Nursing Interview Techniques and Phases

The Interview Process

• Orientation Phase: The nurse introduces themselves, explains the interview's purpose, and builds trust with the patient.
• Working Phase: The nurse collects information by observing verbal and nonverbal communication, asking questions to understand the patient's health.
• Termination Phase: The nurse concludes the interview, ensuring the patient understands next steps and follow-up actions.

Questioning Techniques

• Open-Ended Questions: Encourage detailed responses, helping nurses explore broader issues and identify patient priorities.
• Closed-Ended Questions: Require yes or no answers, best for specific information or time-limited situations.

Observation During an Interview

• Nurses use their senses to observe patient appearance, body language, and interaction patterns.
• Consider a holistic approach encompassing physical, emotional, psychosocial, and spiritual aspects.

Special Needs Considerations

• Adapt communication strategies for patients with disabilities, language barriers or cognitive challenges.
• Use simpler language, visual aids, or interpreters when needed.

Nursing Admission Interview

• Goal is to gather a health history, assess risks, and understand the reason for seeking care.
• The interview captures comprehensive health history, identifies problems, and assesses risk factors.

Impact of Culture

• Cultural factors influence communication, healthcare beliefs, and patient expectations.
• Consider cultural impact on communication, health beliefs, decision-making processes, and expectations.

Professional Communication Among Health Care Workers

• Miscommunication is a major cause of errors in healthcare settings.
• Problems, especially between nurses and physicians, can lead to dissatisfaction and impact teamwork.

RNAO Best Practice Guidelines

• Registered Nurses Association of Ontario provides Best Practice Guidelines (BPG) to ensure evidence-based nursing interventions.

Critical Thinking

• Critical thinking is a process and skillset that is crucial for nurses to navigate complex healthcare environments.
• It requires knowledge, reflective reasoning, and the ability to analyze and make informed decisions.

Importance of Critical Thinking in Nursing

• Nurses use critical thinking to manage fast-paced, ever-changing healthcare settings.
• Critical thinking allows nurses to recognize issues, analyze information, evaluate it, and draw meaningful conclusions.

Critical Thinking Model for Nursing Judgment

• Three levels: Basic (simple, rule-based thinking), Complex (more independent analysis), Commitment (decisions based on experience and responsibility).
• Five components: specific knowledge base, experience, critical thinking competencies, attitudes, and standards.

General Critical Thinking Competencies

• Scientific Method: Involves problem identification, data gathering, hypothesis formation, testing, and evaluation of results.
• Problem-Solving Process: Clarifies the problem, gathers information, evaluates solutions, and monitors outcomes.
• Decision Making: Assesses options, weighs them against criteria, and chooses the best solution.

Specific Critical Thinking Competencies

• Diagnostic Reasoning & Clinical Inference: Process of analyzing patient information (behaviors, symptoms) to determine health status and make conclusions.
• Clinical Reasoning: Cognitive process of gathering and interpreting information to decide on patient care actions.
• Clinical Decision Making: Involves selecting appropriate interventions, distinguishing professional nurses from technical personnel, and applying both reflective and critical thinking.

Clinical Judgment

• The systematic use of the nursing process (assessing, diagnosing, planning, implementing, evaluating) to make complex decisions that combine intuition, critical thinking, and knowledge.

Reflective Practice and Critical Thinking

• Reflective practice is essential for nurses to analyze their actions, learn from experiences, and improve decision-making and critical thinking skills.

Scope of Practice for Licensed Practical Nurses (LPNs)

• RNs may provide oversight, helping LPNs with complex tasks and ensuring compliance with standards of care.

Challenges Affecting Scope of Practice

• Role Conflict: Occurs when responsibilities of LPNs and RNs overlap, creating uncertainty about who should perform specific tasks, leading to inefficiency or conflict.
• Inappropriate Utilization: LPNs are asked to perform tasks outside their legal or educational scope, compromising patient safety and putting the LPN at risk legally.
• Unclear Policies: Vague job descriptions can lead to misunderstandings or role misuse due to unclear responsibilities.

Career Advancement

• Interprofessional Collaboration: LPNs collaborate with other healthcare professionals (e.g., RNs, physicians, therapists) to expand knowledge and improve clinical competencies.
• Intraprofessional Collaboration: LPNs work closely with other LPNs or professionals within their field to share skills and expand knowledge.
• Educational Opportunities: Continued education through courses or certification programs can expand LPN scope of practice (e.g., in specialty fields like geriatrics or pediatrics).

Supervision and Delegation

• Supervision: Ongoing process in nursing where a more experienced professional (usually an RN or nurse manager) provides guidance and oversight to less experienced nurses or healthcare workers.
• Delegation: One healthcare provider (often an RN) transfers authority to perform a task to another person (often an LPN) ensuring it's within the legal and professional boundaries of the LPN's scope of practice.
• Controlled Acts: Tasks that could cause harm if performed incorrectly, often delegated under certain conditions (e.g., medication administration).

Legislation, Regulatory Bodies, and Professional Associations

• Role of Regulatory Bodies: Oversee and protect the professional title of LPNs (and other categories of nurses), ensuring only licensed and registered individuals can use the title.
• Key Function: Enforce standards of practice, conduct licensing exams, and ensure adherence to ethical and professional guidelines.

Controlled or Authorized Acts

• Procedures that are potentially harmful if performed by unqualified individuals.
• Examples include administering certain medications or performing invasive procedures.
• Only qualified nurses and professionals with specific training are allowed to perform these acts, sometimes only under direct supervision or delegation.

Self-Regulation

• Legislative privilege given to the nursing profession, allowing nurses to regulate themselves through their professional bodies to maintain competence and ethical standards.
• Ensures members adhere to laws, continually develop skills, and remain fit to practice.

Professional Associations

• Collective platform for nurses to advocate for issues relevant to their profession.
• Engage with government and policy-makers to address concerns, offer networking opportunities and continuing education programs, and act as a voice for nurses advocating for patient safety, working conditions, and career advancement.

Documentation in Nursing

• Definition: Recording nursing information about care in health records, reflecting care provided and ensuring proper communication between healthcare providers.

Purpose of Nursing Documentation

• Reflects the client's perspective.
• Communicates the plan of care to all healthcare providers.
• Integral to interprofessional communication.
• Demonstrates a nurse's commitment to providing safe, effective, and ethical care.
• Ensures compliance with professional standards and regulations.

Medical Record (Client Record or Chart)

• Legal document providing evidence of a client's care.
• Can be written or electronic, including care plans, progress notes, and medical history.
• Facilitates interdisciplinary communication and care planning.
• Provides legal evidence of care provided.
• Assists in funding, resource management, auditing, and research.

Electronic Documentation

• Advantages: Improved efficiency, easy access, and better coordination.
• Disadvantages: Potential for security breaches if not managed properly.

Security for Computerized Records

• Keep systems secure by using strong passwords.
• Ensure only authorized personnel access patient records.
• Log off electronic records after use.

Personal Health Information Protection Act (PHIPA 2004)

• Ensures that client's health information is kept confidential and secure.
• Gives clients the right to access their health records and request corrections if needed.

Confidentiality

• Nurses are required to protect patient confidentiality.
• Only those directly involved in a patient's care have legitimate access to their records.

Content of Patient Records

• Patient identification and demographic data.
• Informed consent.
• Admission history, nursing problems, diagnosis, and care plan.
• Medical history and diagnosis.
• Progress notes, discharge summary, and patient/family education records.

Common Nursing Record Keeping Forms

• Admission nursing history form.
• Flow sheets and graphic records.
• Standardized care plans.
• Medication Administration Record (MAR).

Guidelines for Quality Documentation

• Factual: Objective and based on observations.
• Accurate: Exact and free from errors.
• Complete: All necessary information is included.
• Current: Up-to-date.
• Organized: Logical and easy to follow.
• Compliant: Meets regulatory standards.

Methods of Documentation

• Narrative: A story-like format, time-consuming and can be repetitive.
• Problem-Oriented Medical Record (POMR): Structured around a database, problem list, care plan, and progress notes.
• SOAP & SOAPIE:
  • S: Subjective (patient's statements).
  • O: Objective (observations).
  • A: Assessment (nursing analysis of S & O).
  • P: Plan (nursing interventions).
  • I: Intervention (actions taken).
  • E: Evaluation (outcomes of interventions).
• PIE:
  • P: Problem (nursing diagnosis).
  • I: Intervention (actions taken).
  • E: Evaluation (outcomes of interventions).
• DAR:
  • D: Data (observations and assessment).
  • A: Action (nursing interventions).
  • R: Response (evaluation of outcomes).

Explore the essential phases of the nursing interview process, including orientation, working, and termination. Learn about effective questioning techniques and the importance of observation in understanding patient needs. This quiz addresses special considerations for adapting communication based on individual patient requirements.