Week 4 (Class 2) - Interviewing, Privacy, and Confidentiality

Question 1

Why do nurses interview?

Answer 1

• To obtain a health history
• To identify health needs and risk factors
• To determine specific changes in level of wellness and pattern of living
• To help clients relate their own interpretation and understanding of their condition

Involves verbal and non-verbal communication strategies

Question 2

What is therapeutic interviewing?

Answer 2

Therapeutic interviewing is a a pattern of communication initiated for a specific purpose and focused on a specific content area (i.e. the nurse and patient are meant to be partners)
- Involves verbal and non-verbal communication strategies

Question 3

What are three components of communication?

Answer 3

1) Verbal
2) Non-verbal
3) Written

Question 4

What does communication happen and who does it happen between?

Answer 4

Communication happens between different providers and patients and families, it’s present when you report your findings, explain a procedure, collect a history, explore a health concern etc.

Question 5

What is therapeutic communication (TC)?

• Who does TC happen between?
• What must there be? Is it focused?

Answer 5

Therapeutic communication (TC) is the type used within the caring relationship, and is focused on the patient and their concerns (S&S p, 20)

• TC is between the patient and the nurse, and ‘patient’ might also include family members
• There is respect and understanding, it’s judgment free, it’s caring and there is empathy there, and it has a particular focus

Question 6

What form of communication can be effective and ineffective? What about TC?

Answer 6

Any form of communication can be effective or ineffective. TC can also be effective or ineffective, and both have tremendous influence on the development and quality of therapeutic relationships

Question 7

What can ineffective communication lead to?

Answer 7

• Poor patient outcomes
• Increased adverse incidents
• Decreased professional credibility
• Negative patient experience

Question 8

What is effective verbal communication?

• Name 3
• What does is involve?

Answer 8

Active listening: Ability to focus on patients and their perspectives, & searching for meanings behind subtleties

1) Words - what the client actually says
2) Feelings - behind the words
3) Essence - the “real” meaning

Involves:

• Vocabulary
• Denotative and connotative meaning
• Pacing
• Intonation
• Clarity and brevity
• Timing and relevance

Question 9

What is effective non-verbal communication?

Answer 9

• Physical appearance of the nurse
• Eye contact
• Body position
• Demeanour
• Touch
• Body language
• Facial expression
• Gestures
• Personal space
• Silence

Question 10

What are the 4 phases of the interview process?

Briefly explain what happens at each stage:

Answer 10

1) Pre-interactive Phase
- Before the client is present
- Gather/review existing data from chart, arrange the space if you can, consider the client’s comfort and privacy

2) Beginning Phase
- Sets the tone for the whole thing
- Set the tone, establish rapport (this might be in the introductions, asking the patient if they are comfortable/would they like anything before you begin, pain, and needing to use the bathroom are common things to attend to here

3) Working Phase
- Open/closed ended questions
- Working phase - data collection phase where you will:
a) Find out what the problem is/reason for seeking care
b) Listen for and observe cues, use critical thinking
c) Collaborate with client to identify problems and goals

4) Closing Phase
- More than declaring it over - wrap up, next steps, questions, etc. happens here

Question 11

What are 2 things must we consider during communication?

Answer 11

Lifespan and cultural considerations

Question 12

What are examples of considerations we take into account when communicating?

Answer 12

• Cultural differences may exist related to group or ethnicity, region, age, degree of acculturation into Western society, or a combination of these factors.
• Communication etiquette: ie space and distance, touching
• Limited English: working with an interpreter, translator
• Gender and sexuality issues
• Children and adolescents

Question 13

What are special situations that might challenge our communication? Think of ways to address each situation:

Answer 13

• Patients in health care settings
• Hearing impaired
• Altered level of consciousness
• Cognitive Impairment
• Mental health-illness
  Substances
• Patients in distress ie, crying, angry
• Personal questions
• Physical/sexual aggression

Question 14

How do you communicate with angry individuals?

Answer 14

• Recognize that the person feels frustrated or frightened
• Treat person with respect & dignity
• Answer their questions clearly & thoroughly
• Stay calm & professional
• Do not take their anger personally
• Do not argue with the person
• Listen & use silence
• Tell the person what you are going to do and when
• Leave if you feel you are in danger
• Document and/or report the behaviour

Question 15

What is privacy vs. confidentiality?

Answer 15

Privacy is about people.

Confidentiality is about duty to protect information

Question 16

Is PT knowledge confidential?

Answer 16

All knowledge is considered confidential unless otherwise stated by the client

Question 17

Describe confidentiality:

Answer 17

• Spoken/written in confidence (electronic format as well)
• Confidential information is “intimate or private knowledge.”
• Information will be shared with the health team aka “circle of care”
• BUT! Some information must be shared outside the team…..
• In context for nursing students: Reflective Practice Reviews (RPRs), cafeteria conversations, elevator conversations, social media posts, etc.

Question 18

What do you do if people define “private” differently?

What is some info that must be shared?

Answer 18

People define ‘private’ differently, so there is a place for preferences, and then there is the law, regardless of preference

Some information must be shared: child abuse, some sexually transmitted diseases, suicidal ideation, homicidal ideation – “to eliminate or reduce a significant risk of serious bodily harm to another person or the public”

Question 19

What is the privacy act?

Answer 19

Healthcare providers are held to it - how to handle confidential information:

• PHIPA
• PIPEDA

Question 20

What is personal health information? Provide examples:

Answer 20

Any identifying information about clients that is in verbal, written, or electronic form:

• Information about physical or mental health:
• Care previously provided
• Plan of service (ie. LTCH act)
• Payments or eligibility for health care
• Donation of body parts or substances
• Health card number/PIN
• Name of a client’s substitute decision-maker
• The patient owns the info, but it’s safeguarded in HC facilities

Question 21

How is technology and social media impacting privacy and confidentiality for nurses?

Answer 21

Complicates things and breaches can happen

- Need a secure email through workplace

Question 22

What are the 6 P’s of social media use?

Answer 22

1) Professional: act professionally at all times.
2) Positive: keep posts positive.
3) Patient/Person-free: keep posts patient or person free.
4) Protect yourself: protect your professionalism, your reputation and yourself.
5) Privacy: keep your personal and professional lives separate; respect privacy of others.
6) Pause before you post: consider implications; avoid posting in haste or anger.

Question 23

Confidentiality and Privacy:

Summary!

Answer 23

• Never share information about your client, except with the professionals who NEED to know.
• Keep documentation in a private place: do not leave notes out for others to see.
• Do not have professional conversations in public places – move to a private space to discuss health related issues.
• NEVER GOSSIP!
• Properly destroy work sheets that may contain sensitive information.
• Close doors and curtains during care. Respect clients’ privacy.
• Respect clients’ wishes and opinions, and do not judge.

Question 24

Reflection and Application:

Nurses collection personal health information on a need to know basis.

An example of how this is applied in my practise is…

Answer 24

When nurses are collecting a history from a client, focus of inquiry is areas that help understand the reasons for seeking care

Question 25

Reflection and Application:

Nurses ensure that clients are aware of their rights concerning their personal and health information and have consented to the collection, use, and disclosure of this information

An example of how this is applied in my practise is…

Answer 25

When collecting information from clients nurses explain how info will be used, and who will see it, and ask if client is ok with that

Question 26

Reflection and Application:

Nurses access personal health information only for purposes that are consistent with their professional responsibilities

An example of how this is applied in my practise is…

Answer 26

I will not look up friends’ or family’s results or records for them, or others’ if they are not directly within my circle of care