1. Chapter 3
The Interview

2. 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.

3. 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

4. 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

5. 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

6. 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

7. 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

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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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)

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