Chapter 3: The Interview

What part of COLDSPA is pertinent to this patient statement: “The pain is worse when I walk”.

Pattern/Association

What part of COLDSPA is pertinent to this patient statement: “Tylenol helps a little”.

Pattern

What part of COLDSPA is pertinent to this patient statement: “It is sharp and pinching”.

Character

What part of COLDSPA is pertinent to this patient statement: “It is on and off during the day”.

Duration

What part of COLDSPA is pertinent to this patient statement: “It is very painful, 10 out of 10”.

Severity

What part of COLDSPA is pertinent to this patient statement: “Three days”.

Onset

Collecting and documenting information should not be delegated to another member of the team (e.g. unlicensed assistive personnel). True or false?

True.

Why is the interview important?

Best chance to gain an understanding of the patient’s beliefs, concerns, and perception of their individual health state. Allows for compilation of subjective data and awareness of objective data (demeanor, posture, appearance, ability to converse)

Why is there a greater risk for misunderstanding in the healthcare setting?

Patient’s frame of reference is narrowed and focused on illness. Patient’s health problems/concerns emotionally charges your professional relationship. Communication intensified because patient depends on you to feel better.

External factors that can affect the interview environment

 Ensure privacy—aim for “geographic” privacy but

ensure “psychological” privacy

 Refuse interruptions—minimize and/or refuse; make sure interview is not interrupted

 Physical environment—“equal-status” seating

 Dress—appearance and comfort

 Note-taking—keep to a minimum, offer “focused” attention

Psychological privacy

If geographic privacy cannot be achieved, “psychological” privacy can be achieved by drawing the curtain partitions so the patient feels mentally separated from the other parts of the room.

How can an Equal-Status setting be achieved?

• Set room temp to comfortable level

• Sit down at patient level

• Provide sufficient lighting; avoid direct, strong lighting that causes squinting

• Ensure environment is quiet, clear of clutter

• Ask patient’s permission if others can be present

Electronic Health Record (EHR)

• Mandated by the government

• EHR can affect patient-provider relationship by engendering a sense of depersonalization

• Capturing of biomedical, psychological, and emotional information may not always be captured via EHR

• Do not allow computer screen to become a barrier in the interview process

How can you more effectively interact with patient while using EHR?

Begin the interview as you usually would by greeting the person, establishing rapport, and collecting the narrative story in a direct face-to-face manner. Explain the computerized charting, and position the monitor so that the client can see it. Be aware that the client narrative, emotional issues, and complex health problems can only be addressed by reciprocal communication and patient-focused interviewing.

Open-ended questions

Asks for narrative information — can lead to more elaborate responses

Closed or direct questions

Asks for specific information leading to a forced choice (yes or no); used to ask for basic information (birth, name, etc.)

Facilitation verbal response

Encourages patient to say more

Silence verbal response

Directed attentiveness; allows patient to collect thoughts and speak. Provides you with a chance to observe client and note nonverbal cues

Reflection verbal response

Echoes patient to help express meaning; mirroring client’s words can help them elaborate on problem

Empathy verbal response

Names a feeling and allows its expression. Useful in instances when client hasn’t identified the feeling or isn’t ready to discuss it

Clarification verbal response

Asking for confirmation; Summarize person’s words, simplify the statement, and ensure that you are on the right track

Confrontation verbal response

Clarifies inconsistent information

• You will need a full bladder for your ultrasound to ensure good visualization of your uterus.

• You may not eat or drink for 12 hours before your blood test because the food may change the results.

Which type of verbal response is this?

Explanation

Interpretation verbal response

Makes association to identify cause or conclusion

Summary verbal response

Provides conclusion based on verified information which in turn identifies that the interview process is closing

• Client: It’s so hard having to stay in bed during my pregnancy. I have kids at home I’m worried about.

• Response: You feel worried and anxious about your children?

What type of verbal response is this?

Reflection

• Earlier you said that you didn’t drink, but just now you said you go out every night after work for 1-2 beers.

What type of verbal response is this?

Confrontation

SBAR

Situation:

Background:

Assessment

Recommend/request

• Client: It’s very important to my partner that I continue aggressive treatment, but I’m ready to stop.

• Response: Could it be that you are afraid to have an end-of-life conversation with him?

Which verbal response is this?

Interpretation

Trappings of Interview

1. Providing false assurance or reassurance

2. Giving unwanted advice

3. Using authority

4. Using avoidance language

5. Distancing

6. Using professional jargon

7. Using leading or biased questions

8. Talking too much

9. Interrupting

10. Using “why” questions

Situation

Provide brief description of pertinent patient’s variables, demographics, clinical diagnosis, and location

Background

Provide relevant history as directly relates to patient’s current health status

Assessment

State pertinent assessment findings obtained with interpretation of data.

Recommendation/request

State what you need or want for the patient in terms of medical treatment and/or assistance.

The nurse is interviewing a 94-year-old client with a family member present. Who does the nurse initially speak to about the clients health history?

Speak to the patient

A client is weeping and anxious, how should the nurse proceed?

Let them express their emotions, ask what’s wrong and validate their feelings

The nurse is interviewing a 28-year-old woman, who does not speak English. What does the nurse do?

Call an interpreter