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Fundamentals of Nursing
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Chapter 16/ Key Concepts/ The Interview

Chapter 16/ Key Concepts/ The Interview

  • Elements of a patient-centered interview include a relationship with the patient and an organized conversation focused on the patient’s needs, which trigger clinical judgment.
  • An empathic, patient-centered interview strengthens a patient’s sense of self-esteem and lessens feelings of helplessness during illness.
  • When beginning a formal patient-centered interview, the nurse goes through the three traditional interview phases, including the orientation phase (setting an agenda), the working phase (collecting assessment data), and the termination phase.
  • Therapeutic communication techniques should be used in every interview or patient interaction to better explore a patient’s story.
  • There are three main types of questions that can be used to gather information from a patient: open-ended, direct closed-ended, and leading.
  • The nursing health history is a formal method used to collect patient data.
  • Obtaining a nursing health history requires competence in assessing a patient’s cultural history and heritage.
  • Nurses should show respect for patients and understand their individual needs and differences without imposing their own attitudes, biases, and beliefs.
  • The nursing health history contains several common components, including biographical information, the chief concern, patient expectations, and present illness.
  • A past health history offers a holistic view of a patient’s health care experiences and current health habits.

BOX 16.3 Interview Skills During Patient Assessment

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Courtesy
  • Knock before entering the room. Address the patient formally and then ask the name by which they prefer to be addressed. Ask, “Would you prefer I call you by Mrs. Silver or by your first name?”
  • Meet and acknowledge others in the room and learn their names.
  • Introduce yourself and explain your role the first time you meet. Shake the patient’s hand if the patient desires. For example, “My name is Julia. I am your nursing student today. I would like to ask you questions about how you are feeling right now. Is that okay with you?”
  • Assure the patient that shared information will remain confidential among the health care team.
  • Ask the patient’s permission to conduct an interview in a visitor’s presence.
  • Try to reduce time entering notes in the computer; remember keywords, and document later.
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Comfort
  • Provide necessary comfort measures. When the patient has symptoms, keep questions short and focused.
  • Maintain privacy. Close room curtains or doors and provide a comfortable room temperature.
  • Ensure necessary quiet by turning off TVs, music devices, and phones. Try to plan 10 to 15 minutes when no other activities are scheduled.
  • Avoid making the patient tired. It is not necessary to complete the interview in one session.
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Connection
  • Make a good first impression. Do not stare at a computer screen while filling in required data fields. Do not talk on the phone; patients will perceive you to be uncaring.
  • Stiff formality may inhibit a patient, but being too casual may not instill confidence. Do not be careless with your choice of words; what you think is harmless may seem very important to a patient who is anxious to understand you.
  • Begin with open-ended questions that encourage patients to tell their stories.
  • Allow patients to fully describe their symptoms without interruption.
  • Do not dominate a discussion or assume that you know the nature of a patient’s problems; listen and be attentive.
  • Be observant. Note the patient’s tone of voice, posture, and level of energy when talking.
  • Respect silence and be flexible and open-minded. Let the patient’s needs, concerns, or questions guide your follow-up questions.
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Confirmation
  • At the end of an interview, ask the patient to summarize the discussion so there are no uncertainties. Be open to further clarification or discussion. End by asking if there is anything else the patient wishes to discuss. Do not make inferences too quickly.
  • If there are questions you cannot answer, say so and let the patient know that you will return with follow-up if possible.

interview phases:

  1. Orientation or setting an agenda

      2. Orientation or Setting an Agenda Phase

      Nurses begin by:

    1. Introducing themselves
    2. Explaining why they are collecting data
    3. Ensuring confidentiality

      4. It is important to:

    4. Set an agenda for the interview
    5. Explain how information will be gathered, for example:
      • Asking questions
      • Performing a physical examination
  2. Working phase—collecting assessment data
    1. When the patient describes symptoms, such as dizziness, nurses should clarify what the patient means.

      2. Nurses should:

    2. Be attentive
    3. Summarize key issues to validate understanding
    4. Avoid rushing to an opinion
  3. termination of the interview

    4. During the termination phase, the nurse should summarize the discussion and check the accuracy of the information. The nurse should inform the patient when the interview is coming to an end. For example, by saying, “I have just two more questions. We’ll be finished in a few more minutes.” This helps the patient stay focused without wondering when the interview will end and gives them an opportunity to ask questions or seek clarification. The interview should end in a friendly manner, with the nurse telling the patient when they will return to provide care.

    Tonya: “You’ve given me a good idea of the topics we need to cover and the plans we need to make to get you ready to go home. And we’ll include your wife in these decisions if that is okay.”

    Mr. Lawson: “Yes, for sure. She always helps me when I need it.”

    Tonya: “I’ll come back after I check on two other patients, okay?”

    Mr. Lawson: “Yes; you’ve been so helpful.”

Probing

Nurses should encourage patients to provide full descriptions of their stories without trying to control the direction. This involves probing with open-ended questions, such as:

  • “Is there anything else you can tell me?”
  • “What else is bothering you?”

Back Channeling

Nurses should reinforce their interest in what a patient has to say by maintaining eye contact and listening. Using back channeling, which includes prompts such as “all right,” “go on,” or “uh-huh” shows that the nurse has heard what the patient said and that they are interested in hearing the full story.

Question Type
Purpose
Open-ended
Invites the patient to share their story freely, revealing concerns or context
Closed-ended
Gathers specific, focused information—great for clarifying symptoms or timelines
Leading
Implies a preferred answer, which can bias the patient's response and should be used cautiously

Implications for Person-Centered Care

  • Language and communication
    • “What language is spoken in your home?”
    • When talking about a patient’s illness, try to understand it “through the patient’s eyes.”
  • Determine health beliefs and practices
    • “Tell me what you consider being healthy is.”
    • “What do you do at home to care for yourself and stay healthy?”
    • “Tell me what your beliefs are about pain and the best way to treat it.”
    • “Do you prefer a caregiver who is of the same gender identity as you?”
  • Determine faith-based influences on health care
    • “Is there a religion, faith, or spiritual practice that you follow? How might it affect the way we care for you?”
    • “Is there a person in your life who gives you guidance and support? If so, how can we include them in your care?”
  • Determine the role of family
    • “Describe for me the members of your family.”
    • “Who makes decisions in the family?”
    • “In what way has your illness affected your role and that of others in your family?”

The nursing health history contains several common components, including biographical information, the chief concern, patient expectations, and present illness. Select each tab to learn more.

Biographical Information

Biographical information is factual demographic data that includes the patient’s:

  • Age
  • Gender
  • Address
  • Insurance information
  • Occupation
  • Working status
  • Marital status
  • Referral source

coping mechanisms: such as sleep, exercise, and nutrition when planning care.

During the ROS, patients are asked about the normal functioning of each body system and any changes. A comprehensive ROS is typically conducted during nonemergent visits, while a problem-focused ROS is used in ongoing or emergent situations.