Chapter 3: The Interview

SBAR

A standardized communication framework (Situation, Background, Assessment, Recommendation) used for clear and concise information exchange.

The Interview

• First step in the therapeutic relationship

• A contract between you and your patient

• Identifies health strengths and problems 

Process of Communication: SENDING

• Communication is behavior

• Communication is conscious and unconscious

• Communication is verbal and nonverbal

Process of Communication: RECEIVING

• The receiver attaches meaning determined by their past experiences, culture, self-concept, and current physical and emotional state

Note: Successful communication requires mutual understanding by sender and receiver

Process of communication: 4 Internal factors

1. Liking others 

2. Empathy

3. Ability to listen

4. Self-awareness

Process of Communication: External factors

• Ensure privacy 

• Refuse interruptions

• Physical environment

• Dress

• Note-taking may be unavoidable

• Electronic Health Record (EHR)

Challenges of Note Taking

• Breaks eye contact too often

• Interrupts patient’s narrative flow 

• May be threatening to the patient’s discussion of sensitive issues

• Shifts attention away from the person, diminishing his or her sense of importance

• Impedes observation of the patient’s nonverbal behavior

• Same issues may arise when using EHR

Introduction Part of Interview

• Address the client by their last name, not their first - this is a very personal gesture for someone we are just meeting

WIPES

• W - Wash your hands

• I - Introduce yourself

• P - Provide Privacy

• E - Explain what you are doing

S - Safety. Provide a safe environment for yourself and the patients

The Working Part of the Interview

• Know the difference between open ended vs closed / direct questions

Open ended

• Ask for narrative responses

• State topic in general terms

When to use Open Ended Questions

Begin the interview

Introduce a new section of questions

When the patient introduces a new topic

Closed / direct questions

• Ask for specific information (a yes or no answer)

When to use Closed Ended Questions

• To fill in the details the patient may have left out

• When you need many specific facts about past health problems

• During the review of systems

• To move the interview along

Verbal Responses

Facilitation, Reflection, Empathy, Clarification, Confronation, Interpretaion, Explanation, Summary

Facilitation

Encourages the patient to say more

Silence

• Gives patient time to think / organize what to say

• Gives you a chance to observe a person and note nonverbal cues

Reflection

• Echoes the patient’s words

• Focuses further attention on a specific phrase

• Helps the person continue in his or her own way

Empathy:

• Recognizes a feeling and puts it into words

• Names the feeling and allows expression of it 

• Patient feels accepted

Clarification: 

• Use when person’s words are ambiguous or confusing

• Used to summarize person’s words / 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 / inconsistency in a person’s narrative

• You have observed a certain action, feeling, or statement and now focus the 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, and ascribes feelings

• Helps a person understand his or her own feelings in relation to the verbal message

Explanation

• These statements inform the person

• Uou share factual and objective information

Summary

• Final review of what the person said

• Condenses facts and presents your view of the health problem

Ten Traps of Interviewing

1. Providing false assurance/reassurance

2. Giving unwanted advice

3. Using authority

4. Using avioudance langage

5. Engaging in distancing 

6. Using professional jargon

7. Using leading or bias questions

8. Talking too much

9. Interrupting

10.) Using “why” questions

Elements of the Interview Process

Nonverbal skills

Physical appearance

Posture

Gestures

Facial expressions

Eye contact

Voice

Touch

Closing the interview

Cross-Cultural Care

• The probability of miscommunication increases when two people are from different cultural backgrounds

• Cultural backgrounds 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

5 Types of Nonverbal Behaviors

1. Vocal cues: pitch, tone, and quality of voice, including moaning, crying, and groaning

2. Action cues: posture, facial expression, and gestures

3. Object cues: clothing, jewelry, and hairstyles

4. Personal space: interpersonal transactions and care of belongings

5. Touch: involves the use of personal space and action

Health Literacy

• 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)