Ch. 11: Fundamental Skills in Diagnostic Services (Slides 1-11)

Ch. 11 - Fundamental Skills in Diagnostic Services
(Slides 1-11)

1. Communication Skills for Patient Diagnosis
- Communicating Observations
- Physical Exams/Assessments
- Reporting/Recording Observations
- Cultural Competence
- Dealing W/ Difficult People

Warm-Up

• What basic, diagnostic-related skills do you already have?

• Which diagnostic skills or procedures would you like to learn?

Communication Skills for Patient Diagnosis

• Diagnostic workers must communicate observations about patients

• Healthcare workers make observations using all their senses:

  • Sight (inspect for signs of injury)

  • Hearing (listen to patient describe symptoms and use auscultation to listen through a stethoscope)

  • Touch (use palpation and percussion)

  • Smell (odors may indicate disease)

• Percussion

  • Process of tapping various body parts during examination and using resulting sounds to assess the condition of internal organs

• Palpation

  • Medical examination that uses touch to detect growths, changes in the size of organs, or tissue reactions to pressure

• Inspection

  • Visual examination used to assess parts of the body by looking for abnormal color, shape, size, or texture

• Auscultation

  • Use of a stethoscope to listen to sounds made by a Pt's internal organs (heart, lungs, abdominal organs) to make a diagnosis

Communication Skills for Patient Diagnosis (Cont.)

Signs vs. Symptoms

• Signs

  • Evidence of a health condition that can be seen or measured (bruising, swelling, rashes, cuts)

• Symptoms

  • Indication of a disease or disorder experienced by the patient, such as pain or discomfort

Critical Thinking...

Describe the difference between subjective and objective observations and give examples of each. 

• Subjective: symptoms that cannot be seen or measured by healthcare workers (ex: back pain)

• Objective: signs that can be seen and measured (ex: bruises, swelling, rashes)

Which are more useful in diagnosis, or are both types of observation valuable? Explain.

• Objective observations are easier to measure, but subjective observations come straight from the patient. The patient must be willing to explain symptoms and the healthcare provider must listen.

Physical Exam & Assessment

• A patient presents with signs of illness and the provider forms a differential diagnosis

  • Differential diagnosis = Determination made by a DR that distinguishes a disease/condition from others that have similar symptoms.

  • It’s like making a list of all the possible reasons someone might be feeling sick and then crossing them off one by one until the most likely one is found.

• Physician then develops a medical diagnosis

  • Medical diagnosis = determination by a DR that identified the cause of the Pt's illness (final determination and diagnosis)

Physical Exam & Assessment (Cont.)

• Nursing staff assess Pt's to determine a nursing diagnosis and care plan

  • Nursing Diagnosis = description of a Pt's health problem that a nurse is licensed and competent to treat

• A minimum data set (MDS) is used for residents entering long-term care

  • Government requirement, provides comprehensive evaluation of each resident's functional capabilities and helps nursing home staff identify health problems.

Reporting & Recording Observations

• Healthcare workers are responsible for reporting unusual events or changes in a patient’s behavior or physical condition

  • Changes in a person’s condition (vital signs, skin color, breathing, or behavior)

  • Reactions to a new treatment or therapy

  • Complaints of pain or discomfort

  • Refusal of treatment

  • Request for a clergy visit

• A shift report is presented at the end of each shift

• Record all observations in the patient record for documentation

Developing Cultural Competence

• Use cultural competence to communicate with patients and coworkers

  • Be aware of cultural attitudes about eye contact, personal space, modesty, and expressing pain

  • Respect all religious and spiritual beliefs

  • Know your personal biases and prejudices

Think Further

Give examples of cultural differences that might affect patient care. Consider the following: 

• Eye contact

• Body language and physical distance/touching

• Sense of time

• Expressing pain

• Speech and communication (first names; formality)

• Modesty (including gender differences)

What opinions do you have about these areas of cultural difference? How would you deal with a patient whose attitudes clashed with yours? What if the person was a coworker?

Think Further

How can you deal with difficult patients, clients, or residents?

• Do not label the person as “difficult”

• Identify the patient’s unmet need

• Remain calm and do not take it personally when a patient complains

• Consider the patient’s emotional state

• Use observation and listening skills

Multiple Choice

When a patient is complaining or upset, what is the most appropriate response from a healthcare worker?

• Label the patient as “difficult” and limit interactions

• Stay calm, listen actively, and try to identify any unmet needs

• Tell the patient to calm down and stop complaining

• Avoid the patient until they feel better

Match

Match the exam/assessment terms

• listening to body sounds made by internal organs (heart, lungs, abdominal organs)

• medical exam that uses to touch to detect growth, changes in the size or organs, tissue, or reactions to pressure

• process of tapping body parts during exams and using resulting sounds to assess the condition of internal organs

auscultation

palpation

percussion

• auscultation

• palpation

• percussion

Multiple Choice

Which of the following is a responsibility of healthcare workers regarding patient care and reporting?

• Only document patient complaints if they are repeated frequently

• Report and document changes in a patient's condition, reactions to treatments, and refusals of care

• Wait until the end of the week to report any unusual behavior

• Share patient information casually with other staff to save time

Multiple Choice

What is the difference between a differential diagnosis and a medical diagnosis?

• A differential diagnosis is the final answer, and the medical diagnosis is a guess

• A differential diagnosis is created by a nurse, while the medical diagnosis is made by a doctor

• A differential diagnosis lists possible causes, while a medical diagnosis identifies the actual cause

• There is no difference between the two