The Interview

Interview Purpose

  • First meeting with the client to understand their beliefs, concerns, and perception of their health.
  • Allows compilation of subjective (beliefs) and objective (physical appearance, posture) data.

Successful Interview Characteristics

  • Gather complete and accurate data, including symptom descriptions and chronology.
  • Establish trust to foster data sharing.
  • Educate the person about their health state.
  • Build rapport for a therapeutic relationship.
  • Discuss health promotion and disease prevention.

The Interview as a Contract

  • Location: Time and place, with follow-up for physical exam.
  • Explanation: Introduction and role delineation.
  • Purpose: Mutual goal of optimal health.
  • Time frame: Length of time for the process.
  • Participation: Expected participation and presence of others.
  • Confidentiality: Reasonable or limited as it applies to legal/ethical standards.
  • Cost: Disclosure of any financial costs.

Confidentiality

  • HIPAA: Health Insurance Portability and Accountability Act.
  • National standards to protect individuals' medical records and personal health information (PHI).
  • Healthcare providers (HCP) must safeguard this information.
    • Share information only on a “Need to Know” basis.
    • Avoid leaving computers unlocked.
    • Do not discuss patient information in public areas.
    • Only access client files when providing care.
    • Do not share information with family members unless authorized by the client.

Process of Communication: Sending

  • Verbal communication
    • Words spoken (vocalization).
    • Tone used in conversation.
  • Nonverbal communication
    • Body language provides cues correlated with true feelings.
    • Recognize the importance of unconscious messages.

Process of Communication: Internal Factors

  • Specific to the healthcare team member to maximize communication skills.
    • Liking others: Using a “genuine” approach.
    • Empathy: Developing understanding and sensitivity for others' feelings.
    • Ability to listen: Employing an “active” process.
    • Self-awareness: Being aware of “implicit bias”.

Process of Communication: External Factors

  • Defining the environment to foster communication.
    • Ensure privacy: Both geographic and psychological privacy.
    • Avoid interruptions: Minimize or refuse interruptions.
    • Physical environment: Arrange for “equal status” seating.
    • Dress: Consider appearance and comfort (hospital gown, street clothes).
    • Note-taking: Keep to a minimum to offer “focused” attention.

Electronic Health Record (EHR)

  • Federal government mandates to improve quality and safety.
  • Technology interface can affect communication in healthcare provider-patient relationships.
  • Capturing biomedical, psychological, and emotional information may not always be complete.
  • Do not allow the computer to become a “barrier” in communication.

Techniques of Communication

  • Introducing the interview: Keep it short and formal.
  • Working phase
    • Data-gathering phase.
    • Verbal skills include questions and responses.
    • Two types of question
      • Open-ended: Asks for narrative information.
      • Closed: Asks for specific information, leading to a forced choice (yes or no).
      • Each type has a different place and function in the interview.

Assisting with Verbal Responses

  • Nine types of verbal responses fall under patient/interviewer perspective.
  • The first five methods assist the client during the interview.
    • Facilitation: Encourages the 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.

Verbal Responses: Assisting the Narrative

  • The last four methods involve the interviewer leading and expressing their thoughts based on obtained information.
    • Confrontation: Clarifying inconsistent information.
    • Interpretation: Making associations to identify cause or conclusion.
    • Explanation: Informing the person by sharing factual and objective information.
    • Summary: Providing a conclusion based on verified information, indicating the interview process is closing.

Ten Traps of Interviewing

  • Providing false assurance or reassurance.
  • Giving unwanted advice.
  • Using authority.
  • Using avoidance language.
  • Engaging in distancing.
  • Using professional jargon.
  • Using leading or biased questions.
  • Talking too much.
  • Interrupting.
  • Using “why” questions.

Nonverbal Skills—Congruency

  • When verbal and nonverbal messages are congruent, the verbal message is reinforced.
  • When they are incongruent, the nonverbal message is viewed as the truer one because it is under unconscious control.
  • Congruency can be viewed as either positive or negative, prompting the importance of self-awareness in order to promote communication.

Nonverbal Modes of Communication

  • Physical appearance
    • Image as an initial perception.
  • Posture
    • Interpretation of body language affecting engagement.
  • Gestures
    • Sending messages—be aware.
  • Facial expression
    • Reflects emotion and culture.
  • Eye contact
    • Maintain within the realm of interest, but be mindful of cultural diversity.
  • Voice
    • Be aware of tone, intensity, and rate of speech.
  • Touch
    • Use caution; interpretation is influenced by age, gender, cultural background, past experience, and current setting.

Closing the Interview

  • The ending should be gradual, allowing for adequate closure to allow for final expression.
  • No new topics introduced.
  • Summarize what was learned and agreed upon regarding health state.

The Older Adult

  • Developmental task of finding purpose and evaluating existence.
  • Address respectfully using Mr. or Mrs. until told otherwise; do not use “honey” or “sweetheart”.
  • The interview process typically takes longer.
    • Consider appropriate pacing.
    • Be aware of physical limitations.
    • Allow increased response time to process information.
    • Remember the client may have more information to provide.
  • Use therapeutic touch to provide empathy.

Interviewing People with Special Needs

  • Consider key elements that address vulnerable populations.
    • Acutely ill, drug/alcohol abuse, sexually aggressive, emotionally distraught (crying), angry and/or threatening violence, and anxious.
  • Use appropriate resources as they relate to the context of the situation (e.g., security available).
  • Be alert to “personal question” queries as they may indicate ulterior motives.
    • Provide appropriate response based on personal ethics.

Culture and Genetics

  • Gender
    • Be aware of maintaining cultural norms during interview and examination.
    • Maintain privacy and modesty.
  • Sexual orientation
    • LGBTQ (Lesbian, gay, bisexual, and transgender).
    • Maintain neutrality related to the patient’s presentation by being mindful of communication patterns.
    • May need to ask what pronoun they prefer (she, he, them, they).
    • Be aware of your own personal bias and baggage.

Working with (and without) an Interpreter

  • The potential exists for a language barrier to be a key element in healthcare interactions due to cross-cultural communications.
  • Consider both verbal and nonverbal cues in communication patterns.
  • Use a bilingual team member or trained medical interpreter of the same gender, if possible.
  • Using a family member is not the preferred method.
  • Language alone does not imply understanding of cultural diversity.

Health Literacy

  • This is more than just the ability to read but rather includes understanding and following directions that lead to effective communication between the patient and the healthcare provider.
  • A patient may be literate but not have health literacy.
  • Involves the use of quantitative measurement and memory aspects.

Techniques to Improve Health Literacy

  • Oral teaching
    • Provide simple, easy instructions.
    • Use conversational structure rather than medical jargon.
  • Written materials
    • Based on standard educational levels.
    • Use 12-point font, avoiding all “CAPS” with use of bullet points.
  • Teach back
    • Encourage verification of understanding.
    • Opens the door for clarification if needed.

Communicating with Other Professionals

  • Promoting effective interpersonal communication
    • Occurs between two or more individuals of the interdisciplinary healthcare team.
    • Creates an environment of mutual respect and enhances collaboration
  • Impact of ineffective interpersonal communication
    • Linked to poor outcomes attributed to delay in treatment, medication errors, clinical misdiagnosis, patient injury, and death
  • Maintaining open lines of communication
    • Provide timely updates in an organized manner

Standardized Communication—SBAR

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