Cultural Competence
List four cultural beliefs and behaviors that will have an impact on your assessment of the patient
(1)Communication: the uses of speech, body language, and space; (2) health beliefs and practices; (3) diet and nutritional practices; and (4) the nature of relationships within a family.
What are the 4 Cs of communication?
courtesy, comfort, connect, and confirmation
Explain negative predictive value
The proportion of persons with an expected observation who ultimately prove not to have the expected condition.
What types of things should you document as a general guideline?
Document what you observe and what the patient tells you rather than the conclusions you interpret or infer.
Differentiate between acute pain and chronic
Acute pain is sudden and of short duration and is usually associated with surgery, injury, or an acute illness episode.
Chronic pain is persistent, lasting many weeks and even many months or longer, and is usually associated with a prolonged disease process
What is the relationship between communication and culture?
Communication and culture are interrelated, particularly in the way feelings are expressed verbally and nonverbally
Flexibility, respect, and confidentiality are key when discussing issues or concerns with which age group?
Adolescents
Why it is important to use a rating scale to assess pain?
A rating scale adds objectivity to a subjective assessment.
Define chief concern.
A brief description of the patient’s main reason for seeking care, stated verbatim in quotation marks. Include the duration of the problem.
Which factors should be addressed as part of the history of which factors should be addressed as part of the history of the present problem?
Onset, quality, intensity, precipitating factors, location, effect of pain on daily activities, effect of pain on psyche, pain control measures, and medications used
Which view sees our lives as part of a much greater whole that must be in harmony?
A naturalistic or “holistic” approach
What are the goals of a patient interview?
Discovering information for diagnosis, providing patient information, negotiating with the patient concerning health care management, and counseling the patient regarding disease prevention.
Compare sensitivity and specificity
Sensitivity is the ability of an observation to identify correctly those who have a disease.
Specificity is the ability of an observation to identify correctly those who do not have the disease
What type of information is included in the personal and social history?
Varies according to the concerns of the patient and the influence of the health problem on the patient’s life.
Which personal and social history factors should be explored in a patient in pain?
Previous experiences with pain and its effect; family’s concerns and cultural beliefs about pain; attitude toward the use of opioids, anxiolytics, and other pain medications for pain control; fear of addiction; and current or past use of illicit substances
Which view is reductionist and looks to very narrow, specific cause and effect?
The scientific view.
Why do older adults present a special challenge in organizing the information obtained from the history?
Multiple health problems (chronic/progressive, or debilitating). Disease symptoms. Pain is often an unreliable symptom (poor perceptions).
What does critical thinking require us to do?
Make decisions, you use your experience, intimate knowledge of your patient, and ability to become aware of the current best evidence regarding the issues involved
Explain the mnemonic OLDCARTS.
O = Onset
L = Location
D = Duration
C = Character
A = Aggravating or associated factors
R = Relieving factors
T = Temporal factors
S = Severity of symptoms
Name some possible behaviors related to pain.
Repeat a behavior pattern from one episode of pain to the next, body movements, vital sign changes, or skin temp/color changes
Family structure and the social organizations to which a patient belongs are among which types of cultural forces?
Many imprinting and constraining cultural forces.
Which examination technique can continue throughout the history-taking process and during the physical examination?
Inspection
Describe the steps in critical thinking
1. Assess what we have learned, 2. Determine its value and significance. 3. Prioritize to the extent to which a particular bit of information might have an impact on our diagnostic effort and on the management plans we formulate with the patient.
What diagram is often helpful in recording family history information?
A pedigree diagram
Identify at least three classic pain patterns.
1. tender, deep, and aching
2. heavy, throbbing, and aching
3. burning, shock-like pain