1. THE NURSING INTERVIEW Interviewing & Documentation J. Carley MSN,MA, RN, CNE Fall, 2009

2. Interviewing & Documentation Unit Objectives 1.Describe the five steps of the nursing process and how it applies to health assessment. 2.Describe an environment suitable for conducting an interview and physical assessment. 3.Recognize personal perceptions and behaviors that facilitate or hinder the interviewing process 4.Define effective interviewing techniques 5.Identify the components of the complete health history. 6.Describe how to assess the characteristics of a chief complaint

3. The Interview Subjective data Results of a successful interview The interview as a contract between patient and examiner ◦ Time and place

4. The Interview Subjective data Results of a successful interview The interview as a contract between patient and examiner ◦ Time and place ◦ Introduction and explanation

5. The Interview Subjective data Results of a successful interview The interview as a contract between patient and examiner ◦ Time and place ◦ Introduction and explanation ◦ Purpose

6. The Interview Subjective data Results of a successful interview The interview as a contract between patient and examiner ◦ Time and place ◦ Introduction and explanation ◦ Purpose ◦ Length

7. The Interview Subjective data Results of a successful interview The interview as a contract between patient and examiner ◦ Time and place ◦ Introduction and explanation ◦ Purpose ◦ Length ◦ Expectations

8. The Interview Subjective data Results of a successful interview The interview as a contract between patient and examiner ◦ Time and place ◦ Introduction and explanation ◦ Purpose ◦ Length ◦ Expectations ◦ Confidentiality

9. Process of Communication Sending The Interview

10. Process of Communication Sending Receiving The Interview

11. Process of Communication Sending Receiving Internal factors  Liking others  Empathy  Ability to listen The Interview

12. Slide 4-2 Process of Communication External factors  Ensure privacy  Refuse interruptions  Physical environment  Dress  Note-taking  Tape and video recording The Interview

13. Establish Rapport Get organized Do not rely on memory Plan enough time Ensure privacy Get focused Be calm, confident, warm, and helpful

14. Begin the Interview Give your name and position Verify the client’s name Briefly explain your purpose

15. The Interview Techniques of Communication Introducing the interview Working phase  Open-ended questions  Closed or direct questions

16. The Interview Techniques of Communication Introducing the interview Working phase  Open-ended questions  Closed or direct questions Responses—assisting the narrative  Facilitation  Silence  Reflection  Empathy  Clarification  Confrontation  Interpretation  Explanation  Summary

17. The Interview Techniques of Communication Introducing the interview Working phase  Open-ended questions  Closed or direct questions Responses—assisting the narrative  Facilitation  Silence  Reflection  Empathy  Clarification  Confrontation  Interpretation  Explanation  Summary

18. The Interview Techniques of Communication Introducing the interview Working phase  Open-ended questions  Closed or direct questions Responses—assisting the narrative  Facilitation  Silence  Reflection  Empathy  Clarification  Confrontation  Interpretation  Explanation  Summary

19. The Interview Techniques of Communication Introducing the interview Working phase  Open-ended questions  Closed or direct questions Responses—assisting the narrative  Facilitation  Silence  Reflection  Empathy  Clarification  Confrontation  Interpretation  Explanation  Summary

20. The Interview Techniques of Communication Introducing the interview Working phase  Open-ended questions  Closed or direct questions Responses—assisting the narrative  Facilitation  Silence  Reflection  Empathy  Clarification  Confrontation  Interpretation  Explanation  Summary

21. The Interview Techniques of Communication Introducing the interview Working phase  Open-ended questions  Closed or direct questions Responses—assisting the narrative  Facilitation  Silence  Reflection  Empathy  Clarification  Confrontation  Interpretation  Explanation  Summary

22. The Interview Techniques of Communication Introducing the interview Working phase  Open-ended questions  Closed or direct questions Responses—assisting the narrative  Facilitation  Silence  Reflection  Empathy  Clarification  Confrontation  Interpretation  Explanation  Summary

23. The Interview Techniques of Communication Introducing the interview Working phase  Open-ended questions  Closed or direct questions Responses—assisting the narrative  Facilitation  Silence  Reflection  Empathy  Clarification  Confrontation  Interpretation  Explanation  Summary

24. The Interview Techniques of Communication Introducing the interview Working phase  Open-ended questions  Closed or direct questions Responses—assisting the narrative  Facilitation  Silence  Reflection  Empathy  Clarification  Confrontation  Interpretation  Explanation  Summary

25. How to listen Be an empathetic listener Use short supplementary phrases Listen for feelings as well as words Let the person know when you see body language that conflicts with what they say Be patient if the patient has a memory block Avoid the impulse to interrupt Allow for pauses

26. How to ask Questions? Ask about the main problem first = chief complaint Focus your questions to gain specific information about the signs and symptoms Don’t lead the witness Restate the other person’s words to clarify Use open-ended questions Avoid closed –ended questions, yes or no questions

27. Observations Carefully assess areas connected to verbal cues Use your senses Note general appearance Observe body language Notice interaction patterns

28. The Interview Techniques of Communication Ten 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

29. The Interview Techniques of Communication Nonverbal skills  Physical appearance  Posture  Gestures  Facial expression  Eye contact  Voice  Touch Closing the interview

30. The Interview Interviewing People With Special Needs Hearing-impaired people Acutely ill people People under the influence of street drugs or alcohol Personal questions Sexually aggressive people Crying Anger Threat of violence Anxiety

31. Slide 4-7 The Interview Cross-Cultural Communication Cultural perspectives on professional interactions Etiquette Space and distance Cultural considerations on gender and sexual orientation

32. Slide 4-8 The Interview Overcoming Communication Barriers Working with (and without) an interpreter Nonverbal cross-cultural communication  Vocal cues (and silence)  Action cues  Object cues  Use of personal and territorial space  Touch

35. Translation Software / Applications

36. Observations Body language Argyle, using video tapes shown to the subjects, analyzed the communication of submissive/dominant attitude and found that non-verbal cues had 4.3 times the effect of verbal cues. Argyle, M, Salter, V., Nicholson, H.,W illiams, M. & Burgess, P. (1970): The communication of inferior and superior attitudes by verbal and non-verbal signals. British Journal of Social and Clinical Psychology 9: 222-231.

37. Observations Body language

38. Observations Body language

39. Observations Body Language A)”Hmm… How long did they say block 2.0 lasts?”

40. Observations Body Language 2. “Power Point could be the miracle cure for insomnia..”

41. Observations Body Language

42. Observations Body Language

43. Observations Body Language

44. Observations Body language

45. Observations Body language

46. Observations Body language

47. Observations Body language

48. Observations Body language

49. Observations Healthcare Provider Body Language

50. How to terminate the interview If the session has been long, give a warning As the person to summarize their primary concerns Ask if there are other areas to be discussed Offer yourself as a resource Explain routines and provide information about who does what End on a positive note

51. Charting & Documentation If it isn’t written, then it wasn’t done Chart at the time it occurs – if possible Follow facility guidelines Is the information clear and logical? Is it true? Is it non - judgmental? Record all abnormals and normals

52. Charting guidelines Be precise Stick to the facts Sign your name after each entry SOAP format – focuses on specific problems AIR, DAR, PIE, DIE formats – focus on nursing interventions and client response Prioritize the client problems

53. Interviewing & Documentation Unit Objectives 1.Describe the five steps of the nursing process and how it applies to health assessment. 2.Describe an environment suitable for conducting an interview and physical assessment. 3.Recognize personal perceptions and behaviors that facilitate or hinder the interviewing process 4.Define effective interviewing techniques 5.Identify the components of the complete health history. 6.Describe how to assess the characteristics of a chief complaint