NUCM 101: HEALTH ASSESSMENT

UNIT 2: THE PATIENT INTERVIEW

2nd SEMESTERINTERVIEW
NURSING | S.Y. 2021-2022 TRANSCRIBED BY: CZEJAN RAE TABARANZA
LECTURER: DEVIANNE JANE E. DAIZ
• essential in developing trust impressions (use effective interview
 a purposeful, time-limited verbal • verbal assurance of confidentiality often techniques)
interaction between the nurse and the eases the patient’s concerns • STAGES OF INTERVIEW PROCESS
patient or his/her significant other • reasons for sharing confidential information: 1. Stage I (Pre-Introductory Stage)
 done to collect subjective data about the ü patient poses danger to self or 2. Stage II (Introductory Stage)
patient others 3. Stage III (Working Stage)
ü institutional policy 4. Stage IV (Termination Stage)
(inform the patient prior when the
FACTORS INFLUENCING THE INTERVIEW STAGE 1: PRE-INTRODUCTORY STAGE
info should be shared)
1. Approach
• the nurse reviews patient’s records before
2. Environment
4. NOTE TAKING meeting with the patient.
3. Confidentiality
4. Note Taking • advisable but may cause patient discomfort
5. Time, Length, Duration • explain the necessity of jotting down STAGE 2: INTRODUCTORY STAGE
6. Biases & Preconceptions pertinent information
• show to patient the form you will be using • the nurse & patient establish trust & get to
• pay attention to patient & defer recording if know each other
1. APPROACH patient discusses sensitive issues
• jot down phrases, words, & dates that can
 gather all appropriate information before STAGE 3: WORKING STAGE
be used
approaching the patient • bulk of patient data is collected
 BEGIN by introducing your name & title 5. TIME, LENGTH, DURATION
 INITIALLY, call the patient by his/her formal
name & ask how the patient prefers to be • interview times should be least disruptive STAGE 4: TERMINATION STAGE
addressed to patient’s daily routine
• try to accommodate patient’s request • information is summarized & validated
• during this stage, give the pt an indication
2. ENVIRONMENT of the amt of time left in the interview
6. BIASES & PRECONCEPTIONS
• has a direct influence on the amt & quality • allow pt opportunity to give addt’l info &
of information gathered • be sensitive to personal as well as patient make comments/statements
• ideal setting for interview: private room, contexts in order to treat all patients fairly (e.g. “We have about 5 minutes more, Mr.
less distractions/interruptions, & increase & respectfully Cruz, is there anything else you would like
comfort level for the patient • avoid faulty assumptions by continually to add or mention?”)
3. CONFIDENTIALITY validating information & personal
FACTORS AFFECTING COMMUNICATION
 1. Active Listening b. Personal distance (18 inches to 4 • used to focus the interview, pinpoint
2. Non-verbal Cues feet) specific areas of concern, & elicit valuable
3. Distance/Proxemics information quickly & efficiently
c. Social distance (4 to 12 feet)
4. Personal Space • can disrupt communication if frequently
d. Public distance (> 12 feet) used
1. ACTIVE LISTENING
e.g.,
• primary goal:
- to decode patient messages in order to 4. PERSONAL SPACE “Are you thinking of hurting yourself?”
understand the situation or problem as • the space over which the person claims
the other person sees it ownership 3. FACILITATING
• always pay particular attention & formulate (e.g. pt’s hospital room & bathroom)
an appropriate response • encourages patient to continue talking
• pt. may be protective over this space &
• coupled with nonverbal cues
consider unauthorized use of it as an
2. NONVERBAL CUES - eye contact
invasion of privacy
- nodding
• communicating a message without words - leaning slightly forward
• may include:
EFFECTIVE INTERVIEW TECHNIQUES
- body position e.g., “Go on.” or “Uh-huh.”
- nervous repetitive movements of the
hands or legs 1. USING OPEN-ENDED QUESTIONS
- rapid blinking • encourages pt. to provide general rather 4. USING SILENCE
- lack of eye contact than more focused communication. • helps structure & pace the interview,
- yawning convey respect & acceptance, and prompt
- fidgeting e.g.,
additional patient data.
- excessive smiling or frowning “What caused you to believe that you might • on the part of the patient, may convey
- repetitive clearing of the throat, etc. be drinking too much?” anxiety, confusion or embarrassment

3. DISTANCE OR PROXEMICS e.g., Validating the right patient before giving

• the amount of space a person considers
appropriate for interaction is a significant
factor in the interview process and is
determined in part by cultural influences.
a. Intimate zone (< 18 inches from pt.)
5. MAKING OBSERVATION
the drug:
• the nurse verbalizes perceptions about the
“May I know your name sir?” patient’s behavior, then shares them with
the patient
2. USING CLOSE-ENDED QUESTIONS
e.g., “Speaking about those symptoms seems to
• restrict or regulate patient response to a
make you tense. I notice that you are
“yes”, a “no” or a response less than 3
clenching your fists and grimacing.”
words
6. RESTATING
• involves repeating or rephrasing the main
idea expressed by the patient & lets the
patient know that you are paying attention
e.g.,
Patient: “I don’t sleep well anymore. I find myself
waking up frequently at night.”
Nurse: “You’re having difficulty sleeping?” or “You
don’t sleep well?”
7. REFLECTING
• the nurse directs the pt’s own questions,
feelings & ideas back to the patient
• provides opportunity for the patient to
reconsider &/or expand on what was said
e.g.,
Patient: “Do you think I should tell the doctor that I
stopped taking my medication?”
Nurse: “What do you think about that?”
Patient: “Well, yes, I think that I probably should.
But that medication just makes me so teary
and agitated.”
Nurse: “You sound a bit agitated now. It seems as if
you’ve been thinking about this a lot.”
Patient: “I told that young doctor that I had
problems with this medication and he just
didn’t listen.”
Nurse: “Sounds as if you are pretty angry with him.”
8. CLARIFYING
• 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.
e.g.,
Patient: “During certain activities, I have the most
awful pain in my back..”
Nurse: “Tell me what you mean by awful.”
9. INTERPRETING
• enables the nurse to link events that
perhaps the patient was not able to piece
together
e.g.,
Patient: “My stomachache seems to occur only
from late summer to midspring.”
Nurse: “From what you have just told me, could it
be the stress of your teaching job (pt works
from September to May) that is causing
your pain?.”
10. SEQUENCING
• involves asking the patient to place a
symptom, a problem, or an event in its
proper sequence.
• facilitating the conversation such that
occurrence of symptoms/events are pieced
together chronologically by pt.
e.g.,
“What specific events led you to feel
overwhelmed and suicidal?”
e.g.,
“Did this sharp pain occur each time you had
sexual intercourse or only when you didn’t
empty your bladder first?”
11. ENCOURAGING COMPARISON
• 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
e.g.,
“In what way was this allergy attack different from
or the same as your previous ones?”
12. SUMMARIZING
• especially useful at the end of the health
assessment interview
e.g.,
“During this past hour, you have shared with me
several health concerns of which the most vexing to
you is your difficulty in losing weight. Is that
correct?”
13. FOCUSING
• allows the nurse to concentrate on or
“track” a specific point the patient has
made
• useful to pts. w/ heightened anxiety &
altered concentration, or jumping from
topic to topic
e.g.,
“Tell me more about the chest pain you experience
when you begin to exercise.”
e.g.,
“You’ve mentioned several times that your wife is
concerned about your smoking. Let’s go back to
that.”
14. EXPLORING
• enables the nurse to develop, in more
detail, a specific area of content or patient
concern.
• helps the nurse identify patterns or themes
in symptom presentation or in the way
patients handle problems or health
concerns
e.g.,
“Tell me more about how you feel when you do not
take your medication.”
e.g.,
“Could you describe for me how you handle those
periods in your life when you feel out of control?”
Patient: “I never knew exactly which of my
symptoms to pay attention to. I think I’m
15. PRESENTING REALITY
such a hypochondriac.”
• typically used with psychiatric or confused
Nurse: “You say that you’re not sure which
patients, or to patients who exaggerate or
symptoms are important and yet it seems
make grandiose statements.
that you are very clear about those
• done in a nonargumentative way,
symptoms you thought were serious
encourages patient to rethink a statement
enough to seek medical care and which
and perhaps modify it
ones you felt comfortable managing on
e.g., your own.”
Patient: “I can never get an appointment at this
clinic.”
17. INFORMING
Nurse: “But Mr. Jasper, I’ve seen you several times
• Providing the patient with needed
in the past 4 months.”
information, such as explaining the nature
Patient: “Well, yes, but I can never get an and/or the reasons for any necessary tests
appointment at a time that is convenient or procedures.
for me.” • allows the nurse to help patients become
aware of possible choices & then evaluate
those choices correctly
16. CONFRONTING e.g.,
• a verbal response that the nurse makes to
Patient: “Dr. Jones told me that I need to have my
some perceived discrepancy or
gallbladder taken out.”
incongruency in the pt’s thoughts, feelings,
or behaviors. Nurse: “Did you understand what Dr. Jones told you
• can be used to focus the patient’s attention about your gallbladder surgery?”
on some aspect of behavior that, if
Patient: “No, I didn’t understand what he said
changed, could lead to more effective
about the new technique. He said
functioning
something about a tube.”
• done in a caring, empathetic manner,
rather than a critical or accusatory one. Nurse: “There is a new technique where the
surgeon inserts a tube in your abdomen to
e.g.,
 remove the gallbladder rather than making
a cut, which is the usual procedure.”

Patient: “Yes, that was it, please tell me more about

that.”
18. COLLABORATING
• the nurse & patient work together, rather
than the nurse taking control of the
interaction
• conveys the message that the patient has
important knowledge and information to
share & encourages active involvement of
patient in their own health care, in setting
goals, in gathering information, & in
problem solving.
e.g.,
“Perhaps you and I talk further about your asthma
and discover what specifically is making you so
anxious.”
19. LIMIT SETTING
• setting specific limits on inappropriate
patient behavior; such situations may
include:
ü sexually aggressive pt.
ü hostile pt.
ü talkative pt.
• provide guidance by calmly, clearly, and
respectfully telling the patient what
behavior is expected
• Limit only the behavior that is problematic
or detrimental to the purpose of the
interview and avoid making a “big issue” of
whatever it is that the patient is doing
• Do not argue or use empty threats or
promises but do offer the patient
alternatives.
e.g., INEFFECTIVE LIMIT SETTING
Nurse: “If you don’t start answering my questions,
we’ll never finish and you’ll never get to see
the doctor.”
e.g., APPROPRIATE LIMIT SETTING
Nurse: “You know, it seems that you are feeling
pretty unsure of how to behave now.”
Patient: “What do you mean?”
Nurse: “Well, you’re asking me a lot of personal
questions & generally making it difficult for
me to find out what is bothering you. The
reason you are here is because you have
some health concerns. How can I help you
more clearly tell me what brought you to
the clinic?”
20. NORMALIZING
• 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.
e.g.,
“It is no wonder that you’ve been feeling shocked
and overwhelmed since you first found that lump in
your breast. Most women who have that experience
react in a similar way.”
NON-THERAPEUTIC INTERVIEW
TECHNIQUES
1. REQUESTING AN EXPLANATION
• 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
e.g., “Why do you think that?”
2. PROBING
• repeated or persistent questioning of the
patient about a statement or behavior
e.g.,
Nurse: “What makes you think that you have
arthritis?”
Patient: “I’m not sure, I just think I do. It just seems
like I have the same health problems as my
mother & she had arthritis.”
Nurse: “Well, do you have pain?”
Patient: “Yes.” (pause)
Nurse: “Why do you think the pain is arthritis
pain?”
• useful responses to prevent probing:
ü going on to the next part of
interview
 ü asking permission to get back to the
subject later
ü just sitting quietly until patient
begins to speak
3. OFFERING FALSE REASSURANCE
• 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
e.g.,
“Don’t worry. There are hardly any problems with
that type of surgery.”
e.g. Appropriate Response:
“It must be frightening to think about the possibility
of surgery.”
4. GIVING APPROVAL OR DISAPPROVAL
• 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.
e.g., “That is bad.” or “You shouldn’t feel that way.”
or “What a good idea.”
e.g. Appropriate Response:
“What do you think the consequences will be if you b. Interrupting the Patient
continue to keep your illness from your wife?”
c. Engaging in Talkativeness
5. ADVISING
d. Using Multiple Questions
• consistently telling a patient what to do
• does not foster competence e. Using Medical Jargon
• nurses should not reinforce dependence, f. Being authoritative
because some patients may resort to
e.g., “I’ve been a nurse, Mr. Haddad, for over 10
dependent, passive behavior when faced
years, and I think I know what is best for
with illness
you?”
e.g., GIVING ADVICE
e.g. Positive Use of Authority:
Patient: “Do you think that I should have an
abortion?” “As your health care provider, knowing
about your previous heart attack, history of
Nurse: “No, I think you should continue the high blood pressure, and family history of
pregnancy. Abortion is never an answer.” stroke, I would suggest you consider
stopping smoking?”
e.g., CORRECT RESPONSES
g. Having Hidden Agendas
Nurse: “Do you think you should?” (reflecting)
Nurse: “Tell me more about what made you
consider an abortion.” (exploring)
6. USING PROBLEMATIC QUESTIONING
TECHNIQUES
a. Posing Leading Questions
e.g., “You’ve never had any type of sexually
transmitted diseases, have you, Miss
Jenkins?”
e.g., “Of course, you’ve told your daughter that her
smoking really bothers you, Mr. Talbott,
isn’t that correct?”
 INTERVIEWING PATIENTS WITH SPECIAL
NEEDS
THE 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.
THE PATIENT WHO IS SPEECH-IMPAIRED
• Ask simple questions that requires yes and
no answers (closed-ended questions);
example: Instead of asking, “How are you
now?” use
“Are you feeling well now?”
• 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 • If necessary, interview the patient’s family
patient, the nurse should speak and direct or caregiver for supplemental information.
questions to the patient, not to the • Always direct the questions to the patient
intermediary and allow assistance from family members
or the caregiver.
• Observe nonverbal communication
THE PATIENT WHO IS NON-ENGLISH between patient and family to gather
information about patient’s health/illness
• Have an interpreter/translator if possible state as well as relationships between them
• Nurse should not assume that the
interpreter can answer questions for the
patient.
THE PATIENT WHO IS UNDER THE INFLUENCE OF
• Direct the questions to the patient and NOT
ALCOHOL OR DRUGS
to the interpreter
• Remember that pure translation from one • May have impaired judgment which may
language to another does not take into lead to physical harm or violence; security
account dialects or colloquialisms (words of personnel should be alerted and stationed
phrases particular to a question) nearby
• Have been known to have superhuman
e.g. “Are you pregnant?” when translated
strength and is capable of inflicting serious
without taking into account colloquialisms may
harm; place yourself at a safe distance,
mean, “Do you intercourse outside of
remain calm, and provide care in a
marriage?”
nonthreatening manner.
THE PATIENT WHO HAS LOW LEVEL OF
THE PATIENT WHO IS VISUALLY IMPAIRED
UNDERSTANDING
• Look directly at the patient as if the patient
• Requires time and patience; patient may
were sighted
require time to process questions and to
• Avoid speaking loudly because this may
formulate answers and may need
insult the patient or hinder communication
clarification of the meaning or intent of
• Touch is very important, however, before
questions.
touching, inform the patient and ask
• Hurrying may cause confusion, loss of
permission to touch.
concentration or refusal to answer the
question.
 • Advise the patient when you are entering
or leaving the room and orient the patient
to the immediate environment
• Use clock hours to indicate position of
items in relation to patient
• Offer assistance to the partially sighted and
follow their cues or responses
THE PATIENT WHO IS CRYING
• Show empathy and allow patient to cry
• Offering of tissues indicates to the patient
that it is okay to cry and conveys a message
of thoughtfulness.
• When the patient has regained composure,
proceed with the interview
THE PATIENT WHO IS ANXIOUS & ANGRY
• Allow the patient to express emotions and
understand that emotional outbursts and
crying are often a result of stress.
• If it is obvious that the person is holding
back tears, give permission to express
emotion with a simple statement such as,
“I can see that you are upset; it’s okay to cry”
• If client is obviously angry, recognize and
acknowledge the emotion.
e.g.,
“You appear very angry about something.
Before we continue with the interview,
please tell me know about your feelings.”
• Avoid statements such as
“take a moment to get hold of your self,”;
this implies that the patient’s feelings are
not appropriate and should not be
expressed.
THE PATIENT WHO IS HOSTILE
• Hostility tends to be contagious. Don’t
reciprocate with anger and hostility
• Minimize aggression through limit-setting
and refocusing (non-threatening
interventions)
• Position yourself near an easily accessible
exit.
• Do not turn your back on the patient and
never allow the patient to walk behind you
or come between you and the exit.
• Watch for signs of increasing tension in the
patient (e.g. clenched fists, loud voice,
angry tone of voice, narrowed eyes)
• Consider leaving the door to the room open
to some degree to deter a potentially
hostile patient.
THE PATIENT WHO IS SEXUALLY AGGRESSIVE
• May act out during interview,
e.g.
“You have been so nice to me, I would like
the to be nice to you.”
• The nurse may counter this behavior by
defining appropriate boundaries, sharing
personal reactions, and refocusing the
patient,
e.g. ,
“It makes me very uncomfortable when
you stand this close to me. Let’s get back to
getting information to assist in your health
care needs”
THE PATIENT WHO IS VERY ILL
• May not have the strength or ability to go
through the entire interview process
• Collect pertinent data from the patient first
and defer remainder of the interview later.
• Interview a family member or significant
other, instead of the patient, if necessary.
Ask permission to do this to show respect.
• If SO is interviewed, allow patient to be
present and allow him/her to participate as
much as possible in answering.
THE PATIENT WHO IS OLDER ADULT
• Hearing acuity is assessed first.
• Avoid ELDERSPEAK (gives the message of
dependence and incompetence)
• May require additional time for questioning
interpretation & patient responses.
• Schedule more than one interview
• Interview older patient’s family member or
caregiver, as necessary.
 CLINICAL APPLICATIONS

2. You are talking to the father of a child with
1. Mr. & Mrs. Quinn are awaiting results of
diagnostic testing that will confirm or deny
a diagnosis of fetal neurological
impairment. She says to the nurse, “It’s
taking so long to get the results, I’m sure
that there must be something wrong with
the baby.” The nurse replies, “Oh no, you
don’t need to worry. Everything will be just
fine!”
4. During history taking, your patient said,
a terminal disease. You feel very badly “These questions are all too personal! Why
about the family situation and offer your are you asking me all of this?” What would
assistance. The father says, “What do you you do?
want? You can’t help us.”
What do you do or say next?

Was the nurse’s response appropriate? If

not, what impact will the nurse’s response
have on the couple? If you were in that
situation, how would you have responded?

ANS:

No, false reassurance 5. You were conducting a complete health

3. A young teenager seeking birth control tells history & the patient stated, “I don’t feel
you, “I hope you won’t tell my mother like talking right now.” How would you
about the abortion I had.” How would you respond to this statement?
respond to this patient?