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