HA CH3: The Interview

The Interview

Gather complete and accurate subjective data about the person's health state, including the description and chronology of any symptoms.

Establish trust so that the person feels accepted and thus free to share all relevant data.

Interview Components

•Time and place

•Introduction

•your role

•purpose

•How long

•Expectation

•Presence

•Confidentiality and to what extent

Costs

External Factors of Communication

Ensure privacy, refuse interruptions, physical environment (equal status sitting), dress, note taking, EHR (electronic health records)

Internal Factors of Communication

Liking others, empathy, listening, self-awareness and biases

Techniques of Communication

Introducing the Interview

The Working Phase

Closing the Interview

Introducing the Interview

•Introduce self and role

•Use the person's last name

•Shake hands- if appropriate

•Can't pronounce name? Ask.

•Introduce self, explain role, and give reason for interview

•Best way to build rapport is to let the client discuss concerns early and actively listening throughout interview

The Working Phase

•Data-gathering phase

•Form questions appropriately

•Respond appropriately to answers given by client

Closing the Interview EX

•"Is there anything else you would like to mention?"

•"Are there any questions you would like to ask?"

•"We've covered several concerns today".

• "What would you most like to accomplish?"

Open-ended questions

•Ask for narrative information

•States the topic to be discussed in general terms

"Tell me how can I help?"

"Tell me more about that?"

Closed or Direct questions

•Ask for specific information

•Elicit a one- or two-word answer, a "yes" or "no," or a forced choice

•Useful when you need specific facts

Do not overuse

"Do you smoke?"

Facilitation, general leads, minimal cues

-encourages client to say more

-shows person you are interested

EX) "mm-hmmm, go on, uh-huh", maintaining eye contact, nodding yes

Silence

communicates that client has time to think

interruptions can make clients lose train of thought

Can observe clients' nonverbal cues

EX) Waiting for a response and sitting quietly without fidgeting. silently counting to 10

Reflection

Echoes clients' words by repeating a part of what they just said.

Can help express feelings behind words

Mirroring words can help them elaborate on a problem

EX) "It's hard having to stay in bed during pregnancy, I'm worried about my kids at home."

"You feel worried and anxious about your children?"

Empathy

Names a feeling and allows its expression

Allows person to feel accepted and strengthens rapport

Useful when client hasn't identified the feeling or does not wish to share it

EX) "This must be very hard for you" or just touching the client's arm

Clarification

Useful when person's word choice is ambiguous or confusing

Summarize person's words, simplify the statement, and ensure that you are on the right track

EX) "The heaviness in your chest occurs with walking up a flight of stairs or more than 1 block, but it stops when you rest is that correct?"

Confrontation

Clarifying inconsistent information

Focusing client's attention on an observed behavior, action, or feeling

EX) "You look sad" or "You sound angry"

"Earlier you said you didn't drink but just now you said you go every night after work for 1-2 beers"

Interpretation

Links events, makes associations, implies cause

Based on inference or conclusion and not direct observation

May be incorrect but can prompt further discussion

EX) "It's very important to my partner that I continue aggressive treatment, but I'm ready to stop."

"Can it be that you're afraid to have the end of life talk with them?"

Explanation

informing person, sharing factual and objective information

EX) "You may not eat or drink for 12 hours before your blood test because the food may chance the results?"

Summary

condenses facts and validates what was discussed during the interview

signals the end of the interview is near

both client and examiner should be active participants

EX) Review penitent facts allow client time to make corrections

10 traps of interviewing

1. Providing false assurance or reassurance

2. Giving unwanted advice

3. Using authority

4. Using avoidance language

5. Engaging in distancing

6. Using professional jargon

7. Using leading or biased questions

8. Talking too much

9. Interrupting

10. Using "why" questions

Positive nonverbal communication

-Appropriate professional appearance

-Equal-status seating, Appropriate proximity to client, Relaxed, open posture

-Occasional facilitating gestures

-Facial animation, interest, smiling

-Appropriate eye contact

-Moderate tone of voice, rate of speech

-Appropriate touch

Negative nonverbal communication

-Unprofessional or unkempt appearance

-Standing above the client, Sitting behind desk, Far away, Too close, Turned away, Tense posture, Slouched

-Critical or distracting gestures

-Bland expression, yawning, tight mouth

-Avoiding eye contact, Focusing on notes

-Strident, high-pitched tone, Rate too slow or too fast

-Too frequent or inappropriate touch

AIDET

Acknowledge, Introduce, Duration, Explain, Thank You

Special considerations when Interviewing

Unique reasons to alter or enhance parts of the interview

Hearing Impaired

Signing, lip reading, writing

Acutely ill

be very clear with statements

Under the influence

simple and direct questions; remain nonthreatening

Personal questions (towards you)

supply only appropriate information

Sexually Aggressive people

set appropriate verbal boundaries

Crying

acknowledge them and provide time for patients to express their sadness

Anger

hear the person out; don't take it personally and remain calm

Threats of Violence

act calm, diffuse the situation and seek support

Anxiety

take time to listen, and avoid the "traps"

Cultural considerations on gender

•Be aware of cultural or religious norms related to appropriate male-female relationships.

•Offer to have a third person present

•Not unusual for a female to refuse to be examined by a male, and vice versa

Sexual Orientation and Gender Identity

All SGM (sexual and gender minority) subgroups experience health disparities. SGM individuals have higher all-cause mortality than their heterosexual counterparts, are less likely to receive high-quality care, and experience discrimination in the health care system

Closing the Interview

The session should end gracefully. An abrupt or awkward closing can destroy rapport and leave the person with a negative impression of the interaction

Health Literacy

•Ability to understand instructions, navigate the healthcare system, and communicate concerns with health care providers

•9 out of 10 people do not have adequate health literacy

Improving Health Literacy

•Oral Teaching

(Give simple, easy-to-understand instructions; Present only necessary info; Avoid medical jargon)

•Written Materials

(Simple & Culturally appropriate)

•Teach Back

(Repeat in own words)

SBAR

consistent, clear, structured, and easy-to-use method of communication between health care personnel; it organizes communication by the categories of: Situation, Background, Assessment, and Recommendations.

Situation

Your name, location, patient name, problem and severity

Background

Provide pertinent information to the current situation

Assessment

What is your assessment? What do you think is wrong?

Recommendation

State what you want/need to

care for patient