Interview

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Interview
• The interview is the first point of contact with a client and the most
important part of data collection.
• Skilled interviewers are able to glean all necessary information while
establishing a rapport with the client.

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Successful interviews allow you to:
1. Gather complete and accurate data about the person’s health state,
including the description and chronology of any symptoms of
illness.
2. Establish trust so the person feels accepted and thus free to share
all relevant data.
3. Teach the person about his or her health state.
4. Build rapport for a continuing therapeutic relationship; this rapport
facilitates future diagnoses, planning, and treatment.
5. Discuss health promotion and disease prevention.

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The interview is a contract between you and your client. The contract
include:
• Time and place of the interview and succeeding physical examination.
• Introduction of yourself and a brief explanation of your role.
• The purpose of the interview.
• How long it will take.
• Expectation of participation for each person.
• Presence of any other people (e.g., family, other health professionals,
students).
• Confidentiality and to what extent it may be limited.
• Any costs to the client.
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Interview
• Although the person already may know some of this information
through telephone contact with receptionists or the admitting office,
the remaining points need to be stated clearly at the outset.
• Any confusion or unclear expectations can cause mistrust and
resentment rather than the openness and trust required to facilitate
the interview.

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The Process of Communication
• The vehicle that carries you and your client through the interview is communication.
Communication is exchanging information so each person clearly understands the other.
• Sending.
• Receiving.
• Internal factors.
- Liking others.
- Empathy.
- The ability to listen.
• External factors.
- Ensure privacy.
- Refuse interruptions.
- Physical environment.

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Dress
• The client should remain in street clothes during the interview except
in an emergency. A hospital gown causes a power differential and may
make the person feel exposed and uncomfortable. Establish rapport
before asking the person to change into a gown.
• Your appearance and clothing should be appropriate to the setting
and should meet conventional professional standards: a uniform or
lab coat over conservative clothing, a name tag, and neat hair. Avoid
extremes.

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Note-taking
Some use of history forms and note-taking may be unavoidable. For example, when you
sit down later to record the interview, you cannot rely completely on memory to furnish
details of previous hospitalizations or the review of body systems. But be aware that
excessive note-taking during the interview has disadvantages:
• It breaks eye contact too often.
• It shifts your attention away from the person, diminishing his or her sense of importance.
• Trying to record everything a person says may cause you to ask him or her to slow down,
or the person may slow his or her tempo to allow for you to take notes. Either way, the
client’s natural mode of expression is lost.
• It impedes your observation of the client’s nonverbal behavior.
• It is threatening to the client during the discussion of sensitive issues (e.g., amount of
alcohol and drug use, number of sexual partners, or incidence of physical abuse).

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Techniques of Communication
• Introducing the Interview.
• The Working Phase.
- Open-Ended Questions.
- Verbal responses: assisting the narrative.
• Closing the interview.

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Ten Traps of Interviewing
1. Providing False Assurance or Reassurance.
2. Giving Unwanted Advice.
3. Using Authority.
4. Using Avoidance Language.
5. Distancing.
6. Using Professional Jargon.
7. Using Leading or Biased Questions.
8. Talking Too Much.
9. Interrupting.
10. Using “Why” Questions.
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Nonverbal Skills
• Physical Appearance.
• Posture.
• Gestures.
• Facial Expression.
• Eye Contact.
• Voice.
• Touch.

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Interviewing People with Special Needs

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Hearing-Impaired People
• People who are hearing impaired may feel marginalized by
professionals and think that their intelligence is questioned because
they cannot always understand what is being asked of them.
• People with a hearing impairment may feel isolated and anxious
because they cannot understand everything that is happening.
• Ask the person his or her preferred way to communicate—by signing,
lip reading, or writing. If the person has hearing aids, make sure that
he or she is using them properly. If you notice a hearing impairment
but no hearing aids are in use, consider a referral for a hearing test
and follow-up.

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Acutely Ill People
• A hospitalized person with a critical or severe illness is usually too weak,
too short of breath, or in too much pain to talk. Focus on making him or
her comfortable first and then ask priority questions about the history.
• Explore the first concern the person mentions. You will find that you ask
closed, direct questions earlier in the interview to decrease response
burden.
• Finally make sure that you are clear in your statements. When a person is
very sick, even the simplest sentence can be misconstrued. The person
will react according to preconceived ideas about what a serious illness
means; thus anything you say should be direct and precise.

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People Under the Influence of Street Drugs
or Alcohol
Many substance abusers are poly-drug abusers. The client’s behavior
depends on which drugs were consumed:
• Alcohol, benzodiazepines, and the opioids (heroin, methadone, morphine,
oxycodone) are CNS depressants that slow brain activity and impair
judgment, memory, intellectual performance, and motor coordination.
• Stimulants of the central nervous system (cocaine, amphetamine) can
cause an intense high, agitation, and paranoid behavior.
• Hallucinogens (LSD, ketamine, PCP) cause bizarre, inappropriate,
sometimes even violent behavior accompanied by superhuman strength
and insensitivity to pain.

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People Under the Influence of Street Drugs
or Alcohol
• When interviewing a person currently under the influence of alcohol
or illicit drugs, ask simple and direct questions.
• Take care to make your manner and questions nonthreatening.
• Avoid confrontation while the person is under the influence and avoid
displaying any scolding or disgust since this may make the person
belligerent.

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People Under the Influence of Street Drugs
or Alcohol
• The top priority is to find out the time of the person’s last drink or
drug, how much he or she took, and the name and amount of each
drug that was taken. This information will help assess any withdrawal
patterns.
• For your own protection, be aware of hospital security or other
personnel who could be called on for assistance.
• Avoid turning your back, and make sure that you are aware of your
surroundings.

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Personal Questions
• Occasionally people will ask you questions about your personal life or
opinions such as, “Are you married?” “Do you have children?” or “Do
you smoke?” You do not need to answer every question, but you may
supply information that you think is appropriate.
• Beware that there may be an ulterior motive to the questions such as
anxiety or loneliness. Try directing your response back to the person’s
frame of reference. You might say something like, “No, I don’t have
children; I wonder if your question is related to how I can help you
care for little Jamie?”

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Sexually Aggressive People
• On some occasions personal questions extend to flirtatious
compliments, seductive innuendo, or sexual advances. Some people
see illness as a threat to their self-esteem and sexual adequacy; this
feeling creates anxiety that makes them act out in sexually aggressive
ways.

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Sexually Aggressive People
• Your response must make it clear that you are a health professional who can
best care for the person by maintaining a professional relationship.
• 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. This may be difficult, considering that the person’s
words or gestures may have left you shocked, embarrassed, or angry. Your
feelings are normal. You need to set appropriate verbal boundaries by saying, “I
am uncomfortable when you talk to me that way; please don’t.” A further
response that would open communication is, “I wonder if the way you’re feeling
now relates to your illness or to being in the hospital?”
• If the behavior continues, you may need to remove yourself from the situation.

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Crying
• A beginning examiner usually feels horrified when the client starts to cry,
but crying is a big relief to a person. Health problems come with powerful
emotions, and it takes a good deal of energy to keep worries about
illness, death, or loss bottled up.
• When you say something that “makes the person cry,” do not think you
have hurt the person. You have just broached a topic that is important. Do
not go on to a new topic. It is important that you allow the person to cry
and express his or her feelings fully before you move on. Have tissues
available and wait until the crying subsides to talk.
• Reassure the crying client that he or she does not need to be
embarrassed and that you are there to listen.
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Anger
• Occasionally you will try to interview a person who is already angry.
Don’t take the anger personally; it typically doesn’t relate to you. The
person is showing aggression as a response to his or her own feelings
of anxiety or helplessness.
• Do ask about the anger and hear the person out. Deal with the angry
feelings before you ask anything else. An angry person cannot be an
effective participant in a health interview.

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Threats of Violence
• The health care setting is not immune to violent behavior, and an individual may act in such a way that you
believe that your personal safety is being threatened. Red-flag behaviors of a potentially disruptive person
include fist clenching, pacing back and forth, confusion, statements out of touch with reality or that do not
make sense, a history of recent drug use, or perhaps a recent history of intense bereavement (loss of partner,
loss of job).
• If you sense any suspicious or threatening behavior, act immediately to defuse the situation or obtain additional
support from other staff or security.
• Make sure that you leave the door to the examination room open, and never turn your back to a potentially
aggressive person.
• You also want to make sure to position yourself between the person and door so you can easily leave the room.
• Make sure that you know the hospital policies and which resources are available.
• Do not raise your own voice or try to argue with the threatening person. Act calm and talk to the person in a
soft voice.
• Act interested in what the person is saying, and behave in an unhurried way. Your most important goal is safety;
avoid taking any risks.

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Anxiety
• Finally take it for granted that nearly all sick people have some
anxiety. This is a normal response to being sick. It makes some people
aggressive and others dependent.
• Appearing unhurried and taking the time to listen to all of the client’s
concerns can help diffuse some anxiety.
• Avoiding the traps to interviews and using therapeutic responses are
other ways to help diffuse anxiety.

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 THANK YOU FOR LISTENING

ANY QUESTION?

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