THE PATIENT INTERVIEW BY ARINITWE ELIZABETH

Patient interview The nursing assessment interview is more holistic in nature and includes information about the total patient as opposed to the medical interview which focuses on the patient’s physical and emotional state.

The role of the nurse The nurse encounters the patient first on the whole medical team therefore she assists the patient to utilise the system effectively. The climate and tone of the initial patient interview may influence all the future interactions the patient will have in the health care setting.

Cont… First impressions of individuals are important and imprint long lasting thoughts and feelings. The nurse is the facilitator of the interview and thus collaborates with the patient in establishing a mutually respectful dialogue. Encourage the patient to express themselves freely.

The role of the patient The patient is an active and equal participant in the interview process and should free to openly communicate.

Factors influencing the interview Approach : before approaching the patient, gather all available patient information e.g. from past data admissions and medical records. Begin the interview with an introduction including your name and title. Call the patient by his or her formal name and ask how they would like to be addressed.

Cont… Providing the patient with explanations of what is to follow and the time frame for the interview helps in establish trust. The more effective you are in building trust, the easier it will be to obtain information from the patient.

Cont.. Environment: the setting for the interview has direct influence on the amount and quality of information gathered. Whenever possible the interview should be conducted in a private room with good lighting and temperature. When a private setting is impossible, control the environment to minimise distractions.

Cont… Confidentiality: this is essential in developing trust between nurse and patient. The patient’s willingness to communicate private and personal information is predicated on the assumption that this information will be used with discretion and for the benefit of the patient. Your verbal assurance of confidentiality often eases the patient’s concerns and fosters trust.

Cont… If the patient came to the health care setting with some other people such as friends or relatives, ask the patient if should like them to be around during the interviewing process.

Cont… Time, length and duration: in order to become fully involved with the patient, enough time must be set aside for the interview. For hospitalised patients, scheduled a time most apropiate for the patient that doesn’t interrupt their other activities such as meal time.

Cont… Biases and preconceptions: personal beliefs and value systems, attitudes, biases and preconceptions of both the nurse and patient influence the sending and receiving of messages.

Stages of the interview process There 3 stages in the interview process which include:  The introduction or the joining stage  The working stage  The termination stage

The joining stage This is also the introduction stage. This the first stage of the interview process during which the nurse and patient establish trust and get to know one another. The nurse works with the patient to define the relationship and establish goals for this and any subsequent interactions.

Working stage This is the second stage of the interview process and it is the time during which bulk of the patient’s data is collected. The nurse should keep the interview goal oriented including refocusing the patient.

The termination stage. This is the last stage of the interview process during which information is summarised and validated. During this time the patient is given an indication of the time that is left for the interview and allow to give the patient an opportunity to give additional information. The nurse also plans for future interviews.

Factors affecting communication Listening : active listening or the act of perceiving what is said verbally and non- verbally is a critical factor in conducting a successful health assessment interview. Active listening helps the nurse to decode the patients messages in order to understand their situation.

Cont.. Non-verbal cues: this is communicating a message without words. Non-verbal behaviors effectively supplement the spoken words and provide information about the nurse and patient. non-verbal cues may be indications of the patients health or feelings that the patient may not feel comfortable expressing verbally.

Cont… Distance : the amount of space a person considers appropriate for interaction is a significant factor in the interview process and is partly determined by cultural influence. May sure you can keep eye contact with the patient and you are able to hear them.

Effective interviewing techniques Effective interviewing techniques facilitate interactions between the patient and the nurse. These include both verbal and non-verbal approaches.

Cont… Using open-ended questions: Open-ended questions encourage the patient to provide general rather than more focused information. Open-ended questions that begin with words how, what, where, when and who are usually more effective in eliciting the maximum amount of information than those that begin with why.

Cont… Open-ended questions may be time consuming and may not be appropriate in situations that require rapid access to information. Its important to first let the patient speak uninterrupted before you proceed to the next question.

Cont… Using closed questions: closed questions are those that regulate or restrict patient response. They can frequently be answered by a “yes” or a “no”.

Cont… Facilitating: once the interview has started, there may be periods when patients stop talking because of anxiety or embarrassments. You can use both verbal and non-verbal means to encourage the patients to continue talking. e.g. head nods.

Cont… Using silence: understood and used effectively, periods of silence can help structure and pace the interview, convey respect and acceptance. Silence on the part of the part of the patient may indicate feelings of anxiety, confusion or the patient may not have understood the question asked.

Grouping communication techniques  Listening responses: Listening responses are attempts made by the nurse to accurately receive, process and then respond to patient’s messages. They provide one way for the nurse to communicate empathy, concern and attentiveness

Cont.. Patients need to know that the interviewer has heard what they have been saying. Listening responses include: making observations, restating,reflecting,clarifying,interpreting,sequ encing,encouraging comparisons and summarizing.

Cont… Making observations: when making observations, the nurse verbalises perceptions about the patient’s behavior, then shares them with the patient. Restating: this involves repeating or rephrasing the main idea expressed by the patient and lets the patient know you are paying attention.

Cont.. It promotes further dialogue and provides the patient with the opportunity to explain on a certain issue. Reflecting: it focuses on the content of the patient’s message as well as their feelings. In reflection the nurse directs the patient’s own questions, feelings and ideas back to the

Cont.. Patient and an opportunity for the patient to reconsider or expand on what was just said. Clarifying: this is a technique used by the nurse to make clear something the patient says or to pinpoint the message when the patient’s words and non verbal behavior do not agree.

Cont.. Always be sure to understand what the patient means before continuing in the interview. Interpreting: with interpreting you have the opportunity to share your influence or conclusions gathered from the patient’s interview.

Assignment Action responses: write brief notes about each Focusing Exploring Presenting reality Confronting Informing Collaborating Limit setting normalising

Non-therapeutic interview techniques Requesting an explanation: questions that begin with “why” are often perceived by the patient as challenging or threatening. Probing: repeated or persistent questioning of the patient about a statement or a behavior may increase patient’s anxiety or hostility.

Non therapeutic communication  False assurance – eg, telling a patient with a terminal illness every thing will be ok.  Giving advise – “ I think you should ……..”. Just give formed information for the patient to chose options.  Probing – asking to many questions without regard for the patient’s feelings.  Changing the subject  Minimizing the patients feelings – eg “it cant be that bad”.  Trite expressions like “don’t cry over spoilt milk”.  Interruptions  Jumping to conclusions  Asking questions that need yes or no responses.  Using professional jagons. 34

assignment Interviewing patients with special needs:  Patients who is hearing impaired.  Patient who is visually impaired.  Patient who is speech impaired.  Patient who has a low level of understanding.  Patient who is crying.