EFFECTIVE INTERVIEW AND HEALTH HISTORY

Question 1

• Conversation with a Purpose
• Interpersonal Skills
• Improve the Patient’s Well-being—Primary Goal of the Nurse-Patient Interview

Answer 1

health history interview

Question 2

• structured framework for
organizing patient information in
written or verbal form for other
health care providers
• focuses the nurse’s attention on
specific kinds of information that
must be obtained from the patient

Answer 2

health history format

Question 3

Much more fluid and demands effective communication and relational skills ; elicit accurate information and the interpersonal skills that allow you to respond to the patient’s feelings and concerns

Answer 3

interviewing process

Question 4

• Take Time for Self-Reflection.
• Review the Medical and Nursing Records.
• Set interview goals
• Review own clinical behavior
and appearance
• Adjust the environment
• Take notes

Answer 4

pre interview

Question 5

• Greet the patient andestablish rapport
• Establish the agenda for
the interview

Answer 5

introduction

Question 6

Mnemonic to responding to emotional cues of the patient

Answer 6

NURS

naming
understanding
respecing

Question 7

• Invite the patient’s story
• Identify and respond to emotional
clues
• Expand and clarify the patient’s story
• Generate and test diagnostic hypotheses
• Create a shared understanding of the problem
• Negotiate a plan

Answer 7

working

Question 8

Mnemonic for the patient’s perspective on the illness

Answer 8

FIFE

feelings
ideas
effect on function
expectations

Question 9

• Summarize important points
• Discuss plan of care
• Give patient chance to ask
questions

Answer 9

termination

Question 10

What are the techniques of skilled interviewing?

Answer 10

• Active listening
• Guided questioning
• Nonverbal communication
• Empathic responses
• Validation
• Reassurance
• Summarization
• Transitions
• Empowering the patient

Question 11

process of closely attending to what the patient is communicating, being aware of the patient’s emotional state, and using verbal and nonverbal skills to encourage the speaker to continue and expand

Answer 11

active listening

Question 12

• Goal is to facilitate the patient’s fullest communication.
• Encourages patient disclosures while minimizing the risk for distorting the patient’s ideas or missing significant details.

Answer 12

Guided Questioning : Options to Expand
and Clarify the Patient’s Story

Question 13

• Allows the nurse to both “read the patient” more effectively and
  send messages.
• Pay close attention to eye contact, facial expression, posture, head position and movement such as shaking or nodding, interpersonal distance, and placement of the arms or legs—crossed, neutral, or open.

Answer 13

nonverbal communication

Question 14

• Conveying empathy greatly strengthens patient rapport.
• To provide empathy, first identify the patient’s feelings.
• Unless you let patients know that you are interested in feelings as well as facts, you may miss important
  insights.

Answer 14

empathetic responses

Question 15

• Another important way to make a patient feel affirmed is to validate or acknowledge the legitimacy of the emotional experience.

Answer 15

validation

Question 16

The first step to effective reassurance is simply identifying and acknowledging the patient’s feelings.

Answer 16

Rreassurance

Question 17

• Capsule summary of the patient’s story during the course of the interview
• Communicates to the patient that you have been listening carefully
• Organize your clinical reasoning and to convey it to the patient, making the relationship more
  collaborative

Answer 17

Summarization

Question 18

• To put them more at ease, tell them when you are changing directions during the interview.
• “sign posting” gives patients a greater sense of control.
• orient the patient with brief transitional phrases.

Answer 18

transitions

Question 19

• Evoke the patient’s perspective.
• Convey interest in the person, not just the problem.
• Follow the patient’s leads.
• Elicit and validate emotional content.
• Share information with the patient, especially at transition points during the visit.
• Make your clinical reasoning transparent to the patient.
• Reveal the limits of your knowledge

Answer 19

empowering the patient

Question 20

Always remember the importance of _ to the patient and __ the patient’s concerns.

Answer 20

listening and clarifying

Question 21

• Patients frequently fall silent for short periods to collect thoughts, remember details, or decide whether you can be trusted with certain information.
• The nurse should appear attentive and give brief encouragement to continue when appropriate.
• Watch the patient closely for nonverbal cues

Answer 21

The silent patient

Question 22

• Some patients present a confusing
  array of multiple symptoms.
• focus on the meaning or function of the symptom, emphasizing the patient’s perspective, and guide the interview into a psychosocial
  assessment
• Although the patient may have several illnesses, a psychological disorder may be in play.

Answer 22

The confusing patient

Question 23

• Delirium from illness, dementia, or
  other health or mental health conditions
• You need to determine whether the patient has “decision-making capacity,”
• Capacity is preferable to the term
  “competence”
• Surrogate informant or decision maker
• Durable power of attorney for
  health care or a health care proxy
• Spouse

Answer 23

Tthe patient with altered capacity

Question 24

• Give the patient free rein for the first 5 or 10 minutes, listening closely to the conversation.
• Focus on what seems most important to the patient.
• Interrupt only if necessary but be
  courteous.
• Learn how to set limits when needed.
• Finally, do not show your impatience
• Setting a time limit for the next
  appointment may be helpful.

Answer 24

The talkative patient

Question 25

• Crying signals strong emotions, ranging from sadness to anger or frustration.
• Pausing, gentle probing, or responding with empathy gives the patient permission to cry.
• Usually crying is therapeutic
• Quiet acceptance of the patient’s distress or pain.
• Offer a tissue and wait for the patient to recover.

Answer 25

The crying patient

Question 26

• Accept angry feelings from patients.
• Allow them to express such
  emotions without getting angry in
  return.
• You can validate their feelings
  without agreeing with their reasons.
• After the patient has calmed down,
  help find steps that will avert such
  situations in the future.

Answer 26

The angry or disruptive patient

Question 27

• Assess the patient’s ability
  to read
• Lack of reading skill may
  explain why the patient has
  not taken medications as
  prescribed or adhered to
  recommended treatments

Answer 27

The patient with low literacy

Question 28

• Find out the patient’s preferred method of communicating.
• If the patient prefers sign language, find an interpreter
• Written questionnaires are also useful

Answer 28

Patient with impaired hearing

Question 29

• Shake hands to establish contact
• Orient the patient to the surroundings and report if anyone else is present
• Encourage visually impaired patients to wear glasses whenever possible

Answer 29

Patient with impaired vision

Question 30

• pay special attention to
  the patient’s schooling
  and ability to function
  independently
• assess simple calculations,
  vocabulary, memory, and
  abstract thinking

Answer 30

Patient with cognitive disabilities

Question 31

• patient’s judgment may beimpaired, which can lead to physical harm to those in the immediate environment
• known to have superhuman strength and are capable of inflicting serious physical harm

Answer 31

The Patient Who is Under the Influence of drugs

Question 32

• Ask about the different approaches the patient has considered and related pros and con
• Letting the patient talk through the problems is more valuable and therapeutic than any answer you could give

Answer 32

Patient with personal problems

Question 33

• Collect pertinent data from
the patient and defer the
remainder of the interview
until later
• If a patient is very sick, it
may be necessary to
interview a family member
or significant other

Answer 33

Patient who is very ill

Question 34

• May require additional time for question interpretation and patient responses
• May be necessary to interview an older patient’s
  family member or caregiver to assess the patient’s past and present health or illness status

Answer 34

The older adult

Question 35

• Accept them as a normal
  human response, and bring
  them to conscious level so they
  will not affect your behavior
• Any sexual contact or romantic
  relationship with patients is
  unethical

Answer 35

Sexuality in the nurse patient relationship

Question 36

Nontherapeutic interviewing techniques

Answer 36

• Requesting an explanation
• Probing
• Offering false reassurance
• Giving approval or disapproval
• Defending
• Advising
• Using problematic questioning
techniques

Question 37

• Patient: I’m not sure why I came to
  the clinic today; I just feel
  miserable. I don’t want to see
  anyone. I just want to stay in bed
  with the covers pulled over my
  head.
• Nurse: Why do you feel that way?
• Patient: I don’t know.

Answer 37

Requesting an explanation

Question 38

Nurse: What makes you drink a six- pack of beer after dinner each night?
Patient: I’m not sure.
Nurse: Well, are there things going on in your life right now that would cause you to drink that much?
Patient: Not really.
Nurse: I don’t really think that you would drink that much if things weren’t happening in your life right now.

Answer 38

Probing

Question 39

False Reassurance:
* “Everything will be fine.”
* I wouldn’t worry about that.

Appropriate response:
* “It must be frightening to think
about the possibility of surgery.”

Answer 39

Offering false reassurance

Question 40

Comments such as:
* “What a good idea”
* “You shouldn’t feel that way”
* “That is bad”

Effective Responses:
* “What made you come to that
conclusion?”
* “What do you think the consequences
will be if you continue to keep your
illnessfromyourwife?”

Answer 40

Giving approval or disapproval

Question 41

Inappropriate responses
* “This hospital has an excellent reputation. I’m
sure that if you were kept waiting so long as
you say, there was a good reason.”
* “No one here would lie to you.”

Appropriate responses:
* Nurse: You sound pretty angry about your
previous experiences in this hospital.
* Patient: Of course I am. Wouldn’t you be
upset if no one ever told you what was going
on and no one answered your call bell?
* Nurse: I guess I’d be pretty upset if I thought
people were not treating me respectfully.

Answer 41

Defending

Question 42

Ineffective responses:
* Patient: Do you think that I should have an
abortion?
* Nurse: Well, If I were you, I’d certainly think long
and hard before I’d have another child. You are
having difficulty feeding the one you have now. OR
No, I think you should continue the
pregnancy. Abortion is never the answer.

Exploring:
* “Tell me more about what made you consider an
abortion.”
* What other alternatives have you considered?”
Reflection:
* “Do you think you should?”
* “How would you feel about having the abortion?”

Answer 42

Advising

Question 43

“You’ve never had any type of
sexually transmitted diseases, have you, Miss Jenkins?”

Answer 43

Posing leading questions

Question 44

Changing the subject or interrupting prevents completion of an idea and introduces a new focus

Answer 44

Interrupting the patient

Question 45

Do not let patient’s outward physical appearances, personalities, or social standing distract you from ascertaining pertinent information

Answer 45

Neglecting to ask pertinent questions

Question 46

May indicate nervousness and uncertainty on the part of the interviewer

Answer 46

Engaging in talkativeness

Question 47

may confuse patients by asking several questions all at once

Answer 47

using multiple questions

Question 48

what can be anxiety provoking for the patient?

Answer 48

using medical jargon

Question 49

• Negative use of authority: “I’ve been a nurse, Mr . Haddad, for over 10 years, and I think I know what is best for you
• Positive use of authority: “As your health care provider, knowing about your previous heart attack, history of high blood pressure, and family history of stroke, I would suggest you consider stopping smoking.”

Answer 49

Being authorative

Question 50

• Frequently, patients seek health care or one problem but actually are concerned about other problems
• The patient may believe that the overriding concern is embarrassing, private, or insignificant.

Answer 50

Having hidden agendas