HEALTH ASSESSMENT LECTURE

MODULE 1: FOUNDATIONS
COMPREHENSIVE ASSESSMENT
OF HEALTH ASSESSMENT
 Accounts the patient’s story, it establishes a
COVERAGE: complete database for problem identification,
LESSON 1: Physical Examination and History Taking reference and future comparison.
 Scope of Assessment  Includes all the elements of the health history
 The 4 Cardinal Techniques of Examination and the complete physical examination.
 Components and Comprehensive Adult Health
History FOCUSED ASSESSMENT
LESSON 2: Interviewing and the Health History To determine the status of a specific problem
 Fundamentals of Skilled Interviewing identified in earlier assessment.
 Sequence and Context of the Interview  Appropriate for established patients especially
 Advance Interviewing during routine or urgent care visits.
 Ethics and Professionalism  Addresses focused concerns or symptoms
 Assess symptoms restricted to specific body
A Health assessment is a plan of care that identifies the system
specific needs of a person and how those needs will  Applies examination methods relevant to
be addressed by the healthcare system or skilled assessing the concern or problem as precisely
nursing facility. Health assessment is the and carefully as possible.
evaluation of the health status by performing a physical For patients you are seeing for the first time in the office
exam after taking a health history. or hospital, you will usually choose to conduct a
LESSON 1: PHYSICAL comprehensive assessment, which includes all the
EXAMINATION AND HISTORY elements of the health history and the complete
physical examination.
TAKING: OVERVIEW
Assessing a client’s health status is a major component In many situations, a more flexible focused or
of nursing care and has two aspects: problem-oriented assessment is appropriate,
 The nursing health history particularly for patients you know well returning for
 The physical examination routine care, or those with specific “urgent care”
concerns like sore throat or knee pain.
The techniques of physical examination and history
taking that you are about to learn embody the time- You will adjust the scope of your history and
honored skills of healing and patient care. Gathering physical examination to the situation at hand, keeping
a sensitive and distinct history and performing a  several factors in mind:
thorough and accurate examination deepen your  the magnitude and severity of the patient’s
relationships with patients, focus your assessment, and problems;
set the guideposts that direct your clinical decision  the need for thoroughness;
making.  the clinical setting—inpatient or outpatient;
 primary or subspecialty care;
LESSON 1.1 THE SCOPE OF  and the time available
ASSESSMENT
The nursing assessment includes gathering information TWO TYPES OF DATA
concerning the patient's individual physiological,
psychological, sociological, and spiritual needs
SUBJECTIVE DATA
Information given verbally by the patient.
It is the first step in the successful evaluation of a  The symptoms and history, from Chief
patient. Subjective and objective data collection are Complaint through Review of Systems.
an integral part of this process. Part of the assessment  Problem: Fever →subjective cue: “Mainit ang
includes data collection by obtaining vital signs such as pakiramdam ko.”
temperature, respiratory rate, heart rate, blood OBJECTIVE DATA
pressure, and pain level using an age or condition
appropriate pain scale. Factual data that are observed by the nurse & could be
noted by any other skilled observer.
 All physical examination findings, or signs.

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 Detectable by an observer or can be tested to the presenting symptoms that the client
against an accepted standard. have.
 Problem: Fever →Objective cues: skin is warm
to touch, temperature is 38.9 C/ax.
LESSON 1.2 THE 4 CARDINAL
TECHNIQUES OF EXAMINATION NURSING HEALTH HISTORY
Structures the patient’s story as the patient relates his
INSPECTION problems.
Close observation of the details of the patient’s THE HEALTH HISTORY
appearance, behavior, and movement such as facial
expression, mood, body habitus and conditioning, skin  Used to gather data which are subjective and
conditions such as petechiae or ecchymoses, eye explore past and present problems.
movements, pharyngeal color, symmetry of thorax,  The accuracy and completeness of the data to
height of jugular venous pulsations, abdominal be gathered is dependent on the skills as an
contour, lower extremity edema, and gait. interviewer.
PALPATION COMPONENTS OF HEALTH
Tactile pressure from the palmar fingers or finger HISTORY
pads to assess areas of skin elevation, depression, 1. Identifying data and source of the history
warmth, or tenderness, lymph nodes, pulses, contours o Reliability
and sizes of organs and masses, and crepitus in the 2. Chief complaint(s)
joints. 3. Present illness
PERCUSSION 4. Past illness
5. Family history
Use of the striking or plexor finger, usually the third,
6. Personal and Social History
to deliver a rapid tap or blow against the distal
7. Review of Systems
pleximeter finger, usually the distal third finger of the
left hand laid against the surface of the chest or IDENTIFYING THE DATA
abdomen, to evoke a sound wave such as  Date and time history
resonance or dullness from the underlying tissue or  Identifying data /Biographic data
organs. This sound wave also generates a o name, address, age, gender,
tactile vibration against the pleximeter finger. occupation, marital status
AUSCULTATION  Source of history /data
Use of the diaphragm and bell of the stethoscope to o Primary–patient
detect the characteristics of heart, lung, and bowel o Secondary -be family member,
sounds, including location, timing, duration, pitch, friend, letter of referral or medical
and intensity. For the heart, this involves sounds records
from closure of the four valves, extra sounds from  If appropriate, establish source of referral,
blood flow into the atria and ventricles, and murmurs. because a written report may be needed.
Auscultation also permits detection of bruits or Reliability – varies according to patient’s memory, trust
turbulence over arterial vessels. and mood.
CHIEF COMPLAINT/S
LESSON 1.3 COMPONENTS OF One or more symptoms or concerns causing the
COMPREHENSIVE ADULT patient to seek care.
HEALTH HISTORY PRESENT ILLNESS
 History is defined as the discipline that Complete clear, and chronologic account of the
studies the chronological record of events (as problems prompting the client to seek care.
affecting a nation or people), based on a Problem should be well characterized as to:
critical examination of source materials and  Onset
usually presenting an explanation of their  Setting in which it has developed.
causes.  Manifestations and treatment.
 A comprehensive health history also requires Principal symptom should be well characterized
the account of significant events that lead and with descriptions of:
 Location

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 Quality, quantity or severity  Any clothes that fit more tightly or loosely than
 Timing (onset, duration, frequency) before weakness
 Setting in which they occur  Fatigue
 Aggravating and relieving factors  Fever
 Associated manifestation

PAST ILLNESS HEAD

List of Childhood illnesses Headache, head injury, dizziness, light-headedness
 List of Adult illnesses EYES
 Medical Vision, glasses or contact lenses, last
 Surgical examination, pain, redness, excessive tearing, double
 Obstetrics/Gynecology vision, blurred vision, spots, specks, flashing lights,
 Psychiatric glaucoma, cataracts.
 Also discuss health maintenance such as
immunizations EARS
Hearing, vertigo, discharges, if hearing aid is decreased,
FAMILY HISTORY use or non-use of hearing aid, tinnitus, ear infections
Record if any of the following condition are present
or absent in the family. NOSE AND SINUSES
 hypertension Frequent colds, nasal stuffiness, discharges or itching
 coronary artery disease hay fever, nose bleeds, sinus trouble
 elevated cholesterol levels THROAT (MOUTH OR PHARYNX)
 stroke  Condition of teeth and gums
 diabetes  Bleeding gums
 thyroid or renal disease  Dentures (if any, and how they fit)
 cancer of any type  Last dental examinations
 arthritis  Sore tongue
 tuberculosis  Dry mouth
 asthma or lung cancer  Frequent sore throats
 headache, seizure, mental illness  Hoarseness
 suicide, alcohol or drug addiction  “swollen glands,”
PRESENT ILLNESS  Goiter, pain,
It includes:  Stiffness
 Occupation BREAST
 Last year of schooling  Lumps,
 Home situation and significant others  Pain or discomfort,
 Sources of stress (both recent and long  Nipple discharge,
term) Important life experiences  Self-examination practices
 Leisure activities
 Religious affiliations and spiritual beliefs RESPIRATORY
 ADL’s  Cough, sputum (color, quantity), hemoptysis,
 Exercise, diet, safety measure and alternative dyspnea, wheezing, pleurisy, last chest x-ray
health care practices.  Include also history of asthma, bronchitis,
emphysema, pneumonia and tuberculosis.
REVIEW OF SYSTEMS
 Head to toe assessment that would uncover GASTROINTESTINAL
problems that the patient may have overlooked.  Problems in swallowing, heartburn
 Some clinicians do review of systems during  Loss of appetite nausea, bowel movements
physical examination  Color and size of stools
 Yes or no question  Change in bowel habits, rectal bleeding or
GENERAL APPEARANCE black or starry stools
 Hemorrhoids, constipation, diarrhea
 Usual weight  Abdominal pain, food intolerance
 Recent height change
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 Excessive belching or passing of gas  Memory change,
 Jaundice, liver or gallbladder trouble,  Suicide attempts, if relevant.
hepatitis
HEMATOLOGIC
URINARY SYSTEM  Anemia
 Frequency of urination,  Easy brushing or bleeding
 Polyuria  Past transfusion
 Nocturia  Transfusion reaction
 urgency
ENDOCRINE
 Burning or pain on urination, hematuria
 Urinary infections, kidney stones, incontinence;  Thyroid trouble
in males, reduced caliber or force of urinary  Heat or cold intolerance
stream, hesitancy, dribbling  Excessive sweating
 Excessive thirst or hunger, polyuria
GENITALS  Change in glove or shoe size
Male
 Hernias, discharge from or sores on penis, LESSON 2: INTERVIEWING AND
testicular pain or masses, history of sexually THE HEALTH HISTORY
transmitted diseases (STDs) and treatments, Interviewing is both a skill and an art.
testicular self-examination practices. Sexual
habits, interest, function, satisfaction, birth Skilled interviewing is both patient-centered and
control methods, condom use, problems. clinician-centered. The clinician must focus on the
Exposure to HIV infection. patient to elicit the full story of the patient’s
Female symptoms, but the clinician must also interpret key
 Age at menarche; regularity, frequency, and information to reach an assessment and plan.
duration of periods; amount of bleeding,
bleeding between periods or after intercourse, Patient-centered interviews “recognize the
last menstrual period; dysmenorrhea, importance of patients’ expressions of personal
premenstrual tension; age at menopause, concerns, feelings, and emotions” and evoke “the
menopausal symptoms, postmenopausal personal context of the patient’s symptoms and disease.
bleeding.
PERIPHERAL VASCULAR SKILLED INTERVIEWING
 Intermittent claudication; TECHNIQUES
 Leg cramps; varicose veins;
 Past clots in veins; ACTIVE LISTENING
 Swelling in calves, legs, or feet; Be aware of the patient's emotional state, and using
 Color change in fingertips or toes during cold verbal and nonverbal skills to encourage the
weather; speaker to continue and expand.
 Swelling with redness or tenderness. EMPHATIC RESPONSE
MUSCULOSKELETAL Conveying empathy is part of establishing and
 Muscle or joint pain, stiffness, arthritis, gout, strengthening rapport with patients. To empathize with
 Backache your patient you must first identify his or her feelings.
 Any swelling, redness, pain, tenderness, GUIDED QUESTIONING
stiffness, weakness, or limitation of motion  Moving from open-ended to focused
or activity; questions
 Neck or low back pain  Using questioning that elicits a graded
 Joint pain with systemic features such as fever, response
chills, rash, anorexia, weight loss, or weakness  Asking a series of questions, one at a time
PSYCHIATRIC  Offering multiple choices for answers
 Nervousness;  Clarifying what the patient means
 Tension;  Encouraging with continuers
 Mood,  Using echoing
 Including depression, NON-VERBAL COMMUNICATION

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Being sensitive to nonverbal cues allows you to  Share information with the patient,
“read the patient” more effectively and send messages of especially at transition points during the visit.
your own. Pay close attention to eye contact, facial  Make your clinical reasoning transparent to
expression, posture, head position and the patient.
movement such as shaking or nodding,  Reveal the limits of your knowledge
interpersonal distance, and placement of the arms or
legs—crossed, neutral, or open. THE SEQUENCE AND CONTEXT
OF THE INTERVIEW
PREPARATION
Reviewing the clinical records
VALIDATION  PURPOSE: partly to gather information
Another important way to make a patient feel and partly to develop ideas about what
accepted is to legitimize or validate his or her to explore with the patient.
emotional experience.  Look for identifying data such as age, gender,
REASSURANCE address, and health insurance, and peruse
the problem list, the medication list, and details
The first step to effective reassurance is identifying
such as the documentation of allergies.
and accepting the patient’s feelings without
 The chart often provides valuable
offering reassurance at that moment.
information about past diagnoses and treatments.
PARTNERING Setting goals for the interview
 When building rapport with patients, express  Must balance the health care provider-
your commitment to an ongoing centered goals with patient-centered goals.
relationship. Reviewing the Clinician Behavior and Appearance
 Make patients feel that no matter what  Posture, gestures, eye contact, and tone of
happens, you will continue to provide their voice all convey the extent of your interest,
care. attention, acceptance, and understanding.
 Even as a student, especially in a hospital  Should be calm and unhurried, even when time
setting, this support can make a big difference. is limited
 Personal appearance can affect clinical
SUMMARIZATION relationships
 It indicates to the patient that you have been  Cleanliness, neatness, conservative clothes and
listening carefully. It can also identify what name tags are reassuring to patients
you know and what you don’t know.  REMEMBER: You want the patient to trust
 This technique allows the clinician, to you.
organize clinical reasoning and to convey Adjusting and Improving the environment
one’s thinking to the patient, which makes  Make the interview setting as private and
the relationship more collaborative. comfortable as possible.
 Adjust the room temperature for the patient's
TRANSITIONS comfort when needed.
 To put the patient more at ease, tell them when  It is part of the job to make adjustments to
you are changing directions during the the location and seating that make the patient
interview. and you more comfortable
 This gives patients a greater sense of  A proper environment improves communication
control.
GREETING THE PATIENT AND
EMPOWERING THE PATIENT ESTABLISHING RAPPORT
TECHNIQUES OF SHARING  Greet the patient by name and introduce
yourself, giving your own name.
POWER  If possible, shake hands with the patient.
 Evoke the patient’s perspective.  Use a formal title to address the patient is
 Convey interest in the person, not just the always best. Except with children or
problem. adolescents, avoid first names unless you have
 Follow the patient’s leads. specific permission from the patient or family.
 Elicit and validate emotional content.  Maintain the patient's confidentiality. Let the
patient decide if visitors or family members

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should remain the room, and ask for the The Seven Attributes of Symptoms
patient’s permission before conducting the 1. Location. Where is it? Does it radiate?
interview in front of them. 2. Quality. What is it like?
 Always be attuned to the patient's 3. Quantity or severity. How bad is it? (For
comfort. Look for signs of discomfort such as pain, ask for a rating on a scale of 1 to 10.)
frequent changes of position or facial 4. Timing. When did (does) it start? How long
expressions that shows pain or anxiety. does it last? How often does it come?
 Arrange the room and how far you should be 5. Onset (setting in which it occurs)Include
from the patient. Cultural background and environmental factors, personal activities,
individual taste influence preferences about emotional reactions, or other circumstances
interpersonal space. that may have contributed to the illness.
 Give the patient your undivided attention. Try 6. Remitting or exacerbating factors. Is
not to look down to take notes or read the chart, there anything that makes it better or worse?
and spend enough time on small talk to put the 7. Associated manifestations. Have you noticed
patient at ease. anything else that accompanies it?
TWO MNEMONICS TO PURSUE
ESTABLISHING THE AGENDA FOR THE SEVEN ATTRIBUTES
THE INTERVIEW OLD CART – Onset, Location, Duration, Character,
 Asking about the foremost concern and Aggravating/Alleviating factors, Radiation, and Timing
saying, “Tell me more about...” OPQRST – Onset, Palliating/Provoking factors,
 Avoid biasing the patient’s story—inject no Quality, Radiation, Site, and Timing
new information and do not interrupt too early
SHARING THE TREATMENT PLAN
Exploring the patient’s perspective  Learning about the disease and
FIFE – Feelings, Ideas, effect on Function, and conceptualizing the illness allow you and the
Expectations. patient to create a shared picture of the
patient’s problems.
 Feelings – fears or concerns about the  It forms the basis for planning further
problem. evaluation and negotiating a treatment plan.
 Ideas about the nature and the cause of the CLOSING THE INTERVIEWAND
problem.
 The effect of the problem on the patient's life
THE VISIT
and Function.  Let the patient know that the end of the
 Expectations of the disease, of the clinician, interview is approaching to allow time for
or of health care, often based on prior personal the patient to ask any final questions.
or family experiences.  Make sure the patient understands the mutual
plans you have developed
Identifying and responding to the patient’s TAKE TIME FOR SELF-
emotional cues
Clues to the patient’s perspective on illness: REFLECTION
 Direct statement(s) by the patient of  Being consistently respectful and open to
explanations, emotions, expectations, and individual differences
effects of the illness.  Keep in mind that we bring our own values,
 Expression of feelings about the illness assumptions, and biases to every encounter
without naming the illness.  We must look inward to clarify how our
 Attempts to explain or understand symptoms. own expectations and reactions which may
 Speech clues (e.g., repetition, prolonged affect what we hear and how we behave.
reflective pauses) THE CULTURAL CONTEXT OF
 Sharing a personal story.
 Behavioral clues indicative of unidentified
THE INTERVIEW
concerns, dissatisfaction, or unmet needs such DIMENSIONS OF CULTURAL
as reluctance to accept recommendations,
seeking a second opinion, or early return HUMILITY
appointment  Self-awareness. Learn about your own biases .
Expanding and Clarifying the patient’s story . . we all have them.
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 Enhanced communication. Work to eliminate  The clinician should appear attentive and
assumptions about what is “normal.” Learn give brief encouragement to continue when
directly from your patients—they are the appropriate
experts on their culture and illness.
PATIENT WITH LANGUAGE
 Collaborative partnerships. Build your
relationships with patients on respect and BARRIER
mutually acceptable plans.  When your patient speaks a different
ADVANCED INTERVIEWING language, make every possible effort to
find an interpreter.
THE CULTURAL CONTEXT OF  A few broken words and gestures are no
substitute for the full story.
THE INTERVIEW
 The ideal interpreter is a neutral
Cultural Competence objective person who is familiar with both
 “A set of attitudes, skills, behaviors, and languages and cultures.
policies that enable organizations and staff to  Beware of using family members or friends
work effectively in cross-cultural situations. as interpreters—confidentiality may be
 It reflects the ability to acquire and use violated, meanings may be distorted, and
knowledge of the health-related beliefs, transmitted information may be incomplete.
attitudes, practices, and communication
patterns of clients and their families to PATIENT WITH LOW LITERACY
improve services, strengthen programs, OR LOW HEALTH LITERACY
increase community participation, and close
 Before giving written instructions, assess the
the gaps in health status among diverse
patient’s ability to read.
population groups.”
 Low Literacy may explain why the patient
 Culturally competent care requires
has not taken medications or followed
“understanding of and respect for the cultures,
your recommendations.
traditions, and practices of a community.
Cultural Humility  To detect low literacy, you can ask about
years completed in school, or “How is your
 A “process that requires humility as
reading?” You can ask “How comfortable are
individuals continually engage in self-
you with filling out health forms?” or check how
reflection and self-critique as lifelong
well the patient reads written instructions.
learners and reflective practitioners.”
 Includes “the difficult work of examining PATIENT WITH IMPAIRED
cultural beliefs and cultural systems of both HEARING
patients and providers to locate the points of
cultural dissonance or synergy that  Find out the patient's preferred method of
contribute to patients’ health outcomes.” communicating.
 It calls for clinicians to “bring into check the  Ask when hearing loss occurred relative to the
power imbalances that exist in the dynamics development of speech and other language
of (clinician) –patient communication” and skills.
maintain mutually respectful and dynamic  If the patient prefers sign language, find
partnerships with patients and communities. an interpreter.
To attain these attributes, seek out the more  For patients with unilateral hearing loss,
effective training models that continue to sit on the hearing side. Speak at a normal
emerge plans. volume
 and rate and do not let your voice trail off
CHALLENGING PATIENTS at the ends of sentences
SILENT PATIENT  For patients who have partial hearing or
can read lips, face them directly, in good
 Silence has many meanings and many purposes.
light. Remember that even the best lip
 Patients frequently fall silent for short periods to readers comprehend only a percentage of
collect thoughts, remember details, or decide what is said, so having patients repeat
whether you can be trusted with certain what you have said is important.
information.
 When closing, write out any oral instructions.

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PATIENT WITH LIMITED  Be careful not to transmit your own anxieties
about completing the interview to the patient
INTELLIGENCE  Watch for nonverbal and verbal cues.
 Patients of moderately limited intelligence Anxious patients may sit tensely, fidgeting with
can usually give adequate histories. their fingers or clothes. They may sigh
 For patients with severe mental frequently, lick dry lips, sweat more than
retardation, you will have to turn to the average, or actually tremble.
family or caregivers to elicit the history. TALKATIVE PATIENT
 Identify the person who accompanies them, but
 Give the patient free rein for the first 5 or 10
always show interest first in the patient.
minutes and listen closely to the conversation.
 Establish rapport, make eye contact, and
 Try to focus on what seems most important to
engage in simple conversation.
the patient.
 As with children, avoid “talking down” or
 Show your interest by asking questions in
using affectations of speech or condescending
those areas. Interrupt if you must, but
behavior.
courteously.
THE ANGRY OR DISRUPTIVE  Remember that part of your task is to structure
PATIENT the interview. It is acceptable to be directive
and set limits when necessary.
 Accept angry feelings from patients. Allow
them to express such emotions without CRYING PATIENT
getting angry in return.  If the patient is on the verge of tears, pausing,
 Avoid joining such patients in their hostility gentle probing, or responding with empathy
toward another provider, the clinic, or the gives the patient permission to cry.
hospital, even when privately you may feel  Usually crying is therapeutic, as is your quiet
sympathetic. acceptance of the patient's distress or pain.
 Before approaching disruptive patients, alert Offer a tissue and wait for the patient to recover.
the security staff—as a clinician, maintaining a  Make a facilitating or supportive remark
safe environment is one of your
responsibilities. Stay calm, appear accepting, CONFUSING PATIENT
and avoid being confrontational in return.  Focus on the meaning or function of
the symptom, emphasizing the patient's
PATIENT WITH READING perspective, and guide the interview into
PROBLEM a psychosocial assessment.
 Before giving written instructions, it is wise to  When you suspect a psychiatric or neurologic
assess the patient’s ability to read. disorder, do not spend too much time
 People cannot read for many reasons, gathering a detailed history. Shift to the
including language barriers, learning mental status examination, focusing on level
disorders, poor vision, or lack of education. of consciousness, orientation, memory, and
 Some people may try to hide their inability capacity to understand.
to read. Asking about educational level may IMPAIRED VISION
be helpful but can be misleading  Shake hands to establish contact and explain
 Ask the patient to read whatever instructions who you are and why you are there.
you have written. Simply handing the  If the room is unfamiliar, orient the patient to
patient written material upside-down to see if the surroundings and report if anyone else
the patient turns it around may settle the is present.
question.  Remember to use words because postures and
 Respond sensitively, and remember that gestures are unseen.
illiteracy and lack of intelligence are not
synonymous. POOR HISTORIAN
ANXIOUS PATIENT  Some patients are totally unable to give their
own histories because of age, dementia, or
 When you detect anxiety, reflect your other limitations
impression back to the patient and encourage  Under these circumstances, you must try to
him or her to talk about any underlying find a third person who can give you the
concerns. story. Even when you have a reasonably
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comprehensive knowledge of the patient,  Explain why you need to know certain
other sources may offer surprising and information. This makes
important information. patients less apprehensive.
 A spouse, for example, may report  Find opening questions for sensitive
significant family strains, depressive symptoms, topics and learn the specific kinds of
or drinking habits that the patient has denied. information needed for your assessments.
PATIENT WITH PERSONAL  Finally, consciously acknowledge whatever
discomfort you are feeling. Denying your
PROBLEMS discomfort may lead you to avoid the
 Patients may ask you for advice about personal topic altogether.
problems outside the range of their health care. SENSITIVE TOPICS THAT CALL
 Before responding, explore the different
approaches the patient has considered and FOR SPECIAL SKILLS
their pros and cons, whom else they have  The sexual history
discussed the problem with, and what supports  The mental health history
are available for different choices.  Alcohol/prescription & illicit drug history
 Letting the patient talk through the problem  Addiction, physical dependence and tolerance
with you is usually much more valuable and  Intimate partner violence and domestic
therapeutic than any answer you could give. violence
SEDUCTIVE PATIENT  Death and dying patient
 When patients are seductive, you may be
tempted to ignore their behavior because you
are not sure it really happened, or you are
just hoping it will go away. Calmly but
firmly set clear limits that your relationship
is professional, not personal.
 If necessary, leave the room and find a ETHICS AND PROFESSIONALISM
chaperone before you continue the visit.
 Think carefully about your own behavior. BUILDINGS BLOCKS OF
 Has your clothing or demeanor been PROFESSIONAL ETHICS IN
inappropriate? Have you been overly warm with
the patient?
PATIENT CARE
 It is your responsibility to evaluate and  Non-maleficence or primum non nocereis
avoid sending any misleading signals to commonly stated as “First, do no harm.”
the patient  Beneficence is the dictum that the clinician
needs to “do good” for the patient.
Cultural Context  Autonomy reminds us that patients have
Sexuality in the Clinician–Patient Relationship. Any the right to determine what is in their own
sexual contact or romantic relationship with patients is best interest.
unethical; keep your relationship with the patient within  Confidentiality, we are obligated not to tell
professional bounds and seek help if you need it. others what we learn from our patients. This
privacy is fundamental to our professional
Sensitive Topics relationships with patients.
 These discussions can be awkward when TRAVISTOCK PRINCIPLES
you are inexperienced or assessing patients you
do not know well.  Rights: People have a right to health and
health care.
 Many of these topics trigger strong
personal responses related to family, cultural,  Balance: Care of individual patients is
and societal values. central, but the health of populations is also
our concern.
GUIDELINES FOR BROACHING  Comprehensiveness: In addition to treating
SENSITIVE TOPICS illness, we have an obligation to ease
suffering, minimize disability, prevent disease,
 The single most important rule is to be non-
and promote health.
judgmental.

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 HEALTH ASSESSMENT LECTURE
 Cooperation: Health care succeeds only if we
cooperate with those we serve, each other, and
those in other sectors.
 Improvement: Improving health care is a
serious and continuing responsibility.
 Safety: Do no harm.
 Openness: Being open, honest, and
trustworthy is vital in health care.

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