Question

1a)_Discuss the difference in assessment techniques in a clinic versus at bedside

Answer 1

Ans. Progress in the field of respiratory care has placed increasing demands on respiratory therapists to develop competent bedside assessment skills. Decisions regarding when to initiate, change, or discontinue therapy depend on accurate clinical assessment. Although the physician has the ultimate responsibility for these decisions, RTs often participate in the clinical decision-making process. To fulfill this role effectively, the RT must assume responsibility for gathering and interpreting relevant bedside patient data.

Bedside assessment is the process of interviewing and examining a patient for signs and symptoms of disease and the effects of treatment. It is a cost-effective way of obtaining pertinent information about the patient’s health status. In many cases, bedside assessment provides the initial evidence that something is wrong and often helps establish the severity of the problem. In contrast to some diagnostic tests, bedside assessment techniques are of little risk to the patient.

Two key sources of patient data are the medical history and the physical examination. Data gathered initially by interview and physical examination help identify the need for subsequent diagnostic tests. After a tentative diagnosis is made, these assessment procedures also help the clinician to select the best approach to therapy. After a treatment regimen begins, these assessment procedures are repeated to monitor patient progress toward predefined goals.

The patient initially is assessed to identify the correct diagnosis. This initial assessment is most often performed by a physician. Exceptions may occur in emergency situations in which a physician is unavailable. In such cases, other health care personnel, such as nurses and RTs, may need to evaluate the patient rapidly to implement appropriate lifesaving treatment (e.g., cardiopulmonary resuscitation). After a tentative diagnosis is reached and the physician orders specific treatment, subsequent evaluations are made by health care personnel to monitor the patient during the hospital stay and to evaluate treatment results.

The skills of bedside assessment described here are not difficult to learn; however, mastery requires practice. Initially, students should practice the skills on healthy individuals. This practice helps improve technique and provides an understanding of normal variations.

Interviewing the Patient and Taking a Medical History

Interviewing furnishes unique information because it provides the patient’s perspective. It serves the following three related purposes:

1. To establish a rapport between the clinician and patient

2. To obtain essential diagnostic information

3. To help monitor changes in the patient’s symptoms and response to therapy.

Principles of Interviewing

Interviewing is a way of “connecting” with the patient. This connection is especially important for the patient who is under the stress of an illness because meaningful human contact lessens the patient’s sense of isolation. The factors that affect communication between the RT and the patient include the following:

• Sensory and emotional factors

• Environmental factors

• Verbal and nonverbal components of the communication process

• Cultural and other internal values, beliefs, feelings, habits, and preoccupations of both the health care professional and the patient.

Structure and Technique for Interviewing :

The ideal interview is one in which the patient feels secure and free to talk about important personal matters. Each interview should begin with the RT introducing himself or herself to the patient and stating the purpose of the visit. The introduction is done in the social space, approximately 4 to 12 feet from the patient. It begins the process of establishing a rapport with the patient and helps the patient feel more comfortable about answering personal questions. Pulling the curtain between the beds of a semiprivate room also may be helpful in making the patient feel more at ease with the interview .