1. The Interview Chapter 3

2. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 3: The Interview The Interview  Subjective data  Results of a successful interview Slide 3-2

3. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 3: The Interview The Interview(cont.) The Interview (cont.)  Goals  Record complete health history  Optimal health for patient  Identify health strengths and problems as bridge to physical examination  First and most important part of data collection  Collects subjective data: what person says about his or her perceived health state  Individual knows everything about his or her own health state, and nurse knows nothing Slide 3-3

4. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 3: The Interview The Interview (cont.)  Gather complete and accurate data about person’s health state, including description and chronology of any symptoms of illness  Establish rapport and trust so person feels accepted and free to share all relevant data  Teach person about health state so that he or she may participate in identifying problems Slide 3-4

5. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 3: The Interview The Interview (cont.)  Build rapport to continue therapeutic relationship and to facilitate future diagnoses, planning, and treatment  Begin teaching for health promotion and disease prevention Slide 3-5

6. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 3: The Interview The Interview (cont.)  Consider interview a contract between nurse and patient  Contract consists of spoken and unspoken rules for behavior:  What person needs and expects from health care and what health professional has to offer  Mutual goal is optimal health for patient Slide 3-6

7. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 3: The Interview The Interview (cont.)  Contract terms include:  Time and place of interview and physical examination  Introduction of and explanation of health care provider’s role  Purpose of interview  How long it will take  Expectation of participation for each person  Presence of others, e.g., family, etc.  Confidentiality and to what extent it may be limited  Any costs that the patient must pay Slide 3-7

8. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 3: The Interview PROCESS OF COMMUNICATION  Sending  Communication is behavior, conscious and unconscious, verbal and nonverbal  All behavior has meaning  Body language: posture, gestures, facial expression, eye contact, foot tapping, touch, even where you place your chair Slide 3-8

9. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 3: The Interview PROCESS OF COMMUNICATION (cont.)  Receiving  Awareness of messages you send is only part of process Words and gestures must be interpreted in a specific context to have meaning Words and gestures must be interpreted in a specific context to have meaning  Receiver attaches meaning determined by his or her past experiences, culture, self-concept, and current physical and emotional state  Successful communication requires mutual understanding by sender and receiver Slide 3-9

10. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 3: The Interview PROCESS OF COMMUNICATION (cont.)  Receiving (cont.)  Patients’ health problems intensify communication because patients depend on you to get better  Communication can be learned and polished when you are a beginning practitioner  Communication is a tool, as basic to quality health care as tools of inspection or palpation Slide 3-10

11. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 3: The Interview PROCESS OF COMMUNICATION (cont.)  Awareness of internal and external factors and their influence allows you to maximize communicating skill  Internal factors  Liking others  Empathy  Ability to listen Slide 3-11

12. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 3: The Interview PROCESS OF COMMUNICATION (cont.)  External factors  Ensure privacy  Refuse interruptions  Physical environment  Dress  Note-taking may be unavoidable Cannot rely completely on memory for details of previous illnesses or review of body systems Cannot rely completely on memory for details of previous illnesses or review of body systems  Tape and video recording Slide 3-12

13. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 3: The Interview PROCESS OF COMMUNICATION (cont.)  Challenges of note-taking  Breaks eye contact too often  Shifts attention away from person, diminishing his or her sense of importance  Interrupts patient’s narrative flow  Impedes observation of patient’s nonverbal behavior  May be threatening to patient’s discussion of sensitive issues Slide 3-13

14. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 3: The Interview TECHNIQUES OF COMMUNICATION  Introducing the interview  Working phase  Data-gathering phase  Verbal skills include questions to patient and your responses to what is said  Two types of questions: Open-ended Open-ended Closed Closed Each has a different place and function in interview Each has a different place and function in interview Slide 3-14

15. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 3: The Interview TECHNIQUES OF COMMUNICATION (cont.)  Open-ended questions  Ask for narrative responses  State topic only in general terms  Use them: To begin interview To begin interview To introduce a new section of questions To introduce a new section of questions Whenever the patient introduces new topic Whenever the patient introduces new topic Slide 3-15

16. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 3: The Interview TECHNIQUES OF COMMUNICATION (cont.)  Closed or direct questions  Ask for specific information  Elicit short, one-or-two word answers, a yes or no answer, or a forced choice  Use them: After opening narrative to fill in details person may have left out After opening narrative to fill in details person may have left out When you need many specific facts about past health problems, or during review of systems When you need many specific facts about past health problems, or during review of systems To move the interview along To move the interview along Slide 3-16

17. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 3: The Interview TECHNIQUES OF COMMUNICATION (cont.)  Responses: assisting the narrative  Facilitation encourages patients to say more and shows you are interested and will listen further  Silent attentiveness Gives patient time to think and organize what to say without interruption from you Gives patient time to think and organize what to say without interruption from you Gives you a chance to observe person unobtrusively and note nonverbal cues Gives you a chance to observe person unobtrusively and note nonverbal cues  Reflection Echoes patient’s words, repeating what person has just said; focuses further attention on a specific phrase; and helps person continue in his or her own way Echoes patient’s words, repeating what person has just said; focuses further attention on a specific phrase; and helps person continue in his or her own way Slide 3-17

18. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 3: The Interview TECHNIQUES OF COMMUNICATION (cont.)  Empathy  Recognizes a feeling and puts it into words  Names the feeling and allows expression of it Patient feels accepted and can deal with feeling openly Patient feels accepted and can deal with feeling openly  Clarification  Use when person’s words are ambiguous or confusing Used to summarize person’s words and to simplify them to make them clearer Used to summarize person’s words and to simplify them to make them clearer  You are asking for agreement, and the person can then confirm or deny your understanding Slide 3-18

19. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 3: The Interview TECHNIQUES OF COMMUNICATION (cont.)  Confrontation  Frame of reference shifts from patient’s perspective to yours May focus on discrepancy or inconsistency in person’s narrative May focus on discrepancy or inconsistency in person’s narrative You have observed a certain action, feeling, or statement and now focus person’s attention on it You have observed a certain action, feeling, or statement and now focus person’s attention on it You give honest feedback about what you see or feel You give honest feedback about what you see or feel Slide 3-19

20. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 3: The Interview TECHNIQUES OF COMMUNICATION (cont.)  Interpretation  Based on your inference or conclusion  It links events, makes associations, implies cause, ascribes feelings  Helps person understand his or her own feelings in relation to the verbal message  If your inference is incorrect, the patient may correct it, and thus prompt further discussion of topic Slide 3-20

21. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 3: The Interview TECHNIQUES OF COMMUNICATION (cont.)  Explanation  These statements inform the person; you share factual and objective information offering reasons for requirements or actions  Summary  Final review of what person has said; it condenses facts and presents your view of health problem  Is a type of validation that person can agree with or correct; both you and patient should participate  Occurring at the end of the interview, it signals that termination of the interview is near Slide 3-21

22. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 3: The Interview TECHNIQUES OF COMMUNICATION (cont.)  These responses now include your own thoughts and feelings  Use the last four responses only when merited by the situation  If you use them too often, you take over at the patient’s expense Slide 3-22

23. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 3: The Interview TECHNIQUES OF COMMUNICATION (cont.)  Ten traps of interviewing  Providing false assurance or reassurance  Giving unwanted advice  Using authority  Using avoidance language  Engaging in distancing  Using professional jargon  Using leading or biased questions  Talking too much or interrupting  Using “why” questions Slide 3-23

24. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 3: The Interview TECHNIQUES OF COMMUNICATION (cont.)  Nonverbal skills  Physical appearance  Posture  Gestures  Facial expression  Eye contact  Voice  Touch  Closing the interview Slide 3-24

25. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 3: The Interview DEVELOPMENTAL CARE  Interviewing parents  Infants  Preschoolers  School-age children  Adolescents  Older adults Slide 3-25

26. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 3: The Interview INTERVIEWING PEOPLE WITH SPECIAL NEEDS  People who are hearing-impaired  People who are acutely ill  People under influence of street drugs or alcohol  People who must be asked personal questions  People who are sexually aggressive  People who are crying  People who are angry and threatening violence  People who are anxious Slide 3-26

27. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 3: The Interview CROSS-CULTURAL CARE  Probability of miscommunication increases with two people from different cultural backgrounds  Cultural backgrounds of both health care professional and patient influence verbal and nonverbal communications Slide 3-27

28. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 3: The Interview CROSS-CULTURAL COMMUNICATION  Cultural perspectives on professional interactions  Etiquette  Space and distance  Cultural considerations on gender  Cultural considerations on sexual orientation Slide 3-28

29. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 3: The Interview OVERCOMING COMMUNICATION BARRIERS  Working with and without interpreters  Nonverbal cross-cultural communication  Touch  Touching patients is a necessary component of comprehensive assessment  Physical contact with patients conveys various meanings cross-culturally  Patient’s significant others may exert pressure on nurses by enforcing culturally meaningful norms in health care setting Slide 3-29

30. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 3: The Interview OVERCOMING COMMUNICATION BARRIERS (cont.)  Five types of nonverbal behaviors convey information about person  Vocal cues: pitch, tone, and quality of voice, including moaning, crying, and groaning  Action cues: posture, facial expression, and gestures  Object cues: clothing, jewelry, and hair styles  Personal space: interpersonal transactions and care of belongings  Touch: involves use of personal space and action Slide 3-30

31. Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc. Chapter 3: The Interview OVERCOMING COMMUNICATION BARRIERS (cont.)  In some cultures, it is considered an acceptable expression of friendship and affection to openly and publicly hold hands with or embrace members of same gender with no sexual connotation  You may find that a patient displays similar behaviors and should feel free to discuss cultural differences and similarities openly with the person Slide 3-31