GUIDELINES OF AN EFFECTIVE INTERVIEW AND HEALTH HISTORY

• The purpose of a health history interview

  • to establish a trusting and supportive relationship
  • gather information
  • offer information
• primary goal of the nurse-patient interview is

  • to improve the well-being of the patient at its most basic level
• The health history interview involves

  • asking the patient questions to learn about their symptoms, functioning, and daily activities
• The American Holistic Nurses Association

  • emphasizes holistic nursing involves considering a patient's body, mind, spirit, culture, socioeconomic background, and environment when delivering care
• The interviewing process requires

  • sensitivity to the patient's feelings and behavioral cues,
  • going beyond just asking a series of questions
• Obtaining a valid nursing health history requires

  • professional, interpersonal, and communication skills to elicit accurate information and respond to the patient's feelings and concerns
• Phases of the interview

  • Pre-Interview
  • Working
  • Introduction
  • Termination
• In the Introduction phase of the interview

  • the nurse greets the patient
  • establishes rapport
  • sets the agenda for the interview by asking open-ended questions
• Working phase of the interview,

  • the nurse summarizes important points
  • discusses the plan of care
  • addresses any related concerns or questions that the patient raises
• In the Termination phase of the interview

  • the nurse informs the patient that the end of the interview is approaching to allow time for any final questions
• Therapeutic communication techniques in nursing interviews include

  • active listening, which is attending to what the patient is communicating
  • using verbal and non-verbal skills to encourage the speaker to continue and expand
• Non-verbal communication tips for nurses:

  • Appearance: neat hair, short and neat fingernails, minimal jewelry
  • Demeanor: be professional, focus on the client, greet calmly by name, avoid overly friendly behavior
  • Facial expression: keep neutral and friendly, explain personal emotions if necessary
• Attitude: maintain a nonjudgmental attitude, accept clients regardless of beliefs, ethnicity, lifestyle, and healthcare practices
• Silence during interactions allows reflection and accurate reporting
• Listening effectively: maintain good eye contact, smile, have an open body position, avoid preconceived ideas or biases
• Verbal communication techniques for nurses:

  • Open-ended questions: begin with "how" or "what," encourage description
  • Closed-ended questions: begin with "when" or "did," focus on specific information
  • Laundry List: provide a list of words for clients to choose from in describing symptoms
  • Rephrasing: clarify information the client has stated
• Well-placed phrases like "um-hum," "yes," or "I agree" encourage client verbalization
• Inferring involves drawing conclusions from patient information using prior knowledge, experiences, and intuition
• Providing information to clients as questions and concerns arise is crucial for their understanding and involvement in their healthcare
• Emphatic responses convey empathy and strengthen patient rapport
• Special considerations during interviews:

  • Gerontologic variations: assess hearing acuity, speak clearly, avoid medical jargon
  • Cultural variations: recognize differences in communication styles, respect cultural differences
• Interacting with different client types:

  • Anxious client: provide simple, organized information, avoid becoming anxious
  • Angry client: approach calmly, maintain a non-threatening aura, obtain help if needed
  • Depressed client: express interest and understanding, respond neutrally
  • Manipulative client: provide structure, set limits, differentiate manipulation from reasonable requests
• When discussing sensitive issues, be aware of your own thoughts and feelings, ask simple nonjudgmental questions, allow time for ventilation of client's feelings
• Interacting with a seductive client: set firm limits on sexual behavior, keep the relationship professional, seek help if needed
• Interacting with a silent patient: appear attentive, give brief encouragement, watch for nonverbal cues
• True or False: During the summary and closing phase of the interview, all the client's concerns are dealt with and no further questions are asked. (False)
• During an interview with a patient, keep the relationship professional and seek help if needed; if unwelcome overtures continue, leave the room and find a chaperone to continue the interview
• In the case of a silent patient, appear attentive, give brief encouragement, and watch for nonverbal cues like difficulty controlling emotions; silence may be part of the patient's culture or a response to how questions are asked
• For a confusing patient who gives inconsistent histories, focus on the meaning or function of symptoms, emphasizing the patient's perspective and guiding the interview into a psychosocial assessment
• When dealing with a patient with altered capacity due to delirium or other conditions, determine their decision-making capacity, find a surrogate informant if needed, and check for a durable power of attorney for health care or a health care proxy
• In the case of a talkative patient, give them free rein initially, set limits when needed, and focus on what seems most important to the patient by asking questions in those areas
• If a patient is crying, offer a tissue, wait for them to recover, and make a supportive remark like "I am glad you are able to express your feelings"
• When interviewing a patient across a language barrier, make every effort to find an interpreter who is neutral and familiar with both languages and cultures; explain that you need the interpreter to translate everything without condensing or summarizing
• Before giving written instructions to a patient with low literacy, assess their ability to read and respond sensitively without confusing literacy with intelligence
• For a patient with impaired hearing, find out their preferred method of communicating, speak at a normal volume, and avoid covering your mouth or looking down at papers when speaking
• When dealing with a patient under the influence of alcohol or drugs, ensure your safety by alerting security if needed, placing yourself at a safe distance, remaining calm, and providing care in a non-threatening manner
• If a patient with personal problems asks for advice outside your expertise, ask about their approaches, let them talk through the problems, and refer them for counseling
• For a very ill patient who may not have the strength for a full interview, collect pertinent data and defer the remainder of the interview if necessary; show respect by asking permission to interview a family member or significant other
• When requesting an explanation from a patient, avoid questions starting with "why" as they can be perceived as challenging or threatening; asking the patient to describe feelings, beliefs, or behaviors is preferable to asking why
• Non-therapeutic interviewing techniques toavoid include probing, offering false reassurance, giving approval or disapproval, defending, advising, and asking questions that begin with "why"