Interviewing to obtain a health history

Collection of assessment data is the first step in the nursing process and an expectation of nurses in clinical nursing practice. American Nurses Association, 2004

The nurse’s role To facilitate discussion in order to collect and record data She may use an outline to prompt questions and take brief notes during the interview The nurse should learn about client’s health concerns, the social, economic and cultural factors that influence their health and their responses to illness.

Phases of interview Introduction Discussion Summary

Introduction Introduce yourself to clients Offer a handshake to clients Tell the client your role in his care Address clients by their title (Mr., Mrs., Ms.) and surname Avoid using the first name with clients unless they request it, except when they are adolescents or children Avoid substituting the client’s role (mom, grandpa) Explain to clients what to expect during the interview and how long the process should take.

Discussion Nurse’s role is to facilitate the direction of conversation, but… Ideally the conversation is client – centered Nurse uses a variety of communication skills and techniques to enhance the conversation and data exchange

Summary Summarize with clients the main points and emphasize data that have implications for health promotion, disease prevention or resolving their health problems Allows for clarification of data Provides validation to clients that you have an accurate understanding of their health issues, problems and concerns

Factors that affect the interview Therapeutic communication process Physical setting Nurse behaviors Types of questions that are asked The way the questions are asked The personality and behavior of clients The nature of information being discussed or problem being confronted

The physical setting Ideally an interview is conducted in a private, quite and comfortable room free from environmental distractions Client should be physically comfortable during an interview (when possible allow the client to remain in street clothes The nurse and client should sit at a distance from each other that provides a comfortable flow of conversation and allows eye contact Interruptions by other individuals should be avoided

Professional nursing behavior The first impression on client ( modest dress, clean fingernails, neat hair) Nurse must convey a professional yet warm demeanor Actively listen to clients and project a genuine interest in them and in what they have to say The nurse must avoid being careless with words Nonverbal behavior is as important as your words Avoid the extremes of reaction – startle, surprise, laughter, grimacing – as clients provide information

Client – related variables Age Physical Mental Emotional status In case of conducting an interview with a client in physical or emotional distress limit the number and the nature of the questions to what is absolutely necessary for the given situation and save additional questions for a later time

The art of asking questions The art of obtaining information from clients and listening carefully to their responses is an essential competency of nurses The questions must be clearly spoken Use terms familiar to clients if possible Adapt questions to a client’s level of knowledge and understanding Encourage patient to be as specific as possible (“How many is few?”)

The art of asking questions Ask one question at a time and wait for the reply before asking the next question Be attentive to the feelings that accompany the client’s responses to some questions If the client ask you a question during an interview avoid overburdening them with an in – depth answer that is more information than necessary to satisfy them

Types of question to ask Open – ended questions (used for the beginning of an interview). The aim is to elicit a response that is more than one or two words. (“How have you been feeling?”) Closed – ended questions. The aim is to gain more precise details. (“Do you become short of breath?”) Directive questions.(used in reviewing systems or in evaluating functional status). They lead clients to focus on one set of thoughts. (“Describe the drainage you have had from your nose.”)

Techniques that enhance data collection Active listening (avoid formulating your next question while the client is talking and predicting how clients will answer questions) Facilitation (usage of phrases to encourage client to continue talking – “Go on”, “uh – huh”, “Then?”) Clarification (is used to obtain more information about conflicting, vague or ambiguous statements – “ what do you mean by…?” Restatement (involves repeating what clients say using different words – “Let me make sure I understand what you said. The pain in your stomach occurs before you eat. Is that correct?”)

Techniques that enhance data collection Reflection (repeating a phrase or sentence the client just said. This encourages elaboration and indicates you are interested in more information) Confrontation (is used when you notice inconsistencies between what the client reports and your observations or other data about the client. Use a tone that communicates confusion or misunderstanding, rather than one that is angry)

Techniques that enhance data collection Interpretation ( is used when you want to share with clients conclusions you have drawn from data they have given. After hearing your interpretation, clients can confirm, deny or revise your interpretation Summary (condenses and orders data obtained during the interview to help clarify a sequence of events)

Techniques that diminish data collection Using medical terminology ( use “high blood pressure” instead of “hypertension”, “stroke” instead of “CVA”) Expressing value judgments Interrupting the client (allow clients to finish their sentences for them.The ending you add to the sentence may not be the ending that clients would have used )

Techniques that diminish data collection Being authoritarian or paternalistic (despite what you believe is best for clients, you must always remember that their health is their responsibility. They may choose to follow or ignore your advice and teaching) Using “why” questions (can be perceived as threatening and may put clients on the defensive). Instead of asking “Why didn’t you take all the antibiotics” you might say “I noticed you stopped using the antibiotics before all the pills were gone”.

Managing awkward moments during an interview Answering personal questions (a brief, direct answer satisfies the client’s curiosity) Silence (clients may need the silence as time to reflect or to gather courage. Become comfortable with silence, it can be useful). Displays of emotion (crying is a natural emotion and should be permitted when it occurs).

Challenges to the interview Managing the overly talkative client (the use of closed – ended questions may help to maintain direction and flow of the conversation) Others in the room (when adult or adolescent client are able to speak for themselves, it is best to interview them directly, and if at all possible in private.If other individuals are to remain present during the interview, be sure this is done with the client’s permission.)

Challenges to the interview Language barrier ( when clients speak a different language than the nurse, a translator is needed for accurate communication. An objective observer who is the same gender as the client will be a better translator than a family member) Cultural differences (the nurse should develop cultural competence, but avoid stereotyping clients just because of their culture or ethnicity.)

Thank You for attention!!!