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)

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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

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.

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

Collecting health information

Purpose as part of comprehensive assessment

Collecting health information

Usually a primary encounter event

Collecting health information

Interviewing previously considered a passive and innate skill

APTAAmerican Physical Therapy Association

This course is part of the Section on Women's Health Certificateof Achievement in Pelvic Physical Therapy (CAPP-Pelvic) Program.

For more details on CAPP, go to http://www.womenshealthapta.org/capp.cfm

For more information on Section on Women's Health sponsored courses go to http://www.womenshealthapta.org/education/education.cfm or contact the SOWH at sowh@apta.org, or 703-610-0224.

The Section on Women’s Health is proud to announce the course schedule for 2014.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.www.womenshealthapta.org/education/regional_courses/index.cfm

For updates on courses and registration openings, please follow the Section’s Twitter and Facebook pages.

This course is part of the Section on Women's Health Certificate of Achievement in Pregnancy and Postpartum Physical Therapy (CAPP-OB) Program.

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

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

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

Pelvic Physical Therapy 1

Pelvic Physical Therapy 2

Pelvic Physical Therapy 3

LEVEL 1-2

October 2-5, 2014 (Thurs-Sun) <<<Speaker: Gail Wetzler, PT Bethlehem, PA

GynecologicVisceralManipulation

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

Fundamental Topicsin Pregnancy andPostpartum PhysicalTherapy

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

Advanced Topics inPregnancy andPostpartum PhysicalTherapy

October 24-26, 2014 (Fri-Sun) <<<Speaker: Susan Steffes, PT, CD (DONA) Austin, TX

2014 CONTINUINGEDUCATION COURSES

Check website for new courses throughout the year!

The Physical Therapist inLabor & Delivery: Advanced Techniques in Labor Support

NEW

NEW

Collecting health information

Accuracy dependent on how the interview is conducted (subjective)

Collecting health Information

Importance demonstrates links to motivation, compliance, retention and satisfaction and outcomes

What is significant in the Pelvic Health

Clinical Interview?

Privacy issues

Normative concerns

Multiple systems involved

Multiple providers involved

Some limitations / considerations in the

Pelvic Health Setting

Time

Privacy

Partner/family member presence

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.

Video 1

Cause Effect

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

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

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

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

Techniques used in Medical

Interviewing

Ask Tell Ask

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.

How to respond

= NAMING.

= UNDERSTANDING.

= RESPECTING.

= SUPPORTING.

= EXPLORING.

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.

Video 2

Item Effect

Communication – The Window

The importance of non-verbal observation

Communication – The Mirror

The importance of non-verbal expression

Communication – The Dance

Getting and Giving with a comfortable frame.

Learning how to lead without effort or force

The Door to Change

Preparing readiness in your patient from the first day

The Writing on the Wall - Interpretation

The Galaxy – Identifying what distribution, pattern, sensitivities mean to the organism

APTAAmerican Physical Therapy Association

HOME STUDY MODULESTRY OUR

Section on Women’s Health

Now Available!

For more information, go tothe Section on Women's Health website at www.womenshealthapta.org or call 703-610-0224.

• 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

The Writing on the Wall - Interpetation

The Planet – Identifying systems that are responding to the threat

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

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.