Ch. 3 Interviewing and Communication

Identify and Respond to Patient's Emotional Cues

-part of the working phase -acknowledge and respond to nonverbal and verbal cues to help build rapport, expand the nurse's understanding of the illness, and improve patient satisfaction -explore the patient's ideas about the effect of the illness in his or her life

Summarizing

-lets the patient know you are listening -identifies what is known and not known -repeat back to the patient what they said to you

Set Goals for the Interview

-part of pre-interview phase -clarify the goals for the interview which can range from following up on health care issues, identifying new problems, and completing forms for health care institutions to obtain a basis for developing a plan of care

Review Medical and Nursing Records

-part of pre-interview phase -this information helps you to identify areas to explore with the patient -review identifying data (age, DOB, gender, address) -chart often provides valuable info about past diagnoses and treatments, but do not let previous documentation bias your problem solving or prevent you from developing new approaches or ideas

Summarize Important Points and Discuss Plan

-part of termination phase -let the patient know that the interview is coming to an end to allow time for them to ask questions -make sure they understand the mutual plans you have developed -summarize the patient's problems and review plan of care/follow up are helpful

Establish Rapport

-part of the intro phase -consider the best way to arrange the room -choose a distance that facilitates conversation and allows good eye contact -pull up a chair and, if possible, sit at eye level with the patient -move any physical barriers -avoid arrangements that convey disrespect or inequality of power (ex: interviewing a patient on a bedpan) -provide the patient undivided attention

Greet the Patient

-part of the intro phase -greet the patient by name and introduce yourself, giving your own name -if culturally appropriate, shake hands with the patient -if this is the first contact, explain your role -use a formal title appropriate to address to the patient (ex: Mr. O'Neil) -if you unsure how pronounce their name, ask them -when visitors are in the room, be sure to acknowledge and great each one in turn, but you are obligated to maintain patient confidentiality whenever their are visitors

Establish Agenda

-part of the intro phase -once rapport has established, the nurse is ready to pursue the patient's reason for seeking health care -the reason is traditionally designated the "chief complaint" -begin with open ended questions that allow full freedom of response such as, "what concerns bring you here today?" or "how can i help you?" -this allows the patient to express any possible concerns and do not restrict the patient to a problem per se -may be more than one concern for the visit

Take the time for self-reflection

-part of the pre interview phase -because we bring our own values, assumptions, and biases to every encounter, we must look inward to clarify how our own expectations and reactions may affect what we hear and how we behave -it brings a deepening personal awareness to our work with patients

Review Clinical Behavior and Appearance

-part of the pre-interview phase -consciously or not, the nurse sends messages through both words and behaviors -posture, gestures, eye contact, and tone of voice all convey the extent of interest, attention, acceptance, and understanding -the skilled interviewer should appear calm and unhurried, even if time is limited -patients find cleanliness, neatness, conservative dress, and a name tag reassuring -pay attention and make eye contact

Adjust the Environment

-part of the pre-interview phase -make the interview setting as private and comfortable as possible -if there are privacy curtains, ask permission to pull them shut -adjust the room temperature for the patient's comfort

Create a Shared Understanding of the Problem

-part of the working phase -ask the patient about the patient about their perception of illness -fife (feelings, ideas, function, expectations) -nurse may ask, "what concerns you the most about the pain?" or "why do you think you have this..." or "what have you tried"

Invite the Patient's Story

-part of the working phase -ask the patient, "tell me more about..." -encourage the patient to tell his or her story in their own words -avoid biasing the patient's story and DO NOT add new information and DO NOT interrupt -use active listening skills, such as leaning forward and using continuers (i.e., nodding and offering phrases like "uh-huh" or "go on) -follow patient's lead -after initial description of each problem, use focused questioning to explore their story in more depth -ex: how would you describe the pain?

Expand and Clarify the Patient's Story

-part of the working phase -guide the patient to elaborate on the areas of the health history that seem most significant -clarify the attributes of each symptom, including context, associations, and chronology -use OLDCART or OPQRST -do not use medical jargon -use the patient's words to clarify their meaning -encourage a chronologic account to establish the timing and sequence of the symptom

Generate and Test Diagnostic Hypotheses

-part of the working phase -identify the attributes and details of the patient's symptoms to recognize patterns of problems and generate nursing diagnoses -go from open ended questions, to more specific questions (seven attributes), to yes or no questions

Negotiate a Plan

-part of the working phase -learning about the effects of the illness gives the nurse and patient the opportunity to create a complete and congruent picture of the problem

Empathic Responses

-to provide empathy, first identify the patient's feelings -ask them, "how did you feel about that?" -once you have identified their feelings, respond with understanding and acceptance -can be nonverbal by simply handing a crying patient a tissue or gently placing your hand on a patient's arm

A patient is trying to explain how he feels about his eye problem. He pauses often during the conversation and often repeats himself when expressing his concern about his problem. After listening, the best response by the nurse would be: a) i can understand why you feel the way you do b) wow, i dont know how you do it! c) it sounds like you've been dealt a bad hand in life d) tell me more about how you feel

a

During the interview process, the nurse uses both open-ended and closed-ended questions. During what phase of the interview process does the nurse use these specific types of questions? a) working b) pre-interaction c) beginning d) closing

a

The principle of confidentiality is of paramount important in the nurse-patient relationship. When should you inform the patient of with whom his or her information will be shared? a) at the beginning of the interview b) whenever it seems appropriate c) at the end of the interview d) when the patient asks

a

When trying to explore a patient's perspective on his or her illness, the question that would best determine the patient's thoughts on the cause of the problem would be: a) "why do you think you (name of specific symptom)?" b) "has this affected your ability to do work?" c) "what can't you do now that you could before?" d) "how has this been for you?"

a

Health History

a conversation with a purpose

Nonverbal communication is a very important aspect in nurse-client relationships. What can the nurse do to help gain trust in clients? select all that apply. a) do not use facial expressions such as rolling the eyes or looking bored or disgusted b) laugh a lot, which puts the client at ease c) do not look the client in the eye d) use gestures intentionally to illustrate points, especially for clients who cannot communicate verbally e) make sure that dress and appearance are professional

a, d, e

Validation

acknowledge the legitimacy of the emotional experience

Techniques of Skilled Interviewing

active listening, guided questioning, non verbal communication, empathetic responses, validation, reassurance, partnering, summarization, transitions, and empowering the patients

A nurse is interviewing a client who seems anxious. Which nonverbal communication by the nurse helps to facilitate a relaxed environment for the client during the interview process? a) wearing casual, neat, and comfortable clothes b) portraying a neutral and friendly expression c) sitting back with crossed arms during the interview d) ensuring that there are no periods of silence

b

A nurse is interviewing a client who uses an expression with which the nurse is unfamiliar. What is the most appropriate expression for the nurse to use to clarify the expression's meaning from the client? a) where did you hear that expression? b) tell me what you mean by _______? c) that expression is unclear to me d) i think that expression means ______

b

A nurse knocks and enters a patient room, makes introductions to the patient and visitors, and explains to the patient that she would like to conduct an interview so a plan of care can be completed. Which statement by the nurse would be most appropriate? a) I see you have visitors. I need to ask that they step out to the lobby for about 30 minutes so I can ask you some questions in private. b) Mrs. Smith, I would like to conduct an interview with you but I see you have visitors. I will come back in about 30 minutes so you can visit before you and I sit privately to talk c) Barbara, I am going to conduct an interview so I would like to ask your visitors to leave so we can have some privacy d) Mrs. Smith, I need to ask your visitors to leave so you and I can talk for about 30 minutes

b

The nurse has just asked a client how he feels about his emphysema. He becomes silent, folds his arms across his chest, and leans back into his chair. Then the client replies, "it is what it is". How should the nurse respond? a) "next, I would like to talk with you about your smoking habit" b) "you seem bothered by this question" c) "you have adopted a practical attitude toward your problem" d) "okay, lets move on to your other problems"

b

The nurse is taking a health history and the patient is describing symptoms experiences in the last few days. The nurse asks, "have you noticed anything else that accompanies it?" The nurse's question is what part of the seven attributes of a symptom? a) characteristic symptoms b) associated manifestations c) onset d) exacerbating factors

b

When performing a health assessment, what is a basic tool that the nurse uses in the caring relationship with the client? a) restatement b) therapeutic communication c) clarification d) critical analysis

b

A nurse is admitting a new client. The client is lying in bed. Where should the the nurse be positioned? a) sitting on the side of the bed, looking down at the client b) standing beside the bed, looking down at the client c) seated in a chair at eye level with the client d) leaning on the nightstand at eye level with the client

c

Which of the following are part of the preinterview of the nurse-patient interview? Select all that apply a) generating diagnostic hypotheses b) establishing the agenda c) taking time for reflection d) setting goals for the interview e) identifying patient's emotional clues f) taking notes

c, d, f

Nonverbal Communication

communication that does not involve speech; occurs continuously and provides important clues to feelings and emotions; pay close attention to eye contact, facial expressions, posture, head position and movement such as shaking or nodding, interpersonal distance, and placement of the arms or legs (crossed, neutral, or open); some can be universal and others can be culturally bound

A client comes to the ER wanting to be examined for the symptom of chest pain. While listening to the client describe his symptom in more detail, the nurse says, "Go on", then later, "Mm-hmmm." This is an example of which of the following skilled-interviewing techniques? a) empathic response b) echoing c) nonverbal communication d) continuers

d

A nurse is providing feedback to a colleague after observing the colleague's interview of a newly admitted client. Which of the following would the nurse identify as an example of a close-ended question or statement? a) what is your typical day like? b) tell me what you eat in a normal day? c) tell me about your relationship with your children?d) are you allergic to any medications?

d

When planning an interview with a patient who has diabetes, the nurse would choose which tool to help find out the patient's perspective on this illness? a) ADPIE b) PERLA c) NURS d) FIFE

d

Guided Questioning

encourages patient disclosures while minimizing the risk for distorting the patient's ideas or missing significant details; you want the patient to tell you their story

T or F: when interviewing a patient with a language barrier, it is best to use a family member to help interpret so the patient has a level of comfort with the process

false

T or F: when interviewing, the nurse should logically move from specific to open-ended questions

false

FIFE

feelings, ideas, effect on function, and expectations -the mnemonic used for the patient's perspective on the illness

Interviewing Process

generates the health information and is much more fluid and demands effective communication and relational skills; requires not only the knowledge of the data needed but also the ability to elicit accurate information and the interpersonal skills that allow you as the nurse to respond to the patient's feelings and concerns

Introduction Phase

greet the patient and establish rapport and agenda

Transitions

helps put the patient at ease when the focus of the interview has changed; simply ask them, "now i'd like to ask some questions about your past health", make clear what the patient should expect or do next

OPQRST

onset, palliating/provoking factors, quality, radiation, site, and timing

Continuers

postures, gestures, or words that encourage the patient to continue talking such as nodding, or saying "uh huhh"

Pre-Interview Phase

requires planning; it includes preliminary steps such as self-reflection, reviewing the patient record, setting goals for the interview, reviewing your behavior and appearance, adjusting the environment, and being ready to take brief notes

Reassurance

simply identifying and acknowledging the patient's feelings; this promotes a connection; true reassurance comes from conveying information in a competent manner, making the patient feel confident that problems have been fully understood and will be addressed

Health History Format

structured framework for organizing patient information in written, electronic, or verbal form to communicate effectively with other health care providers; it is precisely organized into categories of present, past, and family health

Termination Phase

the final, integral phase of the nurse-patient relationship where you summarize important points and discuss the plan

Active Listening

the process of paying close attention to what the patient is communicating and being aware of the patient's emotional state, and using verbal/nonverbal skills to encourage the speaker to continue and expand; be aware of your appearance (make eye contact)

Therapeutic Communication

the use of good communication techniques to help the nurse obtain key information and create a trusting relationship with the patient

What is the purpose of a health history convo?

to establish a trusting and supportive relationship, to gather information, and to obtain information

What is the goal of the nurse-patient interview?

to improve the well-being of the patient

T or F: "tell me about your pain" is an example of an open-ended question

true

T or F: the experiences nurse understands that active listening is the key element when interviewing a patient

true

Working Phase

when the nurse and the patient work together to solve problems and accomplish goals by inviting the patient's story, identifying and responding to emotional cues, expanding and clarifying the patient's story, generating and testing hypotheses, creating an understanding of the problem, and negotiating a plan