UNIT II

Interviewing Skills and

Health History

MR. DILEEP KUMAR

(RN, PRN BSN, MSN, Dip: CHN, DIT) 1
 OBJECTIVES
 Explain the purpose, process & principles of
interviewing.
 Describe the content and format used to obtain a
health history.
 Discuss the process of investigating positive findings
during the health history.
 Practice obtaining and recording a client health history.
 Practice utilizing therapeutic skills with a learner’s
partner.
 Identify strengths and weaknesses via observation of
a videotaped interaction and self/peer analysis.
 Interview patient in clinical and collect feedback from
colleagues and faculty about use of therapeutic
communication
2
 Collecting Subjective Data
Subjective data is an integral part of nursing health
assessment. It consist of;
 Sensations or symptoms

 Feelings

 Perceptions

 Desires

 Preferences

 Beliefs

 Ideas

 Values

 Personal information

3
Cont…
 Subjective data can be elicited and verified only
by the client.
 It provide clues to possible physiologic,
psychological, and sociologic problems.
 also provide the nurse with information that may
reveal a client’s risk for a problem as well as
areas of strengths for the client.
 The information is obtained through interviewing.
 Effective interviewing skills are vital to accurate
and thorough collection of subjective data or a
valid health history
4
 INTERVIEW
 Interview is a communication process focuses on the
client's development of psychological, physiological,
socio-cultural, and spiritual responses, that can be
treated with nursing & collaborative interventions.
 The health assessment interview is an intentional
process and proceeds in a goal directed manner.
 The individual knows everything about his/her own
health state, and you know nothing. Your skill in
interviewing will glean all the necessary information as
well as build rapport for a successful working relationship
 An interview is a conversation between two or more
people (the interviewer and the interviewee) where
questions are asked by the interviewer to obtain
information from the interviewee.
5
 Cont….
The nursing interview is a
communication process that
has two focuses:

1. Establishing rapport and a trusting

relationship with the client
– to elicit accurate and meaningful information
2. Gathering information on the client’s
developmental, psychological, physiologic,
socio-cultural, and spiritual statuses
– to identify deviations that can be treated with nursing
and collaborative interventions or strengths that can be
enhanced through nurse– client collaboration.
6
 Purpose of Interviewing
 Initiate and maintain a helping relationship.
(rapport, trust, care, and concern)
 Identify special concerns and perceptions
 Demographic and social information
 To obtain health history
 To elicit symptoms and the time course of their
development.
7
 Principles of Interviewing
 Rights: People have a right to health and health care.
 Balance: Care of individual patients is central, but the
health of populations is also our concern.
 Comprehensiveness: In addition to treating illness, we
have an obligation to ease suffering, minimize disability,
prevent disease, and promote health.
 Cooperation: Health care succeeds only if we cooperate
with those we serve, each other, and those in other
sectors.
 Improvement: Improving health care is a serious and
continuing responsibility.
 Safety: Do no harm.
 Openness: Being open, honest, and trustworthy is vital
in health care. 8
 Interviewing Process:
(Components/ Phases of interview)
 The nursing interview has three basic phases:
introductory, working, and termination phases.

Introductory Phase:
 Introduce yourself and explains the purpose of the

interview to the client.

 Before asking questions, Let client to feel Comfort,

Privacy and Confidentiality

 Prime purposes are meant to establish rapport, to

ensure a comfortable setting, and to state the

purpose of the interview.
9
Working Phase:
 The nurse must listen and observe cues in
addition to using critical thinking skills to
validate information received from the client.
 The nurse identify client's problems and
goals.
 Most time consuming.

 Collect data of overall health.

 Prime purposes are meant to collect

biographic data, data pertinent to the client's
health status, and to identify, and respond to
client's needs.
10
Termination Phase:
 The nurse summarizes information obtained during
the working phase
 Validates problems and goals with the client.
 Making plans to resolve the problems (nursing
diagnosis and collaborative problems are identified
and discussed with the client)
 Serves to end the interview.
 Pre summary, summary, and follow-up should be
incorporated.
 Summarize to validate perceptions.

11
STAGES OF THE
INTERVIEW:
 Greet the patient and establish the rapport
 Invite the patient's story
 Establish the agenda for the interview
 Generate and test hypothesis about nature of
the problem
 Create a shared understanding of the problem
 Negotiate a plan
 Plan for follow-up, and closing the interview.
12
 Verbal Communication:
 Personalize the interview
 Use open ended questions
 Make broad opening statements
 Verbalize implied ideas
 Provide general leads
 Seek clarification
 Share perceptions
 Confront contradictions
 Review the discussion
 Employ: Reflection, Empathy, Reassurance,
Transitions, and Summarization. 13
Nonverbal Communication:
Learn to listen with your eyes as well as
with your ears.

 Physical Appearance
 Posture
 Gestures
 Facial Expressions
 Eye Contact
 Voice
 Touch
14
 Barriers to Therapeutic
Communication
 Offering advice
 Abruptly changing subjects
 Acting defensively
 Minimizing feelings
 Offering false reassurance
 Jumping to conclusions
 Using authority
 Using avoidance language
 Engaging in distancing
 Using professional jargon
 Using leading or biased questions
 Talking too much
15
 Using "WHY" questions
 Communications techniques
during interview
1. Types of questions :
 Begin with open ended questions to assess client's

feelings e.g. what, how, which“

 Use closed ended question to obtain facts e.g."
when, did…etc
 Use list to obtain specific answers e.g. "is pain
sever, dull sharp
 Explore all data that deviate from normal e.g.
16
“increase or decrease the problem
Cont…
2. Types of statements to be use:
 Repeat your perception of client's response to
clarify information and encourage verbalization

3. Accept the client silence to recognize thoughts

4. Avoid some communication styles e.g.

 Excessive or not enough eye contact.
 Doing other things during getting history.
 Biased or leading questions e.g. "you don't feel
bad"
 Relying on memory to recall information 17
Cont…
5. Specific age variations :-
 Pediatric clients: validate information from parents.
 Geriatric clients: use simple words and assess hearing
acuity

6. Emotional variations:
 Be calm with angry clients and simply with anxious
and express interest with depressed client
 Sensitive issues "e.g. sexuality, dying, spirituality" you
must be aware of your own thought regarding these
things. 18
Cont…
7. Cultural variations:
 Be aware of possible cultural variations in the
communication styles of self and clients

8. Use culture broker:

 Use culture broker as middleman if your client
not speak your language.
Use pictures for non reading clients.

19
Techniques of skilled interviewing
 Active listening
 Adaptive questioning
 Nonverbal communication
 Facilitation
 Echoing (Simple repetition of the patient’s words
encourages the patient to express both factual details
and feelings)
 Empathic responses
 Validation
 Reassurance
 Summarization
 Highlighting transitions 20
 Health History.
 Taking a health history should begin with an
explanation to the client that why the information is
being requested
 It is a collection of subjective data
 Provided by the client and compiled by the nurse
 It provides information about client’s present and past
health status about their health.
 The complete health history is modified or shortened
when necessary. For example, if the physical
assessment will focus on the heart and neck vessels,
the subjective data collection would be limited to the
data relevant to the heart and neck vessels.
21
Content & Format used to obtain
Health History
The health history has eight sections:
 Biographical Data
 Reasons for seeking health care
 History of present health concern
 Past health history
 Family health history
 Review of body systems (ROS) for current health problems
 Lifestyle & Health Practices
 Developmental Level

22
Biographical Data
 Name  Provider of history (patient or
 Address other)
 Phone  Race or ethnic background
 Gender  Educational Level
 Date of birth  Significant others or support
 Occupation persons

Reasons of Seeking Health Care

 Reason for seeking health care
 Feelings about seeking health care
 History of Present Health Concern
 is a chronological story of what has been happening.
 Must get details of the problem.
• Character (How does it feel, look, smell, sound, etc.?)
• Onset (When did it begin; is it better, worse, or the same
since it began?)
• Location (Where is it? Does it radiate?)
• Associated factors (What other symptoms do you have
with it? Will you be able to continue doing your work or
other activities [leisure or exercise]?)
• Duration (How long it lasts? Does it recur?)
• Severity (How bad is it on a scale of 1 [barely noticeable]
to 10 [worst pain ever experienced]?)
• Pattern (What makes it better? What makes it worse?)
24
Past Health History Family Health History
 Problems at birth  Age of parents
(Living? Deceased
 Childhood Illnesses date?)
 Immunizations to date  Parent illnesses
 Adult illnesses  Grandparent’s
(physical, emotional, Illnesses
mental)
Surgeries  Aunt’s and uncle’s age
and illnesses
 Accidents
 Children’s age and
 Prolonged pain or pain illnesses or handicaps
patterns
 Allergies
25
 Review of Systems for Current
Health Problems
 Skin, Hair and Nails: color, temperature, condition,
rashes, lesions, sweating, hair loss dandruff
 Head and Neck: headache, stiffness, difficulty swallowing,
enlarged lymph nodes
 Ears: pain, ringing, buzzing, drainage, difficulty hearing,
exposure, to loud noises, dizziness
 Eyes: pain, infections, vision, redness, tearing, halos,
blurring, black spots, flashes, double vision
 Mouth, Throat, Nose, and Sinuses: mouth pain, sore
throat, lesions, hoarseness, nasal obstruction, sneezing,
coughing, snoring, nosebleeds
 Thorax and Lungs: pain, difficulty breathing, shortness of
breath with activities, orthopnea, cough, sputum, hemoptysis,
respiratory infections

26
Continue
 Breasts and Regional Lymphatics: pain,
lumps, discharge from nipples, dimpling or changes in
breast size, swollen tender lymph nodes in axilla
 Heart and Neck Vessels: chest pain or pressure,
palpitations, edema, last blood pressure, last ECG
 Peripheral Vascular: Leg or feet pain, swelling of
feet or legs, sores on feet or legs, color of feet and legs
 Abdomen: pain, indigestion, difficulty swallowing,
nausea and vomiting. Gas, jaundice, hernias
 Male Genitalia: painful urination, frequency or
difficulty starting or maintaining urinary system, blood in
urine, sexual problems, penile lesions, penile pain,
scrotal swelling, difficulty with erection or ejaculation,
exposure to sexually transmitted diseases
27
Continue
 Female Genitalia: Pelvic pain, voiding pain, sexual
pain, voiding problems (dribbling, incontinence) age of
menarche or menopause (date of last menstrual period),
pregnancies and types of problems, abortions, sexually
transmitted diseases, hormone replacement therapy,
birth control methods
 Anus, Rectum, & Prostate: pain, with refection,
hemorrhoids, bowel habits, constipation, diarrhea, blood
in stool
 Musculoskeletal: Pain, Swelling, red, stiff joints,
strength of extremities, abilities to care for self and work
 Neurological: mood, behavior, depression, anger,
headaches, concussions, loss of strength or sensation,
coordination, difficulty with speech, memory problems,
strange thoughts or actions, difficulty reading or learning
28
 Lifestyle & Health Practices
 Description of a typical day (AM to PM)
 24-hour dietary intake (foods and fluids)
 Who purchases and prepares meals
 Activities on a typical day
 Exercise habits and patterns
 Sleep and rest habits and patterns
 Use of medications and other substances
(caffeine, nicotine, alcohol, recreational drugs)
 Self concept
 Self-care responsibilities
 Social activities for fun and relaxation
2
Continue
 Social activities contributing to society
 Relationships with family, significant others,
and pets
 Values, religious affiliation, spirituality
 Past, current, and future plans for education
 Type of work, level of job satisfaction, work
stressors
 Finances
 Stressors in life, coping strategies used
 Residency, type of environment,
neighborhood, environmental Risks
30
 Developmental Level

 Young Adult: Intimacy versus Isolation

 Middlescent: Generativity versus Stagnation

 Older Adult: Ego Integrity versus Despair

31
Importance of the Health History
 Health history is an excellent way to begin the
assessment process
 It lays the groundwork for identifying nursing problems
and provides a focus for the physical examination
 Provide information that will assist the examiner in
identifying areas of strength and limitation in the
individual’s lifestyle and current health status.
 Provide the examiner with specific cues to health
problems that are most apparent to the client.
 Specific cues to health problems may be more intensely
examined during the physical assessment.
 When a client is having a complete, head-to-toe physical
assessment, collection of subjective data usually
requires that the nurse take a complete health history.
32