Nursing Interview Phases

Interview Phases

• Orientation phase: establishing a nurse-patient relationship while gathering information
• Working phase: patient-centered, goal-directed interaction, and therapeutic communication
• Termination phase: closing the interview

Successful Interview

• Gather: collect complete and accurate data
• Establish: build rapport and trust
• Begin: start teaching
• Discuss: discuss health promotion and disease prevention

Data Collection

• Subjective data: what the person says about themselves (patient's statement, reason for seeking care, perceptions, beliefs, and health history)
• Objective data: what the health professional observes (measurable, observable, physical examination, seeing, feeling, touching, and listening)

Communication Techniques

• Introduce: yourself, role, and purpose
• Open-ended questions: encourage narrative, no "yes/no" answers
• Closed or direct questions: one to two word answers, including yes/no, use after narrative
• Verbal response: assist the narrative
• Closing the interview: end gracefully

Communication Pitfalls

• Providing false assurance or reassurance
• Giving unwanted advice
• Using authority
• Using avoidance language
• Distancing
• Using professional jargon
• Using leading or biased questions
• Talking too much
• Interrupting
• Using "why" questions

Nonverbal Communication

• Physical appearance
• Posture
• Gestures
• Facial expressions
• Eye contact
• Voice (tone)
• Touch (empathy)

Developmental Considerations

• Infant, children, and adolescents: measure weight at regular intervals, best index of nutritional status over time
• Pregnant female: weigh monthly until 30 weeks, then every 2 weeks until final month, then weekly
• Elderly: loss of height beginning in the 30s, loss of muscle mass, loose skin, and change in fat distribution

Special Needs Considerations

• Consider key elements that address vulnerable populations
• Examples: acutely ill, drug/alcohol abuse, sexually aggressive, emotionally distraught, angry and/or threatening violence, anxious, and hearing impaired

Language Barriers

• Need an interpreter (preferably trained, in-person, or hotline)
• Consider both verbal and nonverbal cues in communication pattern
• Use a bilingual team member or trained medical interpreter (same gender preferred)
• Ask for verbatim account of the conversation
• Speak to the patient, not the interpreter
• Plan for longer time period

Health Literacy

• Ability to understand and follow instructions, navigate healthcare system, and communicate concerns
• Not just the ability to read

Techniques to Improve Health Literacy

• Oral teaching
• Written materials
• Teach back

Reason for Seeking Care

• Chief complaint: patient's own words describing reason for visit
• Document reported findings: symptoms and signs
• Reason for care is not a diagnosis
• Focus on patient's prioritized reasons for seeking care

Present Health and/or History of Present Illness (HPI)

• Collect all provided data and identify 8 critical characteristics
• Make sure collected data is precise and accurate (use measurable standards)
• Use standard indicators to document findings (reliable and valid results)

History: Respiratory System (H/O)

• Lung disease
• Chest pain with breathing
• Wheezing or noisy breathing
• Shortness of breath
• How much activity produces shortness of breath
• Cough
• Sputum (color, amount)
• Hemoptysis
• Toxic or pollution exposure