1

Chapter 3: The Interview

The Process of Communication

 The vehicle that carries you and your client through the interview is communication. Communication is exchanging
information so that each person clearly understands the other.
o SENDING
- verbal communication: the words you speak, vocalizations, the tone of voice. more reflective of
true feelings
- Nonverbal communication: as important as verbal communication. This is your body language:
posture, gestures, facial expression, eye contact, foot tapping, touch, even where you place your
chair. less conscious.
o RECEIVING
- Your words and gestures must be interpreted by the receiver.
- Even though you have a specific meaning in mind, the receiver may not understand the message
as it was meant
- interpretations are based on past experiences , culture, and self-concept. Physical and emotional
states also play a role in a person's interpretation.
o INTERNAL FACTORS
- Internal factors are those specific to you , the examiner. You need to focus on foreigner factors of
liking others , empathy, the ability to listen, and self-awareness.
 Liking Others: genuine liking of other people. Having an optimistic view of people, an
assumption of strengths and a tolerance for weaknesses. An atmosphere of warmth and
caring.
 Empathy: viewing the world from the other persons interframe of reference while
remaining new. Acceptance of other’s feelings without criticism.
 The ability to listen: not a passive role. It is active in demanding. Requires complete and
focused attention curious interpreting meaning , asking follow up questions, and
ensuring a thorough understanding of what the person is telling you.
 Self-awareness: to effectively communicate with others, you must know yourself.
Understanding your personal biases , prejudices, and stereotypes is an important part of
developing your skills as an interview.
o External factors
- Preparing of the physical setting
 Ensure privacy: Geographic privacy, your private room in the hospital, clinic, office, or
home. Psychological privacy is the use of curtain partitions, but make sure the person
feels comfortable with the privacy provided.
 Refuse interruptions: You need to concentrate and establish rapport.an interruption can
destroy in seconds which you have spent many minutes building up.
 Physical environment: a comfortable environment, sufficient lighting, quiet
environment, remove distracting equipment, place the distance between you and the
client at four to five feet.
 Equal-status seating: both you and the client should be comfortably seated, at
eye level. The chair should be placed at 90 degrees which allows the person
either to face you or to look straight ahead from time to time.
 Avoid standing, standing does two things: 1 it communicates your haste, 2 it
assumes superiority.
 When interviewing hospitalized bedridden person, arrange a face to face
position, and a voice standing over him or her.
o Dress
- Client should remain in street clothes during the interview except in an emergency.
- Your appearance and clothing should be appropriate to the setting and should meet conventional
professional standards. Avoid extremes
o Note Taking
- Excessive no taking during the interview has disadvantages:
 it breaks eye contact
 it shifts your attention away, diminishing the appliance sense of importance.
 Recording everything causes you to ask the client to slow down which causes the clients
mode of expression to be lost
 it impedes their observation of the clients nonverbal behavior
2
Chapter 3: The Interview
 threatening to the client during the discussion of sensitive issues.
 Electronic health record (EHR): The use of an EHR eliminates handwritten clinical data
and provide access to online health education materials. Improves documentation of bio
medical information, but psychosocial and emotional information are not always
captured.

Techniques of Communication
o Introducing the interview
- Keep introduction short informal. introduce yourself and state your role in the agency and give
the reason for the interview.
- Address the person using his or her username and shake hand if appropriate.
o The working phase
- Data gathering phase. a combination of open ended and closed questions during the interview
o Open-Ended Questions
- ask for narrative information. States the topic to be discussed but only in general terms.
- Example: “what brings you to the hospital?”, “you mentioned shortness of breath. Tell me more
about it?”
o CLOSED OR DIRECT QUESTIONS
- Ask for specific information. They elicit a one-or-two-word answer, a yes or no, or a forced choice.
- Guidelines: 1. ask only one direct question at a time. 2. Choose language the client understands.
o Verbal responses -assisting the narrative
- your role is to encourage free expression while keeping the person focused. Your responses
helped the teller amplify the story.
- Nine types a verbal responses:
 facilitation, silence, reflection, empathy, clarification. (Your reactions to the facts or
feelings that person ask communicated).
 Confrontation, interpretation, explanation, summary. (you express your own thoughts
and feelings)
 in the first 5 responses decline leads; in the last four responses you lead.
o 10 traps of interviewing
1. Providing false assurance or reassurance
 It closes off communication and you have promised something that may not
be true , which can diminish rapport.
2. Giving unwanted advice
 If advice is based on a hunch or feeling or is your personal opinion, then it is
most likely inappropriate. It is important as a healthcare provider to recognize
when giving advice this warranted and when it should be avoided.
3. Using authority
 It should be avoided. You may have more professional knowledge than the
client, but you both have equally important roles so the client must make the
final decision about his or her health.
 It diminishes the clients concerns can you cut off communication.
4. Using avoidance language
 using euphemisms promotes the avoidance of reality it allows people to hide
their feelings. Not talking about uncomfortable topics makes them even more
frightening.(direct language)
5. Distancing
 it is the use of impersonal speech to put space between a threat in the self:
Using specific language blunt terms indicates that you are not fearful of the
disease or procedure and can diminish anxiety and help the client cope with
the reality of the situation.
6. Using professional jargon
 it is important to adjust your vocabulary to ensure understanding without
sounding condescending.
7. Using leading or biased questions
 using bias questions implies that one answer is better than another. Decline
will either answer in a way corresponding to your values or feel guilty when he
3
Chapter 3: The Interview
or she must admit the other answer. By doing this the client feels they risk
your disapproval by not answering the question correctly
8. Talking too much
 A good rule for every interviewer is to listen more than you talk.
9. Interrupting
 It signals impatience or boredom.
10. Using “why “questions
 The adults use of like questions usually implies blame and condemnation; it
puts the person on the defensive pure.

o NONVERBAL SKILLS
- Listening with your eyes is just as important as listening with your ears. They provide clues to
understanding feelings. Non-verbal messages tend to be the true wants because it is under
less conscious control.
 Physical appearance
 Posture
 gestures
 facial expression
 eye contact
 voice
 touch
o closing the interview
- The session should end gracefully. An abrupt or awkward closing can destroy rapport and
leave the person with a negative impression of the interaction.
- gives the person a final opportunity for self-expression.
- Summary: Indicates what you have learned during the interview. It is the final statement of
with you and the client agree the health state to be. That includes positive health aspects,
any health problems that have been identified, any plans for action, and an explanation of
the subsequent physical examination.
o Interviewing the parent or caregiver
- when your child is a client, you must build rapport with two people; the child in the accompanying
caregiver.
- Ignoring the child temporarily allows then to size you up from a safe distance. the child will see
that the caregiver accepts and likes you, and he or she will begin to relax.
- Most of your communication is with the caregiver of a younger child, but make sure that you
don't ignore the child completely.
- Non-verbal communication is even more important to children than it is to adults. Children are
quick to pick up feelings, anxiety, or comfort from non-verbal cues.
o Stages of Cognitive Development
- As an interviewer it is important that you consider the stage of development as you approach the
child and converse with him or her.
- Piaget’s Stage
 Sensorimotor: (Birth -2y)infants learn by manipulating objects kid at birth reflexes
communication, then moves through six stages to reach actual thinking.
 Presymbolic: communication largely nonverbal. Speaking of vocabulary of
more than 4 words by 12 months , increases to more than 200 words and use
of short sentences before age 2.
 Preoperational: (2-6y) beginning use of symbolic thinking, imaginative play, Masters
reversibility.
 Symbolic: actual use of structured grammar in language of communicate. Uses
pronouns. Average vocabulary more than 10,000 words so by age 6 years.
 concrete operations: (7-11y) right logical thinking, Masters use of numbers and other
concrete ideas such as classification and conversation.
 Symbolic: Mastery of passive tense by age 7 years and complex grammatical
skills by age 10 years.
 Formal operations: (12+y) abstract thinking. Futuristic; takes broader, more theoretical
perspective.
 Symbolic: near adult like skills.
4
Chapter 3: The Interview
Communicating with Different Ages
o The infant (birth to 12 months )
- Nonverbal communication is the primary method of communicating with infants.
o the toddler (12 to 36 months)
- Development of communication skills
- Telegraphic speech: usually a combination of a noun and a verb and include only words that have
concrete meaning.
o the preschooler (3 to 6 years )
- Egocentric
- Telegraphic: sentences containing only essential words
o the school age child (7 to 12 years)
- This child is more objective and realistic.
- Decenter: School age children can decenter and consider all sides of a situation to form a
conclusion.
- Pose questions about school, Friends, or activities directly to the child.
o the adolescent
- Puberty: time of dramatic physiological change curious it includes a growth spurt, rapid growth in
height , wait, and muscular development as well maturation of the reproductive organs.
o the older adult
- The aging adult has the developmental task a finding the purpose of his or her own existence and
adjusting to the inevitability of death.
- Avoid elderspeak; honey , sweetie , dearie
- Have a longer story to tell
- consider fiscal limitations when planning the interview.

Interviewing People with Special Needs

 Hearing impaired people
- May feel marginalized and think that their intelligence is questioned because they cannot always
understand what is being asked of them.
- People with a hearing impairment they feel isolated and anxious because they can not understand
everything that is happening.
- Ask the person or preference of way of communication- signing , lip reading, or writing.
 Acutely ill people
- Focus the interview on pertinent information only, including history of present illness, medications,
allergies, last meal, and basic health state.
- Subjective information is a crucial component providing care; it's crucial to try to interview as much as
possible while performing lifesavings actions .
- Identify the main area of distress and inquire about that
 People under the influence of St drugs or alcohol
- Ask simple and direct questions.
- Make your manner any questions nonthreatening.
- avoid displaying any scolding or disgust since it may make the person belligerent
- Top priority: find out the time of the person last drink or drug, how much he or she took, in the name of
each drug that was taken.
- for your own protection, be aware of hospital security or other personnel who could be called on for
assistance, avoid turning her back, and make sure that you are aware of your surroundings.
 Personal questions
- People will ask you questions about your personal life or opinion. Try directing your response back to the
person's frame of reference.
 Sexually aggressive people
- Some people see illness as a threat to their self-esteem and sexual adequacy. It creates anxiety that makes
them act out in sexually aggressive ways.
- It is important to communicate that you cannot tolerate sexual advances, but you should also communicate
that you accept the person and understand his or her need to be self-assertive.
- If the behavior continues, you may need to remove yourself from the situation.
 Crying
- crying is a big relief to a person cute when you say something that makes the person cry you have just
broached a topic that is important.
5
Chapter 3: The Interview
- It is important that you allow the person to cry and express his or her feelings fully before you move on.
- reassure the client tonight be embarrassed and that you are there to listen.
 Anger
- The person is showing aggression as a response to his or her own feelings of anxiety or helplessness.
- Ask about the anger and hear them out.
- an angry person cannot be an effective participant and they held interview
 Threats of violence
- over 70% of nurses report physical or verbal abuse in the workplace.
- Identify red flags behavior of a potentially disruptive person is important
- behaviors include fist clenching, pacing, a vacant stare, confusion and statements out of touch with reality
or history of drug abuse
- always act quickly to diffuse the situation or obtain additional support from others.
- Make sure to leave the door open, and never turn your back to a potentially aggressive person. Always
make sure to position yourself between the person and or so that you can easily leave the room.
- always at com and talk to the person and the soft voice
- act interested in what the person is saying and behave in a unhurried way.
- Most important goal is safety.
 Anxiety
- Appearing on hurry and taking the time to listen to all of the clients concerns can help defuse some anxiety
- avoiding the traps to interviews and using therapeutic responses are other ways to help defuse anxiety

Culture and Genetics

 Cultural considerations on gender
- violating cultural norms related to appropriate male-female relationships may jeopardize a professional
relationship.
- Ask the person about culturally relevant aspects of male female relationships at the beginning of the
interview.
- Offer to have a third person present
- Modesty is another issue; ensure the patient is carefully draped at all times, curtains are closed, and privacy
is given. Never enter a room without knocking.
 Cultural considerations on sexual orientation
- Heterosexism: they believe that heterosexuality is the only natural choice and assumes that everyone is or
should be heterosexual. Form of homophobia and leads to discrimination.
- Do not marginalized a homosexual relationship
- know your state laws
- use appropriate health teaching materials that depict same sex couples
- do not make assumptions about a person's sex based on appearance
- avoid heterosexist assumptions
- ask new patients what their preferred pronoun . Do not assume
- show a caring demeanor and ask open ended questions
- avoid asking unnecessary intrusive questions
- don't assume that anyone knows the client's sexual orientation or status. respect the person's privacy
- be non-judgmental and make sure your workplace has adopted policies to avoid discrimination
- most importantly be aware of your personal bias and baggage
 working with (and without ) an interpreter
- One of the greatest challenges in cross cultural communication occurs when you and the client speak
different languages.
- It is important that you consider not only the meaning of the spoken language, but also nonverbal
communication.
- Language barriers make negative health outcomes.
- Non English speaking clients have longer hospital stays, you see fear preventive services in are less satisfied.
- May suffer adverse drug reactions , have a poor understanding of the diagnosis, pens are at greater risk of
complications.
- It is disadvantageous to ask an untrained interpreter to translate.
- work with a bilingual team member or a trade medical interpreter.
- A trained interpreter is knowledgeable about cultural beliefs and health practices. Can help bridge the
cultural gap and advise you concerning the culture appropriateness of your recommendations.
 Health literacy: ensuring we are understood
6
Chapter 3: The Interview
- Health literacy: the first 2 the ability to understand instructions, navigate the health care system,
communicate concerns with the health care provider.
- People with low health literacy struggle to navigate the healthcare system and may be non compliant
because of a miss understanding.
- Low medication compliance, more ER visits, increased re admission rates, and ability to recall information
after a clinic visit, and inability to affectively manage chronic illness.
 Tools for determining literacy
- No standard approach to measuring health literacy is currently recommended, but it is important that you
know the policy at your place of work and take time to assess your clients health literacy to assure
understanding of important information.
- What can you do?
 Oral teaching: Provide simple, easy to understand instructions
 written materials: written material should be at the 5th grade reading level or below.
 Teach back: it allows you to assess whether the person understands and to immediately
correct misconceptions. encourages the client to repeat in his or her own words what
you have just said.

Communicating with other professionals

 Interprofessional communication: communication that occurs between two or more individuals from different health
professions. Requires an environment of mutual respect collaboration among professionals of various disciplines.
 Provide timely updates, communicate in a clear, succinct manner, Be polite and respectful, and use communication
tools pier
 standardized communication
- Similar to a checklist to ensure safety and to prevent important steps from being missed due to fatigue or
other factors.
- SBAR: Situation , background, assessment, recommendation
 Standardized framework to transmit important in the moment information
 will keep your message concise and focused on the immediate problem yeah gave your colleague
enough information to grasp the current situation and make a decision.

Ch. 3 Study Guide

Terms
 Ad hoc interpreter: Using a patient's family member, friends, or child as interpreter for a patient with limited English
proficiency
 Animism: imagining that inanimate objects come alive and have human characteristics.
 Avoidant language: the use of euphemisms to avoid reality or to hide feelings
 Clarification: examiners response use when the patient's word choice is ambiguous or confusing
 closed questions: questions that ask for specific information and elicit a short, one or two word answers or a forced choice.
 Confrontation: Response and which examiner gives honest feedback about what he or she has seen or felt after observing
a certain patient action, feeling, or statement.
 Distancing: the use of impersonal speech to put a space between One’s self and a threat
 Elderspeak: infantilizing and the meaning language used by a health professional when speaking to an older adult.
 Electronic health recording: direct computer entry of a patient health record while in the patient's presence.
 Empathy: viewing the world from the other person's inner frame of reference while remaining yourself; recognizing and
accepting the other persons feeling without criticism.
 Ethnocentrism: the tendency to view your own way of life as the most desirable, acceptable, or best and to act in a
superior manner to another culture's way of life.
 Explanation: examiners statement that inform the patient; examiner shares factual and objective information.
 Facilitation: examiners response that encourages the patient to say more, to continue with the story.
 Geographic privacy: private room or space with only the examiner and patient present.
 Interpretation: examiner statement that is not based on direct observation, but is based on examiners inference or
conclusion; Links events, makes associations, or implies cause
 Interview: meeting between the examiner and patient with the goal of gathering a complete health history.
 Jargon: medical vocabulary use with the patient in an exclusionary and paternalistic way.
7
Chapter 3: The Interview
 Leading question: a question that implies that one answer will be better than another.
 Nonverbal communication: message conveyed through body language: posture , gestures, facial expression, eye contact,
touch, and even where one places the chairs.
 Open-ended question: asks for longer narrative information; unbiased; leaves the person free to answer in any way.
 Reflection: examiner response that echoes the patient's words; repeat part of what the patient has just said.
 Summary: final review of what examiner understands patient has said; condenses facts and presents a survey of how the
examiner perceives the health problem.
 Telegraphic speech: speech used by H3 or four years in which three or four word sentences contain only the essential
words.
 Verbal communication: messages sent through spoken words, vocalizations or tone of voice.

Review Questions

1. The practitioner, entering the examining room to meet a patient for the first time, states: hello, I'm MM and I'm here
to gather some information from you and to perform your examination. This will take about 30 minutes. DD as a student
working with me. If it's alright with you, she will remain during the examination. Which of the following must be added to
cover all aspects of the interview contracts?

a) A statement regarding confidentiality, patient costs, in the expectations of each person.

b) The purpose of the interview and the role of the interviewer.
c) Time and place of the interview and a confidentiality statement.
d) An explicit purpose of the interview and a description of the physical examination, including diagnostic studies.

2. ______________________ Is exhibiting an accurate understanding of the other persons feelings within a

communication context.

a) Empathy
b) liking others
c) facilitation
d) a nonverbal listening technique

3. you conduct an admission interview. Because you are expecting a phone call , you stand near the door. Which would
be a more appropriate approach?

a) arrange to have someone paged you so you can sit on the side of the bed curious
b) have someone else answer the phone so you can give the patient your full attention.
c) Use this approach given the circumstances.
d) Arrange for a time free of interruptions after the initial physical examination is complete.

4. A patient asks the nurse, “may I ask you a question?” this is an example of:

a) an open ended question.

b) A reflective question.
c) A closed question.
d) A double barreled question.

5. Which statement best describes interpretation as a communication technique?

a) interpretation is the same as clarification

b) interpretation as a summary of a statement made by a patient
c) interpretation is used to focus on a particular aspect of what the patient has just said.
d) Interpretation is based on the interviewers inference from the data that have been presented.

6. Which demonstrates a good understanding of the interview process?

a) the nurse stops the patient each time something is said that is not understood.
b) The nurse spends more time listening to the patient than talking.
8
Chapter 3: The Interview
c) The nurse is consistently thinking of his or her next response so the patient will know he or she is understood curious
d) the nurse uses “why “ questions to see clarification of unusual symptoms or behavior

7. During an interview, a patient denies having any anxiety. The patient frequently changes position in the chair , holds
his arms folded tight against his chest, and has little eye contact with the interviewer. The interviewer should:

a) Used confrontation to bring the discrepancy between verbal and nonverbal behavior to the patient's attention
b) proceed with the interview. Patients usually are truthful with the health care practitioner.
c) Make a mental note to discuss the behavior after the physical examination is completed.
d) Proceed with the interview and examination as outlined on the agency assessment form. The patient's behavior is
appropriate for the circumstances.

8. for what or with whom should touch be used during the interview?

a) only with individuals from a western culture

b) as a routine way of establishing contact with the person in communicating empathy
c) only with patients of the same gender
d) only if the interviewer knows the person well.

9. children usually come for health care with a caregiver. At about what age should the interviewer begin to question
the child himself or herself regarding presenting symptoms?

a) 5 years
b) 7 years
c) 9 years
d) 11 years

10. because of adolescent’s developmental level, not all interviewing techniques can be used with them. Which
techniques should be avoided?

a) Facilitation and clarification

b) confrontation and explanation
c) empathy and interpretations
d) silence and reflection

11. knowledge of the use of personal space is helpful for the health care provider. Personal distance is generally
considered to be:

a) 0 to 1 1/2 feet
b) 1 1/2 to 4 feet
c) 4 to 12 feet
d) 12 or more feet.

12. Mr. B tells you, “everyone here ignores me.” you respond, “ignores you ?” this technique is best described as:

a) clarification
b) selective listening
c) reflecting
d) validation

13. what does active listening NOT include?

a) taking detailed notes during the interview

b) watching for clues and body language
c) repeating statements back to the person to make sure you have understood
d) asking open-ended questions to explore the persons perspective

14. when interviewing a patient who does not speak English, the examiner should:
9
Chapter 3: The Interview

a) take advantage a family member who are readily available and willing to assist
b) use a qualified medical interpreter who is culturally literate
c) seek as much information as possible and then continue with the physical examination
d) wait until a qualified medical interpreter is available before starting the interview

15. With older adults, how should the examiner proceed with the interview?

a) proceed in a more organized and concise manner

b) consider the fatigue of the older person and break the interview into shorter segments
c) ask a family member to complete some of the records while moving ahead with the interview
d) raise your voice if the patient does not appear to hear you