the interview

The Interview

Chapter 4

Subjective Data
  • Definition: What the patient says about themselves.
  • Purposes of the interview:
    • To gather complete and accurate data.
    • To establish rapport and trust with the patient.
    • To facilitate teaching and health promotion for the patient.
    • To consider the Social Determinants of Health affecting patient care.
Communication
  • Emphasized in course 1511.
  • Considerations:
    • Physical, mental, and emotional dimensions of communication.
    • Importance of both verbal and non-verbal communication.
  • Skills Required:
    • Unconditional Positive Regard: Accepting and supporting the patient without judgment.
    • Empathy: Understanding and sharing the feelings of the patient.
    • Active Listening: Engaging fully with the patient to understand their message.
Physical Setting
  • Privacy:
    • Geographical: Ensure a private space.
    • Psychological: Create an atmosphere that feels safe for the patient to share.
  • Minimizing Interruptions:
    • Essential for building good rapport and gathering comprehensive data.
  • Environment Considerations:
    • Ensure personal space is respected.
    • Arrange the space to be conducive to conversation.
    • Sit at eye level with the patient.
    • Maintain a comfortable atmosphere (appropriate lighting, temperature, reduced noise).
Physical Setting Cont’d
  • Professional dress:
    • Dress appropriately to maintain professionalism during interactions.
  • Notes:
    • Taking notes can often be necessary but may have disadvantages such as disrupting the flow of conversation.
    • Nurse should judge when to note-take, ensuring it does not impede communication.
  • Telehealth Considerations:
    • All aspects of the physical setting apply, even in a virtual format.
    • Telehealth is time effective and increases accessibility for many patients.
Interview Techniques
  • Introducing Phase:
    • Keep it short and simple.
    • Example: “Hi (patient's name), My name is ____ and I will be your Nursing Student today. I am here to ask you some questions about your health.”
    • Explain to the patient that redundancy is acceptable. Questions may be rephrased based on previous responses to gain more information.
Interview Techniques Continued
  • Working Phase:
    • Comparison of Open-Ended and Closed Questions:
    • Open-Ended Questions:
      • Purpose: Used for narrative information; calls for longer answers.
      • Encourages the expression of feelings, experiences, understandings, opinions, and ideas.
      • Benefits: Builds and enhances rapport with patients.
    • Closed Questions:
      • Purpose: Used for specific information; calls for short (one- to two-word) answers.
      • Elicits facts but can limit rapport and neutrality in interaction.
Assisting the Conversation
  • Facilitation Skills:
    • Silence: Use appropriately to allow time for thoughts.
    • Reflection: Repeat what the patient has said to show understanding.
    • Empathy: Connect with the patient's feelings.
    • Clarification: Help clear up any confusion in communication.
    • Interpretation: Offer an explanation based on what the patient has shared.
    • Explanation: Provide information clearly and concisely.
    • Summary: Recap important points made during the discussion.
Ten Traps of Interviewing
  1. Providing false assurance or reassurance.
  2. Giving unwanted advice.
  3. Using authority.
  4. Using avoidance language.
  5. Engaging in distancing.
  6. Using professional jargon.
  7. Using leading or biased questions.
  8. Talking too much.
  9. Interrupting.
  10. Using “why” questions.
Nonverbal Skills
  • Physical Appearance: Maintain a professional presentation.
  • Posture: Convey attentiveness and engagement.
  • Gestures: Use appropriate gestures to enhance communication.
  • Facial Expressions: Non-verbal cues that reflect empathy and understanding.
  • Eye Contact: Necessary for building rapport and trust.
  • Voice Tone: Should be warm and inviting, avoiding harshness.
  • Silence: Can be powerful in allowing the patient to express themselves.
  • Bodily Exposure and Touch: Be aware of appropriateness in context.
Closing the Interview
  • Ask:
    • “Is there anything else you would like to mention?”
    • “Are there any questions you would like to ask?”
    • “Are there other areas I should have asked about?”
    • “Did we accomplish what you had hoped?”
Considerations
  • Safety and comfort for:
    • Hearing impaired patients.
    • Acutely ill patients.
    • Patients influenced by drugs or alcohol.
    • Patients exhibiting sexual advances/inappropriateness.
    • Patients who are crying or expressing emotional distress.
    • Patients threatening violence.
    • Anxious patients.
    • Language barriers affecting communication.

Chapter 5

The Complete Health History
Biographical Data
  • Collect relevant patient information that allows patient self-identification.
  • Source of History:
    • Identify who provided the information: the patient or another source (family, case files).
  • Reason for Seeking Care:
    • Record the patient's reason as a quote.
    • Document relevant signs, symptoms, and their duration.
Current Health or History of Current Illness
  • Use the PQRSTU method:
    • P: Provocation/Palliation
    • Q: Quality/Quantity
    • R: Region/Radiation
    • S: Severity Scale
    • T: Timing (Onset, Duration, Frequency)
    • U: Understanding the patient’s perception.
Past Health History
  • Include:
    • Childhood history.
    • Accidents and injuries.
    • Chronic conditions and their management.
    • Hospitalizations and/or surgical history.
    • Obstetrical history for women.
    • Immunization status.
    • Date of the last examination.
    • Allergies (include reactions).
    • Medications (current and previous).
Family Health History
  • Document the age, health status, and cause of death of blood relatives (parents, grandparents, siblings).
  • Analyze the impact of family health history on the patient.
  • Include family history of conditions such as:
    • Heart disease.
    • High blood pressure.
    • Diabetes.
    • Cancer.
    • Mental illness.
Review of Systems
  • Conduct a thorough review of the following systems:
    • General overall health state.
    • Skin, Hair, and Nails.
    • Head, Eyes, Ears, Nose, and Throat.
    • Neck, Breast, Axilla.
    • Respiratory system.
    • Cardiovascular system.
    • Peripheral vascular system.
    • Gastrointestinal system.
    • Urinary system.
    • Genital system and Sexual health.
    • Musculoskeletal system.
    • Neurologic system.
    • Hematologic system.
    • Endocrine system.
Functional Assessment, Including Activities of Daily Living
  • Measure a patient’s self-care ability through Activities of Daily Living (ADLs), including:
    • Examples of ADLs:
    • Bathing.
    • Dressing.
    • Toileting.
    • Eating.
    • Walking.
    • Instrumental Activities of Daily Living (IADLs):
    • Activities necessary for independent living, e.g., housekeeping, shopping, cooking, laundry, phone use, financial management.
Functional Assessment Continued
  • Assess the following factors:
    • Self-esteem and self-concept.
    • Activity and exercise level.
    • Sleep and rest patterns.
    • Nutrition and elimination habits.
    • Interpersonal relationships and resources.
    • Spiritual resources.
    • Coping and stress management strategies.
Functional Assessment Continued
  • Evaluate personal habits:
    • Tobacco use.
    • Alcohol consumption.
    • Substance use and abuse.
  • Consider environmental hazards that may affect health.
  • Review occupational health considerations, including exposure to risks in their work environment.
  • Identify any experiences of intimate partner violence.
Perception of Health
  • Questions to discuss:
    • “How do you define health?”
    • “How do you view your current situation?”
    • “What are your concerns or goals regarding your health?”
    • “What do you anticipate will happen in the future concerning your health?”
    • “What are your expectations from your healthcare providers?”
Reminder
  • Labs commence this week.
  • Complete Chapters 4 & 5 of your lab manual prior to lab session.
  • Bring your textbook to the lab.
  • Review the Nursing Lab Code of Conduct from the welcome PowerPoint.
  • If you have purchased a uniform pair of scrubs and they have not arrived, wear professional attire to the lab in the meantime.
  • Order/Purchase a stethoscope for use in the upcoming week.