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HA
CLIENT INTERVIEW AND HEALTH HISTORY
| Directive | nurse directs and controls the interview; mostly close-ended questions |
| Non-directive | Nurse clarifies, summarizes, and ask mostly open-ended q’s |
| Guidelines for Active and Effective Listening | Avoid interruptions. Concentrate on the speaker. Maintain eye contact if culturally appropriate to do so. Lean toward and face the speaker. Maintain open posture, not crossed arms. |
| Non-verbal communication | Body language, Facial expressions, Eye contact (depends on culture). Gestures Posture, Qualities of voice (intonation, rate, rhythm, pitch) Physical appearance (including clothes and grooming, Space, Touch, Silence, Active listening |
| Guidelines for Use of Touch | it is best to avoid the use of touch, particularly invasive procedures, until a nurse-client relationship is well-established and the nurse is knowledgeable about the beliefs related to touch in the particular culture. |
| Guidelines for Use of Touch (2) | Best used by members of the same gender and culture. If touch seems appropriate while taking a nursing history (e.g., if a client should begin crying), gentle touch of the nurse’s hand on the client’s upper arm or shoulder could be used. |
| Functional Use of Space | Intimate zone (1 1/2ft) best for assessing breath and body odors. Personal Distance (1 1/2 to 4ft) |
| CRITERIA FOR EFFECTIVE VERBAL COMMUNICATION | •BREVITY • CLARITY • SIMPLICITY • TIMING AND RELEVANCY |
| Guidelines for Active and Effective Listening | Avoid interruptions. Concentrate on the speaker. Maintain eye contact if culturally appropriate to do so. Lean toward and face the speaker. Maintain open posture, not crossed arms. |
| Non-verbal communication | Body language, Facial expressions, Eye contact (depends on culture). Gestures Posture, Qualities of voice (intonation, rate, rhythm, pitch) Physical appearance (including clothes and grooming, Space, Touch, Silence, Active listening |
| Guidelines for Use of Touch | it is best to avoid the use of touch, particularly invasive procedures, until a nurse-client relationship is well-established and the nurse is knowledgeable about the beliefs related to touch in the particular culture. |
| Guidelines for Use of Touch (2) | (2) Best used by members of the same gender and culture. If touch seems appropriate while taking a nursing history (e.g., if a client should begin crying), gentle touch of the nurse’s hand on the client’s upper arm or shoulder could be used. |
| Functional use of space | Intimate zone (1 1/2ft) best for assessing breath and body odors. Personal Distance (1 1/2 to 4ft) |
| IMPORTANCE OF CLIENT INTERVIEW | Gather complete and accurate data about the person's health state, including the description and chronology of any S/Sx & Establish trust so that the person feels accepted and thus free to share all relevant data |
| IMPORTANCE OF CLIENT INTERVIEW (2) | Teach the person about his or her health state. Build rapport for a continuing therapeutic relationship. Discuss health promotion and disease prevention. |
| 10 TRAPS OF INTERVIEWING | Providing False Assurance or Reassurance Giving Unwanted Advice I Using Authority I Using Avoidance Language I Distancing I Using Professional Jargon I Using Leading or Biased Questions I Talking Too Much I Interrupting Using “Why” Questions |
| COMMUNICATING WITH PEOPLE WHO ARE DEPRESSED | Express interest in, and understanding of client and respond in a neutral manner. • Don’t try to communicate in an upbeat, encouraging manner—this will not help the depressed client. |
| COMMUNICATING WITH AGGRESSIVE PEOPLE | Speak softly. Be calm and reassuring. Avoid quick, sudden, or erratic movements. Never argue or try to reason with the person. Be empathetic. Keep out of striking distance. Never threaten verbally or strike back. |
| COMMUNICATING WITH PEOPLE WHO ARE COGNITIVELY CHALLENGED | Ask simple yes or no questions. Speak slowly. Always assume that the person has the capacity to understand. If the person is having trouble communicating an idea, help with the word he or she is trying to find. Do not interrupt or appear impatient. |
| Communicating with anxious client | Provide client with simple, organized information in a structured format. • Explain who you are, along with your role and purpose. • Ask simple, concise questions. • Avoid becoming anxious like your client. • Do not hurry |
| Communicating with the visually impaired | Touch is important. Call out the person’s name before touching. Allow the person to touch you. Tell the person if you are leaving. Let the person know if others will remain in the room or if she or he will be alone. |
| Communicating with the hearing impaired | Wait until you are directly in front of the person, you have the person’s attention, and you are close to the person before you begin speaking. Be on the same level with the person whenever possible and gain eye contact. |
| Communication | a process of sharing information and meaning, of receiving and sending message. |
| Vocal Cues or Paralinguistic | Describe the quality of your voice and its inflections, tone, intensity, and speed when speaking. These voice characteristics usually reflect underlying feelings |
| Action Cues and Kinetics | are body movements that convey messages. Posture, arm position, hand gestures, body movements, facial expressions, and eye contact all convey a message. The message may reflect a feeling, a mood, or an underlying physiological or psychological problem |
| Object Cues | Your patient’s dress and grooming reflect his or her identity and how he or she feels about himself or herself. Poor grooming or disheveled clothing may indicate a psychological problem such as depression. |
| Personal Space | Personal space is the territory surrounding a person that she or he perceives as private or the physical distance that needs to be maintained for the person to feel comfortable. |
| Touch | Touch is a means of communication. An array of feelings, including anger, caring, and protectiveness, can be conveyed through touch. |
| Cultural Considerations | Culture can influence every aspect of communication, so consider not only the language but also the vocal, action, object cues, personal space, and touch. |
| Affirmation | Acknowledge your patient’s responses through both verbal and nonverbal communication to reassure him that you are paying attention to what he is saying |
| Silence | Although silence is difficult to maintain at times, it can be very effective at facilitating communication. Periods of silence allow your patient to collect her or his thoughts before responding and help prevent hasty responses that may be inaccurate |
| Clarifying | . If you are unsure or confused about what your patient is saying, rephrase what she said and then ask the patient to clarify. Use phrases like “Let me see if I have this right, or “I want to make sure I’m clear on this,” or “I’m not sure what you mean.” |
| Restating | Restating the patient’s main idea shows him that you are listening, allows you to acknowledge your patient’s feelings, and encourages further discussion. |
| Active Listening | Pay attention, maintain eye contact, and really listen to what your patient tells you both verbally and nonverbally. As you listen, keep in mind what you are telling your patient nonverbally. Actively listen- ing conveys interest and acceptance |
| Broad or General Openings. | This technique is effective when you want to hear what is important to your patient. Use open-ended questions such as, “What would you like to talk about?” |
| Reflection | Reflection allows you to acknowledge your patient’s feelings, encouraging further discussion. When your patient expresses a thought or feeling, you echo it back. |
| Humor | Humor can be very therapeutic when used in the right context. It can reduce anxiety, help patients cope more effectively, put things into perspective, and decrease the social distance |
| Informing | Giving information allows your patient to be involved in his or her healthcare decisions. An example would be explaining the postoperative course and the importance of coughing and deep breathing to your patient preoperatively. |
| Redirecting | Redirecting your patient helps keep the communication goal-directed. It is especially useful if your patient goes off on a tangent. To get your patient on track again, you might say, “Getting back to what brought you to the hospital |
| Focusing | Focusing allows you to hone in on a specific area, encouraging further discussion. Examples include: "You said your mother and sister had breast cancer" you have identified a risk factor and a potential area for health education |
| Sharing perceptions | With this technique, you give your interpretation of what has been said in order to clarify things and prevent misunderstandings. You may need to question your patient if there is a discrepancy in the message sent. |
| Identifying themes | Identifying recurrent themes may help your patient make a connection and focus on the major theme. For example, you might say, “From what you’ve told me, it sounds like every time you were dis- charged from the hospital to home you had a problem.” |
| Sequencing events | If your patient is having trouble sequencing events, you may need to help her or him place the events in proper order. Start at the beginning and work through the event until the conclusion. |
| Suggesting | Presenting alternative ideas gives your patient options. This is particularly helpful if the patient is having difficulty verbalizing his or her feelings. |
| Presenting reality | Summarizing is useful at the conclusion of a major section of the interview. |
| Types of interviews | directive or nondirective. |
| Types of questions | closed or open |
| Closed question | Closed questions are often those that elicit a “yes” or “no” response for example: do you have pain? |
| Open question | elicit the patient’s perceptions, for example, “What brought you to the hospital?” More time is needed for this type of question. |
| Interviewing Techniques | 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. |
| Interviewing Techniques (2) | (2) Work at the same level as your patient. Pull up a chair and sit next to her or him. Don’t invade your patient’s personal space. Two to 4 feet away is a comfortable distance for most patients. |
| Interviewing Techniques (3) | (3) 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. |
| Interviewing Techniques (4) | (4)Consider your patient’s cultural background. How does it affect the interview and your interpretation of the data |
| Interviewing Techniques (5) | (5)Consider your patient’s developmental level. How does it affect the interview and your interpretation of the data? Don’t become preoccupied with writing. |
| Interviewing Techniques (6) | (6)Be nonjudgmental. Avoid “why?” questions; they tend to put patients on the defensive |
| Interviewing Techniques (7) | (7) 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. Is it consistent with what she or he is telling you? |
| Interviewing Techniques (8) | (8)Now, look at your patient’s nonverbal behavior another way. Does it indicate health problems?. Never pass up an opportunity to teach |
| Interviewing Techniques (9) | (9)Present reality. ■ Be honest. ■ Provide reassurance and encouragement. ■ Be respectful |
| Comprehensive examination | does more than assess body systems. It is a source of fundamental and personalized knowledge about the patient that strengthens the clinician-patient relationship |
| Focused examination | you will select the methods relevant to a thorough assessment of the targeted problem. |
| Subjective data | are covert and not measurable. |
| Objective data | are overt and measurable and it is referred to as signs. The physical examination and diagnostic studies |
| Communicating with SEDUCTIVE Client | Set FIRM limits on overt sexual client behavior and avoid responding to subtle seductive behaviors. Encourage client to use more appropriate methods of coping in relating to others. If the overt sexuality continues, DO NOT INTERACT WITHOUT A WITNESS. |
| Nursing process | is used to identify, prevent, and treat actual or potential health problems and promote wellness. |
| Maam Carmel | Guazon |
Created by:
Jon Anderson
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