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NUR 1060 NotesChapter 3 – The Interview
The Interview
• Subjective data collection
• Patient perception of health
• First step in the therapeutic relationship
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
The Interview Contract Terms
• 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 (family, etc.)
• Confidentiality and to what extent it may be limited
• Any costs that the patient must pay
,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
Process of Communication: Receiving
• Awareness of messages you send is only part of process
• 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
• 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
Process of Communication: Internal Factors
• Awareness of internal and external factors and their influence allows you to
maximize communicating skill
• Internal factors
• Liking others
• Empathy
• Ability to listen
Process of Communication: 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
Question
Which of the following would be the best way to refer to an adult patient when initiating the
interview?
1. Hello Mr. Jones, what brought you to the emergency department today?
2. Hello James, what brought you to the emergency department today?
3. Hi, I’m nurse John, what brought you into the hospital today Jim?
4. Hi Mr. J., what’s up? Why are you here today?
,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
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
• State topic only in general terms
• 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
• Use them 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
Question
Which of the following questions would likely warrant the best response?
1. Why did you come in today?
2. Where does it hurt?
3. Have you been checking your blood pressure?
4. When was the last time you were seen by a doctor?
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
• 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
• 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
• Summary
• Final review of what person has said; it condenses facts and presents your
view of health problem
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