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Manilyn B. Bagiao, MSN

This document provides guidance on conducting health histories and interviews with patients. It discusses establishing rapport, using open and closed-ended questions, dealing with sensitive topics, and communicating effectively with different populations such as children, older adults, and those with impairments or under the influence. Barriers to communication like personal questions, sexual aggression, crying, anger, threats, and anxiety are also addressed. The goal is to gather complete subjective health data and assess problems by maintaining a therapeutic relationship.

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manilyn
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© Attribution Non-Commercial (BY-NC)
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Download as PPT, PDF, TXT or read online on Scribd
56 views

Manilyn B. Bagiao, MSN

This document provides guidance on conducting health histories and interviews with patients. It discusses establishing rapport, using open and closed-ended questions, dealing with sensitive topics, and communicating effectively with different populations such as children, older adults, and those with impairments or under the influence. Barriers to communication like personal questions, sexual aggression, crying, anger, threats, and anxiety are also addressed. The goal is to gather complete subjective health data and assess problems by maintaining a therapeutic relationship.

Uploaded by

manilyn
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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Manilyn B.

Bagiao, MSN
Hyperthermia r/t dehydration
Hyperthermia r/t active fluid loss
Diarrhea r/t GIT irritation
Diarrhea r/t infectious processes
Diarrhea r/t malabsorption
Fluid volume deficit r/t active fluid loss
Maintain temperature within normal
range
Re-establish or maintain normal
pattern of bowel functioning
Maintain fluid volume at a functional
level
Monitor VS
TSB
Loosen/lessen clothing
Ensure adequate ventilation
Encourage to increase OFI
Ensure proper IVF regulation
Ensure adequate rest periods
Antipyretics as ordered
Encourage to increase OFI
Constipating diet
Avoid GI stimulating foods
Monitor I and O
Perianal care
Meds as ordered
Monitor I and O
Assess characteristic and amount of urine
Increase fluid intake
A purposeful conversation between the nurse and the
patient
Goal: to gather a complete health history, which is the
foundation which data collection and the process of
assessment are based
Consists of questions designed to elicit SUBJECTIVE
DATA
Requires nurses to be EFFECTIVE
COMMUNICATORS
Purpose:
Gather organized, complete, and accurate
data about the patient’s health state
Establish rapport and trust
Teach patient about health state so he can
participate in identifying problems and
planning for health care
Internal factors
Liking others
- An atmosphere of warmth and caring is necessary
- The patient must feel that he or she is accepted
Empathy
- “putting one’s self in the shoes of others”
- Means recognizing and accepting the other person’s
feelings without criticisms
Ability to LISTEN
- Requires the nurse’s complete attention
External factors
Ensure privacy
Physical environment
Room temperature at a comfortable level
Sufficient lighting, reduce noise
Maintain appropriate distance
Intimate distance: ~ 1.5 ft
Personal distance: 1.5-4 ft
Social distance: 4-12 ft
Public distance: 12 ft or more
Arrange “equal-status” setting – comfortably seated at eye
level
External factors
Refuse interruptions
Dress
Note – taking
Necessary to remember important information
Keep it to a minimum during the interview, pay
attention to the patient
Introductory phase
ORIENTATION PHASE
Involves establishment of rapport, clarifying roles,
and alleviating anxiety
- Introduce self, explain purpose and content of interview
- Convey a caring, interested attitude
- Observe patient’s behavior
- Explain the time frame for the relationship
- Explain how the information collected will be used and
that confidentiality will be maintained
Maintenance phase
WORKING PHASE
The nurse and patient work toward achieving the
specific task or goal agreed on the introductory phase
- time during which bulk of the patient data is collected
- keep interview goal-directed, refocus client if necessary
- listen, observe cues, and use critical thinking to interpret
and validate information
- collaborate with client to identify problems and goals.
Concluding phase
TERMINATION PHASE
- information is summarized and validated
- identify and discuss possible plans to resolve the
problem
- allow patient opportunity to give additional
information or ask questions
Open-ended questions
 Asks for narrative information
 Unbiased, leaves the person free to answer in any way
 Lets the person express himself fully
 Build and enhances rapport

- encourages patient to give general rather than focused


information
- what to say, how much to say, and how to say it depends
on the client
-begins with how, what, where
- may be time consuming
Closed or Direct Questions
Asks for specific information
Elicits a short one or two word answer (yes
or no)
Focuses the interview an pinpoints specific
areas of concern
Limits rapport and leaves interaction neutral
Facilitation of General Leads
 Encourage the patient to say more, to continue with the
story
 “go on”, “continue”
Silence
 Conveys that the patient has the time to think, to organize
what he wants to say without interruption
 Allows the patient to collect his thoughts
Reflection
 Echoes the patient’s words
Empathy
 Recognizes a feeling and puts it into words
 Makes the patient feel accepted and can deal with the
feelings openly
Clarification
 Used when the person’s choice of word is ambiguous or
confusing
Confrontation
 The nurse focuses the patient’s attention on the observed
action, feeling or behavior
 “you sound angry”, “you looked sad”
Interpretation
 Links events, makes associations or implies cause
Explanation
 Provides information to the patient
 Shares factual and objective information
Summary
 Final review of what the nurse understand the patient has
said
 Condenses the fact and presents a survey of how the nurse
perceives the health problem or need
Providing False Assurance or Reassurance
Giving unwanted advise
Using authority
Using avoidance language
Engaging in distancing
Using professional jargon
Using leading or biased questions
Talking too much
Interrupting
Using “why” questions
Parent
 Greet/refer to the parents by name
 Explore sensitive topics with the parent when he is alone
 Avoid questions that put parenting ability in question or
implying lack of parenting skill
Infant
 Nonverbal cues is important
 Crying is the infants primary expression of discomfort
 Use firm, gentle handling and quiet, calm voice
 Infants – more cooperative in the presence of parents
Pre-Schooler
 Egocentric – perceives that everything revolves around him,
only his experience is relevant
 Communication should be direct, concrete, literal and set in
the present
 Use short, simple sentences with concrete explanation
School-age child
 Can tolerate and understand other’s viewpoint
 More objective and realistic
 Wants to know how things work and why things are done
 Pose questions about school, friends or activities directly to
the child
Adolescent
 Communicate with the adolescent with respect and must be
totally honest
 Stay in character, do not try to be his peer
 Use icebreakers, focus first on the adolescent not on the
problem
 Explain every step and give the rationale
 Keep questions short and simple
 Silent periods are best avoided, adolescent is very sensitive
to nonverbal communication
 Establish rapport before addressing emotionally charge
topics
 Use positive reinforcement
Older adult
Always address the person by the last name
Adjust the pace of the interview to the aging
person, avoid trying to hurry them along
Consider physical limitations, aging person may
require shorter segments of interview
Hearing impaired
Be aware of clues of hearing deficit (staring at your
mouth and face)
Ask his preferred way to communicate(sign
language, lip reading, writing)
Do not exaggerate lip movements
Avoid shouting, speak slowly, use gestures
Be sure the patient understands your questions
Acutely Ill people
Prompt action is required, combine interviewing
with physical examination to determine lifesaving
actions
Subjective data are crucial to determine the cause
and course of emergency
Ask brief and concise questions, use closed direct
questions, focus on main area of distress
Statements should be very clear
Attend to the comfort of the patient first
People under influence of street drugs or alcohol
 Ask simple and direct questions
 Manner and questioning should be nonthreatening, avoid
confrontation
 Find out the time of the patient’s last intake and name and
amount of the substance
 Be aware of hospital security or other personnel who could
be called for assistance
 Assess for the extent of the problem and the meaning of it to
him and his family
Personal questions
If the patient asks you personal questions such as:
Are you married?
Do you have children?
Do you smoke?
Supply brief information when you feel it is appropriate
Try directing your response back to the person’s
frame of reference
No, I don’t have children, I wonder if your question is
related to how I can help you care for your baby.
Sexually aggressive people
Response must make it clear that you are a health
professional who can best care for him, and that
you cannot tolerate sexual advances, maintain
professional relationship
set appropriate boundaries by saying :
“I am uncomfortable when you talk to me that way;
please don’t. I wonder if the way you’re feeling now
relates to your illness or to being in the hospital”
Crying
Anger
 Try not to personalize the anger of the patient
 Ask about the anger and hear the patient out
Threat of Violence
 Be aware of the “red flag” behaviors of a potentially
disruptive or violent patient, TRUST YOUR INSTINCTS
Anxiety
 Allow verbalization of feelings, fears and concerns

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