Health Assessment -- (EXAM I) The Interview

interview -- first point of contact

allows for compilation of subjective data and awareness of objective data

interview -- establishing rapport

several factors contribute to the development of a POSITIVE relationship:

- courtesy

- comfort

- connection

- confirmation

- confidentiality

the process of communication: sending

verbal communication + nonverbal communication (i.e. body language)

the process of communication: receiving

- awareness & perception about understanding the message

- increased risk of misunderstanding in a healthcare setting (i.e. impact of illness, physical & emotional states)

the process of communication: external factors

- ensure privacy—aim for "geographic" privacy but ensure "psychological" privacy

- refuse interruptions—minimize and/or refuse

- physical environment—"equal-status" seating

- dress—appearance and comfort

- note-taking—keep to a minimum, offer "focused" attention

electronic health record (EHR)

- technology interface can affect communication in the health care provider-patient relationships

- do not allow the computer to become a "barrier" in the communication exchange process.

techniques of communication -- two types of questions

- open-ended—asks for narrative information

- closed or direct—asks for specific information leading to a forced choice (yes or no)

- each has a different place and function in the interview

verbal responses: assisting the narrative

- nine types of verbal responses help the patient to express and keep the person focused

- the first 5 involve reactions to the answers provided to you as the interviewer & the client leads

the five types of verbal responses

- facilitation: encourages patient to say more

- silence: directed attentiveness

- reflection: echoes to help express meaning

- empathy: names a feeling and allows its expression

- clarification: asking for confirmation

effective communication

the nurse should do the following if a patient does not understand the question being asked:

- facilitate

- reflect

- clarify

- empathize

- confront

- interpret

interviewing the older adult

- typically, the interview process will take longer

- consider appropriate pacing

- physical limitations

- may need increased response time to process

- may have more information to provide

interviewing people with special needs

consider key elements that will address vulnerable populations:

- hearing-impaired, acutely ill, drug/alcohol abuse, sexually aggressive, emotionally distraught (crying), angry and/or threatening violence, and anxious

cultural considerations on gender

- being aware of maintaining cultural norms during the interview and examination process

- maintaining privacy and modesty

SBAR

S: situation

B: background

A: assessment

R: recommendation

situation

provide a brief description of pertinent patient variables, demographics, clinical diagnosis, and location

background

provide pertinent history as it 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