Strategies to Deal with Difficult Patients and History Patients - Essay Example

Prof’s Lesson Plan: Difficult Patients and History Patients and Taking Medical Histories this will be a lesson plan identifying strategies to deal with difficult patients when collecting family history. Many patients in a clinical environment will either be unwilling or unable to provide family history in cogent ways, and nurses will have to learn how to cope with that. Section 1: Educational Need Nurses have to learn a great deal on the job and from their own or from other nurses experience. However, they should also be prepared as well as possible before unleashed on the public. Furthermore, many attempts at giving experience in a classroom setting fail because of unrealistic situations: things are never so simple as we would like them to be. This lesson will teach students some strategies for dealing with patients who are unwilling or unable to cooperate when giving a family history. Furthermore, this lesson can include a swath of transferable skills that will be useful in other areas, thus providing a much greater benefit than its narrow focus would seem to suggest. However, the most important reason for this might be that this kind of lesson can force a nurse to be critical of the role that informal theory plays in their practice towards patients, to gain confidence as creators of informal theory, and to understand the interaction between formal and informal theory. Section 2: Learner outcomes for the lesson & Learning Objectives This experience will have several general learning outcomes a) allow nurses to be more proficient in such skills when they first experience them in a clinical setting b) give nurses an approximation of the kinds of experiences they could have c) provide transferable skills for patient interaction for a variety of other situations that are not directly covered in and d) understand their role in forming informal theory, and the relationship between formal theory and informal theory. Specific goal: for nurses to be critical in the formation of informal theory. Learner outcomes: that nurses learn and develop specific techniques for dealing with patients in difficult situations, while understanding how they develop those techniques. Hopefully, each prospective nurse will leave with a greater understanding for the real-world situation of patient interaction, a greater degree of comfort in dealing with issues that may arise, and a closer relationship with their classmates, hopefully furthering future learning outcomes. Learner Characteristics Nurses who have already achieved some knowledge of patient history. The goal of this lesson is not for nurses to take a history: they should already know this skill so that they will not have to focus on it throughout the lesson. Rather, they should have enough experience that taking a history will be second nature, and so they can focus on techniques of patient interaction that they employ. Learning Theory While nursing often uses the see one, do one, teach one model, this will differ significantly and focus rather on the development of difficult to define skills and subjective experiences though one-on-one interaction with fellow students. Based on self-authorship theory, this will attempt to both allow nurses to develop their own skills and techniques that will work for them, hear widely used techniques (as provided by instructors) and techniques developed and used by peers, with the goal of critiquing each technique given. This will allow a great deal of exposure to different ideas without dictating what the right thing to do in a situation. This will hopefully allow nurses to acknowledge their role in developing theories of practice every time they interact with a patient, and note that they have and can develop authority as knowledge creators based on their personal experiences in patient interactions. Instructional methods used for delivery This lesson will rely heavily on role-playing, allowing the students to develop experience, try out different techniques, and form their own conclusion about what works and what does not. It will then go deeper and ask them to try to evaluate why a particular strategy worked, why it might work in a clinical situation, and why it might not work in a clinical situation. The answers to these questions will show that the nurses were inherently using a kind of theory to guide their actions: in some cases they may have been guided directly by formal theory, in other cases by informal theory. This will allow the students to understand the role formal theory can have, in that it effects informal theory, which is the guiding principle of patient interaction. It will also make nurses critically aware of their roles as knowledge creators, and hopefully make them critical of their own informal theory: its origins, its weaknesses, and its strengths. This learning method will use role plays and group discussions to critically analyze the course of the role plays. Content Outline Welcome Explanation of why we are here: to develop practitioner skills Explanation of the development of informal theory, and the fact that informal theory, while informed by formal theory, will actually be what guides actions in particular situations Explanation of the challenge: to divide into pairs and role-play a family history with a difficult patient Brainstorming of reasons that a patient might be difficult Hope for them to hit on: Unwilling to be in the hospital Unconcerned Emotionally distressed by their experience or medical care Suffering from mental illness (include warnings about role-playing mental illness: sensitivity is paramount – this might not be the best thing for a mentally well person to try to role play) Distracted/tired etc. Divide group into pairs *randomly* People should not be allowed to be with people they are comfortable with, it will make it a little too easy Go over general medical interviewing tips (slide one: see below) Distribute handout for questions to ask Allow time for two interviews: one for each student in a pair. Each student should take a turn role-playing a difficult patient and a nurse interviewer Ask them to share experiences Give a few well known patient interaction tips: things like controlling the conversation, getting at the reason the conversation is failing, etc. Allow two more interviews Reconvene as a group. Asked what worked? What didn’t? Ask how it felt to be the uncooperative patient. Did you feel compelled at any point to actually converse? What made you want to cooperate? What made you not want to? List, as a group, successful strategies. Ask why those strategies were successful Point out any instance on reliance of formal theory Point out how an informal theory or worldview guided all of the actions, and that they were theory creators Resources: Slide 1: The Trouble with Physicians In one study, physicians did not allow patients to complete their opening statements 69% of the time. The mean time until the first interruption was 18 seconds. Once interrupted, fewer than 2% of patients went on to complete their statements. [1] "Data are thus very much physician-determined, skewed toward problems that are biomedical in nature... It has been proposed that current interviewing practices are at odds with scientific requirements: They produce biased, incomplete data about the patient." [2] Physician-Centered vs. Patient-Centered Interviewing Physician-Centered Patient-Centered Physician's Agenda Patient's Agenda Biomedical Focus Symptom Focus Physician Gathers Data Patient Tells Story An Outline for the Opening the Interview Setting the Stage Goal: To establish a favorable context for the interview Welcome the patient Know and use the patient's name Introduce and identify yourself Ensure comfort and privacy Chief Complaint/Setting the Agenda Goal: To establish the agenda for the interview Obtain list of all issues - avoid detail Chief Complaint Other complaints or symptoms Specific requests (i.e. medication refills) Patient's expectations for this visit Ask the patient "Why now?" Eliciting the Patient's Story Goal: To establish a good flow of information Open-ended questions initially Encourage with silence, nonverbal cues, and verbal cues Focus by paraphrasing and summarizing Transition Goal: To smoothly shift into physician-centered interviewing Summarize interview up to that point Verbalize your intention to make the transition [3] (Rathe, 1996b). Handout: the one minute medical history: The One Minute Past Medical History 1. Allergies and Reactions to Drugs (What happened?) 2. Current Medications (Including "Over-the-Counter") 3. Medical/Psychiatric Illnesses (Diabetes, Hypertension, Depression, etc.) 4. Surgeries/Injuries/Hospitalizations (Appendectomy, Car Accident, etc.) 5. Immunizations 6. Tobacco/Alcohol/Drug Use 7. Reproductive Status for Females Last Menstrual Period Last Pelvic Exam/Pap Smear Pregnancies/Births/Contraception 8. Birth History/Developmental Milestones for Children 9. Marital/Family Status 10. Occupation/Exposures (Rathe, 1996a). Works Cited Rathe, R (1996a). Tips and Tricks to Medical Interviews. University of Florida. Retrieved from http://medinfo.ufl.edu/year1/bcs96/clist/history.html Rathe R (1996b). One Minute History Interview. University of Florida. Retrieved from: http://medinfo.ufl.edu/year1/bcs96/interv/pmh.html Read More