Chapter 3: The Interview Flashcards
interview purpose
-Best chance to gain an understanding of the patient’s beliefs, concerns, and perception of their individual health state
-Allows for compilation of subjective data and awareness of objective data (physical appearance, posture, ability to carry on a conversation, and demeanor)
interview contract terms
-Location: Time and place with follow-up for physical exam
-Explanation: Introduction and delineation of role
-Purpose: Mutual goal is optimal health.
-Time frame: Length of time for process
-Participation: Expected participation and/or presence of others
-Confidentiality: Reasonable and/or limited as it applies to legal/ethical standards
-Cost: Disclosure of any financial costs
process of communication include:
sending?
internal factors?
external factors?
sending: verbal and nonverbal communication
internal factors:
-Liking others:using a “genuine” approach
-Empathy: develop an understanding and sensitivity
for others feeling’s
-Ability to listen: using an “active” process
-Self-awareness: be aware of “implicit bias”
external factors:
-Ensure privacy: aim for “geographic” privacy but ensure “psychological” privacy
-Avoid interruption:minimize and/or refuse
-Physical environment: “equal status” seating
-Dress: appearance and comfort
-Note-taking: keep to a minimum, offer “focused” attention
what is EHR
Electronic Health Record
-Federal government mandates to improve quality and safety
-Do not allow the computer to become a “barrier” in the communication exchange process
techniques of communication
-Introducing the interview: keep it short and formal
-Working phase:
-Data-gathering phase
-Verbal skills include questions to patient and your responses to what is said
-Two types of questions
* Open-ended—asks for narrative information
* Closed—asks for specific information leading to a forced
choice (yes or no)
nine types of verbal responses that fall under patient perspective and interviewer perspective
-Facilitation: encourages 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
-Confrontation: clarifying inconsistent information
-Interpretation: makes association to identify cause or conclusion
-Explanation: informing person by sharing factual and objective information
-Summary: provides conclusion based on verified information which in turn identifies that the interview process is closing
10 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
-the quality of being similar to or in agreement with something
-When verbal and nonverbal messages are congruent, the verbal message is reinforced
-When they are incongruent, nonverbal message is viewed as the truer one as it is under unconscious control
what are the nonverbal mods of communication
-physical appearance
-posture
-getsures
-facial expression
-eye contact
-voice/tone
-touch
closing the interview
-Ending should be gradual thereby
allowing for adequate closure to allow for final expression
-No new topics introduced
-Summary provided as final statement
Interviewing the parent or caregiver of a child or children
-Focus on both individuals so as to encourage participation
-Obtain information and relevant data
stages of cognitivei development
infants (birth to 1 year): Gentle
handling with quiet, calm voice
toddlers (1-3 years): Give one
direction at a time and
provide simple explanations
preschoolers (3-6): short directions with concrete explanation
school-age (7-12): Ask questions
to gather data and be nonjudgmental
adolescents:Respectful, honest attitude with focus on the individual
interviewing people with special needs:
-Consider key elements that will 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
-Be alert to “personal question” queries as they may indicate ulterior motives
health literacy
-A patient may be literate but not have health literacy.
-Involves the use of quantitative measurement and memory aspects
-Tools for determining literacy:
-Several available vary in terms of reliability and validity and time
needed to administer
-Follow established policy and procedure in clinical practice
settings
techniques to improve health literacy
-oral teaching
-written materials
-teach back
