Professionalism

Respect

Genuiness

Empathy

Self awareness

Data gathering

Relationship building

Patient education

motivate

negotiate

create treatment plan

Shake hands

welcome patient

use patient's name

wash hands

ensure patients readiness and privacy

remove barriers

ensure comfort

ask permission

Indicate time available

Indicate your own needs

obtain a list of the patients issues they want to discuss

summarize and finalize agenda

2-3 issues per visit is reasonable

Emblems

illustrators

affective displays

regulators

adaptors

paralanguage

Elements ancillary to language

volume

pitch

tone

articulation

rate

rhythem

pauses

Set the stage

ellicit info

give info

understand patinent's perspective

end encounter

objectivity

active listening

paraphrasing and clarification

reflecting

validating

Support or corroborate

encouraging

facilitation

clarification

summarizing

confrontation

Empower patient's

improve patient's health outcomes

increase compliance/adherence

enhance quality of care

reduce malpractice risk

lower utilization of health services

increase patient's own satisfaction

based upon patient's knowlege

beliefs and values

needs

experiences

treatment plan is devised jointly by the provider and the patinet

Empathy

partnership

1) value patients input

2) involve patient as a parter

3) work with patient to devise a treatment plan

4) emphasize patients contribution and responsibility to own health care

patients own needs/goals

lifestyle issue

personal disabilities

personal crises

economic issues

Feal appeals -short term

informative appeals

Attention

comprehension

yielding

retention

action

= developing action plan may promote feeling of compentance and make behavioral change more likely

Relapse is the RULE, not the exception

? genetic

Initiation of coping responses

self-observation and self-monitoring

Healthcare providers/Therapists

Client centered

Tone: non judgemental

empatheic

encouraging

readiness fluctuates

desire to change needs to be illicited not imposed

collaborative

Signal clinician needs to change

non-agreement of goals

collision of wills

absence of collaboration

pre-contemplative stage

predictable when patient and clinician are out of sinc

ignoring

denial

argument

interrupting

Express empathy- validate patient

avoid argument-roll with resistance

support self efficiacy

creating and resolving discrepancies

Realistic

baby steps

reinforce positive changes and behaviors

postive results=eager for more improvement

measure effort= 1-10 scale

work on improving consistancy

prepares clients to enter treatment

brief intervention

more effectively manage growing patient load

more efficacious use of facetime and phone time

used individually or in groups

helps created expectations of sucess

sustained effects

effects appear early

increases treatment retention

encourages a rapid return

efficacious alone and as adjust treatment

ignoring response

additive response

Minimizing response

interchangable response(feed back awareness at same intensity) *strive for

Demographics

Occupational history

nutrition and diet

daily activity and exercise

alchohol, tobacco and recreational drug use

spirituality and belifs

relationships

• Seek out mentors who strive for balance in their personal and professional lives.Build habits of self-appreciation
  Cultivate your capacity and skills for working in a team.
• Learn the skills of negotiating and resolving conflict in a respectful fashion.
  
• Consider emotions (your own and others’) as information.
  
• Develop a language for your emotions.
  
• Disclose your feelings to significant persons in your life.
  
• Learn to recognize emotions in others.
  
• Learn the skills of empathy.
  
• Develop your capacity for intimacy.
  
• Develop intimate partner communication skills.
  
• Learn and implement the practice of mindfulness.
  
• Focus on right action instead of outcomes. (Replace pursuit of “control” with realistic awareness of your “influence.”)
  
• Look for opprtunities for personal renewal in the midst of work.
  
• Engage in reflection on meaningful moments at the end of the day.
  
• Keep a journal on meaningful moments from the day.
  
• Keep a “gratitude journal.

• Developing self-awareness
• Acquiring a language for your emotions
• Controlling impulses
• Delaying gratification
• Regulating your moods
• Recognizing emotions in others
• Expressing empathy (modules 6, 13)

Attentiveness and warmth

empathy

-legitimization

-reflection

Respect

Support

partnership

In safety, the predominant feature is that the body is engaged, relaxed, and in an open posture

.

In “fight,” the predominant stance is one of engagement, and of attack or retaliation as a defense to feeling unsafe. 

In full expression, it looks like a “raging bull.” Typical nonverbal signals of fight include heightened body tension, leaning forward with jutting jaw, clenched fists, narrowing of the inner eye brows, flaring of the nostrils, and tensing of the mouth. Voice volume typically increases and becomes more staccato, and breathing is deeper. The face may flush.

“Flight” is characterized by increased body tension, as in “fight”, but shows disengagement, rather than engagement. 

Characteristics of the flight pattern are easy to remember because everything flees nonverbally: the person may pull back or tuck the chin, turn the head and avert the eyes; barriers of crossed arms and legs may go up; the voice volume diminishes and speech may be strained or hesitant; color may blanch, and breathing may be faster, more shallow, or held.

In “conservation-withdrawal,” the person is overwhelmed with excessive input and unable to mount a response.  

The nonverbal cues are disengagement and relative immobility. The still body is slumped with sagging face and limbs; the voice is very soft and speech is hesitant when present; color is more neutral, neither flushed nor blanched; barriers are down. This pattern is well known to experienced clinicians as the look of a patient with marked depression, and the look of someone who is emotionally and physiologically overwhelmed in an intensive care unit.

1. Assess (risk, past behavior, readiness, conviction and confidence)
2. Advise and inform
3. Agree (on goals and methods)
4. Assist (overcome barriers)
5. Arrange Follow-up

1. Explore and Hear the Patients Perspective
2. Provide Emotional Support and Express Empathy
3. Provide Information that is Useful and Relevant
4. Negotiate a Plan
5. Anticipate Problems and Barriers and Identify Potential Solutions
6. Offer Ongoing Monitoring of Adherence and Adherence Difficulties

1. Assess (before Telling)
   • Strive to understand the patient’s perspective (experience, feelings, ideas, function, expectations)
   • Assess readiness, conviction and confidence
     
     
     
2. Build Rapport
   • Reflective listening
   • Express empathy
   • Provide affirmation and support
     
     
     
3. Tailor Counseling : Match goals and strategies to readiness, conviction and confidence

   For low conviction:

   • Provide information and feedback (with permission)
   • Explore ambivalence
   • Provide a menu of options and support choice and autonomy

   For low confidence:

   • Review successful past experience
   • Teach problem-solving and coping skills
   • Encourage small steps

1. Use an open-ended beginning question or statement to begin the HPI. It focuses on the chief complaint, the primary problem you identified in Step 2. 
   2.Use non-focusing open-ended skills
   like silence, neutral utterances (e.g. “uh-huh”) and nonverbal encouragement (nodding, leaning forward) to encourage patients to talk. .  3. Obtain additional data from non-verbal sources by mentally noting the patient’s physical characteristics, appearance and environment. For example, a framed picture of a young military officer could be a key to eliciting a patient’s anxiety about his son at war.

1. Define the cardinal features of the patient’s chief concern
   
2. Define the cardinal features of other symptoms (those already mentioned by the patient and those not yet introduced) in the organ system of the patient’s chief concern
   
3. Inquire about relevant symptoms outside the involved system
   
4. Inquire about relevant nonsymptom (secondary) data

language

unable to read

age= loss of cognition

decreased hearing

decreased vision

education

cultural

1) slow down

2) use living room language

3) show or draw pictures

4) limit information given out at each interaction + repeat

5) use show me method

6) be caring, respectful and sensitive

asking staff for help

bringing someone in who can read

non compliance

not keeping appointments

making excuses

postponing descision making

watching or mimicking others

poor adherence to recomendations