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The Interview
Chapter 3
Chapter 3: The Interview
The Interview
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Subjective data
Results of a
successful interview
Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
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Chapter 3: The Interview
The Interview (cont.)
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Goals
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Record complete health history
Optimal health for patient
Identify health strengths and problems as
bridge to physical examination
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First and most important part of data collection
Collects subjective data: what person says about
his or her perceived health state
Individual knows everything about his or her own
health state, and nurse knows nothing
Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
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Chapter 3: The Interview
The Interview (cont.)
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Gather complete and accurate data about
person’s health state, including description
and chronology of any symptoms of illness
Establish rapport and trust so person feels
accepted and free to share all relevant data
Teach person about health state so that he or
she may participate in identifying problems
Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
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Chapter 3: The Interview
The Interview (cont.)
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Build rapport to continue therapeutic
relationship and to facilitate future diagnoses,
planning, and treatment
Begin teaching for health promotion and
disease prevention
Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
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Chapter 3: The Interview
The Interview (cont.)
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Consider interview a contract between nurse
and patient
Contract consists of spoken and unspoken
rules for behavior:
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What person needs and expects from health care
and what health professional has to offer
Mutual goal is optimal health for patient
Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
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Chapter 3: The Interview
The Interview (cont.)
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Contract terms include:
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Time and place of interview and physical
examination
Introduction of and explanation of health care
provider’s role
Purpose of interview
How long it will take
Expectation of participation for each person
Presence of others, e.g., family, etc.
Confidentiality and to what extent it may be limited
Any costs that the patient must pay
Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
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Chapter 3: The Interview
PROCESS OF
COMMUNICATION
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Sending
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Communication is behavior, conscious and
unconscious, verbal and nonverbal
 All behavior has meaning
 Body language: posture, gestures, facial
expression, eye contact, foot tapping, touch, even
where you place your chair
Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 3-8
Chapter 3: The Interview
PROCESS OF
COMMUNICATION (cont.)
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Receiving
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Awareness of messages you send is only part of
process
• Words and gestures must be interpreted in a specific
context to have meaning
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Receiver attaches meaning determined by his or
her past experiences, culture, self-concept, and
current physical and emotional state
 Successful communication requires mutual
understanding by sender and receiver
Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 3-9
Chapter 3: The Interview
PROCESS OF
COMMUNICATION (cont.)
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Receiving (cont.)
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Patients’ health problems intensify communication
because patients depend on you to get better
Communication can be learned and polished
when you are a beginning practitioner
Communication is a tool, as basic to quality health
care as tools of inspection or palpation
Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 3-10
Chapter 3: The Interview
PROCESS OF
COMMUNICATION (cont.)
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Awareness of internal and external factors
and their influence allows you to maximize
communicating skill
Internal factors
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Liking others
Empathy
Ability to listen
Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 3-11
Chapter 3: The Interview
PROCESS OF
COMMUNICATION (cont.)
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External factors
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Ensure privacy
Refuse interruptions
Physical environment
Dress
Note-taking may be unavoidable
• Cannot rely completely on memory for details of previous
illnesses or review of body systems
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Tape and video recording
Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 3-12
Chapter 3: The Interview
PROCESS OF
COMMUNICATION (cont.)
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Challenges of note-taking
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Breaks eye contact too often
 Shifts attention away from person, diminishing his
or her sense of importance
 Interrupts patient’s narrative flow
 Impedes observation of patient’s nonverbal
behavior
 May be threatening to patient’s discussion of
sensitive issues
Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 3-13
Chapter 3: The Interview
TECHNIQUES OF
COMMUNICATION
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Introducing the interview
Working phase
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Data-gathering phase
Verbal skills include questions to patient and your
responses to what is said
Two types of questions:
• Open-ended
• Closed
• Each has a different place and function in interview
Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 3-14
Chapter 3: The Interview
TECHNIQUES OF
COMMUNICATION (cont.)
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Open-ended questions
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Ask for narrative responses
State topic only in general terms
Use them:
• To begin interview
• To introduce a new section of questions
• Whenever the patient introduces new topic
Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 3-15
Chapter 3: The Interview
TECHNIQUES OF
COMMUNICATION (cont.)
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Closed or direct questions
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Ask for specific information
 Elicit short, one-or-two word answers, a yes or no
answer, or a forced choice
 Use them:
• After opening narrative to fill in details person may have
left out
• When you need many specific facts about past health
problems, or during review of systems
• To move the interview along
Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 3-16
Chapter 3: The Interview
TECHNIQUES OF
COMMUNICATION (cont.)
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Responses: assisting the narrative
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Facilitation encourages patients to say more and
shows you are interested and will listen further
Silent attentiveness
• Gives patient time to think and organize what to say
without interruption from you
• Gives you a chance to observe person unobtrusively and
note nonverbal cues
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Reflection
• Echoes patient’s words, repeating what person has just
said; focuses further attention on a specific phrase; and
helps person continue in his or her own way
Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 3-17
Chapter 3: The Interview
TECHNIQUES OF
COMMUNICATION (cont.)
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Empathy
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Recognizes a feeling and puts it into words
Names the feeling and allows expression of it
• Patient feels accepted and can deal with feeling openly
Clarification
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Use when person’s words are ambiguous or
confusing
• Used to summarize person’s words and to simplify them
to make them clearer
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You are asking for agreement, and the person can
then confirm or deny your understanding
Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 3-18
Chapter 3: The Interview
TECHNIQUES OF
COMMUNICATION (cont.)
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Confrontation
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Frame of reference shifts from patient’s
perspective to yours
• May focus on discrepancy or inconsistency in person’s
narrative
• You have observed a certain action, feeling, or statement
and now focus person’s attention on it
• You give honest feedback about what you see or feel
Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 3-19
Chapter 3: The Interview
TECHNIQUES OF
COMMUNICATION (cont.)
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Interpretation
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Based on your inference or conclusion
 It links events, makes associations, implies cause,
ascribes feelings
 Helps person understand his or her own feelings
in relation to the verbal message
 If your inference is incorrect, the patient may
correct it, and thus prompt further discussion of
topic
Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 3-20
Chapter 3: The Interview
TECHNIQUES OF
COMMUNICATION (cont.)
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Explanation
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These statements inform the person; you share
factual and objective information offering reasons
for requirements or actions
Summary
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Final review of what person has said; it condenses
facts and presents your view of health problem
Is a type of validation that person can agree with
or correct; both you and patient should participate
Occurring at the end of the interview, it signals that
termination of the interview is near
Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 3-21
Chapter 3: The Interview
TECHNIQUES OF
COMMUNICATION (cont.)
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These responses now include your own
thoughts and feelings
Use the last four responses only when
merited by the situation
If you use them too often, you take over at the
patient’s expense
Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 3-22
Chapter 3: The Interview
TECHNIQUES OF
COMMUNICATION (cont.)
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Ten traps of interviewing
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Providing false assurance or reassurance
Giving unwanted advice
Using authority
Using avoidance language
Engaging in distancing
Using professional jargon
Using leading or biased questions
Talking too much or interrupting
Using “why” questions
Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 3-23
Chapter 3: The Interview
TECHNIQUES OF
COMMUNICATION (cont.)
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Nonverbal skills
Physical appearance
Posture
Gestures
Facial expression
Eye contact
Voice
Touch
Closing the interview
Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 3-24
Chapter 3: The Interview
DEVELOPMENTAL CARE
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Interviewing parents
Infants
Preschoolers
School-age children
Adolescents
Older adults
Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 3-25
Chapter 3: The Interview
INTERVIEWING PEOPLE
WITH SPECIAL NEEDS
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People who are hearing-impaired
People who are acutely ill
People under influence of street drugs or alcohol
People who must be asked personal questions
People who are sexually aggressive
People who are crying
People who are angry and threatening violence
People who are anxious
Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 3-26
Chapter 3: The Interview
CROSS-CULTURAL CARE
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Probability of miscommunication increases
with two people from different cultural
backgrounds
Cultural backgrounds of both health care
professional and patient influence verbal and
nonverbal communications
Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 3-27
Chapter 3: The Interview
CROSS-CULTURAL
COMMUNICATION
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Cultural perspectives on professional
interactions
Etiquette
Space and distance
Cultural considerations on gender
Cultural considerations on sexual orientation
Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 3-28
Chapter 3: The Interview
OVERCOMING COMMUNICATION
BARRIERS
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Working with and without interpreters
Nonverbal cross-cultural communication
Touch
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Touching patients is a necessary component of
comprehensive assessment
Physical contact with patients conveys various
meanings cross-culturally
Patient’s significant others may exert
pressure on nurses by enforcing culturally
meaningful norms in health care setting
Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 3-29
Chapter 3: The Interview
OVERCOMING COMMUNICATION
BARRIERS (cont.)
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Five types of nonverbal behaviors convey
information about person
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Vocal cues: pitch, tone, and quality of voice,
including moaning, crying, and groaning
 Action cues: posture, facial expression, and
gestures
 Object cues: clothing, jewelry, and hair styles
 Personal space: interpersonal transactions and
care of belongings
 Touch: involves use of personal space and action
Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 3-30
Chapter 3: The Interview
OVERCOMING COMMUNICATION
BARRIERS (cont.)
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In some cultures, it is considered an
acceptable expression of friendship and
affection to openly and publicly hold hands
with or embrace members of same gender
with no sexual connotation
You may find that a patient displays similar
behaviors and should feel free to discuss
cultural differences and similarities openly
with the person
Elsevier items and derived items © 2012, 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
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