Chapter 3 The Interview

Copyright © 2016 by Elsevier, Inc. All rights reserved. The Interview Subjective data collection Patient perception of health First step in the therapeutic relationship Copyright © 2016 by Elsevier, Inc. All rights reserved. Copyright © 2012, 2008, 2004, 2000, 1996, 1993 by Saunders, an affiliate of Elsevier Inc.

Interview Goal Identification 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

Successful Interview Characteristics 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 Build rapport to continue therapeutic relationship and to facilitate future diagnoses, planning, and treatment Begin teaching for health promotion and disease prevention

The Interview Contract 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

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

Facilitating Communication: Internal & External Factors Internal factors The nurse must cultivate Liking others Empathy Ability to listen 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 Tape and video recording

Challenges of Note-Taking What are some of the challenges or problems that could occur with note-taking?

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 Closed Each has a different place and function in interview

Open-Ended Questions Ask for narrative responses Use them in the following situations: To begin interview To introduce a new section of questions Whenever the patient introduces a new topic

Closed or Direct Questions Ask for specific information Elicit short one- or two-word answers, a yes or no answer, or a forced choice Used in the following situations: 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 To move the interview along

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 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

Types of Verbal Responses 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 Clarification Use when person’s words are ambiguous or confusing 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

Types of Verbal Responses (Cont.) Confrontation Frame of reference shifts from patient’s perspective to yours 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 give honest feedback about what you see or feel

Types of Verbal Responses (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 Explanation These statements inform the person; you share factual and objective information, offering reasons for requirements or actions

Types of Verbal Responses (Cont.) 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

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 Interrupting Using “why” questions

Elements of the Interview Process Nonverbal skills Physical appearance Posture Gestures Facial expression Eye contact Voice Touch Closing the interview

Developmental Competence Interviewing the caregiver Communicating with different ages across the life cycle Infants Toddlers and preschoolers School-age children Adolescents Adults and older adults

Interviewing People with Special Needs Hearing impaired Acutely ill Under influence of street drugs or alcohol Those who must be asked personal questions Sexually aggressive Crying Angry and threatening violence Anxious

Culture and Genetics Gender Sexual orientation Being aware of maintaining cultural norms during interview and examination process Maintaining privacy and modesty Sexual orientation Maintaining neutrality related to patient’s presentation by being mindful of communication patterns Being aware of your own personal bias and baggage

Cross-Cultural Care Probability of miscommunication increases when two people are from different cultural backgrounds Cultural backgrounds of both health care professional and patient influence verbal and nonverbal communications Cultural perspectives on professional interactions Etiquette Space and distance

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

Nonverbal Behaviors 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 hairstyles Personal space: interpersonal transactions and care of belongings Touch: involves use of personal space and action

Health Literacy This is more than just the ability to read but rather includes understanding and following directions that lead to effective communication between the patient and the health care provider A patient may be literate but not have health literacy Involves the use of quantitative measurement and memory aspects Tools for determining literacy Test of Functional Health Literacy (TOFHLA) Rapid Estimate of Adult Literacy in Medicine (REALM) Newest Vital Sign (NVS)

Techniques to Improve Health Literacy Oral teaching Use of written materials based on standard educational levels Teach back or use of return demonstration