables the nurse and patient to have mutual understanding before

!5 parting ways (Forbes & Watt, 2016). The nurse should also end the interview gracefully, therefore I thanked Mr Smith for his time and cooperation (Forbes & Watt, 2016). ! Use of Questioning Techniques Some of the questioning styles and techniques that can be used to establish and maintain rapport can vary from open ended to closed ended questions (O’Toole, 2016). Questions such as “tell me a little more about your problem?” or “how have you been getting along?” allowed me to obtain narrative information about Mr Smith (Forbes & Watt, 2016, p.63). It was a good idea to use open ended questions to begin the interview, when introducing a new set of questions or whenever Mr Smith introduced a new topic as it allowed myself to gain objective data which I was able to use when making a clinical decision (Bramhall, 2014). Asking open ended questions showed Mr Smith that I was interested in his concerns and was attempting to understand his circumstances which is crucial when developing rapport (Eberts, 2019). The use of close ended questions are also useful when obtaining specific information from the patient (Crisp et al., 2017). These can be questions like “do you smoke?” or “how old are you” (Forbes & Watt, 2016, p. 63). I asked closed and direct questions only at a time to avoid bombarding Mr Smith with long lists, hence it can be a good idea to use both closed and open questions together to help allow the information in the assessment to be specific, relevant and goal directed (Bramhall, 2014). In addition to these questioning styles, I ensured that I asked questions that required me to work towards understanding as much as possible what the illness meant for Mr Smith (Brunero, Lamont & Coates, 2010). Questions such as “how does this situation impact on your life?” allowed me to step beyond sympathy and display empathy for him (Forbes & Watts, 2016, p. 61). This allowed Mr Smith to feel understood, forming the basis of rapport (Eberts, 2019).

!6 ! Conclusion ! In order to demonstrate the application of rapport in the clinical setting I established a health assessment interview which outlined the considerations, techniques and questioning styles used to establish and maintain rapport. The most important tool for establishing and maintaining rapport is the use of effective communication, which can be incorporated in a variety of ways ranging from verbal to non verbal cues (Forbes & Watt, 2016). Similarly, there are many intrinsic and extrinsic factors that can also contribute to the establishment and maintenance of rapport such as the ability to empathise with the patient and view them optimistically or the setting and environment in which the interview is being conducted (O’Toole, 2016). The use of effective questioning styles also plays an important part when building rapport as it facilitates the flow of communication and the type of information obtained (Forbes & watt, 2016). Rapport is an essential component of high quality healthcare as it ensures better patient satisfaction and overall therapeutic outcome (Boykins, 2014).

!7

References !

Boykins, A. D. (2014). Core communication competencies in patient-centered care. The ! ABNF Journal: Official Journal of the Association of Black Nursing Faculty in Higher ! Education, Inc, 25(2), 40–45.

Bramhall, E. (2014). Effective communication skills in nursing practice. Nursing Standard ! (Royal College of Nursing (Great Britain) : 1987), 29(14), 53–59. https://doi.org/10/7748! /ns.29.14.53.e9355. !

Brunero, S., Lamont, S. and Coates, M. (2010). A review of empathy education in nursing. ! Nursing Inquiry. 17: 65-74. doi:10.1111/j.1440-1800.2009.00482.

Crisp, J., Taylor, C., Douglas, C., & Rebeiro, G. (2017). Potter & Perry’s Fundamentals of ! Nursing (5th ed.). Sydney, N.S.W.: Mosby/Elsevier Australia.!

Eberts, S. (2019). Understanding the Patient in Patient-Centered Care. Audiology Today, ! 31(6), 40–46.

Establish a rapport that allows clear communication. (2015). Nursing Children and Young! People, 27(9), 13. https://doi.org/10.7748/ncyp.27.9.13.s16 ! Forbes, H., & Watt, E. (2016). Jarvis’s physical examination and health assessment (2nd ! Australian and New Zealand ed.). Chatswood, N.S.W.: Churchill Livingstone/Elsevier.

!8

Gallagher, A. (2012). Nursing. In Encyclopedia of Applied Ethics (pp. 252–259). Elsevier ! Inc. https://doi.org/10.1016/B978-0-12-373932-2.00157-5

Holland, K., Jenkins, J., Solomon, J. & Whittam, S. (2019). Applying the Roper-Logan- ! Tierney Model in Practice (3rd ed.). London: Churchill Livingstone/Elsevier.

O’Toole, Gjyn. (2016). Communication: Core interpersonal skills for health professionals ! (3rd ed.). Chatswood: Elsevier. ! Richards, T., Coulter, A., & Wicks, P. (2015, February 10). Time to deliver patient centred ! care. BMJ (Online). BMJ Publishing Group. https://doi.org/10.1136/bmj.h530....