 Define the goals of the clinical interview.  Describe the principles of setting a therapeutic tone.  Describe the key techniques to use in a structured interview.  Identify methods to assist the patient to describe the problem.  Identify the phases within the interview.  Identify how to provide closure.

Interview

 Establishing rapport and a trusting relationship with the client to elicit accurate and meaningful information  Gathering information

 Introductory  Working  Summary

Phases Purpose nterview Gather Establish rapport Introductory Working Summary

The content and direction of the clinical interview are decided by the client. The client leads Nurse employs communication skills and active listening

 client feels understood and comfortable  identify and explore problems relating to others  discuss healthy ways of meeting emotional needs  experience a satisfying interpersonal relationship

 Constant practice and observation  Anxiety during first meeting  Concerns on how to begin the interview and how to do in response to specific client behaviors

 Can happen anywhere  Establish a setting that enhances feelings of security  Privacy  When done in the home, it will give opportunity for the nurse to assess the person in the context of everyday life

 Arrange chairs such that conversation can take place in normal tones of voice and eye contact can be comfortably maintained  Same height, avoiding a face-to-face stance when possible, side-by-side position may be less intense.  Avoid settings without ready access to door  Avoid desk barrier between the nurse and client

 Orientation phase – name, school, purpose, time of meeting  Confidentiality  Ask how the client would like to be addressed: conveys respect, gives client a direct control over an important ego issue

 After introductions, start with open-ended statements. e.g. “Tell me a little about what has been going on with you.”  Offer leads (“Go on…”)  Make statements of acceptance (“Uh-huh”)  Avoid barriers to communication

 Nonverbal  Verbal

 Appearance  Demeanor  Facial expression  Attitude  Silence  Listening

 Open-ended Questions  Closed-ended Questions  Laundry List  Rephrasing  Inferring  Providing Information

 Excessive or insufficient eye contact  Distraction and distance  Standing  Biased or leading questions  Rushing through the interview  Reading the questions

 Speak briefly  When you do not know what to say, say nothing  When in doubt, focus on feelings  Avoid advice  Pay attention to nonverbal cues  Keep the focus on the client

Communication Starting Phases Purpose nterview Gather Establish rapport Introductory Working Summary setting seating verbal nonverbal

 Gerontologic  Cultural  Emotional

 “You seem ready to cry.”  “You are still upset about your brother’s death.”  “What are you thinking right now?” offer tissue

 “I cannot make that promise. It might be important for me to share it with other staff.”  The client decides whether to share information

 “I will wait for you here for 15 minutes, until our time is up.”  The nurse does not engage in any conversation  When the time is up, the nurse approaches the client, tells him or her the time is up, and restates the day and time the nurse will see the client again.

 “I am with Mr. Rob for the next 20 minutes. At 10 AM, after our time is up, I can talk to you for 5 minutes.”

 “This is very serious Mr. Lamb. I do not want any harm to come to you. I will have to share this with other staff.”

 “It’s alright. I would like to spend time with you. We don’t have to talk.”  “Our 5 minutes is up. I’ll be back at 10am and stay with you for 5 minutes more.”

 “Our time is up now, Mr. Jones. This would be a good place to start our next session, which is on Wednesday at 10am.”

 “Thank you but it is our job to care for our clients. Are you concerned that some aspect of your care will be overlooked.”

 Client: “Are you married?” Nurse: “Yes. Do you have a spouse?”  Client: “Do you have any children?” Nurse: “This time is for you – tell me about yourself.”  Client: “You can just tell me if you have any children.” Nurse: “this is our time to focus on your concerns. Tell me something about your family.”

 Purpose  Content: Nurse, Client, Analysis (with reference), student’s thoughts and feelings

 Weber J., Kelley, J. (2007) Health Assessment in Nursing (3 rd edition) Philadelphia: Lippincott Williams and Wilkins.  Vacarolis, E., Carson V., & Shoemaker N. (2006). Foundations of Psychiatric Mental Health Nursing A Clinical Approach(5 th edition)St. Louis Missouri: Elsevier Inc.