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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Topics Establishing Patient Rapport The Comprehensive Patient History Special Challenges
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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Paramedic Care:Principles & Practice
Volume 2 Patient Assessment
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Chapter 1 The History
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Topics
Establishing Patient RapportThe Comprehensive Patient HistorySpecial Challenges
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
The Interview
In the majority of medical interviews, field diagnosis is based on history.It is conducted simultaneously with the physical exam.It is a structured, flexible, tool with several components.Patient condition dictates length and completeness.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Establishing Patient Rapport
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Establishing Patient Rapport
Situation, the patient, and conditions will determine ability to establish rapport.Respond to the patient with empathy to gain trust.Patient’s response to questions will guide the exam.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Establishing Patient Rapport
Setting the Stage – In a healthcare facility, if a patient’s chart is
available, review it before interviewing the patient.
– Gather information from the first responder personnel.
– Reconfirm information.Maintain an open mind!
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
If the patient cannot provide useful information, gather it from family or
bystanders.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Establishing Patient Rapport The First Impression – Your appearance should suggest neatness,
cleanliness, pride, and professionalism. – Present yourself as a caring, competent, and
confident health care professional.– Your voice, body language, gestures, and
especially eye contact should communicate that you care about your patient’s problems.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Establishing Patient RapportIntroductions – Make eye contact with your patient and maintain
it as you conduct the interview. – Use your patient’s name frequently during the
interview. Avoid slang terms such as “honey,” “chief,” “pops,” or “sweetie.”
– Be aware of other forms of nonverbal communication.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Establishing Patient RapportAsking Questions – Ask questions in a way that elicits accurate
information from your patient.– Use a combination of open-ended and closed-
ended questions.Open-ended questions allow patient to explain how he/she feels.Closed-ended questions elicit short answers.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Establishing Patient Rapport Language and Communication – Effective communication means connecting with
your patient. – Barriers to communication include:
Cultural differencesLanguage differencesDeafnessSpeech impedimentsBlindness
– When encountering communication barriers, try to enlist someone to help.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Establishing Patient Rapport
FacilitationReflectionClarificationEmpathy
ConfrontationInterpretationAsking about feelings
Active listening techniques:
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Establishing Patient Rapport
Sensitive Topics – A paramedic must learn to become comfortable
dealing with sensitive topics.– Sensitive topics may include sexual activities,
death and dying, physical deformities, bodily functions, and domestic violence.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Establishing Patient Rapport
Sensitive Topics – Familiarize yourself with and practice some
opening questions on sensitive topics. – It is critical that you remain calm, objective, and
nonjudgmental.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
The Comprehensive Patient History
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Preliminary DataAlways record the date and time of the physical exam. Determine your patient’s age, sex, race, birthplace, and occupation. – These questions provide a starting point for the
interview. After you have gathered the information, you should establish its reliability.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
The Chief ComplaintBegin with an open-ended question about your patient’s chief complaint. The chief complaint is the pain, discomfort, or dysfunction that caused the patient to request help.When possible, report and record the chief complaint in the patient’s own words.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
The Present Illness OPQRST-ASPN
Onset of the problemProvocative/ Palliative factorsQualityRegion/Radiation
SeverityTime Associated SymptomsPertinent Negatives
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Past HistoryAsk questions about the patient’s general state of health, childhood and adult diseases, psychiatric illnesses, accidents or injuries, surgeries, and hospitalizations. The patient’s condition, the situation, and time constraints will determine how much information you can and should gather on the scene.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Current Health Status
Current medicationsAllergiesTobaccoAlcohol, drugs, and related substancesDietScreening testsImmunizations
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Current Health Status
Sleep patternsExercise and leisure activitiesEnvironmental hazardsUse of safety measuresFamily historyHome situation and significant othersDaily life
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Current Health Status
Important exercisesReligious beliefsThe patient’s outlook
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
You should take your patient’s medications with you to the hospital, when practical.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Review of SystemsA system-by-system series of questions designed to identify problems your patient has not already identified:
– Skin– Head– Eyes– Ears– Nose– Mouth/Throat– Respiratory– Cardiovascular
– Gastrointestinal– Genitourinary– Musculoskeletal– Neurologic– Psychologic– Endocrine– Hematologic
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Special Challenges
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Special Challenges
SilenceOverly talkative patientsMultiple symptomsAnxiety
DepressionSexually attractive or seductive patientsConfusing behaviors or symptoms
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Special Challenges
Patients needing reassuranceAnger and hostilityIntoxicationCrying
Limited intelligenceLanguage barriersHearing problemsBlindnessTalking with families or friends
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Summary
Establishing Patient RapportThe Comprehensive Patient HistorySpecial Challenges
