Effective Interviewing in Pelvic Rehabilitation

Transcription

1 Effective Interviewing in Pelvic Rehabilitation Karen Brandon, PT DSc PT WCS Susan Clinton,PT MHS, OCS, WCS Lorimer Moseley, PhD, B App SC (Phty) (Hons)

2 Touch The Future In Women s Health Research Excellence! Donate now to support the SOWH Endowment for Research Excellence Help us reach our goal of $10,000! Section on Women s Health Donations of any amount will contribute to the legacy of improving women's and men's health. Three convenient ways to donate: Online: By Phone: Call Toll-Free (800) By Mail: Foundation for Physical Therapy 1111 North Fairfax Street Alexandria, VA Specify your contribution is for the Section on Women's Health Endowment Fund All donations to the SOWH Endowment for Research Excellence are tax-deductible. Please make checks payable to: The Foundation for Physical Therapy

3 Objectives By the end of this session the attendee should be able to: List principles of effective interview technique and how to apply these to current practice in pelvic health PT Describe the purpose of the medical interview, factors that are specific to pelvic health patients, and best environmental and interpersonal tools that promote clarity, positive rapport and understanding. Identify the differences in effective and non-effective interview skills and the impact on patient/client response. Determine which aspects of poor interview skills can be changed based on knowledge gained through this session and develop an action plan to increase the efficiency of the interview Organize clinical reasoning from the subjective interview the direction of highest impact for the structure of physical exam Be able to apply new strategies to ensure good patient/client understanding

4 BASICALLY... our goals are: 1. To implore the practitioner to have an open respectful and collaborative style of interviewing that does not shut down the patient or their capability of capturing valuable data. 2. To teach/share ways of communicating with patients to get the subjective information you need and how to interpret it when you get it.

5 To do so we will: 1. Establish the "WHY" 2. Set up the "HOW" 3. Explain the "WHAT OF the best practice examples of gathering relevant and accurate information from your patient and establishing a continuing conduit

6 Collecting health information Purpose as part of comprehensive assessment

7 Collecting health information Usually a primary encounter event

8 Collecting health information Interviewing previously considered a passive and innate skill

9 2014 CONTINUING EDUCATION COURSES The Section on Women s Health is proud to announce the course schedule for We hope you will be able to take advantage of the variety of course options and locations throughout the country. Registration for 2014 educational courses and the 2014 Fall Conference is now open on our website. For updates on courses and registration openings, please follow the Section s Twitter and Facebook pages. Pelvic Physical Therapy 1 Pelvic Physical Therapy 2 Pelvic Physical Therapy 3 January 17-19, 2014 (Fri-Sun) <<< Speakers: Lori Mize, PT, DPT, WCS Carina Siracusa Majzun, PT, DPT Greenville, SC March 21-23, 2014 (Fri-Sun) <<< Speaker: Lori Mize, PT, DPT, WCS Houston, TX June 20-22, 2014 (Fri-Sun) <<< Speakers: Lori Mize, PT, DPT, WCS MJ Strauhal, PT, BCB-PMD Baton Rouge, LA July 11-13, 2014 (Fri-Sun) <<< Speakers: Lori Mize, PT, DPT, WCS Barb Settles-Huge, PT Des Moines, IA October 10-12, 2014 (Fri-Sun) <<< Speaker: Carina Siracusa Majzun, PT, DPT East Lansing, MI November 14-16, 2014 (Fri-Sun) <<< Speaker: Barb Settles Huge, PT Boca Raton, FL Gynecologic Visceral Manipulation LEVEL 1-2 October 2-5, 2014 (Thurs-Sun) <<< Speaker: Gail Wetzler, PT Bethlehem, PA February 28-March 2, 2014 (Fri-Sun) <<< Speaker: MJ Strauhal, PT, BCB-PMD Portland, OR April 25-27, 2014 (Fri-Sun) <<< Speaker: Barb Settles Huge, PT Madison, WI August 1-3, 2014 (Fri-Sun) <<< Speakers: Carina Siracusa Majzun, PT, DPT Towson, MD Fundamental Topics in Pregnancy and Postpartum Physical Therapy March 28-30, 2014 (Fri-Sun) <<< Speakers: Suzanne Badillo, PT, WCS Susan Giglio, PT, RYT Baton Rouge, LA May 16-18, 2014 (Fri-Sun) <<< Speakers: Karen Litos, PT, MPT Valerie Bobb, PT, MPT, WCS, ATC East Lansing, MI July 25-27, 2014 (Fri-Sun) <<< Speaker: Suzanne Badillo, PT, WCS Edina, MN August 22-24, 2014 (Fri-Sun) <<< Speakers: Susan Giglio, PT, RYT Karen Litos, PT, MPT Longmont, CO June 27-29, 2014 (Fri-Sun) <<< Speakers: MJ Strahaul, PT, BCIA-PMDB Carina Siracusa Majzun, PT, DPT Rochester, NY September 12-14, 2014 (Fri-Sun) <<< Speaker: MJ Strahaul, PT, BCIA-PMDB Portland, OR (Hybrid Course details coming soon!) November 7-9,2014 (Fri-Sun) <<< Speaker: MJ Strahaul, PT, BCIA-PMDB Madison, WI Advanced Topics in Pregnancy and Postpartum Physical Therapy February 21-23, 2014 (Fri-Sun) <<< Speaker: Susan Giglio, PT, RYT St. Louis, MO May 4-6, 2014 (note Sun-Tues) <<< Speakers: Susan Giglio, PT, RYT Susan Steffes, PT Baltimore, MD October 24-26, 2014 (Fri-Sun) <<< Speaker: Susan Steffes, PT, CD (DONA) Austin, TX NEW The Physical Therapist in Labor & Delivery: Advanced Techniques in Labor Support NEW Check website for new courses throughout the year! This course is part of the Section on Women's Health Certificate of Achievement in Pelvic Physical Therapy (CAPP-Pelvic) Program. For more details on CAPP, go to For more information on Section on Women's Health sponsored courses go to or contact the SOWH at [email protected], or This course is part of the Section on Women's Health Certificate of Achievement in Pregnancy and Postpartum Physical Therapy (CAPP-OB) Program. APTA American Physical Therapy Association

10 Collecting health information Accuracy dependent on how the interview is conducted (subjective)

11 Collecting health Information Importance demonstrates links to motivation, compliance, retention and satisfaction and outcomes

12 What is significant in the Pelvic Health Clinical Interview? Privacy issues Normative concerns Multiple systems involved Multiple providers involved

13 Some limitations / considerations in the Pelvic Health Setting Time Privacy Partner/family member presence

14 Video 1: The Don ts Please watch the following video and highlight what you see as areas that could have improved the interview. For each area write what potential problems it set up for the provider or the patient.

15 Video 1 Cause Effect

16 Elements of a Successful Interview Non-Verbal Awareness: gestures, postures, and facial expressions by which a person manifests various physical, mental, or emotional states and communicates non verbally with others" Stage I: Preparation Offer restroom before the evaluation Select a private room free from distractions Make certain room is clean, neat, and free of odors Room should be a comfortable temperature Comfortable chairs should be available for both the patient and any family members present Place procedure trays out of the patient's sight Stage II: Greeting and Introduction Sets the tone for the remainder of the interview May shake patient's hand, introduce yourself, and state your title Address adults by using their title (Mr., Mrs., Dr., etc.) followed by their last name; and ask what they would like you to call them Stage III: Body of the Interview Question and answer stage Keep gaging patients interest and comprehension during interview Avoid expressing surprise or disapproval at patient's responses Stage IV: Conclusion Summarize and validate information collected. Inform patient of what to expect for the remainder of the visit and provide disrobing instructions, if appropriate Ask if they have any questions about consent and readiness for physical exam as well

17 Environment Intimate distance Direct contact to 1.5 feet Personal distance 1.5 to 4 feet In health care the closeness may be necessary when performing specific procedures such as phlebotomy, blood pressures, and catheterizations Social distance 4 to 12 feet this distance is considered appropriate for patient interviews Public distance Greater than 12 feet usually a class room setting

18 Provider "Good" body language Direct, open, and relaxed body posture Avoid facial expressions or body language that make it appear as if you are bored or preoccupied Make frequent eye contact Touching conveys concern and compassion Touching in a Therapeutic Environment Appropriate touching may include be used to give assurance, permission to continue sharing: a pat on the shoulder, pat on patient's hand, or Watch for signs that may indicate a patient's discomfort over such gestures

19 Communication Skills Clarification clear confusion or uncertainty.this is the process that is used when the patient uses a phrase or term that needs further interpretation or the patient has mixed signals either verbally or non verbally Restating to state again or to state in a new form. This is repeating or rephrasing the main idea of the sentence an validating what the patient just stated Reflecting means to ponder or think. gives the patient an opportunity to expound on something that is bothering him and stimulates the patient to revisit his original thought Summarizing the listening response is usually incorporated at the conclusion of the interview. This listening component helps to separate what is relevant from what is irrelevant

20 Techniques used in Medical Interviewing Ask Tell Ask

21 Handling a patients difficult emotions during an interview The concept of an accepting response is helpful here. Rather than providing immediate reassurance, rebuttal, or agreement, the accepting response: a. accepts what the patient says non-judgmentally, b. acknowledges that patients ought to hold their own views and feelings, and c. validates the importance of the patient s contributions in a therapeutic relationship. It is important to note that acceptance is not the same as agreement. A physician could accept that a patient wishes to be cured of cancer, yet not agree that it is possible. This distinction is important is building and main- taining a relationship.

22 How to respond = NAMING. = UNDERSTANDING. = RESPECTING. = SUPPORTING. = EXPLORING.

23 Video 2: The Do s Please watch the following video and highlight what you see as areas were demonstrated good communication techniques in the interview. How did that change the interview? List areas that could further improve.

24 Video 2 Item Effect

25 Communication The Window The importance of non-verbal observation

26 Communication The Mirror The importance of non-verbal expression

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28 Communication The Dance Getting and Giving with a comfortable frame. Learning how to lead without effort or force

29 The Door to Change Preparing readiness in your patient from the first day

30 The Writing on the Wall - Interpretation The Galaxy Identifying what distribution, pattern, sensitivities mean to the organism

31 TRY OUR HOME STUDY MODULES Now Available! Physical Therapist Management of Patients with Chronic Pelvic Pain Medical Management and Physical Therapy Management of High-Risk Pregnancy EMG Homestudy Physical Therapy in Obstetrics Physical Therapy for Osteoporosis: Prevention and Management Anatomy and Physiology of Intra-abdominal Pressure For more information, go to the Section on Women's Health website at or call Section on Women s Health APTA American Physical Therapy Association

32 The Writing on the Wall - Interpetation The Planet Identifying systems that are responding to the threat

33 The Writing on the Wall - Interpretation Your street Determining the system that is ready for change, that is the most pertinent to the patients high bother and that is the earliest in the chain of impairments that will set up foundation for other impairments changing. Determine how you will assess it in physical exam, functional tools, measure it and remeasure it s

34 Summary The provider in pelvic rehabilitation can use their knowledge of effective communication [key elements, skill sets, relevance, and interpretation] to achieve a positive therapeutic relationship and optimize the initiation of care for the patient.

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