Hi everyone, I'm Nancy Robertson. I'm a palliative care nurse practitioner on faculty here at the University of Colorado and Anschutz medical campus. This week, we're going to talk about assessing the full dimension of the seriously ill person in the family. Now, the usual approach, to assessing a sick person involves a short interview about the problem. There is a focused physical exam looking only at the parts of the body that are obviously affected, sometimes blood works done or other tests are ordered, then all this information is put together to decide what the problem is and what to do about it. This kind of approach makes health care providers fast and effective. But when it comes to applying this kind of format to the seriously ill patient and their loved ones, it will not uncover the full dimension of suffering. When these areas of suffering are not found and they're not addressed and they're not treated. When working with seriously ill persons, a health care provider needs to address all aspects of suffering. To do this, a thorough thoughtful approach to assessing the whole person must be used. In this module, we will look at the different areas where suffering occurs. The six key areas we're going to talk about in this module are practical challenges, the physical impact, the effect on mental health or what I'll refer to as psychological well-being, the social aspect, to the impact on finances and spiritual health. As we go along, we'll also talk about using clinical tools which can play an important part in helping to identify the full suffering experienced. As I mentioned earlier, the usual approach health care providers take on someone who's sick, is to ask about the history of this specific sickness and do a physical exam on the parts of the body that hurt. So, for example, if your throat hurts, the health care provider will look at your throat, probably look at other parts for your head like your ears and your eyes. Then the healthcare provider will probably listen to your heart and your lungs. And sometimes tests are done like blood work, X-rays or even the dreaded throat swab. I don't know if you've had one of those but count yourself lucky if you haven't. I have had more than my share and if I ever have another one, it will be too soon. But anyway, let's get back on topic. This format works well for those with simple illnesses that are straightforward and relatively easy to diagnose. But using this approach for people who are trying to live with serious illness can miss many signs of suffering. That was wonderful if you're able to answer yes to either of the questions on the previous slide. But more often than not, health care providers are too busy to ask these types questions. To identify and address the many dimensions of suffering experienced by patients and family caregivers living with serious illness, an assessment of the whole person is needed. This approach is very different than the usual approach I just described. While the whole person approach includes the usual pieces of the medical exam, it also includes a structured path to figuring out the full aspect of the pain and other physical symptoms. It also looks for mental or the psychological or emotional issues such as depression and fear and stress. It checks for thinking related signs of suffering such as delirium or confusion. There's also a discussion about the person's understanding of the illness and what kind of care is desired. Finances and social problems are assessed as well. With the traditional history and physical, information is gathered only from the patient and the health care records. Close family and friends are talked to only upon the patient's request, and if those people happen to attend to visit. The whole person assessment on the other hand, requires talking to and looking at a broad range of sources. Getting to know all the people who love and care for this patient is important. It's also important to talk to other health care providers for their opinions as well. The whole person assessment is best done with the help of lots of specially trained health care professionals, that include nurses, doctors, physicians assistants, chaplains, social workers, pharmacists and therapists. When all these professionals work together, a group effort happens and the full picture of the effect of illness experienced by patients and their families is discovered. This complete and thorough approach needs more than one session to complete and often extends over multiple meetings. Now let's go over some important concepts that are good to know when you're doing a whole person assessment. One, you should be ready, be prepared, read all the healthcare information you can find, speak with collaborating team members. Remind yourself that you're walking into a story in progress, you don't know what's happened in the past or what's going on now. Be sure to introduce yourself and why you're there, also tell the person and the family caregiver how long you intend to be there. Take a close seat and be alert to cultural sensitivities, to closeness and eye contact. Ask the person what name he or she would like to be called, and invite that person to tell you how he or she learned of the diagnosis originally and what they understand about the diagnosis and the situation now. Be sure to make the most of your listening skills and be careful not to make quick judgements. Avoid interrupting and use the good communication techniques you will learn in this course. As a person talks, listen for distressing physical symptoms, mental stress, social issues and spiritual distress that are affecting the quality of their days. Jot notes quietly. You might hear something you don't completely understand so make a note so you can go back and ask about that once the person is done. Be alert to sensory impairments, for example, can the person see and hear you? Can they understand what you're saying? Or do they have a thinking related problem? Do you speak their language? Any breakdowns in this area will make the assessment difficult. And finally, select clinical assessment tools to help you make the best of your time together. Gathering information at each visit will help you look objectively to see if your help is effective. I will introduce you to a few tools as we move along this module. So that's a brief overview of the whole person assessment. Please join me on the next video, where we will look in-depth at the practical and physical issues facing seriously ill persons and their family caregivers.
