EFFECTIVE INTERVIEW AND HEALTH HISTORY Flashcards
- Conversation with a Purpose
- Interpersonal Skills
- Improve the Patient’s Well-being—Primary Goal of the Nurse-Patient Interview
health history interview
• 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
health history format
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
interviewing process
• 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
pre interview
• Greet the patient andestablish rapport
• Establish the agenda for
the interview
introduction
Mnemonic to responding to emotional cues of the patient
NURS
naming
understanding
respecing
• 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
working
Mnemonic for the patient’s perspective on the illness
FIFE
feelings
ideas
effect on function
expectations
• Summarize important points
• Discuss plan of care
• Give patient chance to ask
questions
termination
What are the techniques of skilled interviewing?
- Active listening
- Guided questioning
- Nonverbal communication
- Empathic responses
- Validation
- Reassurance
- Summarization
- Transitions
- Empowering the patient
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
active listening
- 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.
Guided Questioning : Options to Expand
and Clarify the Patient’s Story
- 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.
nonverbal communication
- 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.
empathetic responses
- Another important way to make a patient feel affirmed is to validate or acknowledge the legitimacy of the emotional experience.
validation
The first step to effective reassurance is simply identifying and acknowledging the patient’s feelings.
Rreassurance
- 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
Summarization
- 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.
transitions
• 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
empowering the patient
Always remember the importance of _ to the patient and __ the patient’s concerns.
listening and clarifying
- 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
The silent patient
- 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.
The confusing patient
- 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
Tthe patient with altered capacity
- 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.
The talkative patient
- 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.
The crying patient
- 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.
The angry or disruptive patient
- 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
The patient with low literacy
- Find out the patient’s preferred method of communicating.
- If the patient prefers sign language, find an interpreter
- Written questionnaires are also useful
Patient with impaired hearing
- 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
Patient with impaired vision
- pay special attention to
the patient’s schooling
and ability to function
independently - assess simple calculations,
vocabulary, memory, and
abstract thinking
Patient with cognitive disabilities
- 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
The Patient Who is Under the Influence of drugs
- 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
Patient with personal problems
• 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
Patient who is very ill
- 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
The older adult
- 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
Sexuality in the nurse patient relationship
Nontherapeutic interviewing techniques
• Requesting an explanation
• Probing
• Offering false reassurance
• Giving approval or disapproval
• Defending
• Advising
• Using problematic questioning
techniques
- 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.
Requesting an explanation
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.
Probing
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.”
Offering false reassurance
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?”
Giving approval or disapproval
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.
Defending
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?”
Advising
“You’ve never had any type of
sexually transmitted diseases, have you, Miss Jenkins?”
Posing leading questions
Changing the subject or interrupting prevents completion of an idea and introduces a new focus
Interrupting the patient
Do not let patient’s outward physical appearances, personalities, or social standing distract you from ascertaining pertinent information
Neglecting to ask pertinent questions
May indicate nervousness and uncertainty on the part of the interviewer
Engaging in talkativeness
may confuse patients by asking several questions all at once
using multiple questions
what can be anxiety provoking for the patient?
using medical jargon
- 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.”
Being authorative
- 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.
Having hidden agendas
