Chapter # 02 Introduction to the Interviewing Process.pptx

Chapter # 02
Introduction to the Interviewing Process
1. Interviewing
2. Compassion V/S caring
3. Types of Documentation
4. Reasons for documentation
5. Interviewing list for Do’s
6. Interviewing list for Don't's
7. Interviewing techniques:
8. Open Ended & Close Ended Questions
9.
STEP 2: CORE INTERVIEW

1. Chapter # 02 Introduction to the Interviewing Process Dr. Ayesha Ashraf

2. Interviewing It is a skill that requires careful nurturing and refinement over time. Even the most experienced health care professional should self assess and work toward improvement. Taking an accurate medical history can be a challenge.

3. Client’s nature Clients may forget, underreport, or combine separate health events into a single memory, a process called telescoping. They may even (intentionally or unintentionally) fabricate or falsely recall medical events and symptoms that never occurred. The individual's personality and mental state at the time of the illness or injury may influence their recall abilities Adopting a compassionate and caring attitude, monitoring your communication style, and being aware of cultural differences will help ensure a successful interview. Everyone has a slightly different interviewing and communication style. The interviewer may need to adjust his or her personal interviewing style to communicate effectively.

4. Compassion V/S caring Compassion is the desire to identify with or sense something of another's experience and is a precursor of caring. Caring is the concern, empathy, and consideration for the needs and values of others. Interviewing clients and communicating effectively, both verbally and nonverbally, with compassionate caring takes into consideration individual differences and the client's emotional and psychological needs. Establishing a trusting relationship with the client is essential when conducting a screening interview and examination Illiteracy Cultural competency

5. Important goal of our profession An important goal of the profession is to promote recognition that we are the health profession with the expertise to appropriately screen, diagnose, and then develop treatment programs that are safe and effective for individuals with all levels of movement system dysfunction.

6. Types of Documentation

7. Reasons for documentation

8. Interviewing list for Do’s

9. Interviewing list for Dont’s

10. Interviewing techniques: The most basic skills required for a physical therapy interview include: • Open-ended questions • Closed-ended questions • Funnel sequence or technique • Paraphrasing technique

11. Open Ended & Close Ended Questions:

12. Advantages and limitations Each question format has advantages and limitations. The use of open-ended questions to initiate the interview may allow the client to control the interview, but it can also prevent a false-positive or false-negative False responses elicited by closed-ended questions may develop from the client's attempt to please the health care provider or to comply with what the client believes is the correct response or expectation. Closed-ended questions tend to be more impersonal and may set an impersonal tone for the relationship between the client and the therapist.

13. Funnel Sequence or Techniques Moving from the open ended line of questions to the closed-ended questions is referred to as the funnel technique or funnel sequence.

14. Funnel – FUPs (follow up questions)

15. Paraphrasing Technique A useful interviewing skill assisting in synthesizing and integrating the information obtained during questioning is the Paraphrasing technique. When using this technique, the interviewer repeats information presented by the client. This technique can assist in fostering effective, accurate communication between the health care recipient and the health care provider. For example, once a client has responded to the question, "What makes you feel better?" the therapist can paraphrase the reply by saying, "You've told me that the pain is relieved by such and such, is that right? What other activities or treatment brings you relief from your pain or symptoms?"

16. Outcome management/measures Documenting the effectiveness of intervention is called outcomes management. Using standardized tests, functional tools, or questionnaires to relate pain, strength, or range of motion to a quantifiable scale is defined as outcome measures. The information obtained from such measures is then compared with the functional outcomes of treatment to assess the effectiveness of those interventions. Pain assessment is often a central focus of therapist’s interview

17. Interviewing tools: There are a wide variety of anatomic region, function, or disease-specific assessment tools available. Each test has a specific focus whether to assess pain levels, level of balance, risk for falls, functional status, disability, quality of life, and soon. Some tools focus on a particular kind of problem such as activity limitations or disability in people with low back pain (e.g., Oswestry Disability Questionnaire, Quebec Back Pain Disability Scale, Duffy-Rath Questionnaire. The Simple Shoulder Test, and the Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) may be used to assess physical function of the shoulder.

18. Subjective examination: The subjective examination must be conducted in a complete and organized manner. Evaluation forms are used. The order of flow may vary from therapist to therapist and clinic to clinic Sequence of interviewing process

19. Key components of subjective examination:

20. STEP 1 SUBJECTIVE EXAMINATION

21. Family/Personal History form

22. The therapist may need to make a qualifying statement to the client regarding the need for such detailed information.

23. Age & Aging Age is the most common primary risk factor for disease, illness, and comorbidities. It is the number one risk factor for cancer. The age of a client is an important variable to consider when evaluating the underlying neuro-musculoskeletal pathologic condition and when screening for medical disease. Human aging is best characterized as the progressive constriction of each organ system's homeostatic reserve. This decline, often referred to as " homeostenosis ," Begins in the third decade and is gradual, linear, and variable among individuals. Each organ system's decline is independent of changes in other organ systems and is influenced by diet, environment, and personal habits.

24. Gender In the screening process, gender may be an important issue. To some extent, men and women experience some diseases that are different from each other. When they have the same disease, the age at onset, clinical presentation, and response to treatment is often different.

25. Race/Ethnicity "race" as a sociopolitical way of categorizing a population. race is used epidemiologically as a medical profiling for risk of disease based on genetically defined differences. An individual's ethnicity is defined by a unique sociocultural heritage that is passed down from generation to generation but can change as the person changes geographical locations or joins a family with different cultural practices. Ethnicity looks at geographical origins, cultural differences in diet, and other habits.

26. Example: A child born in Korea but adopted by a Caucasian American family will grow up speaking English, eating American food, and studying U.S. history. Ethnically, the child is American but will be viewed racially by others as Asian.

27. Past medical/personal history It is important to take time with these questions and to ensure that the client understands what is being asked. Ensure for any kind of allergies, other systemic sign and symptoms. ‘yes’ response lead to further follow up questions Some time ‘No’ response may also need follow up questions

28. Eating disorders/disordered eating This have an impact over client’s health and recovery The therapist must consider the potential for a negative impact of anorexia on bone mineral density In male eating disorders remains under reported. Athletes participating in sports that use weight classifications such as wrestling and weightlifting are at greater risk for anorexic behaviors such as fasting, fluid restriction, and vomiting. A form of body image disturbance in male bodybuilders and weightlifters referred to as muscle dysmorphia. Previously referred to as "reverse anorexia" This disorder is characterized by an intense and excessive preoccupation or dissatisfaction with a perceived defect in appearance, even though the men are usually large and muscular. The goal in disordered eating for this group of men is to increase body weight and size. The use of performance enhancing drugs and dietary supplements is common in this group of athletes. Gay men tend to be more dissatisfied with their body image and may be at greater risk for symptoms of eating disorders compared to heterosexual men.

29. General Health Self-assessed health is a strong and independent predictor of mortality and morbidity. People who rate their health as "poor" are four to five times more likely to die than those who rate their health as "excellent’’. Self-assessed health is also a strong predictor of functional limitation. The therapist should consider it a red flag anytime a client chooses "poor’’ to describe his or her overall health.

30. Medication/Substance abuse Over the counter drugs/medication usage should be asked Substances refer to any agents taken non-medically that can alter mood or behavior Addiction refers to the daily need for the substance in order to function Addiction is based on physiologic changes associated with drug use but also has psychologic and behavioral components.

31. Substance abuse Dependence is the physiologic dependence on the substance so that withdrawal symptoms emerge when the drug is stopped abruptly. Once a medication is no longer needed, the dosage will have to be tapered down for the client to avoid withdrawal symptoms. Tolerance refers to the individual's need for increased amounts of the substance to produce the same effect. Among the substances most commonly used that cause physiologic responses but are not usually thought of as drugs are alcohol, tobacco, coffee, black tea, and caffeinated carbonated beverages.

32. Key factors for substance abuse Behavioral and physiologic responses to any of these substances depend on: Characteristics of the chemical itself, The route of administration, Adequacy of the client's circulatory system

33. Alcohol abuse It is also becoming a problem in Pakistan, so considering it in screening process is necessary.

34. Cont.. The RAFFT Questionnaire (Relax, Alone, Friends, Family, Trouble) poses five questions that appear to tap into common themes related to adolescent substance use, such as peer pressure, self-esteem, anxiety, and exposure to friends and family members who are using drugs or alcohol. R: Relax—Do you drink or take drugs to relax, feel better about yourself, or fit in? A: Alone—Do you ever drink or take drugs while you are alone? F: Friends—Do any of your closest friends drink or use drugs? F: Family—Does a close family member have a problem with alcohol or drugs? T: Trouble—Have you ever gotten into trouble from drinking or taking drugs?

35. Assessment of alcohol abuse There are several tools used to assess a client's history of alcohol use, including the Short Michigan Alcoholism Screening Test (SMAST), The CAGE questionnaire, Separate list of alcohol related screening questions AUDIT (Alcohol Use Disorders Identification Test) When administered during the screening interview, it may be best to use a transition statement

36. Tobacco abuse

37. Cont … Smoking has been linked with disc degeneration and acute lumbar and cervical intervertebral disc herniation. Nicotine interacts with cholinergic nicotinic receptors, which leads to increased blood pressure, vasoconstriction, and vascular resistance. These systemic effects of nicotine may cause a disturbance in the normal nutrition of the disc

38. Caffeine abuse: Caffeine is a substance with specific physiologic (stimulant) effects. Caffeine ingested in toxic amounts has many effects, including Nervousness, Irritability, Agitation, Sensory disturbances, Tachypnea (rapid breathing), Heart palpitations (strong, fast, or irregular heartbeat), Nausea, Urinary frequency, Diarrhea, and Fatigue.

39. Cont …

40. Aspartame abuse:

41. Working & Living environment:

42. Common occupational exposure Conducting a quick survey may be helpful when a client presents with puzzling, nonspecific symptoms including myalgias , arthralgias,headaches , back pain, sleep disturbance, loss of appetite, loss of sexual interest, or recurrent upper respiratory symptoms.

43. History of fall:

44. STEP 2 CORE INTERVIEW

45. Core interview Once the therapist reviews the results of the Family/Personal History form and reviews any available medical records for the client, the client interview (referred to as the Core Interview in this text) begins

46. Components of core interview

47. History of present illness: During this initial phase of the interview, allow the client to carefully describe his or her current situation. Follow-up questions and paraphrasing can be used in conjunction with the primary, open-ended questions.

48. Pain & Symptom assessment

49. History of trauma When the symptoms seem out of proportion to the injury, or when the symptoms persist beyond the expected time for that condition, a red flag should be raised in the therapist's mind. Even if the client has a known (or perceived) cause for his or her condition, the therapist must be alert for trauma as an etiologic factor. Emotional overlay, trauma, assault or undiagnosed cancer may b the reason for such symptoms

50. Types of trauma: Intrinsic trauma (occurring within the body) or Intrinsic trauma can also occur secondary to extrinsic (external) trauma. Extrinsic trauma(external accident or injury, especially assault or domestic violence) The therapist must remain aware that some motor vehicle "accidents" may be reported as accidents but are, in fact, the result of domestic violence in which the victim is pushed, shoved, or kicked out of the car or deliberately hit by a vehicle.

51. ASSAULT Domestic violence is a serious public health concern that often goes undetected by clinicians. Women, children, and older adults are at greatest risk, regardless of race, religion, or socioeconomic status. Each question must be presented in a sensitive, respectful manner with observation for nonverbal cues. Violence against women is more prevalent and dangerous than violence against men

52. ABUSE: encompasses the terms physical abuse, mental abuse, sexual abuse, neglect, self-neglect, and exploitation. ASSAULT it is by definition any physical, sexual, or psychologic attack. This includes verbal, emotional, and economic abuse. DOMESTIC VIOLENCE (DV) OR INTIMATE PARTNER VIOLENCE (IPV) It is a pattern of coercive behaviors perpetrated by a current or former intimate partner that may include physical, sexual, and/or psychologic assaults.

53. Child abuse It includes neglect and maltreatment that includes physical, sexual, and emotional abuse. Failure to provide for the child's basic physical, emotional, or educational needs is considered neglect even if it is not a willful act on the part of the parent, guardian, or caretaker Elder abuse Multiple trips to the emergency department Depression Falls7fractures Bruising/suspicious sores Malnutrition/weight loss Pressure ulcers Changing physicians/therapists often Confusion attributed to dementia

54. Medication/Medical treatment

55. 4 Ds associated with OTC medicine

56. Side effects of different drugs

57. NSAIDs

58. Effects of NSAIDs on different systems

59. Current level of fitness The level of fitness can be a valuable indicator of potential response to treatment based on the client's motivation (i.e., those who are more physically active and healthy seem to be more motivated to return to that level of fitness through disciplined self-rehabilitation).

60. Sleep-Related History Sleep patterns are valuable indicators of underlying physiologic and psychologic disease processes. The primary function of sleep is believed to be the restoration of body function. When the quality of this restorative sleep is decreased, the body and mind cannot perform at optimal levels. Physical problems that result in pain, increased urination, shortness of breath, changes in body temperature, perspiration, or side effects of medications are just a few causes of sleep disruption. Any factor precipitating sleep deprivation can contribute to an increase in the frequency, intensity, or duration of a client's symptoms.

61. Stress Most symptoms (pain included) are aggravated by unresolved emotional or psychologic stress. Prolonged stress may gradually lead to physiologic changes. Stress may result in depression, anxiety disorders, and behavioral consequences (e.g., smoking, alcohol and substance abuse, and accident proneness). The effects of emotional stress may be increased by physiologic changes brought on by the use of medications or poor diet and health habits

62. Final Questions It is always a good idea to finalize the interview by reviewing the findings and paraphrasing what the client has reported.

63. Hospital inpatient information Medical Record Treatment of hospital or nursing home inpatients requires a slightly different interview (or information-gathering) format. Important information to look for might include: • Age • Medical diagnosis • Surgery report • Physician's/nursing notes • Associated or additional problems relevant to physical therapy • Medications • Restrictions • Laboratory results • Vital signs

64. Nursing assessment The essential components of the nursing assessment that are of value to the therapist may include: • Medical status • Pain • Physical status • Patient orientation • Discharge plans The nursing staff are usually intimately aware of the patient's current medical and physical status.