Interviewing

INTERVIEWING
• Obtaining a valid nursing health history requires
professional, interpersonal, and interviewing
skills. The nursing interview is a communication
process that has two focuses:
1. Establishing rapport and a trusting relationship
with the client to elicit accurate and meaningful
information
 INTERVIEWING
2. Gathering information on the client’s
developmental, psychological,
physiologic, sociocultural, and spiritual
status to identify deviations that can be
treated with nursing and collaborative
interventions or strengths that can be
enhanced through nurse-client
collaboration.
 Phases of the Interview
The nursing interview has 4 basic phases:
1. pre-introductory phase
2. introductory phase
3. working phase
4. summary and closing phase
 Pre-Introductory Phase
• The nurse reviews the medical record
before meeting with the client. Knowing
some of the client’s already documented
biographical information may assist the
nurse with conducting the interview.
• The record may also reveal the client’s
past health history and reason for
seeking health care. However, there may
not be a medical record established in
some instances.
 Introductory Phase
• The nurse explains the purpose of the
interview, discusses the types of questions
that will be asked, explains the reasons for
taking notes, and assures the client that
confidential information will remain
confidential.
 Introductory Phase
• The nurse makes sure that the
client is comfortable
(physically and emotionally)
and has privacy. Conducting
the interview at eye level with
the client demonstrate respect
and places the nurse and the
client at equal level.
Introductory Phase
• At this point in the interview, it is also
essential for nurses to develop trust and
rapport, which are essential to promote
full disclosure of information. The nurse
can begin this proces by conveying a
sense of priority
and interest in the client.
• Developing rapport depends heavily on
verbal and nonverbal communication on
the part of the nurse.
 Working Phase
• The nurse elicits the client’s comments
about major biological data, reasons for
seeking care, history of present health
concern, past health history, family history,
review of body system for current health
problems, lifestyle and health practices,
and developmental level.
 Working Phase
• The nurse then listens, observes cue, and
uses critical thinking skills to interpret and
validate information received from the
client.
 Working Phase
• The nurse and client collaborate to identify
the client’s problems and goals. The
facilitating approach may be free-flowing
or more structured with specific questions,
depending on the time available and the
type of data needed.
 Summary and Closing Phase
• The nurse summarizes the information
obtained during the working phase and
validates problems and goals with the
client.
• She also identifies and discusses possible
plans to resolve the problem (nursing
diagnosis and collaborative problems) with
the client.
 Summary and Closing Phase
• Finally, the nurse makes
sure to ask if anything
else concerns the client
and if there are any
further questions.
 Communication During the
Interview
• The client interview involves two types
of communication: verbal and non-verbal.
• Several special techniques and certain
general considerations will improve both
types of communication as well as promote
an effective and productive interview.
 Non-verbal Communication
• It is important because the techniques that
the nurse will use will show on how the
client perceives the questions that the nurse
will ask.
• Facilitate eye to eye contact
and never overlook the
importance of communication
or take it for granted
 1. Appearance
• Ensure that your appearance is professional. The
client is expecting to see a health professional;
therefore, you should look the part.
• Wear a comfortable neat clothes and be sure that
your nametag is clearly visible.
• Your hair should be neat and pulled back if long.
Fingernails should be short and neat; jewelry
should be minimal.
 2. Demeanor
• When you enter a room to interview a client,
display poise. Focus on the client and the
upcoming interview and assessment.
• Do not enter the room laughing loudly, yelling to
coworkers, or muttering under your breath. This
appears unprofessional to the client and will have
an effect on the entire interview process.
 2. Demeanor
• Greet client calmly, by name and not with
references such as honey, sweetie, or sugar.
• Focus your full attention on the client. Do
not overwhelming friendly or “touchy”;
many clients are uncomfortable with this
type of behavior. It is best to maintain a
professional distance.
 3. Facial Expression
• Facial expression is often overlooked aspect of
communication. Because facial expressions often
show what you are truly thinking (regardless of
what you are saying), monitor them closely.
• No matter what you think about a client or what
kind of day you are having, keep your expression
neutral and friendly.
• If your face shows anger or anxiety, the client
will sense it and may think it is
directed towards him or her.
 3. Facial Expression
• Displaying a neutral expression does not mean
that your face lacks expression. It means using
the right expression at the right time, if the client
looks upset, you should appear and be
understanding and concerned.
• Conversely, smiling when the client is on the
verge of tears will cause the client to believe that
you do not care about his or her problems
 4. Attitude
• One of the most important nonverbal skills to
develop as a health care professional is a
nonjudgmental attitude.
• All clients should be accepted, regardless of
beliefs, ethnicity, lifestyle, and health care
practices.
• Do not act as though you feel superior to the
client or appear shocked, disgusted, or surprised
at what you are told.
 4. Attitude
• These attitudes will cause the client to feel
uncomfortable about opening up to the
nurse, and important data concerning his or
her health status could be withheld.
 5. Silence
• Periods of silence allow you and the client
to reflect and organize thoughts which
facilitate more accurate reporting and data
collection.
 6. Listening
• It is the most important skill to learn and
develop fully in order to collect complete
and valid data from your client.
• To listen effectively, you need to maintain
good eye contact, smile or display an open,
appropriate facial expressions, and
maintain an open body position (open arms
and hands, and lean forward).
 6. Listening
• Avoid preconceived ideas or biases about
your client.
• Avoid crossing your arms, sitting back,
tilting your head away from the client,
thinking about other things, looking blank
or inattentive, or engaging with an
electronic device instead of the client.
• Becoming an effective listener takes
concentration and practice.
 Verbal Communication
• Effective verbal communication is
essential to a client interview. The goal of
the interview process is to elicit as much
data about the client’s health status as
possible.
• Several types of questions and techniques
to see during the interview are follows:
 1. Open – Ended
Questions
• It is used to elicit the client’s feelings and
perceptions. They typically begin with the words
“how” or “what”.
• This question is important because they require
more than one-word response from the client and,
therefore, encourage description.
• Asking open-ended questions may help to reveal
significant data about the client’s health status.
 2. Close – Ended
Questions
• Use close-ended questions to obtain facts and to
focus on specific information. The client can
respond with one or two words.
• Closed-ended questions typically begin with the
words “when” or “did.” Closed-ended questions
are useful in keeping the interview on course.
• They can also be used to clarify or obtain more
accurate information about issues disclosed in
response to open-ended question.
 3. Laundry List
• Another way to ask questions is to provide
the client with a list of words to choose
from in describing symptoms, conditions,
or feelings.
• This laundry list approach helps you to
obtain specific answers and reduces the
likelihood of the client perceiving or
providing an expected answer.
 4. Rephrasing
• Rephrasing information the client has
provided is an effective way to
communicate during the interview.
• This technique helps you to clarify
information the client has stated.; it is also
enables you and the client to reflect on
what was said.
 5. Well-Placed
Phrases
• The nurse can encourage client
verbalization by using well-placed phrases.
• Listen closely to the client during his or her
description and use phrases such as “uh-
huh”, “yes”, or “I agree” to encourage the
client to continue.
 6. Inferring
• Inferring information from what the client tells
you and what you observe in the client’s behavior
may elicit more data or verify existing data.
• Be careful not to lead the client to answers that
are not true. This technique, if used properly,
helps to elicit the most accurate data possible
from the client.
 7. Providing
Information
• Another important thing to do throughout the
interview is to provide the client with information
as questions and concerns arise.
• Make sure your answer every questions as
thoroughly as you can.
• If you do not know about their own health, the
more they likely they are to be equal participants
in caring for their health.
 Communication to
Avoid
A. Nonverbal Communication
1. Excessive or insufficient eye contact
•Avoid extreme eye contact. Some clients feel very
uncomfortable with too much eye contact; other
believe that you are hiding something from them if
you do not look them in the eye. Therefore, it is
best to use moderate amount of eye contact.
 2. Distraction and
distance
• Avoid being occupied with something else
while you are asking questions during the
interview. This behavior makes the client
believe that the interview may be
unimportant to you.
• Avoid appearing mentally distant as well.
The client will sense your distance and will
be less likely to answer your questions
thoroughly.
 2.Distraction and
distance
• Rapport and trust are established when
client sense that you focus and concern are
solely on them and their health.
• Physical distance may portray a noncaring
attitude or a desire to avoid close contact.
 3. Standing
• Avoid standing while the client is seated
during the interview. Standing puts you
and the client at different levels. You may
be perceived as the superior, making the
client feel inferior.
• Care of the client’s health should be an
equal partnership between the health care
provider and the client.
 3. Standing
• If the client is made to feel inferior, he or
she will not feel empowered to be an equal
partner and the potential for optimal health
may be lost.
• In addition, vital information may not be
revealed if the client believes that the
interviewer is untrustworthy, judgmental,
or disinterested.
 B. Verbal Communication
1. Biased or Leading questions

• Avoid using biased or leading questions.

These cause the client to provide answers
that may not be true.
• The way you phrase a
question may actually lead
the client to think you want her to answer in
a certain way.
 2. Rushing through the
Interview
• Avoid rushing the client. If you ask questions on
top of questions, several things may occur.
• With this type of interview
technique, the client may believe
that his individual situation is of
little concern to the nurse.
• Taking time with clients shows that you are
concerned about their health and helps them to
open up.
 2. Rushing through the
Interview
• Finally, rushing someone through the
interview process undoubtedly causes
important information to be
left out of the health history.
• A client will usually sense
that you are rushed and may try to help hurry
the interview by providing abbreviated or
incomplete answers to questions.
 3. Reading the questions
• Avoid reading questions from the history form.
This deflects attention from the client and results
in an impersonal interview
process.
• As a result, the client may feel
ill at ease opening up to a
formatted question.
 Special Considerations
During the Interview
• Three variations in communications must
be considered as you interview clients.
• These variations affect the nonverbal and
verbal techniques you use during the
interview.
 1. Gerontologic Variations
in Communication
• Age affect and commonly slows
all body systems to varying degrees.
However, normal aspects of aging
do not necessarily equate with a health
problem
• it is important not to approach an interview
with an elderly client assuming that there is
a health problem.
 1. Gerontologic Variations
in Communication
• Older clients may have the potential to be
as healthy as younger clients.
• When interviewing an older client, you
must first assess hearing acuity.
• Hearing loss occurs normally with age, and
undetected hearing loss is often
misinterpreted as mental slowness
or confusion
 1. Gerontologic Variations
in Communication
• If you detect hearing loss,
speak slowly, face the client at
all times during the interview, and
position yourself so that you are speaking on
the side of the client that has the ear with
better acuity.
• Positioning yourself facing the
client allows a client who reads
lips to better understand.
 1. Gerontologic Variations
in Communication
• Establish trust, privacy, and partnership with the
older client is important.
• Older client may feel as though their health
complaints are ignored, or not taken seriously,
causing them to withhold information.
• Speak clearly and use straightforward language
during the interview with the older client.
• Ask questions in simple terms. Showing
respect is very
important.
 2. Cultural Variations in
Communications
• Ethnic/cultural variations in
communication and self-disclosure
styles may significantly affect the
information obtained.
• Be aware of possible variations in your
communication style and the client’s.
• If misunderstanding or difficulty in
communicating is evident, seek
help from an expert.
 2. Cultural Variations in
Communications
• Frequently noted variations in
communication styles include:
a. Reluctance to reveal personal information
to strangers fro various culturally based
reason
b. Variations in willingness to openly express
emotional distress or pain
c. Variations in ability to receive
information
 2. Cultural Variations in
Communications
d. Variations in meaning conveyed by language.
e. Variation in use and meaning of nonverbal
communication; eye contact, stance, gestures,
demeanor
f. Variations in disease/illness perception; culture-
specific syndromes or disorders are accepted by
some groups
 Cultural Variations in
Communications
g. Variations in past, present, or future time
orientation
h. Variations in the family’s role in the
decision-making process
 3. Emotional Variations in
Communication
• Client’s emotions vary for a number of reasons.
They may be scared or anxious about their health
or about disclosing personal information, angry
that they are sick or about having to have an
examination, depressed about their health or
other life events or they may have an ulterior
motive for having an assessment performed.
 3. Emotional Variations in
Communication
• Not every client you encounter will be
calm, friendly and eager to participate in
the interview process.
 Interacting with clients with
various emotional Status
1.When interacting with an anxious client
•Provide with simple, organized information in a
structured format
•Explain who you are, along with your role and
purpose
•Ask simple, concise questions
•Avoid becoming anxious also
•Do not hurry, and decrease any external stimuli
 Interacting with clients with
various emotional Status

2. When interacting with an angry client

• Approach the client in a calm, reassuring,
in-control manner
• Allow the client to ventilate feelings.
However, when the client is out of control,
do not argue with or touch the client
 Interacting with clients with
various emotional Status

• Obtain help from other health care

professionals as needed.
• Avoid arguing and facilitate personal space
so that the client does not feel threatened
• Never allow the client to position him or
herself between you and the door
 Interacting with clients with
various emotional Status

3. When interacting with a depressed client

• Express interest in and understanding of
the client and respond in a natural manner
• Do not try to communicate in an upbeat,
encouraging manner.
 Interacting with clients with
various emotional Status
4. When interacting with a manipulative client
• Provide structure and set limits
• Differentiate between manipulation and a
reasonable request
• If you are not sure whether you are being
manipulated, obtain an objective opinion from
other nursing colleague
 Interacting with clients with
various emotional Status
5. When interacting with seductive client
• Set firm limits on evert sexual client behavior
and avoid responding to subtle seductive
behavior
• Encourage client to use more appropriate
methods of coping in relating to others
• If the overt sexually continues, do not
interact without a witness
• Report inappropriate behavior
to a supervisor
 Interacting with clients with
various emotional Status

6. When discussing sensitive issues

• First, be aware of your own thoughts and
feelings regarding dying, spirituality, and
sexuality; then recognize that these factors
may affect the client’s health and may need
to be discussed with someone
• Ask simple questions in a
nonjudgmental manner
 Interacting with clients with
various emotional Status

• Allow time for ventilation of client’s

feelings as needed.
• If you do not feel comfortable or
competent discussing personal, sensitive
topics, you make referrals as appropriate.
Thank You