Client Interview Techniques

Data Collection

• Data collection involves processes to gather accurate and meaningful patient information.

Nursing Interview

• It is a communication process to establish rapport and trust to elicit accurate data.
• Information is gathered to identify deviations that can be treated by independent or collaborative interventions, considering developmental, psychologic, physiologic, sociocultural, and/or spiritual aspects.
• The phases include introduction, working, and summary/closure.

Introductory Phase

• Self-introduction to the client is done in this phase.
• The purpose of the interview is cited.
• Discussion of the types of questions that may be raised.
• Explaining the reason for writing notes.
• Assurance of confidentiality.
• Ensuring privacy.

Working Phase

• This phase involves gathering comments and biographic data.
• The reasons for seeking care and present health concerns are discussed.
• Listening and observing for cues.
• Collaboration between both parties is essential in the working phase.

Summary and Closure Phase

• Sets of information are summarized in this phase.
• Potential plans to resolve problems are identified and discussed.
• Clarification is encouraged about the information presented.

Types of Communication

• Non-verbal communication includes aspects like appearance, demeanor, posture, facial expressions, and attitude.
• Verbal communication is a necessity to gather information and uses communication strategies.

Non-Verbal Communication: Appearance

• Presentation should be professional through neat clothes, hair, and a name tag with credentials.

Non-Verbal Communication: Demeanor

• Aim for composure upon entering the room.
• Maintain focus towards the client.
• Maintain professional distance when uncomfortable.
• Avoid being too "touchy" or overwhelmingly friendly.
• Avoid laughing loudly, yelling with coworkers, and muttering under your breath.

Non-Verbal Communication: Facial Expression

• An often overlooked aspect of communication.
• It reflects what you are truly thinking.
• Facial expressions should be kept in check regardless of the situation.

Non-Verbal Communication: Attitude

• Maintain a non-judgmental attitude by accepting all beliefs, ethnicities, lifestyles, and health practices.
• It is important to not preach to clients and impose personal ethics/morality i.e. smoking.
• Developing this non-verbal skill is one of the most important.

Non-Verbal Communication: Silence

• Silence allows both the nurse and client to reflect and organize thoughts.
• Silence facilitates more accurate reporting and data collection..

Non-Verbal Hindrances to Communication

• Excessive or insufficient eye contact should be avoided.
• Distractions and distance should be minimized.
• Standing is generally discouraged.

Non-Verbal Hindrances to Communication: Eye Contact

• Extremes in eye contact should be avoided.
• Cultural orientation may also affect patient perception of eye contact.

Non-Verbal Hindrances to Communication: Distraction & Distance

• Being occupied distracts the patient while asking questions, giving the idea that the interview is unimportant.
• Avoid physical distances more than 2-3 feet.
• Rapport and trust are built when a client senses the focus and concern entirely on them.

Proxemics

• Proxemics are the study of distance between people in their interactions.
• The four distances are:
  • Intimate (0-1.5 feet)
  • Personal (1.5-4 feet)
  • Social (4-12 feet)
  • Public (>12 feet)
• Intimate Distance
  • Preferred by parents with young children, people desiring personal contact, or whispering.
  • It can can cause anxiety if anyone else invades this space.
• Personal Distance
  • Comfortable between family and friends talking to one another.
• Social Distance
  • Acceptable for communication in social, work, and business settings.
• Public Distance
  • This is an acceptable distance between a speaker and an audience, small groups, or other informal functions.

Non-Verbal Hindrances to Communication: Standing

• It puts concerned parties at different levels.
• The nurse (higher level) may be perceived as superior.
• Patient care should instead be viewed as a partnership otherwise patients may not feel empowered.

Therapeutic Communication Techniques

• Listening
• Rephrasing
• Broad Openings and General Statements
• Clarification
• Focusing

Therapeutic Communication: Listening

• Listening should be active and mindful.
• It involves using all the senses.
• Paying attention to what the client says, does, and feels as opposed to listening passively with just the ears.

Therapeutic Communication: Rephrasing

• Actively listening for the basic message and repeating those thoughts in similar words.
• For example, if a patient says that they could not manage to eat any dinner last night, even dessert, the nurse can respond with that they had difficulty eating yesterday.

Therapeutic Communication: Broad Opening and General Statements

• Using statements to encourage clients to verbalize.
• Choose a topic of conversation.
• Facilitate continued verbalization.
• For example, "Where would you like to begin?"

Therapeutic Communication: Clarification

• Makes the client's broad overall meaning of the message understandable.
• Used when paraphrasing is difficult or when communication is garbled.
• For example, "I'm not sure I understand that, would you please say that again?"

Therapeutic Communication: Focusing

• Helps clients expand on and develop a topic of importance.
• For example, a patient states my wife will look after me, but they do not think she can, with all the children and homework etc.
  • A nurse can focus on the problem stating: "Sounds like you are worried about how well she can manage."

Interview Considerations

• They include gerontologic and cultural considerations along with emotional variations and responses.

Gerontologic Considerations

• Age affects and commonly slows body systems, especially hearing and visual acuity.
• Slowing of body systems is a physical change, and the nurse should lessen medical jargon and slow down in speech, but should not talk down to the patient.
• Older persons may have more health concerns than younger patients, making them feel more vulnerable/scared; it’s not unusual for their health complaints to be ignored.

Cultural Considerations

• The patient's willingness to openly express emotional distress or pain.
• Reluctance to reveal personal information.
• Ability to receive information.
• Knowledge of disease and illness.
• Decision-making process.

Emotional Variations and Responses

• Anxious: Provide simple and organized information and explain roles and purpose
• Angry: Be reassuring and adopt a calm demeanor.
  • Allow patients to ventilate feelings.
  • Avoid arguing and facilitate personal space.
• Depressed: Express interest and understanding in a neutral manner.
• Manipulative
• Patients with sensitive issues require awareness of nurse's thoughts and feelings.

Collection of Data: Health History

• The health history serves as groundwork for identifying nursing problems.
• It provides focus for the physical examination.
• An example commencement is "..so that I will be able to plan an individualized nursing care with you.”

Health History Components:

• Biographical Data.
• Chief Complaints.
• Present Health History.
• Past Health History.
• Family History.
• Psychosocial History.
• Lifestyle and Health Practices.
• Review of Systems.

Health History Components: Biographical Data

• Personal information like name, address, phone number, sex/gender, informant, birthdate, social security number, medical record number, place of birth, nationality, ethnicity, marital status, educational level, occupation, and other similar data.

Health History Components: Chief Complaints

• Questions to ask:
  • What is your major health problem or concerns at this time?
    • The goal being to focus on significant health concerns - “Why are you here?”
  • How do you feel about having to seek healthcare?,
    • The nurse is trying to encourage a discussion of fears and other feelings toward the healthcare provider.

Health History: Present Health History

• This includes several aspects of the health problem:
  • Detailed description of the concern
  • Symptom
  • Treatments
  • Precipitating factor
  • Expectations (prognosis)
• Questions to ask:
  • When did you first notice the pain in your back?
  • How long have you experienced it?
  • Has it become worse, better, or stayed the same since it first occurred?

Present Health History Components

• Character: Feeling, look, sound, and smell: Describing the pain as a sharp, stabbing sensation.
• Onset: Asking when it began: The pain started approximately 12 hours ago while the patient was eating lunch. It began as a mild cramping but quickly intensified.
• Location: asking where it is: If located in the upper right side of the abdomen under the rib cage, radiating toward the lower back.
• Duration: Asking how long it lasts: The pain has been persistent for the past 12 hours without relief when resting or drinking fluids.
• Severity: How bad is it?: On a scale of 1-10, the patient marks it as a 7. It is severe enough to interfere with daily activities and causes some difficulty with breathing when it worsens.
• Pattern: Asking what makes it better or worse: The pain has remained constant without any significant relief, but worsens after eating/moving around and does not change with deep breathing.
• Associated Factors: What other symptoms occur with sensation? Reporting feeling nauseous with occasional vomiting but without diarrhea, and no fever but lightheadedness

Health History: Past Health History

• Related to the client's past condition by eliciting data on client strength and weakness, points to trends of unhealthy behavior and information gained assists in identifying risk factors.
• This includes but is not limited to:
  • birth, growth, and development
  • childhood diseases
  • immunizations
  • allergies
  • previous diseases or hospitalizations
  • surgeries, pregnancies, deliveries, accidents & injuries and pain experiences.
• Questions to ask include:
  • Can you tell me how your mother described your birth?
  • Where there any problems?
  • As far as you know, did you progress normally as you grew to adulthood?
  • What illnesses or allergies have you had?
  • Have you ever been pregnant, and delivered a baby?

Health History: Family History

• Including as many blood relatives as can be recalled, identifying vertical and horizontal relations, and helps identify diseases with a genetic/familial pattern.
• Genograms are tools used to include at least three(3) generations, in the drawing patient is known as the “proband/index patient", has standard formats including the patient's.
• Male relatives with a square (left side), female relatives with a circle (right side), and lines between relatives show relationship.

Health History: Psychosocial Data

• Psychosocial data includes human responses, nutritional habits, typical daily pattern/regular exercise plan.
• Nurse is to get information on the patient's sleep and rest, asking about sleeping patterns if have trouble falling/staying asleep.
• Nurses also collect information on patient use of substances, quantity of alcohol consumption, self-concept and self-care activities, like special talents or abilities etc.
• Further exploration include social life like the community activity and relationship to family an friends.

Psychosocial Data Values & Beliefs

• Questions to ask include:
  • Who is the most important in your life?
  • What is most important to you in life?
  • What gives you hope and strength?
• Also asked for are Education and work, including compensation for dealing with stress, its levels and environment.

Health History: Review of Systems

• Questions draw out current health problems from recent issues
• May still affect/be recurring: With documentation being the description of patient's health status for each body system and notation of comments to the question.

Functional assessment

• It is a systematic method to evaluate the ability to function within the environment, identify self-care abilities and deficits in order to match needs with services, that is;
  • acquisition of database to use for comparison.
  • identify individual patient needs and specific self-care deficits by providing foundation to develop individualized plan of care for referral to special services, that is; promote independence and evaluate treatment
  • rehabilitation (health/day care as well as house-keeping).

Functional Assessment Tools

• Includes the APGAR and Ballard scores as well as Denver Developmental Screening Test II (DDST-II).
• Also considered are Katz Index of Activities of Daily Living (as well as Barthel Index) and last Instrumental Activities of Daily Living.

Functional Assessment Tools: APGAR Score

• APGAR provides accepted and convenient method for reporting the status of the newborn infant immediately after birth with response to resuscitation.
• The score is calculated from 0-2 points for each of these features:
  • Appearance for having pink all over = 2 points or blue extremities and pink torso = 1 point or completely blue = 0 points.
  • Pulse: >100 bpm = 2 / < 100 bpm = 1 / No pulse =0.
  • Grimace: Cries or pulls away = 2 pts / Weak grimace when stimulated = 1 / No response =0.
  • Activity: Arms flexed , legs resist extension =2 / Some flexion of arms = 1/ No reaction from the child =0.

Functional Assessment Tools: Ballard Scoring

• Test for Neuromuscular maturity with evaluation of baby the older and more the mature baby the higher is the score.
• It is calculated for posture from 0-4 with 4 being the maximum points.

Ballard Score: Neuromuscular Maturity

• Square window(wrist): the more mature the the child the fewer degree are calculated >90.
• Arm Recoil: the more mature the child the great is the reaction, the maximum is <90
• Popiteal angle the mature and older child gives fewer points with <90
• Scarf sign the very low and pre mature child gives few points
• Heel to ear the more the heel touches the war is a sign of im maturity, and fewer points
• Three(!!) categories for Genitals:
  • Male: scrotum gets point depending on flatness or if smooth vs a the higher mark and score is given in pendulous with good rugue
  • Female genital give few points in large with flat labials

Functional Assessment Tools:Denver Developmental Screening Test II

• This test is used screen proper development in child by suggested milestones for different ages.

Functional Assessment Toddler to Preschool Timeline.

• Toddlers two to three get to name and recognize one colour, and perform function such as stacks building blocks.
• Toddler between three to four able recognize and name the colour, tell age and name and make stories based of pass memories
• To preschooler at older years start learn know the address and count until five.

Functional Assessment: Katz Index of Activities of Daily Living

• Independent: without supervision , direction or active personal assistance ,status actual not ability, patient is known and described as not performing despite being able.
• The index functions a a measurement of independently living able client, assisting doctors for planning care taking.
• Six (6)Functions:
  • Bathing (sponge, shower, or tub)
  • Dressing
  • Toileting
  • Transfer
  • Continence
  • Feeding

The Barthel Index (BI)

• It measures the extent to which somebody can functions independently and has mobility daily on activities for which scores as following total dependancy as 0-20, to total independence as 91 to even 100.
• Factors such as:
  • Self-care: Includes self help for example eating; dressing the body; or grooming including artificial limb, all by doing it themselves
  • Mobility: Includes, by using or not aids.

ADL: Instrumental Activities of Daily Living

• ADL measures ability to perform more complex are are skills then Katz Index of Daily Living for:
  • independent
  • needed with and or some help
  • and complete disability when there is no way to perform.

This lesson covers key techniques for effective client interviews in healthcare. It discusses establishing trust, active listening, handling silence, and demonstrating a non-judgmental attitude. Also, it includes note taking techniques and summarization strategies.