Guidelines

• Genuineness


  • Be open, honest, and sincere with your patient
• Respect


  • Everyone should be respected as a person of worth and value
• Empathy


  Knowing what your patient means and understanding how she or he feels
• Effective verbal communication


  • Clarity
  • Simplicity
  • Timing and Relevancy
  • Reflection
  • Humor
  • Informing
  • Redirecting
  • Focusing
  • Sharing Perceptions
  • Summarizing
  • Affirmation
  • Silence
  • Clarifying
  • Restating
  • Active Listening
  • Broad and General Openings
• Posture


  • A relaxed posture with arms at the sides conveys openness
  • A tense posture with arms crossed may reflect anger, discomfort, or mistrust
  • A tense guarded posture may also indicate pain
• Hand gestures


  • May convey approval but if overused may indicate anxiety
• Facial expressions


  • Reflect a variety of emotions, including happiness, sadness, fear, anger, approval, and disapproval
• Eye contact


  • Conveys interest, caring, and trust
  • Lack of eye contact may reflect shyness, depression, disinterest, or mistrust
• Personal space


  • Public Space - 12ft or more
  • Social-consultative Space - 4 to 12 ft
  • Personal Space - 18inches to 4ft
  • Intimate - 0 to 18inches
• Object cues


  • Physical appearance
  • Demeanor
• Vocal cues or paralinguistics

  • Quality of voice
  • Tone
  • Intensity
  • Speed
• Touch


  • An array of feelings such anger, caring, and protectiveness, can be conveyed through touch
  • Necessary for physical assessment
• Phases of health assessment

  • Preinteraction Phase
  • The Initial Interview
  • The Health History
• Preinteraction Phase


  1. Collect data from medical record

  2. Plan and guide the direction of the initial interview

  3. Reflect on own strengths and limitations

  4. Choose setting and time
• Initial interview


  Helps establish a nurse-client relationship based on mutual trust and communication, and gives the nurse insight into the client's lifestyle, values, and feelings about wellness, health, and illness
• Directive interview


  Nurse establishes the purpose, controls the interview, used to gather and give information when time is limited
• Nondirective interview


  Rapport-building, client controls the purpose, subject matter, and pacing
• Combination of directive and nondirective is usually appropriate during the information-gathering interview
• Beginning/Orientation Phase of initial interview

  Introduce yourself, describe the interview process, explain its importance, tell the client what to expect
• Example of beginning/orientation phase


  • "Good morning, Mr. Darwin, I'm Janet Smith, the nurse responsible for your care today. To plan the care, I need some additional information. For about the next 45mins, I would like to find out as much as possible about you and why you are here. Since we will be talking about a variety of things, I'll be jotting down some notes as we speak. Please stop me at any time if you don't understand a question or need more information about something. Some questions have to do with personal and private subjects, such as your beliefs, family, income, emotions, and sexual activity. Everything we discuss will be held in strict confidence. However, you may choose not to disclose some information".
• Working Phase of initial interview

  Seek information about the client's health status, collect data by asking specific questions (closed-ended/direct and open-ended), avoid "why" questions, observe for restlessness, distraction, agitation
• Observing during the interview

  • Does the patient show signs of physical or psychological stress?
  • Does the patient seem comfortable?
  • What position is she or he assuming?
  • Are there any abnormal movements?
  • What is the patient's body language telling you?
  • Is the patient's verbal language consistent with his or her nonverbal language?
  • Do you notice any unusual odors?
  • Do you hear any unusual sounds?
  • Is there anything unusual, unsafe, or risky in the patient's environment?
• Things to look for during the interview

  • Facial expression, color change breathing problems
  • Grimacing, guarding, diaphoresis
  • Eye contact
  • Tone of voice and flow of speech
  • Position, orthopnea
  • Grooming and dress
  • Nervousness, restlessness, voluntary/involuntary movements
  • Unusual odors, such as fruity smell associated with diabetic ketoacidosis, or foul odors
  • Unusual sounds associated with respiratory problems
• Active listening


  • Concentrate on the patient
  • Maintain eye contact if culturally appropriate
  • Maintain open posture, not crossed arms
  • Make a conscious effort to hear and understand the other person, avoid premature interruptions
  • Avoid extensive note-taking
• Closing Phase of initial interview

  Indicate that the interview is almost at an end and give the client an opportunity to express any final questions or concerns, ask whether the patient would like to mention anything or needs anything else, thank the patient and family members for taking the time to provide information
• Health history


  The purpose is to clarify previously obtained assessment data, gather missing information about a specific health concern, update and identify or validate probable nursing diagnoses, nurses use it continually to update diagnostic cues because signs, symptoms, and client health concerns often change
• Activity


  Interview a family member and gather information by utilizing Gordon's Functional Health Pattern of Assessment and apply appropriate communication techniques both verbal and nonverbal