Chapter 3

The InterviewThe Interview
Chapter 3Chapter 3

Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 3: The InterviewChapter 3: The Interview
The InterviewThe Interview
 Subjective dataSubjective data
 Results of aResults of a
successful interviewsuccessful interview
Slide 3-2

The InterviewThe Interview (cont.)(cont.)
 GoalsGoals
 Record complete health historyRecord complete health history
 Optimal health for patientOptimal health for patient
 Identify health strengths and problems asIdentify health strengths and problems as
bridge to physical examinationbridge to physical examination
 First and most important part of data collectionFirst and most important part of data collection
 Collects subjective data: what person says aboutCollects subjective data: what person says about
his or her perceived health statehis or her perceived health state
 Individual knows everything about his or her ownIndividual knows everything about his or her own
health state, and nurse knows nothinghealth state, and nurse knows nothing
Slide 3-3

The Interview (cont.)The Interview (cont.)
 Gather complete and accurate data aboutGather complete and accurate data about
person’s health state, including descriptionperson’s health state, including description
and chronology of any symptoms of illnessand chronology of any symptoms of illness
 Establish rapport and trust so person feelsEstablish rapport and trust so person feels
accepted and free to share all relevant dataaccepted and free to share all relevant data
 Teach person about health state so that he orTeach person about health state so that he or
she may participate in identifying problemsshe may participate in identifying problems
Slide 3-4

 Build rapport to continue therapeuticBuild rapport to continue therapeutic
relationship and to facilitate future diagnoses,relationship and to facilitate future diagnoses,
planning, and treatmentplanning, and treatment
 Begin teaching for health promotion andBegin teaching for health promotion and
disease preventiondisease prevention
Slide 3-5

 Consider interview a contract between nurseConsider interview a contract between nurse
and patientand patient
 Contract consists of spoken and unspokenContract consists of spoken and unspoken
rules for behavior:rules for behavior:
 What person needs and expects from health careWhat person needs and expects from health care
and what health professional has to offerand what health professional has to offer
 Mutual goal is optimal health for patientMutual goal is optimal health for patient
Slide 3-6

 Contract terms include:Contract terms include:
 Time and place of interview and physicalTime and place of interview and physical
examinationexamination
 Introduction of and explanation of health careIntroduction of and explanation of health care
provider’s roleprovider’s role
 Purpose of interviewPurpose of interview
 How long it will takeHow long it will take
 Expectation of participation for each personExpectation of participation for each person
 Presence of others, e.g., family, etc.Presence of others, e.g., family, etc.
 Confidentiality and to what extent it may be limitedConfidentiality and to what extent it may be limited
 Any costs that the patient must payAny costs that the patient must pay
Slide 3-7

PROCESS OFPROCESS OF
COMMUNICATIONCOMMUNICATION
 SendingSending
 Communication is behavior, conscious andCommunication is behavior, conscious and
unconscious, verbal and nonverbalunconscious, verbal and nonverbal
 All behavior has meaningAll behavior has meaning
 Body language: posture, gestures, facialBody language: posture, gestures, facial
expression, eye contact, foot tapping, touch, evenexpression, eye contact, foot tapping, touch, even
where you place your chairwhere you place your chair
Slide 3-8

COMMUNICATION (cont.)COMMUNICATION (cont.)
 ReceivingReceiving
 Awareness of messages you send is only part ofAwareness of messages you send is only part of
processprocess
• Words and gestures must be interpreted in a specificWords and gestures must be interpreted in a specific
context to have meaningcontext to have meaning
 Receiver attaches meaning determined by his orReceiver attaches meaning determined by his or
her past experiences, culture, self-concept, andher past experiences, culture, self-concept, and
current physical and emotional statecurrent physical and emotional state
 Successful communication requires mutualSuccessful communication requires mutual
understanding by sender and receiverunderstanding by sender and receiver
Slide 3-9

 Receiving (cont.)Receiving (cont.)
 Patients’ health problems intensify communicationPatients’ health problems intensify communication
because patients depend on you to get betterbecause patients depend on you to get better
 Communication can be learned and polished whenCommunication can be learned and polished when
you are a beginning practitioneryou are a beginning practitioner
 Communication is a tool, as basic to quality healthCommunication is a tool, as basic to quality health
care as tools of inspection or palpationcare as tools of inspection or palpation
Slide 3-10

 Awareness of internal and external factorsAwareness of internal and external factors
and their influence allows you to maximizeand their influence allows you to maximize
communicating skillcommunicating skill
 Internal factorsInternal factors
 Liking othersLiking others
 EmpathyEmpathy
 Ability to listenAbility to listen
Slide 3-11

 External factorsExternal factors
 Ensure privacyEnsure privacy
 Refuse interruptionsRefuse interruptions
 Physical environmentPhysical environment
 DressDress
 Note-taking may be unavoidableNote-taking may be unavoidable
• Cannot rely completely on memory for details of previousCannot rely completely on memory for details of previous
illnesses or review of body systemsillnesses or review of body systems
 Tape and video recordingTape and video recording
Slide 3-12

 Challenges of note-takingChallenges of note-taking
 Breaks eye contact too oftenBreaks eye contact too often
 Shifts attention away from person, diminishing hisShifts attention away from person, diminishing his
or her sense of importanceor her sense of importance
 Interrupts patient’s narrative flowInterrupts patient’s narrative flow
 Impedes observation of patient’s nonverbalImpedes observation of patient’s nonverbal
behaviorbehavior
 May be threatening to patient’s discussion ofMay be threatening to patient’s discussion of
sensitive issuessensitive issues
Slide 3-13

TECHNIQUES OFTECHNIQUES OF
 Introducing the interviewIntroducing the interview
 Working phaseWorking phase
 Data-gathering phaseData-gathering phase
 Verbal skills include questions to patient and yourVerbal skills include questions to patient and your
responses to what is saidresponses to what is said
 Two types of questions:Two types of questions:
• Open-endedOpen-ended
• ClosedClosed
• Each has a different place and function in interviewEach has a different place and function in interview
Slide 3-14

 Open-ended questionsOpen-ended questions
 Ask for narrative responsesAsk for narrative responses
 State topic only in general termsState topic only in general terms
 Use them:Use them:
• To begin interviewTo begin interview
• To introduce a new section of questionsTo introduce a new section of questions
• Whenever the patient introduces new topicWhenever the patient introduces new topic
Slide 3-15

 Closed or direct questionsClosed or direct questions
 Ask for specific informationAsk for specific information
 Elicit short, one-or-two word answers, a yes or noElicit short, one-or-two word answers, a yes or no
answer, or a forced choiceanswer, or a forced choice
 Use them:Use them:
• After opening narrative to fill in details person may haveAfter opening narrative to fill in details person may have
left outleft out
• When you need many specific facts about past healthWhen you need many specific facts about past health
problems, or during review of systemsproblems, or during review of systems
• To move the interview alongTo move the interview along
Slide 3-16

 Responses: assisting the narrativeResponses: assisting the narrative
 Facilitation encourages patients to say more andFacilitation encourages patients to say more and
shows you are interested and will listen furthershows you are interested and will listen further
 Silent attentivenessSilent attentiveness
• Gives patient time to think and organize what to sayGives patient time to think and organize what to say
without interruption from youwithout interruption from you
• Gives you a chance to observe person unobtrusively andGives you a chance to observe person unobtrusively and
note nonverbal cuesnote nonverbal cues
 ReflectionReflection
• Echoes patient’s words, repeating what person has justEchoes patient’s words, repeating what person has just
said; focuses further attention on a specific phrase; andsaid; focuses further attention on a specific phrase; and
helps person continue in his or her own wayhelps person continue in his or her own way
Slide 3-17

 EmpathyEmpathy
 Recognizes a feeling and puts it into wordsRecognizes a feeling and puts it into words
 Names the feeling and allows expression of itNames the feeling and allows expression of it
• Patient feels accepted and can deal with feeling openlyPatient feels accepted and can deal with feeling openly
 ClarificationClarification
 Use when person’s words are ambiguous orUse when person’s words are ambiguous or
confusingconfusing
• Used to summarize person’s words and to simplify themUsed to summarize person’s words and to simplify them
to make them clearerto make them clearer
 You are asking for agreement, and the person canYou are asking for agreement, and the person can
then confirm or deny your understandingthen confirm or deny your understanding
Slide 3-18

 ConfrontationConfrontation
 Frame of reference shifts from patient’sFrame of reference shifts from patient’s
perspective to yoursperspective to yours
• May focus on discrepancy or inconsistency in person’sMay focus on discrepancy or inconsistency in person’s
narrativenarrative
• You have observed a certain action, feeling, or statementYou have observed a certain action, feeling, or statement
and now focus person’s attention on itand now focus person’s attention on it
• You give honest feedback about what you see or feelYou give honest feedback about what you see or feel
Slide 3-19

 InterpretationInterpretation
 Based on your inference or conclusionBased on your inference or conclusion
 It links events, makes associations, implies cause,It links events, makes associations, implies cause,
ascribes feelingsascribes feelings
 Helps person understand his or her own feelingsHelps person understand his or her own feelings
in relation to the verbal messagein relation to the verbal message
 If your inference is incorrect, the patient mayIf your inference is incorrect, the patient may
correct it, and thus prompt further discussion ofcorrect it, and thus prompt further discussion of
topictopic
Slide 3-20

 ExplanationExplanation
 These statements inform the person; you shareThese statements inform the person; you share
factual and objective information offering reasonsfactual and objective information offering reasons
for requirements or actionsfor requirements or actions
 SummarySummary
 Final review of what person has said; it condensesFinal review of what person has said; it condenses
facts and presents your view of health problemfacts and presents your view of health problem
 Is a type of validation that person can agree withIs a type of validation that person can agree with
or correct; both you and patient should participateor correct; both you and patient should participate
 Occurring at the end of the interview, it signals thatOccurring at the end of the interview, it signals that
termination of the interview is neartermination of the interview is near
Slide 3-21

 These responses now include your ownThese responses now include your own
thoughts and feelingsthoughts and feelings
 Use the last four responses only whenUse the last four responses only when
merited by the situationmerited by the situation
 If you use them too often, you take over atIf you use them too often, you take over at
the patient’s expensethe patient’s expense
Slide 3-22

 Ten traps of interviewingTen traps of interviewing
 Providing false assurance or reassuranceProviding false assurance or reassurance
 Giving unwanted adviceGiving unwanted advice
 Using authorityUsing authority
 Using avoidance languageUsing avoidance language
 Engaging in distancingEngaging in distancing
 Using professional jargonUsing professional jargon
 Using leading or biased questionsUsing leading or biased questions
 Talking too much or interruptingTalking too much or interrupting
 Using “why” questionsUsing “why” questions
Slide 3-23

 Nonverbal skillsNonverbal skills
 Physical appearancePhysical appearance
 PosturePosture
 GesturesGestures
 Facial expressionFacial expression
 Eye contactEye contact
 VoiceVoice
 TouchTouch
 Closing the interviewClosing the interview
Slide 3-24

DEVELOPMENTAL CAREDEVELOPMENTAL CARE
 Interviewing parentsInterviewing parents
 InfantsInfants
 PreschoolersPreschoolers
 School-age childrenSchool-age children
 AdolescentsAdolescents
 Older adultsOlder adults
Slide 3-25

INTERVIEWING PEOPLEINTERVIEWING PEOPLE
WITH SPECIAL NEEDSWITH SPECIAL NEEDS
 People who are hearing-impairedPeople who are hearing-impaired
 People who are acutely illPeople who are acutely ill
 People under influence of street drugs or alcoholPeople under influence of street drugs or alcohol
 People who must be asked personal questionsPeople who must be asked personal questions
 People who are sexually aggressivePeople who are sexually aggressive
 People who are cryingPeople who are crying
 People who are angry and threatening violencePeople who are angry and threatening violence
 People who are anxiousPeople who are anxious
Slide 3-26

CROSS-CULTURAL CARECROSS-CULTURAL CARE
 Probability of miscommunication increasesProbability of miscommunication increases
with two people from different culturalwith two people from different cultural
backgroundsbackgrounds
 Cultural backgrounds of both health careCultural backgrounds of both health care
professional and patient influence verbal andprofessional and patient influence verbal and
nonverbal communicationsnonverbal communications
Slide 3-27

CROSS-CULTURALCROSS-CULTURAL
 Cultural perspectives on professionalCultural perspectives on professional
interactionsinteractions
 EtiquetteEtiquette
 Space and distanceSpace and distance
 Cultural considerations on genderCultural considerations on gender
 Cultural considerations on sexual orientationCultural considerations on sexual orientation
Slide 3-28

OVERCOMING COMMUNICATIONOVERCOMING COMMUNICATION
BARRIERSBARRIERS
 Working with and without interpretersWorking with and without interpreters
 Nonverbal cross-cultural communicationNonverbal cross-cultural communication
 TouchTouch
 Touching patients is a necessary component ofTouching patients is a necessary component of
comprehensive assessmentcomprehensive assessment
 Physical contact with patients conveys variousPhysical contact with patients conveys various
meanings cross-culturallymeanings cross-culturally
 Patient’s significant others may exertPatient’s significant others may exert
pressure on nurses by enforcing culturallypressure on nurses by enforcing culturally
meaningful norms in health care settingmeaningful norms in health care setting
Slide 3-29

BARRIERS (cont.)BARRIERS (cont.)
 Five types of nonverbal behaviors conveyFive types of nonverbal behaviors convey
information about personinformation about person
 Vocal cues: pitch, tone, and quality of voice,Vocal cues: pitch, tone, and quality of voice,
including moaning, crying, and groaningincluding moaning, crying, and groaning
 Action cues: posture, facial expression, andAction cues: posture, facial expression, and
gesturesgestures
 Object cues: clothing, jewelry, and hair stylesObject cues: clothing, jewelry, and hair styles
 Personal space: interpersonal transactions andPersonal space: interpersonal transactions and
care of belongingscare of belongings
 Touch: involves use of personal space and actionTouch: involves use of personal space and action
Slide 3-30

BARRIERS (cont.)BARRIERS (cont.)
 In some cultures, it is considered anIn some cultures, it is considered an
acceptable expression of friendship andacceptable expression of friendship and
affection to openly and publicly hold handsaffection to openly and publicly hold hands
with or embrace members of same genderwith or embrace members of same gender
with no sexual connotationwith no sexual connotation
 You may find that a patient displays similarYou may find that a patient displays similar
behaviors and should feel free to discussbehaviors and should feel free to discuss
cultural differences and similarities openlycultural differences and similarities openly
with the personwith the person
Slide 3-31

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