1. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 2The Interview and Therapeutic Dialogue

2. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Purpose of interview To gather valuable information regarding their health status and establish a therapeutic rapport with the patient The interview is a contract which consists of spoken and unspoken rules for behavior. Terms include: time and place, introductions, purpose, length, expectations, presense of others, confidentiality, and cost.

3. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Communication Process Complex, ongoing, interactive process –Always subject to interpretation –Communication ability, culture, and personal experience all influence the interpretation and decoding of messages –Culture

4. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Perceptions about the relationship Therapeutic communication Caring and empathy

5. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nonverbal Communication Skills Equally as, if not more, important as verbal communication Physical appearance of the nurse Eye level Touch is an essential and dominant component of the physical examination

6. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Verbal Communication Skills Effective interviewing skills Nurse’s speech Patients with limited English

7. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Non-Verbal Skills Physical appearance Posture Gestures Facial expressions Eye Contact Voice Touch

8. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Active Listening Ability to focus on patients and their perspectives Talking about difficult feelings helps patients to heal

9. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Therapeutic Techniques of Communication Restatement relates to the content of the communication –Purpose is to ask patients to elaborate

10. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Reflection is when the nurse summarizes the main themes of communication –Echoes the patient’s words, feelings, or gestures

11. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Encouraging elaboration (facilitation) assists patients to more completely describe problems –General leads, mm-hmm, go on, continue –Encourages patient to continue

12. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Silence allows patients time to gather their thoughts and provide accurate answers –Allows patient to gather thoughts –No more than 60 seconds

13. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Empathy –Recognizes one’s feeling and put them into words. Clarification –Patient’s words or ambiguous or confusing –Used to summarize the person’s words, to make them clearer, make sure you are on the right track

14. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Responses that include the interviewers thoughts and feelings Confrontation –You identify a patients actions, feeling, or statements Interpretation The interveiwer makes conclusions or implies causes

15. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Explanation –You share factual and objective information Summary –Final review of your understanding of the conversation

16. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nontherapeutic Responses False reassurance Sympathy Unwanted advice Biased questions Changes of subject

17. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Distractions Technical or overwhelming language Interrupting

18. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nonprofessional involvement Sexual boundary violation –Set Boundaries Professional Expectations

19. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false. Therapeutic communication with a patient includes reflection. Reflection is when the nurse relates the content of the communication to the patient. Its purpose is to encourage the patient to elaborate.

20. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False Rationale: Reflection is similar to restatement; however, instead of simply restating comments, the nurse summarizes the main themes of communication.

21. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Phases of the Interview Process Nurse–patient relationship differs from social relationship Preinteraction phase Beginning phase

22. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Working phase –Closed-ended or direct questions –Open-ended questions Closing phase

23. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Beginning Phase Introduction Phase Address the person Introduce self Describe the purpose Length of interview Ask an open-ended question

24. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Good leading sentence Tell me what brought you to the hospital?

25. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Working Phase Data gathering phase Involves asking questions, and responding to what the patient says. Use of therapeutic communication techniques

26. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins 2 Types of questions Open-ended questions –Asks for narrative information –Elicits feelings, opinions, ideas –Builds and enhances rapport

27. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Closed or direct questions –Used for specific information –One to two work answers.

28. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Closing Phase Prepare client End gracefully, not abruptly Summarize and clarify information

29. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Intercultural Communication Cultural differences may exist related to group or ethnicity, region, age, degree of acculturation into Western society, or a combination of these factors Communication etiquette Limited English

30. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Working with an interpreter –Should use a trained medical interpreter –Use picture cards if needed –Do not use children or opposite sex Gender and sexual orientation issues

31. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Lifespan Issues Children Newborns and infants –More Non-verbal Older children and adolescents –Depending on age and development may be unable to tell problems, must rely on parents

32. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Older adults –May be hard of hearing –Memory/cognitive impairment causing a limited attention span –Need to keep the interview short

33. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Special Situations Patients in health care settings Hearing impaired Low level of consciousness Cognitive impairment Mental health/illness Anxiety

34. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Special Situations (cont.) Crying Anger Alcohol or drug use Personal questions Sexual aggression

35. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question In what phase of the interview are open-ended questions used? A. Preinteraction B. Beginning C. Working D. Ending

36. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer C. Working Rationale: During the working phase, the nurse collects data by asking specific questions. Two types of questions are closed-ended questions and open-ended questions. Each type has a purpose; the nurse chooses which type will help solicit the appropriate information.