The Interview
purposeful conversation between the nurse and the patient
goal is to gather a complete health history
o foundation which data collection and the process of assessment are based
o comprehensiveness will depend on the information available in the patient’s
record
skill in interviewing > glean all the necessary information elicited as well as build rapport
for a successful nurse-patient relationship
Purpose
Encourage information between the client and the nurse
o gather, organized, complete and accurate data about the patient’s health state.
chronology and description of any signs and symptoms of illness
o establish rapport and trust
o teach the patient about the health state
o build rapport for a contiuing nurse-patient theraoeutic relationship
o begin teaching for health promotion and disease prevention
Forming a contract between the nurse and the patient
o time and place of the interview and succeeding physical examination
o introduction of self and the brief explanation of the nurse’s role
o the purpose of the interview
o how long will it take?
o expectation of participation for each patient
o presence of any other people
o confidentiality and its limitation
o any costs that the patient may pay
THE COMMUNICATION PROCESS
SENDING
through verbal and non verbal communication
verbal communication
o spoken or written words, vocalizations
non verbal communication
o gestures, facial expressions, posture, body movement, voice tone and volume, rate
of speech, dress
o under less conscious control
o more accurate expressio of one’s inner thoughts and feelings
RECEIVING
words and gestures must be interpreted in a specific context to have meaning
FACTORS THAT AFFECT COMMUNICATION
INTERNAL FACTORS
Liking others
o atmosphere of warmth and caring
o patient must feel that he or she is accepted
Empathy
o viewing the world from the other person’s inner frame of reference while
remaining one’s self (“putting oneself in the shoes of other”)
o recognizing and accepting the other person’s feelings without criticism
o “feeling with the person rather than feeling like the person”
EXTERNAL FACTORS
Ensure privacy
Refuse Interruptions
Physical Environment
Dress
Note-taking
Tape and Video Recording, Computer Recording
PHASES OF THE INTERVIEW
1. PREPARATORY PHASE
“Pre-interaction phase
actions to be taken by the nurse is to ensure that the interview will be as productive as
possible
a. Review as much information as possible about the patient
b. Decide what data is needed and what type of data collection form will be used
c. Review the literature pertinent to the patient’s developmental age, psychosocial
aspects and pathophysiological considerations if needed
d. Assess own feelings or reactions to previous patients that might interfere with the
nurse - patient relationship
e. Seek assistance from more experienced nurses, mentors or supervisors as
needed
f. Plan for a private, quiet setting for the interview; schedule a mutually convenient
time of day; and determine the length of time needed for data collection
g. Modify the environment to facilitate the interview
2. INTRODUCTORY PHASE
“orientation phase”
assist in establishing rapport, clarifying roles, and alleviating anxiety
o Introduce self by name and position and explain the purpose and content of the
interview
o Begin to establish rapport with the patient by conveying a caring, interested
attitude
o Observe the patient’s behavior and listen attentively to determine the patient’s self
perception and how the patient view his or her problems
o Let the patient know how long the nurse-patient relationship is expected to last
o Inform the patient how the information collected will be used and that
confidentiality will be maintained
o Start with non threatening specific questions and proceed to open-ended questions
o establish a verbal contract with the patient, incorporating the goals of the
interview
3. MAINTENANCE PHASE
“working phase”
the nurse and the patient work toward achieving the specific task or goal agreed on in the
introductory phase
Actions to be taken by the nurse:
o Keep focused on the tasks or goals
o Encourage the patient to express his or her feelings concerns and questions
o Use techniques that facilitate communication between the nurse and patient
o Observe the non verbal behavior that accompanies verbal responses
o Assess the patient’s ability to continue the interview
o Facilitate goal attainment by moving to the next step of discussion after needed
data are collected
4. CONCLUDING PHASE
termination phase
o review goal or task attainment
o summarize the highlights of the interview and its meaning to the nurse and patient
o encourage the patient to share his or her feelings regarding the termination of the
nurse-patient relationship
o use language congruent with the client’s culural background and local custom
TYPES OF QUESTIONS USED DURING INTERVIEW
OPEN ENDED QUESTIONS
o asks for narrative information
o unbiased; let the person answer the question in any way
o encourages the patient to answer in paragraphs and to give spontaneous account
o let the person express himself or herself fully
o builds and enhances rapport
CLOSED OR DIRECT QUESTION
o asks for specific information
o elicits a short one or two word answer, a yes or no, or a forced choice
o use direct question after the person’s narrative to fill in any details he or she left
out
o use direct question when you need many specific facts
o it limits rapport and leaves interaction neutral
TECHNIQUES OF COMMUNICATION
Facilitation of General Leads
Silence
Reflection
Empathy
Clarification
Confrontation
Explanation
Interpretation
Summary
TEN TRAPS OF COMMUNICATION
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
DISTANCE ZONES
Intimate Zone (0 to1 1/2 feet)
o Visual distortions occur
o Best for assessing breast and other body odors
Personal DIstance ( 1 1/2 to 4 feet)
o No visual distortion
o Body Odors Inapparent
o Much of the physical assessment occur at the distance
Social Distance (4 to 12 feet)
o used for impersonal business transactions
o perceptual information less detailed
Public Distance (12 feet or more)
o Interaction with others is impersonal
o Speaker’s voice must be projected
o Subtle facial expressions are imperceptible
DEVELOPMENTAL COMPETENCE
Interviewing the parent or caregiver
The Infant
The Preschooler
The School - Aged Children
The Adolescent
The Older Adult
INTERVIEWING PEOPLE WITH SPECIAL NEEDS
Hearing Impaired People
Acutely Ill People
People Under the Influence of Street Drugs or Alcohol
Personal Questions
Sexually Aggressive People
Crying
Anger
Threats of Violence
Anxiety
NON VERBAL SKILLS
Physical Appearance
Posture
Gestures
Facial Expression
Eye Contact
Voice
Touch
