Chpt. 3: The Interview

What are some ways to ease into the closing of the interview?

"Is there anything else you would like to mention?" "Are there any questions you would like to ask?" "Are there any other areas I should have asked about?" "We have covered a number of concerns today. What would you most like to accomplish?"

What are some examples of open-ended questions?

"Tell me how I can help you." "What brings you to the hospital?" "Tell me why you have come here today."

What are the 2 major guidelines when using direct questions?

1. Ask only 1 direct ? at a time. Don't bombard them with lists. Avoid double barrelled questions 2. Choose language that the person understands. You may need to use regional phrases or colloquial expressions

What are the 7 external factors?

1. Ensure privacy 2. Refuse interruptions 3. Physical environment 4. Dress 5. Note-taking 6. Tape and video recording 7. Electronic health recording (EHR)

What are some things that show you had a successful interview?

1. Gather complete and accurate data about the person's health state, including the description and chronology of any symptoms of illness. 2. Establish rapport & trust so the person feels accepted and thus free to share all relevant data 3. Teach the person about the health state so that they can participate in identifying problems 4. Build rapport for a continuing therapeutic relationship. This rapport facilitates future diagnosis, planning, & treatment 5. Being teaching for health promotion & disease prevention

What are the 10 traps of interviewing?

1. Providing false assurance or reassurance 2. giving unwanted advice 3. using authority 4. using avoidance language 5. engaging in distancing 6. using professional jargon 7. using leading or biased questions 8. talking too much 9. interrupting 10. using "why" questions"

What are the nine types of responses (assisting the narrative)?

1. facilitation 2. silence 3. reflection 4. empathy 5. clarification 6. confrontation 7. interpretation 8. explanation 9. summary

What are some disadvantages of note taking?

1. it breaks eye contact too often 2. It shifts your attention away from the person, diminishing his/her sense of importance 3. It can interrupt the pt's narrative flow 4. It impedes your observation of the pt's nonverbal behavior 5. It is threatening to the pt during the discussion of sensitive issues

What are 2 reasons that you should avoid standing?

1. it communicates haste 2. it assumes superiority

What are some things you can do to help with the physical environment?

1. set the room temp at a comfortable level 2. sufficient lighting 3. reduce noise 4. remove distracting objects or equipment 5. distance b/w you and the pt 6. arrange equal-status seating 7. arrange face-to-face position

What are some of the contract terms?

1. time & place of the interview & succeeding physical examination 2. intro of yourself and a brief explanation of your role 3. the purpose of the interview 4. how long it will take 5. Expectation of participation for each person 6. Presence of other people (e.g., pt's family, other HCPs, students) 7. Confidentiality and to what extent it may be limited 8. Any costs that the patient must pay

What is the appropriate distance to place between you and the pt during an interview? Why?

4-5 ft (twice arm's length) too close may invade their private space and create anxiety too far can make you seem distant and aloof

What age range is the school-age child/

7-12

What is your summary?

A final statement of what you and the pt agree the health state to be.

Why is talking too much a bad thing?

As the interviewer, listen more than you talk

Why is nonverbal communication more important with children than with adults?

Children are quick to pick up feelings, anxiety, or comfort. Keep gestures, slow, deliberate, and close to your body. Don't try to maintain constant eye contact- this can seem threatening to a small child

Why is providing false assurance or reassurance a bad thing?

Closes off communication, trivializes pt's anxiety, denies further talk, promises something that you have no control over

Why is communication more than talking?

Communication is all behavior, conscious and unconscious, verbal and nonverbal

What is reflection (as a response)?

Echoes the pt's words Repeating part of what the person has just said Can help express feeling behind a pt's words Helps the pt elaborate on the problem

What is summary (as a response)?

Final review of what you understand the pt has said. Condenses facts and presents a survey of how you perceive the health problem or need. Type of validation that the pt can agree with or correct

What is silence (as a response)?

Golden after open-ended questions. Silent attentiveness communicates that the pt has time to think, to organize whatever they want to say w/o interruption.

How can you help prevent interruptions during an interview?

Inform support stuff and ask them to not interrupt Discourage other health professionals from interrupting you with their need for access to the patient

With a young child (1-6 years old), why should you ignore the child temporarily?

It allows the child to size you up from a safe distance. The child can observe your interaction with the parent, see that the parent accepts and likes you, and relax

How is tape recording a good thing?

It can help you learn what you did right or wrong

Why should you provide toys for the child to play with?

It frees the parent to concentrate on the hx. It also indicates the child's level of attention span or independent play

Why is using leading or biased questions a bad thing?

It implies that one answer is better than another. It can force the person to answer the way they think you want to hear, not what is actually true. Person may feel guilty when their answer isn't what seems like the "right" answer

Why is nonverbal communication more reflective of your true feelings?

It is under less conscious control than verbal communication

What is equal-status seating?

It puts you and the pt on the same level (eye level)

Why is interrupting a bad thing?

It shows that you are impatient or bored w/the interview You're not really listening b/c you may be so focused on what you want to say

What are the three internal factors?

Liking others Empathy Ability to listen

Why is giving unwanted advice a bad thing?

Never say the "If I were you" statement. You are not the pt. If you use this, you have shifted the accountability for decision making from her to you. Instead, involve the pt in the problem-solving process

What are the 3 components of the working phase?

Open-ended questions Closed/direct questions Responses- assisting the narrative

Why type of dress should the patient be in? What about you?

Patient- street clothes unless it's an emergency You- appropriate to the setting, should meet conventional professional standards (uniform or lab coat over conservative clothing, a name tag, and neat hair. Avoid extremes

Why is using "why" questions a bad thing?

Places blame Pt may not know answer It sounds whining, accusatory, and judgmental

What should your summary include?

Positive health aspects, any health problems that have been identified, any plans for action, and an explanation of the following physical examination

Why is using authority a bad thing?

Promotes dependency and inferiority

Why is engaging in distancing a bad thing?

Pt can deny any association with their condition/illness and protect them self from it. Also communicates that you are afraid of the procedure The use of blunt, specific terms is preferable to defuse anxiety

What is the receivers role in communication?

Puts his or her own interpretation on the senders verbal/nonverbal communication. The receiver attaches meaning determined by his or her past experiences, culture, self-concept, physical, and emotional state

Why is using professional jargon a bad thing?

Sounds exclusionary and paternalistic Adjust your vocabulary to the person, but don't sound condescending. Just because a pt uses medical jargon, don't assume that they know what they're talking about. If they're wrong, politely correct them

When first greeting an adult pt, should you call them their first name or use their surname?

Surname- "Mrs. Sanchez....."

In an interview setting, what is the contract? What is the mutual goal?

The contract concerns what the person needs and expects from health care and what you, the HCP, have to offer The mutual goal is optimal health for the patient

What is empathy (as a response)?

The pt feels accepted and can deal with the feeling openly Doesn't cuff off further communication (giving false reassurance) or doesn't deny the feeling and indicate that it isn't justified. Recognizes the feeling, accepts it, and allows the pt to express is w/o embarrassment

Why is an atmosphere of warmth and caring necessary?

The pt must feel that he or she is accepted unconditionally

What is facilitation (as a response)?

These responses encourage the pt to say more. "Mhm, go on, continue, uh-huh". Aka general leads, show the pt you are interested and will listen further.

During the interview, why is the patient still in charge?

They know everything about his or her own health state, and I know nothing

A 2-6 year old is egocentric. What does this mean?

They see the world mostly from his or her own POV

What is clarification (as a response)?

Use this when a pt's word choice is ambiguous or confusing Used to summarize the pt's words, simplify the words to make them clearer, and then ask if you are on the right track. You are asking for agreement, and the pt can confirm or deny

What is psychological privacy?

Used when geographic privacy isn't available Curtained partitions may suffice as long as the person feels sure no one can over hear the conversation or interrupt

What are the two components of "sending"?

Verbal and nonverbal communication

What is the difference between verbal and nonverbal communication?

Verbal- the words you speak, vocalizations, tone of your voice Nonverbal- body language, posture, gestures, facial expression, eye contact, foot tapping, touch, even where you place your chair

What is empathy?

Viewing the world from the other person's inner frame of reference while remaining yourself. It recognizes and accepts the other person's feelings without criticism

When interviewing a parent and child, when should you ask about sensitive topics?

When you and the parent are alone

Can interruption break concentration and interfere with establishing rapport?

Yes, it can destroy in seconds what you have spent minutes building up

How is video recording a good thing?

You can look at your verbal and nonverbal communication

Why is note taking used?

You can't remember everything

What do the last 4 responses involve?

You express your own thoughts and feelings. The frame of reference shifts from the pt's perspective to yours. You lead.

What is confrontation (as a response)?

You have observed a certain action, feeling, or statement and you now focus the pt's attention to it. You give your honest feedback about what you see or feel. This can focus on a discrepancy, the pt's affect, or when you notice parts of the story are inconsistent

What is explanation (as a response)?

You inform the person, share factual and objective info Can be orientation to the agency setting or to explain cause

What is interpretation (as a response)?

Your statement is based on your inference or conclusion. It links events, makes associations, or implies cause. Ascribes feelings and helps the person understand his or her own feelings in relation to the verbal message.

What is telegraphic speech?

a combination of a non and a verb includes only words that have concrete meaning Ex: "all gone" "baby crying"

What does an audio tape document?

a complete record of what was said during the interview

What is the interview?

a meeting between you and your patient

What is geographic privacy? What might you have to do to ensure this type of privacy?

a private room in the hospital, clinic, office, or home Asking an ambulatory roommate to step out for a while, finding an unoccupied room, or an empty lounge

What type of role is listening: active or passive? Why?

active It requires your complete attention, you can't be preoccupied by other things

What is the route to understanding?

active listening

What are closed-ended/direct questions?

ask for specific information short one or two word answer, "yes" or "no", or a forced choice Limits pt's answer

What are open-ended questions?

asks for narrative info Unbiased (leaves the person free to answer in any way) Encourages the person to respond in paragraphs and to give a spontaneous account in any order chosen. Stop and listen to pt's response

What is the vehicle that carries you and your patient through the interview?

communication

What does decenter mean?

consider all sides of a situation to form a conclusion

Consider the interview as being similar to forming a ____________ between you and your patient.

contract

If a pt is sitting in a closed position, what does that show?

defensive and anxious

What is communication?

exchanging info so that each person clearly understands each other

Your goal is not to make your pt's depend on you, but to what?

help them to be increasingly responsible for themselves

Why is placing the chairs at 90 degrees good?

it allows the pt to face you or look straight ahead from time to time

Why should you avoid facing the pt across a desk or table?

it creates a barier

Why is health history important?

it helps you begin to identify the person's health strengths and problems and as a bridge to the next step in data collection, the physical exam

What are some advantages of silence?

lets the pt collect their thoughts Gives you a change to observe the pt unobtrusively and to note nonverbal cues Gives you time to plan the next approach

What is language like for a 3 year old?

more complex sentences containing only essential words

Why is preparing the physical setting important?

optimal conditions are important to have a smooth interview

If you use any tape recording, what should you tell the patient about it?

purpose of the recording who will hear it it will be destroyed after

What is the goal of the interview?

record a complete health history

If a pt is sitting in an open position with extension of large muscle groups, what does that show?

relaxation, physical comfort, and willingness to share info

What is language like for a 5-6 year old?

sentences are 6-8 words long and grammar is well developed

What does lack of eye contact suggest?

shy, withdrawn, confused, bored, intimidated, apathetic, or depressed. However, remember culture differences

What does a contract consist of?

spoken or unspoken rules for behavior

What is language like for a 2 year old?

telegraphic speech they seem to understand all that is said to him/her

What is language like for a 3-4 year old?

the child uses 3-4 word telegraphic sentences containing only essential words

What is the working phase of the interview?

the data-gathering phase

What is the first and most important step of data collection?

the interview

During the interview who/what is most important?

the pt and their needs

What is the worst thing that could happen while using an electronic health recording (EHR)?

the pt sits idly by while the examiner interacts silently w/the computer

What are internal factors?

those particular to the examiner, what you bring to the interview

When should direct questions be used?

to fill in any details that the pt may have left out specific facts speed up the interview

What is subjective data?

what the person says about him or herself

What is empathy often described as? "feeling _____ the person rather than feeling _______ the person"

with; like

Can a school-age child read?

yes

Can the sender's message be sabotaged by the receiver's bias?

yes

Should you obtain consent when using tape recordings?

yes

When using the EHR, should the pt be able to see the screen?

yes

What do the first five responses involve?

your reactions to the facts or feelings the pt has communicated. Your response focuses on the pt's frame of reference, your frame of reference doesn't enter the response. Pt leads