Interviewing Skills &

Health History

Ashfaq Ahmad Sahil (Lecturer INS,KMU)

BSN, MPH, PGD (PSY), MSN*
Objectives
By the end of presentation, learners will be
able to:
 Explain the purpose, process and
principals interviewing.
 Describe interview techniques.
 Discuss interviewing pitfalls.
 Identify phases of interview.
 Discuss communication techniques.
Cont….
 Practice utilizing therapeutic skills with a
learner‟s partner.
 Discuss the process of investigating
positive findings during the health history.
 Identify strengths and weaknesses via
observation of a videotaped interaction
and self/peer analysis.
Interview
 Is goal directed purposeful interaction
between two people.
Purposes:
 Gather information to base nursing care
 Establish a helping relationship
(promoting, motivating, supporting)
 Identify health status, concerns and
problems
 Screening
 Identify need for education
Interview process/approaches
 Directive
Formal & structured to collect wide range
of information usually content focused,
control, close ended
 Indirective
Informal and focused on specific area of
concern, process freedom, open ended
Interview Principles
 Introduce yourself.
 Don‟t rush. Allow enough time for the interview.
 Avoid interruptions.
 Explain that information from the interview is
confidential.
 Actively listen to what your patient is saying.
 Maintain eye contact.
 Work at the same level as your patient. Pull up a
chair and sit next to her or him.
Cont….
 Don‟t invade your patient‟s personal space. Two
to 4 feet away is a comfortable distance for most
patients.
 Explain what you are doing and why.
 If the patient presents with a problem, begin by
asking questions about that.
 Begin with nonsensitive issues. Leave more
sensitive topics until the end.
 Consider your patient‟s cultural background.
Cont….
 Consider your patient‟s developmental level.
How does it affect the interview and your
interpretation of the data?
 Don‟t become preoccupied with writing. You may
convey to the patient that the forms you are
completing are more important than he or she is.
 Be nonjudgmental.
 Avoid “why?” questions; they tend to put patients
on the defensive.
Cont…..
 Nonverbal behavior is more accurate than
verbal. Take a look at yours—What is it telling
your patient?
 Take a good look at your patient‟s nonverbal
behavior.
 Never pass up an opportunity to teach.
 Present reality.
 Be honest.
 Be respectful.
Interviewing Pitfalls
 Leading the patient
 Biasing yourself
 Letting family members answer for patient.
 Asking more than one question at a time.
 Not allowing enough response time.
 Using medical jargon
 Assuming rather than clarifying and validating.
Cont….
 Feeling personally uncomfortable
 Offering false reassurance
 Asking persistent or probing questions
 Changing the subject
 Jumping to conclusions.
Phases of interview
1. Introductory
 Orientation
 Purpose
 Interview environment
 Psychological (nonjudgmental and respectful)
 Physical ( privacy, noise, seating, light,
temperature)
Phases of interview cont….
2. Working phase
 Built trust and rapport
 Patient readiness (less sensitive topic
first)
 Use of therapeutic self ( common
techniques)
 Goal in mind
Phases of interview cont….
3. Termination phase
 Closure/ summarize
 Plan for future
 Evaluate (goals)
Communication Pattern
1. Verbal
 Conversation
2. Non verbal
 Body motion
 Eye contact, posture and distance
 Appearance
 Silence
 Touch
The Environment
 Improve communication
 Develop trust
 Use proper name and title
 Setting
 Quite
 Privacy
 Lighting
 Distance ( 4 feet)
 Personal Appearance
Note Taking
 Explain the purpose of record

 Should not divert attention

 Note down short phrases, words & dates

 Avoid writing on sensitive matters

 Communication Techniques

1.Greeting the patient

 Great the patient by name
 Shake hand
 Avoid “Auntie” or “Bibi”
 Explain your status & relation to patient
care.
Cont …..

2.Patient's comfort
 Explore feeling & convenience
 Watch for signs of:
 Discomfort or pain
 Poor positioning
 Anxiety
 Need to urinate
Cont …..

3.Opening question
 Start with general question

 Inquire again

 Ask one by one about multiple issues

Cont…
4.Empathetic Responses
 Ways that shows understanding and
acceptance
 “ I understand”
 “you must have been very upset”
Non verbal
 Offering a tissue to a crying patient
 Gently placing your hand on patient‟s arm
Cont…….
5.Confrontation
 Point out something about there own words
 Confrontation helps to bring hidden feelings out
 “ you said that you don‟t care but there are tears
in your eyes”
6.Interference
 Inference
 “you are asking a lot of questions about x-rays.
Are you worried”
Cont…….
7.Facilitation
 By posture, action or word
 Learning forward, making eye contact
 Saying “hmm” or “go on” I m listning.
8.Reflection
 A repetition of the patient‟s words that
encourages the patient to give you more details
 E.g.: Patient: the pain got worse and began to
spread (pause)
 Nurse: ok its spread
Cont…….
9.Clarification
 Some time patients words are nuclear
 Request clarification “tell me what you
mean by a „cold‟.”
10. Asking about feelings
 Ask them how they feel, or felt, about
something such as symptoms or events
Cont….
10. Transition
 Move from one part of history to another

 “now I would like to ask some question

about your past health”
Cont…..
11. Closing
 Address patient questions
 Rephrase
 Get feed back
Components of Health History
1. Identifying Data
 Identifying data—such as age, gender, occupation,
marital status
 Source of the history—usually the patient, but can
be a family member or friend, a letter of referral or
the medical record
2. Chief Complaint(S)
 Quote the patient’s own words. “My stomach
hurts and I feel awful”; or “I have come for my
regular check-up.”
 Cont…..
3. Present Illness
 This section is a complete, clear, and chronological
account of the problems prompting the patient to seek
care.
 It should include the problem‟s onset, the setting in
which it has developed, its manifestations, and any
treatments.
 Seven features are listed below as pertinent positives
and negatives from relevant areas of the Review of
Systems.
Cont….
1) Location,
2) Quality,
3) Quantity or severity,
4) Timing, including onset, duration, and
frequency,
5) Setting in which they occur,
6) Aggravating and relieving factors,
7) Associated manifestations
Cont…..
4. Past History
 List childhood illnesses, then list adult illnesses
in each of the four areas:

 Medical (e.g., diabetes, hypertension, hepatitis,

asthma,(HIV), with dates of onset; also information
about hospitalizations with dates; numbers and
gender of sexual partners; risky sexual practices.

 Surgical (dates, indications, and types of operations)

Cont…..
 Obstetric/gynecologic (obstetric history, menstrual
history, birth control, and sexual function).

 Psychiatric (illness and time frame, diagnoses,

hospitalizations, and treatments)

 Also discuss health maintenance, including

immunizations.
 Cont…..
5. Family History
 Outline or diagram the age and health, or age and
cause of death, of each immediate relative, including
grandparents, parents, siblings, children, and
grandchildren.
 Record the following conditions as either present or
absent in the family: hypertension, coronary artery
disease, elevated cholesterol levels, stroke, diabetes,
thyroid or renal disease, cancer (specify type), arthritis,
tuberculosis, asthma or lung disease, headache,
seizure disorder, mental illness, suicide, alcohol or
drug addiction, and allergies, as well as symptoms that
the patient reports.
Cont…..
6. Personal and Social History
 Include occupation and the last year of schooling;
home situation and significant others; sources of
stress, both recent and long-term; important life
experiences, such as military service; leisure
activities; religious affiliation and spiritual beliefs;
and activities of daily living (ADLs).
 Also include lifestyle habits such as exercise and
diet, safety measures, and alternative health care
practices.