UNIT 2A Flashcards
a purposeful, time-limited verbal interaction between the nurse and the patient or his/her significant other
Nursing interview
nursing interview is done to collect ______ about the patient
subjective data
What are the factors influencing the interview
Approach
Environment
Confidentiality
Note Taking
Time, Length, Duration
Biases and Preconceptions
gather all appropriate information before approaching the patient
approach
How do you begin interviewing the pt?
introducing your name and title
Initially, call the patient his or her _____ and ask how the patient prefers to be addressed
formal name
has a direct influence on the amt & quality of information gathered
environment
What is the ideal setting for interview?
private room
less distractions/interruptions
increase comfort level for the patient
essential in developing trust
confidentiality
_______ of confidentiality often eases the patient’s concerns
verbal assurance
What are the reasons for sharing confidential information?
patient poses danger to self or others
institutional policy (inform the patient prior when the info should be shared)
advisable but may cause patient discomfort
note taking
explain the necessity of jotting down _____ information
pertinent or relevant
pay attention to patient & ______ if patient discusses sensitive issues
defer recording
interview times should be least _____ to patient’s _____ & try to accommodate patient’s request
Time, Length, Duration
disruptive
daily routine
be sensitive to personal as well as ______ in order to treat all patients fairly & respectfully
biases and preconceptions
patient context
avoid faulty assumptions by continually validating information & ______ ( use _______)
personal impressions
effective interview techniques
What are the stages of the interview process?
Stage 1 (Pre-Introductory Stage)
Stage 2 (Introductory Stage)
Stage 3 (Working Stage)
Stage 4 (Termination Stage)
the nurse reviews patient’s records before
meeting with the patient.
What stage of interview process?
Stage 1 (Pre-Introductory Stage)
In stage 2 of the interview process, the nurse and patient _____ and _____
establish trust
get to know each other
in this stage, bulk of patient data is collected
Stage 3 Working Stage
In Stage 4, information is ____ and _____
summarized and validated
during this stage, give the pt an indication of the amt of time left in the interview, & allow pt opportunity to give addt’l info & make comments/statements
Termination stage
What are the factors affecting communication?
active listening
nonverbal cues
Distance or proxemics
Personal Space
to decode patient messages in order to understand the situation or problem as the other person sees it
Active Listening
Nurses should always pay attention and formulate ____
Active Listening
appropriate response
communicating a message without words
Nonverbal cues
List down the nonverbal cues.
body position
nervous repetitive movements of the hands or legs
rapid blinking
lack of eye contact
yawning
fidgeting
excessive smiling or frowning
repetitive clearing of the throat
the amount of space a person considers appropriate for interaction is a significant factor in the interview process and is determined in part by _____
what is this?
Distance or Proxemics
cultural influences
What are the four distances?
Intimate zone (< 18 in. from pt.)
Personal zone (18 inches to 3 feet)
Social Distance (4 to 12 ft.)
Public Distance (> 12 feet)
the space over which the person claims ownership (e.g. pt’s hospital room & bathroom)
Personal Space
pt. may be protective over this space & consider ______ of it as an invasion of privacy
unauthorized use
encourages pt. to provide general rather than more focused communication.
Using Open-ended Questions
Validating the right patient before giving the drug: “May I know your name sir?”
Using Open-ended questions
restrict or regulate patient response to a “yes”, a “no” or a response less than _____
Using close-ended questions
3 words
used to focus the interview, pinpoint specific areas of concern, & elicit valuable information quickly & efficiently
using close-ended questions
using close-ended questions can ______ if frequently used
disrupt communication
encourages patient to continue talking
facilitating
coupled with nonverbal cues - eye contact, nodding & leaning slightly forward
facilitating
Go on. uh-huh
Facilitating
helps structure & pace the interview, convey respect & acceptance, and prompt additional patient data.
Using silence
using silence on the part of the patient, may convey
anxiety, confusion or embarrassment
the nurse verbalizes perceptions about the patient’s behavior, then shares them with the patient
making observations
Speaking about those symptoms seems to make you tense. I notice that you are clenching your fists and grimacing.”
making observations
involves repeating or rephrasing the main idea expressed by the patient & lets the patient know that you are paying attention
restating
the nurse directs the pt’s own questions, feelings & ideas back to the patient & provides opportunity for the patient to _____ &/or expand on what was said.
reflecting
reconsider
used by the nurse to make clear something the patient says or to pinpoint something in the message when the patient’s words & nonverbal cues do not agree.
clarifying
enables the nurse to link events that perhaps the patient was not able to piece together
interpreting
involves asking the patient to place a symptom, a problem, or an event in its proper sequence.
sequencing
facilitating the conversation such that occurrence of symptoms/events are pieced together ______ by pt.
sequencing
chronologically
helps the patient to deal more effectively with unfamiliar situations by placing the symptoms or problems in the context of something else that is familiar
Encouraging comparison
In what way was this allergy attack different from or the same as your previous ones?”
encouraging comparison
especially useful at the end of the health assessment interview
summarizing
also provides a means of smoothly transitioning to a new topic or section of the health assessment.
summarizing
allows the nurse to concentrate on or “track” a specific point the patient has made
focusing
Focusing is useful to patients with ?
heightened anxiety
altered concentration
jumping from topic to topic
enables the nurse to develop, in more detail, a specific area of content or patient concern.
exploring
helps the nurse identify ______ in symptom presentation or in the way patients handle problems or health concerns
exploring
patterns or themes
typically used with psychiatric or confused patients, or to patients who exaggerate or make grandiose statements.
presenting reality
presenting reality should be done in a ?
non-argumentative way
a verbal response that the nurse makes to some perceived discrepancy or incongruency in the pt’s thoughts, feelings, or behaviors.
confronting
can be used to focus the patient’s attention on some aspect of behavior that, if changed, could lead to more effective functioning
confronting
confronting is done in a caring, empathetic manner, rather than a ______
critical or accusatory
Providing the patient with needed information, such as explaining the nature and/or the reasons for any necessary tests or procedures.
informing
allows the nurse to help patients become aware of possible choices & then evaluate those choices correctly.
informing
the nurse & patient work together, rather than the nurse taking control of the interaction
collaborating
conveys the message that the patient has important knowledge and information to share & encourages
1. active involvement of patient in their own health care
2. in setting goal
3. in gathering information
4. in problem solving.
collaborating
setting specific limits on inappropriate patient behavior
limit setting
What scenarios do you set specific limits?
sexually aggressive patients
hostile patients
talkative patients
provide guidance by calmly, clearly, and respectfully telling the patient what behavior is expected
limit setting
____ only the behavior that is ______ to the purpose of the interview and avoid making a “big issue” of whatever it is that the patient is doing
limit
problematic or detrimental
allows the nurse to offer appropriate reassurance that the pt.’s response may be quite common for the situation and helps decrease patient’s anxiety and fear of being misunderstood.
Normalizing
Enumerate the different therapeutic or effective interview techniques
using open-ended questions
using close-ended questions
facilitating
using sulience
making observations
restating
reflecting
clarifying
interpreting
sequencing
encouraging comparisons
summarizing
focusing
exploring
presenting reality
confronting
informing
collaborating
limit setting
normalizing
What are the different non-therapeutic interview techniques?
Requesting an Explanation
Probing
Offering false reassurance
giving approval or disapproval
advising
using problematic questioning techniques
such questions ask the patient to provide a reason or justification for personal beliefs, feelings, thoughts, and behaviors and imply criticism and may make the patient feel inadequate, defensive, or angry
requesting an explanation
using “why” in the question
requesting an explanation
repeated or persistent questioning of the patient about a statement or behavior
probing
What are the useful responses to prevent probing
going on to the next part of interview
asking permission to get back to the subject later
just sitting quietly until patient begins to speak
giving vague, simplistic responses that question the patient’s judgment, devalue and block patient feelings, and communicate a lack of understanding and sensitivity on the part of the nurse w/c often increases pt. anxiety
Offering false reassurance
telling a patient what is right or wrong is demoralizing and may limit patient’s freedom to verbalize or behave in certain ways and hinder the nurse’s attempts to establish rapport.
giving approval or disapproval
What should be the appropriate response instead of giving approval or disapproval?
What do you think the consequences ______
What non therapeutic interview does consistently telling a patient what to do?
advising
advising does not foster ______
competence
nurses should not reinforce ______ because some patients may resort to _____ passive behavior when faced with illness
dependence
What are the different problematic questioning techniques?
Posing leading questions
interrupting the patient
engaging in talkativeness
using multiple questions
using medical jargon
being authoritative
having hidden agendas
What should you do with patient who is hearing impaired?
Often lip-read; remain within the sight of the patient & face the patient when talking.
• Ensure that the hearing aid is in working order and turned on.
• Minimize background noise.
• Always face the patient and direct all communication to the patient
Avoid speaking loudly and slowly
• Use nonverbal cues such as facial expression and body movements to convey the meaning
• May also have speech difficulty; allow additional time and use a written form of gathering data.
What should you do with patient who is speech impaired?
Ask simple questions that requires yes and no answers (closed-ended questions);
Allow additional time for patient responses
• Repeat or rephrase the question if the patient did not understand
If unable to understand the patient’s responses, use a written interview format, letter boards, or yes/no cards.
• When someone else is speaking for the patient, the nurse should speak and direct questions to the patient, not to the intermediary
What should you do with patient who is non-english speaking?
Have an interpreter/translator if possible • Nurse should not assume that the interpreter can answer questions for the patient.
• Direct the questions to the patient and NOT to the interpreter
What should you do with patient who has low level of understanding?
Requires time and patience;
Hurrying may cause confusion, lose of concentration or refusal to answer the question.
If necessary, interview the patient’s family or caregiver for supplemental information.
Always direct the questions to the patient and allow assistance from family members or the caregiver.
Observe nonverbal communication between patient and family to gather information about patient’s health/illness state as well as relationships between them
How should you interview patient who is under the influence of alcohol or drugs?
-security personnel should be alerted and stationed nearby
-place yourself at a safe distance
-remain calm
-provide care in a non-threatening manner
How should you interview patient who is visually-impaired?
-look directly at the patient as if the patient were sighted
- avoid soeaking loudly
- touch is very important
-advise the patient when you are entering or leaving the room
-use clock hours to indicate position of items
-offer assistance to partially sighted
When using clock hours
12 is
3 is
6 is
9 is
12 is ahead
3 is right
6 is behind
9 is left
How should you interview patient who is crying?
-show empathy and allow patient to cry
-offering of tissues
In dealing or interviewing patient who is anxious or angry avoid statements such as?
Take a moment to get hold of yourself
______ tends to be contagious. Don’t reciprocate with anger and ____
hostility
Minimize aggression through
limit-setting and refocusing
When dealing with patient who is hostile, position yourself near an easily accessible ___
exit
How should you deal with patient who is sexually aggressive?
define appropriate boundaries
sharing personal reactions
refocusing the patient
When you interview patient who is very ill, you should collect ____ from the patient first and defer remainder of the interview later
pertinent
When interviewing patient who is older adult, what should be assessed first?
hearing acuity
When dealing with older patient, avoid?
Elderspeak
because it gives message of dependence and incompetence
