Patient Management

Front 1

Patient Interview

Back 1

The art of establishing a relationship with your patient and of gleeming the information you need to best treat them. The cornerstone of the care process

Front 2

Patient Interview

Back 2

The art of establishing a relationship with your patient and of gleeming the information you need to best treat them. The cornerstone of the care process

Front 3

Critical Components of the Patient Interview

Back 3

Interest
Genuininess
Acceptance
Positive Regard

Front 4

Appropriate Attitude

Back 4

Positive self esteem, a locus of control centered on the patient, critical listening skills, acceptance without judgement, and assertiveness skills

Front 5

Good Timing

Back 5

Not interupting, using silence appropriately, listening carefully

Front 6

Artful Phrasing

Back 6

asking correct questions at the right time
Avoiding slang, jargon, or dialect,
tuning into ones words and gestures
assuring the patient that they will be treated with thoughtfullness and seriousness.

Front 7

3 Parts to an Interview

Back 7

Initiation- a statement of purpose
Body or development- gathering information needed
Closure- summarizing

Front 8

Feedback should be:

Back 8

1. Positively phrased
2. non judgemental
3. facilitative of learning
aimed at the behavior, not the person.

Use the sandwich technique and always give an example to keep feedback in context.

Front 9

Assessment

Back 9

Determines how a student uses knowledge and what they will need to further develop and grow.

-the self reflection and feedback posrtions of assessment help correct behaviors and make them permenant, thus developing a professional and making them more successful.

Front 10

Assesment essentials

Back 10

1. expectations
2. samples of performance
3. judgement of performance
4. goals of the course/curriculum
5. student involvement (done with the student, not to them)
6. methods

Front 11

Why might someone be resistant to self reflection

Back 11

!. Rationalize that graduate students don't need to self assess
2. used to having someone else assess them
3. Don't know how
4. DOn't see the advantage of assessing, such as development and success professionally
5. To busy to assess
6. Feel one's own feelings about their performance should be private.

Front 12

Domains of Learning

Back 12

1. Cognitive- What we know
@. Psychomotor- What we can do
3. Affective- our values, what we believe, our personality

Front 13

Generic Abilities

Back 13

Focuses on the Affective Domain of learning. Certain beliefs, characteristics, and traits that aren't explicitly within a professions range of knowledge, but are still necessary for success in that profession

ex. stress management, problem solving, critical thinking, use of constructive feedback, responsibility, professionalism.

Front 14

ex. of a taxonomy of generic abilities

Back 14

stress managemnt
Begginer- recognizes stressors and problems in their self and problems and distress in others

Developing- Able to properly balance professional and personal life, develop effective affective responses to situations

Entry Level- Able to prioritizes multiple commintments, responds well to urgent situations.

Front 15

Clinical Performance Instrument

Back 15

uses the cognitive, affective, and phychomotor domains.
Asseses a student from novice to entry level on the visual analog scale based on their performance on 5 performance dimensions

1. Quality- limited skills to high skill performance
2. Supervision required- constant monitoring to independent with consultation
3. Consistency- inconsistent to consistent
4. Complexity of skills and situations- simple to complex
5. Efficiency- High time use to timeliness

Front 16

what is entry level?

Back 16

Ablity to independently manage (not treat) a case load

Front 17

"with distinction"

Back 17

a student excells at a particular skill within certain academic levels.....not beyond entry level.

Front 18

what is teh comment session for on the clinical performance instrument?

Back 18

For feedback. Provides examples of the student excelling and context within which the student needs to improve.

Front 19

Clinical Performance Criteria (examples)

Back 19

ethical practice, legal practice, responsible behavior, professional behaviors, safety, communication

Front 20

effective communication skills

Back 20

helping the patient to understand their illness so theat they make decisions about their treatment, modify their lifestyle to prevent future problems, and live successfully with the problems that can't be treated.

Front 21

unhelpful responses

Back 21

1. Indifference- failure to listen
2. Offering Reassurances-unwillingness to listen to patient's perception of the illness
3. Offering judgemental responses- failure to allow the patient to decide for themselves
4. Defensiveness- personalization and failure to listen carefully

Front 22

who owns the problem?

Back 22

the person with the intense feelings

Front 23

Active Listening skills

Back 23

1. Restatement- repeating what was said as you heard it
2. Reflection- verbalizing the context and the implied feelings
3. Clarification- summarizing and simplifying your thoughts and feelings.

Front 24

Congruence

Back 24

when the picture and the words match

Front 25

Power Communication Skills

Back 25

Pacing- Creating a common experience to diminish the differences between patient and PT
Backtracking- repeating what you think someone has said- shows them you are listening
Clarification- asking who, what, why, when how- confirms understanding
Speaking your intent- saying exactly what you mean- no implications, no guessing

Front 26

Factors in successful communication

Back 26

1. Presentation
3. Attitude of the speaker
3. Voice
4. Effective listening

Front 27

3 types of communication

Back 27

1. verbal
2. nonverbal-meta communication and demonstration
3. Written

Front 28

Communication

Back 28

non stop process of taking learned and stored meaning and assigning it to things
-guided by unwritten rules

Front 29

misunderstanding

Back 29

a difference in the interpretation of meaning

Front 30

interpersonal skills

Back 30

good communication skills, responsible, true interest, respect, establishes trust

Front 31

What needs to be assessed on a patient?

Back 31

belief system, ability to learn, willingness to learn, history of compliance, knowledge base.

Front 32

what can detract from patient interactions

Back 32

lack of trust, anxiety, current physcial and emotional state, motivation

Front 33

how can patient interest be built?

Back 33

Relate an interest, use humor, ask comprehension and learning questions, use analogies and anecdotes, state advantages of learning

Front 34

how can patient interest be maintained?

Back 34

provide frequent response opportunities, use accountability, use breaks if necessary, clearly state goals and objectives, vary your presentation styles.

Front 35

transfer activity

Back 35

any activity that involves the patient moving from one location or position to another.

The goal is to facilitate, not to move, the patient's movement and to educate both the patient and anyone else who might be helping them at home

Front 36

Primary concern and motto for transfers?

Back 36

Safety of the patient and the helper.

Set up for success

Front 37

How to utilize mechanical advantages:

Back 37

1. take advantage of the patient's size and weight
2. take advantage of your own size and weight
3. Pivot to the person's good side
4. Position chair/comode/etc. at the proper angle of approach
5. work with a count of a clear audible initiation so that all parties can work in unison.

Front 38

Initial Preperation steps (8)

Back 38

1. position cushions
2. Cover or drape any surfaces for sanitary reasons
3. Determine if the patient's backside needs to be draped
4. Determine if bracing is needed by the patient
5. Check the lines for any functional problems
6. Know the weight bearing precations
7. Know any surgeical restrictions (i.e. Blood pressure restictions)
8. Brakes on from where they are coming from/where they're going to

Front 39

Reminders during activity (4)

Back 39

1. Always use a gait belt- make transfers easier, safer, are required for insurance reasons
2. Communication- pt. has the right/need to know what the final goal is
3. Break down large tasks into smaller, more physically and emotionally manageable.
4. Guidance, Reassurance and praise should constantly be provided....should be in clear, consise, lay terms.

Front 40

Body Mechanics

Back 40

Always use the correct posture, Base of Support, and leverage
-they keep you and the patient safe and improve your future viability as a PT

Front 41

Side to Side or to the head of the bed

Back 41

Position head of the bed flat

Adjust bed so that it's on an appropriate level of your helpers

Use a sheet or a blanket or chicks under the patient, roll to their sides, grasp with an underhand grip

allow patient to help if appropriate using bridging, trapeize

Front 42

supine to sidelying

Back 42

prop up the opposite leg on the bed
cross the opposite arm over the trunk
have the patient look in the direction they will be moving
have the patient push with their propped leg and reach in the direction they are moving, provide support at the illiac crest and the shoulder.

Front 43

sidelying to sit

Back 43

pt. laying on the side of the bed, knees flexed

bring legs over the top of the bed by placing your arm over the top of the bent legs behind the knees

Encourage the patient to push up on the bed with their arms, PT assists with their arm behind the patient's neck and shoulders.

pt. facillitates at the illiac crest and shoulder

Front 44

Sit to sidelying

Back 44

With PT's arm guiding at the shoulder and neck, pt. leans back and rests their head/shoulder on the bed.

PT uses a scooping motion to assist in bringing their legs back onto the bed.

PT assists as necessary, guards patient's position as necessary

Front 45

Sit to Stand.

Back 45

Shift Patient to front of the bed

Position Patient's feet under their knees as much as possible

Patient leans forward shifting weight over feet

Using feet, patient straightens LE's for partial or full standing

Patient should push from the bed, or place arms around a gait belt on PT or on the PT's upper arms

arms to the neck is bad- can injure PT

Front 46

Considerations for standing

Back 46

Pt's weight bearing capability of their LE and UE, weight bearing due to pain, buckling threat to pelvis, trunk, knees.

Front 47

Seated Pivot

Back 47

Scoot patient to the front of the bed

Position patient's feet at an angle, with their heels facing the direction they are moving in

Lean forward, shifting weight over feet, assist if needed

Using a gait belt for support if needed, lift buttocks from old surface to new surface.

Front 48

Purpose of a sliding board

Back 48

A sliding board can be used in a seated pivot to use small movements as opposed to one large one.

CVA's and new amputees have better sucess with small movements, but need their feet repositioned after every movement

Front 49

Quad Transfers

Back 49

Place flexed legs onto your upper thigh or waist, grabbing their lower back and buttocks, lean back and bring the patient forward and on a diagnal of the movement onto the PT's thigh, and pivot to new surface.

Front 50

Halo transfer

Back 50

Lean the patient from the hips to the non-movement side, place their shoulders on the PT's hips (hips bear weight), Grab their buttocks and lower back lean back and move the pt. onto the new surface.

Front 51

2 ways to reposition a patient in a wheelchair

Back 51

1. The patient provides more assistance if they lean forward, and a PT uses their lower back and buttocks to move them back in their chair. they can also push back with their feet.

2. Minimizes patient involvement.....one PT geos from behind the chair and grabs the pt's crossed forearms. Another can grab beneath the pt's knees and using a timed basis, lift and shift back in the chair.

Front 52

2 person lift

Back 52

bed-chair-floor
One person goes behind the patient and grabs their forearms, the other scoops beneath their knees.

Lift in sequence and transfer patient from one surface to another

Front 53

Bed 2 person lift

Back 53

one person graps forearms around pt.'s knees, the other forms a cradle under the pt's lower back

pt can grap helpers if it doesn't endanger/immobilize

may need to utilize a stool as an intermediate

Front 54

4 person lift

Back 54

remember to setup for sucess-position destination at an appropriate angle, determine direction pt. will be carried. each helpers stepping patterns must allign for balance. place forearms under pt, lift up forearms, thus forklifting patient into your bodies. The helper with the greatest mechanical advantage should be placed at the heaviest/lightest place, The patient at the head is called the lead. A practice lift should be done on the bed, adjustments hsould be made if necessary, and then the real lift should be done on the count of the lead

Front 55

floor transfer

Back 55

Use a blanket/sheet if able, position helpers on each side of the body and grasp the forearm of the person across from you, 4-6 helpers may be needed. determine who is the lead and the direction to be traveled.

Front 56

hoyer lift

Back 56

enables a lift to be done with minimal mmechanical work or risk to the helper

two helpers still are needed

position sling under pt. in correct manner (heavy part under head, torso/buttocks portion under torso/buttocks)
position hoyer over pt., widen hoyer's base of support, place loops of sling into hoyer hooks, rase hoyer so that it clears the surface. One helper opperates the hoyer, the other guards the pt's head and feet.