Chapter 003 Interview

Chapter 3
The Interview
Copyright © 2020 by Elsevier Inc. All rights reserved.

Introduction
 The interview is the first
point of contact with a client
and the most important part
of data collection.
 During the interview you collect
subjective data and objective
data
Interview Purpose
 Best chance to gain an understanding of the
patient’s beliefs, concerns, and perception of their
individual health state
 Allows for compilation of subjective data and
awareness of objective data (physical appearance,
posture, ability to carry on a conversation, and
demeanor)
 Skilled interviewers can glean all necessary
information while establishing a rapport with the
client

Successful Interview Characteristics
 Gather complete and accurate data about
person’s health state including description and
chronology of any symptoms.
 Establish trust to foster acceptance and allow for
data sharing.
 Teach the person about their individual health
state.
 Build rapport to continue therapeutic
relationship.
 Discuss health promotion and disease
prevention.
Successful Interview Characteristics
 Consider the interview a contract between you
and your client. The contract concerns what the
client needs and expects from health care and
what you as a clinician have to offer. Your mutual
goal is optimal health for the client
The Interview Contract Terms
 Location: Time and place with follow-up for physical
exam
 Explanation: Introduction and delineation of role
 Purpose: Mutual goal is optimal health.
 Time frame: Length of time for process
 Participation: Expected participation and/or
presence of others
 Confidentiality: Reasonable and/or limited as it
applies to legal/ethical standards
 Cost: Disclosure of any financial costs

Process of Communication: Sending
 Verbal communication
 Words you speak—vocalization
 Tone used in conversation
 Nonverbal communication
 Body language helps to provide cues which may be
correlated with truer feelings.
 Recognize importance of unconscious messages

Process of Communication: Receiving
 Being aware of the messages you send is only part of

the process. Your words and gestures must be
interpreted by the receiver.
 Although you have a specific meaning in mind, the
receiver may not understand the message as it was
meant.
 The receiver uses his or her own interpretations of your
words.
Process of Communication:
Internal Factors
 Specific to you as the health care team member
which can help you to maximize communication
skills
 Internal factors
 Liking others—using a “genuine” approach
 Empathy—develop an understanding and sensitivity
for others feeling’s:-
Empathy means viewing the world from the other
person's inner frame of reference while remaining you.
It is a recognition and acceptance of the other person's
feelings without criticism.
Internal Factors
Empathy is described as the ability to understand and
be sensitive to the feelings of someone else.
Empathy does not mean that you lose yourself in the
other person at your own expense. By losing
yourself, you cease to be useful. Empathy is the ability
to recognize how someone perceives his or
her world.
 Ability to listen—using an “active” process:-
Listening is not a passive role in the communication
process; it is active and demanding.

Internal Factors
Listening requires complete and focused attention.
You are not only hearing the person's words but also
interpreting their meaning, asking follow-up questions,
and ensuring a thorough understanding of
what the person is telling you.
 Self-awareness—be aware of “implicit bias”:-
Understanding your personal biases, prejudices, and
stereotypes is an important part of developing your
skills as an interviewer. By knowing your behaviors and
responses, you become aware of how some
unintentional actions can have a negative impact on
your communication

External Factors
 Defining the environment so as to foster
communication
 External factors
 Ensure privacy—aim for “geographic” privacy but if
not possible ensure “psychological” privacy
 Avoid interruptions—minimize and/or refuse

External Factors
 Physical environment—“equal status” seating:
Both you and the client should be comfortably seated,
at eye level.
Placing the chairs at 90 degrees is good because it
allows the person either to face you or to look straight
ahead from time to time. Make sure that you avoid
facing a client across a desk because this creates a
barrier.

Physical environment
 Set the room temperature at a comfortable level.
 Provide sufficient lighting so that you can see each other
clearly, but avoid strong, direct lighting that may cause
squinting.
 Secure a quiet environment. Turn off televisions, radios, and
any unnecessary equipment.
 Remove distracting objects or equipment. It is appropriate to
leave some professional equipment
(otoscope/ophthalmoscope, blood pressure manometer) in
view, but avoid clutter such as stacks of mail, other files, or
your lunch.
Physical environment
 Place the distance between you and the client at 4 to 5
feet (around 1 to 1.5 meters). Personal space is any
space within 4 feet of a person. Crossing the personal
space can cause anxiety, but if you position yourself
farther away, you may seem aloof and distant.
External Factors
 Dress—appearance and comfort:
The client should remain in street clothes during the
interview except in an emergency. A hospital gown
causes a power differential and may make the person
feel exposed and uncomfortable. Establish rapport
before asking the person to change into a gown.
• Your appearance and clothing should be appropriate
to the setting and should meet conventional
professional standards: a uniform or lab coat over
conservative clothing, a name tag, and neat hair. Avoid
extremes.

External Factors
 Note-taking—keep to a minimum, offer “focused”
attention:
 Be aware that excessive note-taking during the
interview has disadvantages:
• It breaks eye contact too often.
• It shifts your attention away from the person,
diminishing his or her sense of importance.
• Recording everything a person says may cause you to
ask him or her to slow down, or the person may slow his
or her tempo to allow for you to take notes. Either way,
the client's natural mode of expression is lost.

External Factors
• It impedes your observation of the
client's nonverbal behavior.
• It is threatening to the client during
the discussion of sensitive issues
(e.g., alcohol and illicit drug use,
number of sexual partners, or
incidence of abuse).
When interviewing a hospitalized
bedridden person, arrange a face-to-
face position, and avoid standing
over him or her

Techniques of Communication
 Introducing the interview—keep it short and
formal:
Ask about preferences of name, introduce oneself
and the reason for the interview
 Working phase
 Data-gathering phase
 Verbal skills include questions to patient and your
responses to what is said.
 Two types of questions
• Open-ended—asks for narrative information
• Closed/direct—asks for specific information leading to a
forced choice (yes or no).
• Each has a different place and function in interview.
Techniques of Communication
Direct questions are also useful when you need specific
facts such as past medical history. It also speed up the
interview.
Guidelines of direct questions: (a) Ask only one direct
question at a time; (b) Avoid double-barreled questions,
such as “Do you exercise and follow a diet for your
weight?”; (c) Choose language the client understands.

Verbal Responses: Assisting the
Your reaction to Narrative (1 of 2)
what was said
 Nine types of verbal responses that fall under
patient perspective and interviewer perspective
 Patient leads and reactions obtained from
interviewer (The interviewers' reactions to the
facts or feelings that the person has
communicated):-
 Facilitation—encourages patient to say more
 Silence—directed attentiveness
 Reflection—echoes to help express meaning
 Empathy—names a feeling and allows its expression
 Clarification—asking for confirmation
Verbal Responses: Assisting the
You start to express
your thoughts Narrative (2 of 2)
 Interviewer leads and expression of own
thoughts based on obtained information
 Confrontation—clarifying inconsistent information
 Interpretation—makes association to identify cause or
conclusion when stressed, my stomach hearts.
 Explanation—informing person by sharing factual and
objective information
 Summary—provides conclusion based on verified
information which in turn identifies that the interview
process is closing

Ten Traps of Interviewing
Traps are the non-productive negative verbal and
nonverbal messages. It may do the opposite of what you
intended by cutting off communication:
1. Providing false assurance or reassurance
2. Giving unwanted advice: when it is based on your
feelings or personal opinions it is likely to be
inappropriate. Although it is quicker just to give advice,
take the time to involve the patient in a problem-solving
process.
3. Using authority
4. Using avoidance language: Using euphemisms
promotes the avoidance of reality and allows people to
hide their feelings. Use direct language.

Ten Traps of Interviewing
5. Engaging in distancing: Health professionals use
distancing to soften reality, but in actuality it may
communicate that you are afraid of the procedure or
disease. Clients use distancing to avoid admitting that
they have a problem. Examples: “There is a lump in the
left breast.”; “My doctor told me that the prostate was
enlarged.”
6. Using professional jargon
7. Using leading or biased questions
8. Talking too much
9. Interrupting
10. Using “why” questions: The adult's use of “why”
questions usually implies blame and condemnation; it
puts the person on the defensive
Nonverbal Skills—Congruency
 When verbal and nonverbal messages are
congruent, the verbal message is reinforced.
 When they are incongruent, nonverbal message
is viewed as the truer one as it is under
unconscious control.
 Can be viewed as either positive or negative
thereby prompting the importance of self-
awareness in order to promote communication

Nonverbal Modes of
Communication (1 of 2)
 Physical appearance
 Image as an initial perception (look sick, poor
grooming, dressing of both the client and the nurse)
 Posture
 Interpretation of body language affecting engagement
(relaxed or anxious)
 Gestures
 Examples: nodding, moving hands, fist
 Sending messages—be aware
 Facial expression
 Reflects emotion and culture

Nonverbal Modes of
Communication (2 of 2)
 Eye contact
 Maintain within the realm of interest but be
mindful of cultural diversity.
 Voice
 Be aware of tone, intensity, and rate of
speech.
 Touch
 Interpretation is influenced by age, gender,
cultural background, past experience, and
current setting.
Closing the Interview
 Ending should be
gradual thereby
allowing for adequate
closure to allow for
final expression.
 No new topics
introduced
 Summary provided as
final statement

The Older Adult
 Developmental task of finding purpose and
evaluating existence
 Accepting inevitability of death
 Address respectfully
 Typically the interview process will take longer.
 Consider appropriate pacing
 Physical limitations
 May need increased response time to process
 May have more information to provide
 Use therapeutic touch to provide empathy.
Interviewing People with
Special Needs
 Consider key elements that will address
vulnerable populations.
 Impaired hearing, acutely ill, drug/alcohol abuse,
sexually aggressive, emotionally distraught (crying),
angry and/or threatening violence and anxious
 Use appropriate resources as they relate to the
context of the situation.
 Be alert to “personal question” queries as they
may indicate ulterior motives:
 Provide appropriate response based on personal
ethics.
Culture and Genetics
 Gender
 Being aware of maintaining cultural norms during
interview and examination process
 Maintaining privacy and modesty
 Sexual orientation
 LGBTQ (Lesbian, gay, bisexual, and transgender)
 Maintaining neutrality r/t patient’s presentation by
being mindful of communication patterns
 Being aware of your own personal bias and baggage

Working with (and without) an
Interpreter
 Potential exists for language barrier to be a key
element in health care interactions due to cross-
cultural communications
 Consider both verbal and nonverbal cues in
communication pattern.
 Bilingual team member or trained medical
interpreter preference same gender
 Language alone does not imply understanding
of cultural diversity.

Health Literacy
 This is more than just the ability to read but rather
includes understanding and following directions that lead
to effective communication between the patient and the
health care provider.
 health literacy refers to the ability to understand
instructions, navigate the health care system, and
communicate concerns with the health care provider.
 A patient may be literate but not have health literacy.
 Involves the use of quantitative measurement and
memory aspects
 Tools for determining literacy
 Several available vary in terms of reliability and validity and time
needed to administer
 Follow established policy and procedure in clinical practice
settings Copyright © 2020 by Elsevier Inc. All rights reserved.
Techniques to Improve
Health Literacy
 Oral teaching
 Provide simple, easy instructions.
 Use conversational structure rather than medical
jargon.
 Written materials
 Written materials should be at the 5th-grade reading
level or below
 Use of 12 point font, avoiding all “CAPS” with use of
bullet points
 Teach back
 Encourages verification of understanding.
 Opens the door for clarification if needed
Communicating with Other
Professionals
 Promoting effective interpersonal communication
 Occurs between two or more individuals of the interdisciplinary
health care team
 Creates an environment of mutual respect and enhances
collaboration
 Impact of ineffective interpersonal
communication
 Linked to poor outcomes attributed to delay in treatment,
medication errors, clinical misdiagnosis, patient injury, and death
 Maintaining open lines of communication
 Provide timely updates in an organized manner

Standardized Communication—SBAR
Situation Background Assessment Recommendation
or Request
Provide a brief Provide pertinent State pertinent State what you
description of history as it directly assessment findings need or want for
pertinent patient relates to patient’s obtained with the patient in terms
variables, current health interpretation of of medical
demographics, status data treatment and/or
clinical diagnosis, assistance
and location

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Chapter 3

Copyright © 2020 by Elsevier Inc. All rights reserved.

Copyright © 2020 by Elsevier Inc. All rights reserved.

Copyright © 2020 by Elsevier Inc. All rights reserved.

Copyright © 2020 by Elsevier Inc. All rights reserved.

 Being aware of the messages you send is only part of

Copyright © 2020 by Elsevier Inc. All rights reserved.

Copyright © 2020 by Elsevier Inc. All rights reserved.

Copyright © 2020 by Elsevier Inc. All rights reserved.

Copyright © 2020 by Elsevier Inc. All rights reserved.

Copyright © 2020 by Elsevier Inc. All rights reserved.

Copyright © 2020 by Elsevier Inc. All rights reserved.

Copyright © 2020 by Elsevier Inc. All rights reserved.

Copyright © 2020 by Elsevier Inc. All rights reserved.

Copyright © 2020 by Elsevier Inc. All rights reserved.

Copyright © 2020 by Elsevier Inc. All rights reserved.

Copyright © 2020 by Elsevier Inc. All rights reserved.

Copyright © 2020 by Elsevier Inc. All rights reserved.

Copyright © 2020 by Elsevier Inc. All rights reserved.

Copyright © 2020 by Elsevier Inc. All rights reserved.

Copyright © 2020 by Elsevier Inc. All rights reserved.

Copyright © 2020 by Elsevier Inc. All rights reserved.

Copyright © 2020 by Elsevier Inc. All rights reserved.

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