Unit 2A: The Patient Interview

Main Topics: (1) Factors Influencing the Interview (2) Stages of the Interview Process (3) Factors Affecting Communication (4) Effective Interviewing Techniques (5) Non-therapeutic Interviewing Techniques (6) Developmental Considerations in Interviewing (7) Interviewing People with Special Needs

Nursing Interview

A purposeful, time-limited verbal interaction between the nurse and the patient or his/her significant other

Done to collect subjective data about the patient

Subjective Data

What is the nursing interview done to collect?

BEAN CT

Acronym for the 6 Factors Influencing the Interview

Biases & Preconceptions

Environment

Approach

Note Taking

Confidentiality

Time, Length, Duration

6 Factors Influencing the Interview

Approach

One of the 6 Factors Influencing the Interview

Gather all appropriate information before approaching the patient

Begin by introducing your name & title

Initially, call the patient by his/her formal name & ask how the patient prefers to be addressed

Environment

One of the 6 Factors Influencing the Interview

Has a direct influence on the amount & quality of information gathered

1. Private room

2. Less distractions/interruptions

3. Increase comfort level for the patient

3 components of an ideal setting for interview

Confidentiality

One of the 6 Factors Influencing the Interview

Essential in developing trust

Verbal assurance of this often eases the patient's concerns

1. Patient poses danger to self or others

2. Institutional policy (patient should be informed about this before sharing info)

2 reasons for sharing confidential information

Note Taking

One of the 6 Factors Influencing the Interview

Advisable but may cause patient discomfort

Explain the necessity of jotting down pertinent information

Show to patient the form you will be using

Pay attention to patient & defer recording if patient discusses sensitive issues

Jot down phrases, words, & dates that can be used

Time, Length, Duration

One of the 6 Factors Influencing the Interview

Interview times should be least disruptive to patient's daily routine, & try to accommodate patient's request

Biases & Preconceptions

One of the 6 Factors Influencing the Interview

Be sensitive to personal as well as patient contexts in order to treat all patients fairly & respectfully

Avoid faulty assumptions by continually validating information & personal impressions (use effective interview techniques)

1. Stage I: Introductory Stage

2. Stage II: Working Stage

3. Stage III: Termination Stage

3 stages of the interview process

Stage I: Introductory Stage

One of the stages of the interview process

The nurse & patient establish trust & get to know each other; rapport

Stage II: Working Stage

One of the stages of the interview process

Bulk of patient data is collected

Stage III: Termination Stage

One of the stages of the interview process

Information is summarized & validated

During this stage, give the patient an indication of the amount of time left in the interview, & allow patient have the opportunity to give additional info & make comments/statements

Stage III: Termination

In which stage of the patient interview would the following be said:

We have about 5 minutes more, Mr. Cruz, is there anything else you would like to add or mention?

1. Active Listening

2. Nonverbal Cues

3. Distance/Proxemics

4. Personal Space

4 Factors Affecting Communication

Active Listening

One of the 4 Factors Affecting Communication

Primary goal: to decode patient messages in order to understand the situation or problem as the other person sees it

Always pay particular attention & formulate an appropriate response

Nonverbal Cues

One of the 4 Factors Affecting Communication

Communicating a message without words

May include:

• body position,

• nervous repetitive movements of the hands or legs,

• rapid blinking,

• lack of eye contact,

• yawning,

• fidgeting,

• excessive smiling or frowning,

• repetitive clearing of the throat

Distance/Proxemics

One of the 4 Factors Affecting Communication

The amount of space a person considers appropriate for interaction is a significant factor in the interview process and is determined in part by cultural influence

1. Intimate

2. Personal

3. Social

4. Public

4 types of distance

Less than 18 inches

What is the measurement of intimate distance?

18 in-4 ft

What is the measurement of personal distance?

4-12 ft

What is the measurement of social distance?

Greater than 12 ft

What is the measurement of public distance?

Personal Space

One of the 4 Factors Affecting Communication

The ___ over which the person claims ownership (example: patient’s hospital room & bathroom)

Patient may be protective over this and consider unauthorized use of it as an invasion of privacy

1. Using Open-Ended Questions

2. Using Close-Ended Questions

3. Facilitating

4. Using Silence

5. Making Observations

6. Restating

7. Reflecting

8. Clarifying

9. Interpreting

10. Sequencing

11. Encouraging Comparisons

12. Summarizing

13. Focusing

14. Exploring

15. Presenting Reality

16. Confronting

17. Informing

18. Collaborating

19. Limit Setting

20. Normalizing

20 Effective Interview Techniques

Using Open-Ended Questions

One of the 20 Effective Interview Techniques

Encourages pt. to provide general rather than more focused communication

Using Open-Ended Questions

What effective interview technique is being exhibited?

What caused you to believe that you might be drinking too much?

Validating the right patient before giving the drug: “May I know your name sir?”

Using Close-Ended Questions

One of the 20 Effective Interview Techniques

Restrict or regulate patient response to a "yes", "no" or response less than 3 words

Used to focus the interview, pinpoint specific areas of concern, & elicit valuable information quickly & efficiently

Can disrupt communication if frequently used

Using Close-Ended Questions

What effective interview technique is being exhibited?

Are you thinking of hurting yourself?

Facilitating

One of the 20 Effective Interview Techniques

Encourages patient to continue talking

Coupled with nonverbal cues:

• eye contact

• nodding

• leaning slightly forward

Facilitating

What effective interview technique is being exhibited?

“Go on.”

“Uh-huh.”

Using Silence

One of the 20 Effective Interview Techniques

Helps…

• structure & pace the interview

• convey respect & acceptance

• prompt additional patient data

On the part of the patient, may convey anxiety, confusion or embarrassment

Making Observations

One of the 20 Effective Interview Techniques

Nurse verbalizes perceptions about the patient's behavior, then shares them with the patient

Making Observations

What effective interview technique is being exhibited?

“Speaking about those symptoms seems to make you tense. I notice that you are clenching your fists and grimacing.”

Restating

One of the 20 Effective Interview Techniques

Involves repeating or rephrasing the main idea expressed by the patient & lets the patient know that you are paying attention

Restating

What effective interview technique is being exhibited?

Patient: "I don't sleep well anymore. I find myself waking up frequently at night."

Nurse: "You're having difficulty sleeping?" or "You don't sleep well?

Reflecting

One of the 20 Effective Interview Techniques

Nurse directs the pt's own questions, feelings & ideas back to the patient

Provides opportunity for the patient to reconsider &/or expand on what was said

Reflecting

What effective interview technique is being exhibited?

Clarifying

One of the 20 Effective Interview Techniques

Used by the nurse to make clear something the patient says

OR to pinpoint something in the message when the patient's words & nonverbal cues do not agree

Clarifying

What effective interview technique is being exhibited?

Patient: "During certain activities, I have the most awful pain in my back."

Nurse: "Tell me what you mean by awful.”

Interpreting

One of the 20 Effective Interview Techniques

Enables the nurse to link events that perhaps the patient was not able to piece together

Interpreting

What effective interview technique is being exhibited?

Patient: "My stomachache seems to occur only from late summer to mid-spring."

Nurse: "From what you have just told me, could it be the stress of your teaching job (pt works from September to May) that is causing your pain?"

Sequencing

One of the 20 Effective Interview Techniques

Involves asking the patient to place a symptom, a problem, or an event in its proper order.

Facilitating the conversation such that occurrence of symptoms/events are pieced together chronologically by pt

Sequencing

What effective interview technique is being exhibited?

"What specific events led you to feel overwhelmed and suicidal?"

"Did this sharp pain occur each time you had sexual intercourse or only when you didn't empty your bladder first?

Encouraging Comparisons

One of the 20 Effective Interview Techniques

Helps the patient to deal more effectively with unfamiliar situations by placing the symptoms or problems in the context of something else that is familiar

Encouraging Comparisons

What effective interview technique is being exhibited?

"In what way was this allergy attack different from or the same as your previous ones?”

Summarizing

One of the 20 Effective Interview Techniques

Especially useful at the end of the health assessment interview

Also provides a means of smoothly transitioning to a new topic or section of the health assessment

Summarizing

What effective interview technique is being exhibited?

"During this past hour, you have shared with me several health concerns of which the most vexing to you is your difficulty in losing weight. Is that correct?"

Summarizing

What effective interview technique is being exhibited?

“You talked about your past experience with diabetes and what happened to you yesterday; now let's talk about why you came in today."

Focusing

One of the 20 Effective Interview Techniques

Allows the nurse to concentrate on or "track" a specific point the patient has made

Useful to patients w/ heightened anxiety & altered concentration, or jumping from topic to topic

Focusing

What effective interview technique is being exhibited?

“Tell me more about the chest pain you experience when you begin to exercise.”

"You've mentioned several times that your wife is concerned about your smoking. Let's go back to that.”

Exploring

One of the 20 Effective Interview Techniques

Enables the nurse to develop, in more detail, a specific area of content or patient concern.

Helps the nurse identify patterns or themes in symptom presentation or in the way patients handle problems or health concerns

Exploring

What effective interview technique is being exhibited?

"Tell me more about how you feel when you do not take your medication."

"Could you describe for me how you handle those periods in your life when you feel out of control?”

Presenting Reality

One of the 20 Effective Interview Techniques

Typically used with psychiatric or confused patients, or to patients who exaggerate or make grandiose statements.

Done in a nonargumentative way, encourages patient to rethink a statement and perhaps modify it

Presenting Reality

What effective interview technique is being exhibited?

Patient: "I can never get an appointment at this clinic."

Nurse: "But Mr. Jasper, I've seen you several times in the past 4 months."

Patient:"Well, yes, but I can never get an appointment at a time that is convenient for me."

Confronting

One of the 20 Effective Interview Techniques

A verbal response that the nurse makes to some perceived discrepancy or incongruency in the pt's thoughts, feelings, or behaviors.

Can be used to focus the patient's attention on some aspect of behavior that, if changed, could lead to more effective functioning

Done in a caring, empathetic manner, rather than a critical or accusatory one.

Confronting

What effective interview technique is being exhibited?

Informing

One of the 20 Effective Interview Techniques

Providing the patient with needed information, such as explaining the nature and/or the reasons for any necessary tests or procedures.

Allows the nurse to help patients become aware of possible choices & then evaluate those choices correctly

Informing

What effective interview technique is being exhibited?

Collaborating

One of the 20 Effective Interview Techniques

The nurse & patient work together, rather than the nurse taking control of the interaction

Conveys the message that the patient has important knowledge and information to share

Encourages active involvement of patient in the following:

• own health care

• in setting goals

• in gathering information

• in problem solving

Collaborating

What effective interview technique is being exhibited?

“Perhaps you and I talk further about your asthma and discover what specifically is making you so anxious.”

Limit Setting

One of the 20 Effective Interview Techniques

Setting specific restrictions on inappropriate patient behavior; such situations may include:

• sexually aggressive pt.

• hostile pt.

• talkative pt.

Provide guidance by calmly, clearly, and respectfully telling the patient what behavior is expected

Limit only problematic or detrimental behavior to the purpose of the interview and avoid making a "big issue" whatever it is that the patient is doing

Do not argue or use empty threats or promises, but do offer the patient alternatives

Normalizing

One of the 20 Effective Interview Techniques

Allows the nurse to offer appropriate reassurance that the pt's response may be quite common for the situation

Helps decrease patient's anxiety and fear of being misunderstood

Normalizing

What effective interview technique is being exhibited?

“It is no wonder that you've been feeling shocked and overwhelmed since you first found that lump in your breast. Most women who have that experience react in a similar way."

1. Requesting an Explanation

2. Probing

3. Offering False Reassurance

4. Giving Approval or Disapproval

5. Advising

6. Using Problematic Questioning Techniques

6 Non-Therapeutic Interview Techniques

Requesting an Explanation

One of the 6 Non-Therapeutic Interview Techniques

Such questions ask the patient to provide a reason or justification for personal beliefs, feelings, thoughts, and behaviors

Imply criticism and may make the patient feel inadequate, defensive, or angry

Requesting an Explanation

What non-therapeutic interview technique is exhibited?

Why do you think that?

Probing

One of the 6 Non-Therapeutic Interview Techniques

Repeated or persistent questioning of the patient about a statement or behavior

Useful responses to prevent this:

• going on to the next part of interview

• asking permission to get back to the subject later

• just sitting quietly until patient begins to speak

1. going on to the next part of interview

2. asking permission to get back to the subject later

3. just sitting quietly until patient begins to speak

3 useful responses to prevent probing

Probing

What non-therapeutic interview technique is exhibited?

Offering False Reassurance

One of the 6 Non-Therapeutic Interview Techniques

Giving vague, simplistic responses that question the patient's judgment, devalue and block patient feelings

Communicate a lack of understanding and sensitivity on the part of the nurse which often increases pt. anxiety

Offering False Reassurance

What non-therapeutic interview technique is exhibited?

Don’t worry. There are hardly any problems with that type of surgery.

Giving Approval or Disapproval

One of the 6 Non-Therapeutic Interview Techniques

Telling a patient what is right or wrong is demoralizing

May limit patient's freedom to verbalize or behave in certain ways

Hinder the nurse's attempts to establish rapport

Giving Approval or Disapproval

What non-therapeutic interview technique is exhibited?

“That is bad."

“You shouldn't feel that way."

"What a good idea."

Advising

One of the 6 Non-Therapeutic Interview Techniques

Consistently telling a patient what to do

Does not foster competence

Nurses should not reinforce dependence, because some patients may resort to dependent, passive behavior when faced with illness

Advising

What non-therapeutic interview technique is exhibited?

1. Reflecting: “Do you think you should?”

2. Exploring: “Tell me more about what made you consider an abortion.”

What are examples of proper, therapeutics responses to the following statement?

Patient: Do you think I should have an abortion?

Using Problematic Questioning Techniques

One of the 6 Non-Therapeutic Interview Techniques

Consists of the following:

1. Posing Leading Questions

2. Interrupting the Patient

3. Engaging in Talkativeness

4. Using Multiple Questions

5. Using Medical Jargon

6. Being Authoritative

7. Having Hidden Agendas

1. Posing Leading Questions

2. Interrupting the Patient

3. Engaging in Talkativeness

4. Using Multiple Questions

5. Using Medical Jargon

6. Being Authoritative

7. Having Hidden Agendas

7 problematic questioning techniques

Posing Leading Questions

One of the 7 problematic questioning techniques

Being Authoritative

One of the 7 problematic questioning techniques

"As your health care provider, knowing about your previous heart attack, history of high blood pressure, and family history of stroke, I would suggest you consider stopping smoking."

Example of positive use of authority attempting to encourage a patient to stop smoking

Lip-Read

1. Remain within the sight of the patient

2. Face the patient when talking

Actions/acknowledgements for a patient who is hearing-impaired:

Hearing-impaired patients often ___ so that nurse should (1) ___ & (2) ____

hearing aid

Actions/acknowledgements for a patient who is hearing-impaired:

Nurse should ensure that the ___ __ of the patient is working and turned on.

background noise

Actions/acknowledgements for a patient who is hearing-impaired:

Nurse should ensure that the ___ ___ is minimized.

directed

Actions/acknowledgements for a patient who is hearing-impaired:

Nurse should ensure that all communication is ___ to the patient.

loudly; slowly

Actions/acknowledgements for a patient who is hearing-impaired:

Nurse should avoid speaking ___ and ___

nonverbal cues; facial expression; body movements

Actions/acknowledgements for a patient who is hearing-impaired:

Nurse should use ___ ___ such as ___ ___ and ___ ___ to convey the meaning.

speech difficulty; time; written

Actions/acknowledgements for a patient who is hearing-impaired:

Nurse should acknowledge the patient may also have ___ ___ so should allow additional ___ and use a ___ form of gathering data.

1. Often lip-read; remain within sight of the patient and face the patient when talking.

2. Ensure that the hearing aid is in working order and turned on

3. Minimize background noise

4. Always face the patient and direct all communication to the patient.

5.  Avoid speaking loudly and slowly

6. Use nonverbal cues such as facial expression and body movements to convey the meaning

7. May also have speech difficulty; allow additional time and use a written form of gathering data.

7 actions/acknowledgements that should be done when with a patient is hearing-impaired

close-ended

Actions/acknowledgements for a patient who is speech-impaired:

Nurse should ask ___-___ questions

time

Actions/acknowledgements for a patient who is speech-impaired:

Nurse should allow additional ___ for patient responses

repeat; rephrase

Actions/acknowledgements for a patient who is speech-impaired:

Nurse should ___ or ___ the question if the patient did not understand

written; letter board; yes/no

Actions/acknowledgements for a patient who is speech-impaired:

If nurse is unable to understand the patient’s responses, they should use a ___ interview format, ___ ___, or __/__ cards.

direct

Actions/acknowledgements for a patient who is speech-impaired:

When someone else is speaking for the patient, the nurse should ___ questions to the patient.

1. Ask simple questions that requires yes and no answers (close-ended questions)

2. Allow additional time for patient responses

3. If unable to understand the patient’s responses, use a written interview format, letter boards, or yes/no cards

4. When someone else is speaking for the patient,

   the nurse should speak and direct questions to the

   patient, not the intermediary.

4 actions that should be done when with a patient is speech-impaired

interpreter/translator

Actions/acknowledgements for a patient who is non-English speaking:

Have an ___ if possible