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Clinical Nursing Skills

3.2 Comprehensive Interview Practices

Clinical Nursing Skills3.2 Comprehensive Interview Practices

Learning Objectives

By the end of this section, you will be able to:

  • Recall the four phases of a comprehensive interview
  • Apply techniques the nurse can use during a comprehensive interview
  • Recognize special considerations when conducting a comprehensive interview

A comprehensive patient interview has many purposes. It provides an opportunity for the nurse to establish a rapport with the patient and begin a therapeutic relationship. It also enables the nurse to gather detailed information about the individual patient. This includes medical history, current symptoms, and medications, as well as emotional, psychological, cultural, and social needs. This information is essential for developing an accurate nursing diagnosis, developing an appropriate care plan, and making informed decisions about patient care.

A comprehensive patient interview is crucial in nursing. It gives the nurse vital information about the patient that cannot be gathered elsewhere, such as their feelings, perceptions, beliefs, values, and other subjective personal information. This type of information is extremely important and can inform the patient’s care in many ways, including how the patient processes health information, what types of treatment they will allow or not allow, and whether they will use any complimentary or alternative medicine.

Phases of a Comprehensive Interview

Performing a comprehensive nursing interview requires professional, interpersonal, and interviewing skills. Sometimes the questions that need to be asked are of a very personal nature and would seem intrusive in any other environment. However, nurses have to ask these questions and by remaining professional, they can minimize the patient’s discomfort. The nurse must also have interpersonal or soft skills when interviewing the patient. Interpersonal skills help the nurse to develop a productive conversation with the patient. Soft skills include being aware of the patient’s emotional status, having empathy, being a good listener, speaking positively, and many more. People who have these skills can approach anyone and start a conversation with ease. Lastly, the nurse must develop strong interviewing skills. These are skills that will allow them to steer the conversation into specific areas to reveal patient needs and to offer assistance when necessary. There are four phases to a comprehensive nursing interview: the preparatory phase, introductory phase, maintenance phase, and termination phase.

Preparatory Phase

The preparatory phase happens before the face-to-face meeting with the patient. Prior to conducting the interview, the nurse should ensure that the interview environment is private, quiet, and comfortable. The nurse should also schedule interviews when time is not limited or under pressure; minimize interruptions by silencing their cell phone and using other "do not disturb" strategies. This will help the patient feel more relaxed and focused during the interview. Gather any necessary equipment or supplies such as a computer for taking notes during the conversation. Review the patient's medical record for important information about the patient's medical history, current medical conditions, medications, and any recent procedures or tests that may be relevant to the interview.

Introductory Phase

During the brief introductory phase, patients may realize they need assistance as they adjust to their current status. Simultaneously, nurses introduce themselves and begin to obtain essential information about patients as individuals with unique needs, values, beliefs, and priorities. In addition, the nurse establishes trust and begins to develop rapport with the patient. Nurses ensure privacy when talking with the patient and providing care and respect the patient’s values, beliefs, and personal boundaries.

A common framework used for introductions during patient care is AIDET, a mnemonic for Acknowledge, Introduce, Duration, Explanation, and Thank You.

  • Acknowledge: Greet the patient by the name documented in their medical record. Make eye contact, smile, and acknowledge any family or friends in the room. Ask the patient their preferred way of being addressed (for example, “Mr. Doe,” “Jonathon,” or “Johnny”) and their preferred pronouns (e.g., he/him, she/her, they/them).
  • Introduce: Introduce yourself by your name and role. For example, “I’m Marie, and I am a nursing student working with your nurse to take care of you today.”
  • Duration: Estimate a timeline for how long it will take to complete the task you are doing. For example, “I am here to perform an admission assessment. This should take about 15 minutes.”
  • Explanation: Explain step by step what to expect next. For example, “I will be putting this blood pressure cuff on your arm and inflating it. It will feel as if it is squeezing your arm for a few moments.” Answer any questions the patient may have.
  • Thank You: At the end of the encounter, thank the patient and ask if they need anything before you leave. In an acute or long-term care setting, ensure the call light is within reach and the patient knows how to use it. If family members are present, thank them for being there to support the patient, as appropriate. For example, “Thank you for taking time to talk with me today. Is there anything I can get for you before I leave the room? Here is the call light [place within reach]. Press the red button if you would like to call the nurse.”

Maintenance Phase

The majority of a nurse’s time with a patient is in the maintenance phase. During this phase, nurses use active listening. The nurse begins by asking the reason the patient is seeking care; the answer helps to reveal what is important to the patient. The nurse then uses assessment findings to develop a nursing plan of care and plan education for the patient. If a care plan has already been established on admission, nurses use this time to implement interventions targeted to meet short-term outcomes and long-term goals. During the maintenance phase, patients begin to accept nurses as health educators, counselors, and care providers. Nurses use therapeutic communication techniques to facilitate patients’ awareness of their thoughts and feelings and mutually develop goals and an individualized plan of care. Nurses provide reflective and nonjudgmental feedback to patients to help them clarify their thoughts, goals, and coping strategies.

Termination Phase

The final phase of a nurse-patient relationship is the termination phase. This phase typically occurs at the end of a shift or upon discharge from care. If the previous working phase has been successful, the patient’s needs have been successfully met by collaboration among the patient, nurses, and other members of the interprofessional healthcare team. The nurse should be aware the patient may try to return to the working phase to avoid termination of the relationship. During the termination phase, the nurse can encourage the patient to reflect on progress they have made and review post-discharge goals. The nurse also makes community referrals for follow-up and continuation of support in meeting goals.

Techniques Used in Effective Interviewing

Techniques used in effective patient interviewing reflect techniques used in therapeutic communication. Empathy, a nonjudgmental attitude, and cultural sensitivity remain important methods of putting patients at ease and establishing trust between nurse and patient. Effective interviewing techniques are therapeutic communication methods that have been made slightly more specific in order to elicit responses from the patient while keeping the interview patient-centered. When preparing for an effective interview, the nurse should refresh themselves on the specific techniques that are helpful in the particular situation.

Ask Open-Ended Questions

An interviewing technique called open-ended questioning requires the interviewer to ask questions that prompt detailed answers from the interviewee. Unlike closed-ended questions, which lead to simple yes-or-no responses, open-ended questions encourage the interviewee to speak more freely and provide more comprehensive information. For example, the open-ended question “tell me about your pain” will elicit a more detailed response than the close-ended question “are you in pain?” which warrants a yes or no response.

Open-ended questions can help build rapport between the interviewer and interviewee by allowing the interviewee to share their thoughts and experiences. This technique also encourages reflective thinking, leading to more thoughtful and insightful responses. Furthermore, open-ended questions can explore unexpected areas, uncovering valuable information that may have been missed with closed-ended questions.

When using open-ended questioning as an interviewing technique, it is essential to structure questions carefully to avoid leading the interviewee in a particular direction. The interviewer should remain neutral and nonjudgmental in their responses and actively listen to the interviewee's answers, following up on any interesting points to ensure that all valuable information is captured.

Adaptive Questioning

Also referred to as guided questioning, adaptive questioning is a form of open-ended questioning that helps to encourage a patient to fully communicate without interrupting the flow of their narrative. The questions and follow-up questions are adjusted based on the patient’s previous answers. Start with general questions, making them more specific as you move through the interview. A series of questions, asked one at a time, often helps patients open up, as does offering multiple choices for answers. Request additional information when necessary by asking the patient to clarify their statements. The following is an example that shows how adaptive questioning works. Imagine yourself interviewing an older female patient who is at the primary care provider’s office because of hypertension complications. She mentions casually to you, “Today is the six-month anniversary of my husband’s death.” Failure to follow up with adaptive questions such as “How does this make you feel?” may result in the loss of important data that could provide clues to the patient’s current state of health.

Encourage the Patient to Verbalize Feelings

Encouraging patients to verbalize their feelings is a highly effective technique in the interview process. Not only does it help clarify communication with their nurse, it helps the patient gain insight and understanding into their own emotions, which is a powerful healing tool.

Verbalizing feelings can help patients to build trust and establish a therapeutic relationship with their nurse. When patients feel that they are being listened to and understood, they are more likely to feel comfortable sharing their thoughts and feelings. This can create a safe and supportive environment in which patients feel able to explore their emotions and work toward positive change.

Additionally, expressing feelings can help patients to gain insight into their own emotions and thoughts. When patients put their feelings into words, it can help them to identify and understand the root causes of their problems, and this can be a crucial first step in the healing process. Verbalizing feelings can also help patients to make sense of their experiences and feel more in control of their lives.

Verbalizing feelings can help patients to release pent-up emotions and reduce stress. Often, when patients keep their feelings bottled up inside, it can lead to emotional distress and physical symptoms such as headaches, stomach problems, and sleep disturbances. Verbalizing feelings can help patients release these emotions and feel a sense of relief and catharsis.

Provide Empathy and Validation

Empathy is key in nursing health assessments, as it demonstrates that the nurse understands and cares about what a patient is experiencing and helps establish a trusting nurse–patient relationship. Empathic responses during a comprehensive assessment interview can be both verbal (“I understand”) and nonverbal (offering a tissue if the patient is crying). Beyond being empathic, the nurse should be sure to validate a patient’s feelings to help reassure them that their emotions are natural and reasonable and their problems are understood and will be fully addressed. This offers a reassuring environment in which patients are free to express their feelings. An example might be with a patient who has a history of claustrophobia but needs to have an MRI. The patient tearfully tells the nurse that they know their fear is not rational and they will be supervised during the test, but they can’t help but feel scared. A nurse who seeks to validate the patient’s feelings will offer them reassurances that their feelings and emotions are natural and understood by the staff involved, and their concerns will be addressed before proceeding with the test.

Respect the Patient’s Values and Beliefs

Respecting the patient's values and beliefs is an essential aspect of therapeutic communication. It involves acknowledging and validating the patient's cultural, spiritual, and personal beliefs and values and incorporating them into the therapeutic process.

When communicating with patients, nurses should be sensitive to cultural differences, religious beliefs, and personal preferences that may influence the patient's decisions about their health. For example, some patients may have specific dietary restrictions or may prefer certain treatments based on their cultural or religious beliefs. Others may have different beliefs than their healthcare provider has about the causes and treatments of their illness.

Cultural Context

Respecting Cultural Differences

We live in an increasingly multicultural society. An individual’s culture has an enormous impact on their beliefs, feelings, and attitudes toward health care. As a nurse, you will encounter diverse patients who have different cultural beliefs regarding their health or treatment, or perhaps beliefs that you do not agree with or find confusing. For example, a Chinese patient may rely on acupuncture and herbs for their care, even for serious illness. A Filipino family may request that the family be informed of a poor prognosis before the patient, so that the family can decide what is appropriate for the patient to know. In these cases, it is the nurse’s role to approach the relationship with empathy, cultural humility, and cultural acceptance.

Special Considerations During the Comprehensive Interview

There are three variations in communication that carry special considerations during the comprehensive interview. Differences in age, culture, and emotion all have special importance that the nurse must be aware of and address during the comprehensive interview. What is appropriate behavior for a child might be inappropriate for a teenager or an older adult. The nurse might enter into the interview with minimal information, but based on the patient’s behavior (appropriate or inappropriate), they may have to make adjustments to connect with the patient. An example of this is when a nurse attempts to administer a vaccine to a 16-year-old boy. The patient backs away, climbs onto his mothers’ lap and hides his face into her neck. This behavior should tell the nurse that the patient might be 16 years old but is displaying behavior indicative of a young child. The nurse will have to alter their approach and communication to meet the patient at the developmental level of a young child.

Age Considerations

Age is an important factor to consider during a comprehensive nursing interview, as patients' healthcare needs and concerns can differ based on their age. As such, nurses need to consider age in various aspects, such as developmental stage, health history, lifestyle, and communication style.

When interviewing children, it is important to use age-appropriate language and communication techniques. An example is by engaging the child in play during the interview, this can decrease the child’s anxiety, provide distraction from the medical evaluation, and allow the nurse to assess developmental milestones. Use simple words and avoid medical jargon. Establish rapport with the child and allow them to express their concerns and needs. Involve the parent or guardian in the interview process and be mindful of any cultural or religious considerations.

Adolescents may have unique health concerns related to puberty, sexuality, and mental health. It is important to use age-appropriate language and respect their privacy and confidentiality. Consider involving them in their care decisions. Establish trust and a nonjudgmental attitude to encourage open communication.

Adults may have different health concerns based on their age, gender, and lifestyle factors. Young adults might be more concerned with career goals and reproductive health versus middle-aged adult whom acknowledge responsibility and family roles, might inquire about work-related stress and want to discuss preventative measures. Consider the patient's cultural background, occupation, educational level, health status, and family history when conducting the interview. Use open-ended questions to encourage the patient to express their concerns and provide sufficient time for the patient to answer. Teach-back, as always, is the best way of evaluating the effectiveness of the education provided.

Older adults may have unique health concerns related to chronic diseases, functional decline, and cognitive impairment. Use clear and simple language and allow sufficient time for the patient to answer. Be mindful of sensory and mobility impairments, and adjust the interview techniques accordingly. Involve family members or caregivers as needed to provide support and help with communication.

Life-Stage Context

Hearing Impairment in Older Adults

The ability to hear often decreases with age. Hearing deficiencies can be mistaken for confusion or cognitive slowing in older patients. Older patients should be screened for hearing loss regularly. When performing an interview with an older adult with hearing loss, the nurse should sit directly in front of the patient, speak clearly and at a normal pace, and avoid covering their face with their hands. Be prepared to be patient and repeat questions or statements frequently.

Cultural Considerations

Culture is a central consideration during a comprehensive nursing interview, as it can affect a patient's health beliefs, values, and practices. Cultural factors include ethnicity, religion, language, socioeconomic status, and geographic location. Nurses need to be aware of these factors to ensure effective communication with patients from diverse cultural backgrounds.

Language barriers may make effective communication difficult; therefore, professional interpreters or language translation services should be used. Printed materials should be provided in the preferred language whenever possible.

Cultural beliefs and values regarding health and illness may vary across different cultures, and nurses should be sensitive to these differences and adapt their care accordingly.

Patients from low-income or marginalized communities may have low health literacy and understanding of health information. Nurses should use plain language and avoid medical jargon to ensure that patients understand their diagnosis, treatment plan, and medication regimen. Patients from collectivist cultures may rely heavily on family or community support when making health-related decisions. In these cases, nurses should involve family members or caregivers in the care process and respect their input.

Nurses should be aware of their own cultural biases and stereotypes that may impact their care of patients from diverse cultural backgrounds. (This should include awareness about biases, assumptions, or stereotypes about people from the nurse's own cultural background.) It is important to approach each patient as an individual with unique needs and beliefs. By considering these cultural factors, nurses can provide patient-centered care, promote effective communication, and improve health outcomes.

Unfolding Case Study

Unfolding Case Study #1: Part 1

The nurse is conducting the initial assessment on a 28-year-old female who presents to the family walk-in clinic. The female patient is accompanied by her 10-year-old son.

Past Medical History Patient is a mother of one, who cares for her child and older mother in a small apartment. The mother is homebound and is not present at appointment. Patient cleans houses to support her family, but income is inconsistent. Patient has an eighth-grade education and speaks no English. Medical history includes seasonal allergies, sinusitis, and two episodes of COVID-19 in the past two years.
Family history: Patient’s father is deceased and patient’s mother has Alzheimer’s disease, stage II. Patient’s son is in good health, talkative, and attentive to his mother.
Social history: Patient is primary caregiver for older mother and adolescent. No other support systems available. Patient has difficulty shopping and making doctor’s appointments due to lack of care for older mother. Patient has difficulty communicating in English, but son translates for his mother.
No current medications and no known allergies.
Nursing Notes 1630: Triage Assessment
Patient responds to gestures but speaks little English. Son provides translation for his Spanish-speaking mother. Patient reports frequent coughing episodes with production of large amounts of yellow sputum which are exacerbated with activity. Patient is alert and cooperative, but son reports frequent recent periods of lethargy, sleepiness, and states “Momma feels hot and sweaty.” Patient holds the side of her head in her hands and son states that she has been complaining of an earache for three days.
Flow Chart 1630: Triage Assessment
Blood pressure: 142/88 mmHg
Heart rate: 100 beats/minute
Respiratory rate: 24 breaths/minute
Temperature: 101.1°F (37.2°C)
Oxygen saturation: 95% on room air
Pain: 8/10 - ear
Lab Results CBC - (Abnormal) WBC 17,000 WBCs per microliter (4.5 to 11.0 × 109/L).
Rapid Strep Test - negative
Rapid COVID Test - negative
1.
Recognize cues: Which findings from the information provided are most relevant? Which are the highest priority?
2.
Analyze cues: Based on the current history and findings, what additional information should be obtained from the patient at this time?

Emotional Considerations

Nurses often encounter patients as they are undergoing stressful, frightening, or confusing situations. During a comprehensive nursing interview, emotions are an important factor to consider as they can have a significant impact on a patient's ability to communicate their health concerns, willingness to follow a treatment plan, and overall health outcomes. Because of this, nurses need to be equipped to effectively handle patients who may be experiencing strong emotions.

As a nurse, you will encounter patients and family members who are experiencing strong emotions, including anger. When dealing with an angry patient, your first step is always to make sure that the patient and others are safe. After that, assure the individual that you are there to help. Using therapeutic communication techniques, encourage them to express their feelings and tell you why they are angry. Often, anger is the result of fear or frustration. Allowing the patient to express their emotions in a judgment-free environment creates a trusting relationship between the patient and nurse, allowing the patient’s anger to be addressed.

To provide effective care for patients experiencing strong emotions, nurses should begin by actively listening and providing emotional support by empathizing with patients’ experiences and validating their feelings. It is important to adopt a nonjudgmental attitude to create a safe and supportive environment for patients to share their emotions. Cultural differences may play a role in how patients express their emotions, so nurses should be aware of these differences and adjust their communication style accordingly. For example, some cultures may view expressing emotions as a sign of weakness, while others may be more expressive. For many, a simple “tell me what happened,” or asking “how can we resolve this” can cut through anger, fear, or other strong emotions and lead to a resolution. There are many factors the nurse can use to diffuse a situation. These factors include to remember the importance of ensuring safety, reducing triggers, creating a secured environment, building rapport and trust, avoiding re-traumatization, demonstrating flexibility and patience, and focusing on the patient’s strength and resilience.

For patients who have experienced trauma, it is important to provide trauma-informed care, which considers the impact of trauma on an individual's physical, emotional, and mental well-being, by creating a safe environment and avoiding triggering language or actions. Nurses should also make appropriate referrals to healthcare professionals, such as psychologists, social workers, or psychiatrists, if a patient is experiencing significant emotional distress or mental health concerns.

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