Health Assessment-Interview skills notes

Health Assessment : Interview skills

1. INTERVIEWING SKILLS AND HEALTH HISTORY Rifa Z ulfiqar A li Nursing Instructor Acknowledged: T ariq Aziz

2. Objectives By the end of the presentation students will be able to: Define interview Discuss the interview process and purpose Identify the factors influencing the interview Explore three phases of clients interactions Define therapeutic communication Recognize patterns of therapeutic communication Discuss the effective and ineffective communication techniques Describe the principles of communication Discuss the don’ts of therapeutic communication Identify major categories of a complete health history Describe a genogram to identify patterns within family history Identify information to be obtained in ROS Summarization

3. Interview The nursing health assessment interview is a purposeful, time- limited verbal interaction between the nurse and the patient. It is initiated to collect the specific information regarding the patient and the patient’s health status. (Elen, 2010) OR It is goal directed and purposeful interaction between two people

4. interview PROCESS/approaches Directive: Formal & structured to collect wide range of information, Usually content focused, control, closed ended. In-Directive: Informal, & focused on specific area of concern, process, freedom, open ended. Balance between them.

5. Purpose: G ather information to base nursing care. Establish a helping relationship (promoting, motivating, supporting) Identifying health status, concerns, & problems. Screening purpose. Identifying need for education

6. factors influencing the interview Approach Environment Confidentiality Note taking Time, length and duration Biases and preconception

7. Phases of nurse client interactions

8. Phases of Therapeutic Relationship Pre-interaction Phase Introductory Phase Working Phase Termination Phase

9. Pre-interaction Phase This phase begins when the nurse is assigned to initiate a therapeutic relationship and includes all that the nurse thinks, feels, or does immediately prior to the first interaction with the patient.

10. Task Explore own feeling, fears and fantasies Analyze own professional strengths and limitations Plan for first meeting with patient

11. Introduction Phase This phase is the foundation of the relationship. The nurse and patient meet for the first time TASK : Establish rapport, trust and acceptance Establish communication; assist in the verbal expression of thoughts and feelings Gather data , including the client’s feelings, strength and weakness

12. Working Phase Most of the therapeutic work is carried out during the working phase. This usually is the longest phase of a trust relationship and the most overtly productive. The client begins to trust the nurse and starts to focus on problem or behaviors that need to be changed

13. Task Gather further data; explore relevant stressors Promote patient’s development of insight and use of constructive coping mechanisms Facilitate behavioral change; encourage him/her to evaluate the results of his/her behavior. Provide him with opportunities for independent functioning Evaluate problems and goals and redefine as necessary

14. Termination Phase This phase provides closure to the relationship. The goal of this phase is to bring a therapeutic end to the relationship. Ideally, planning for termination of the relationship begins during the orientation phase or as soon as the client is able to comprehend it.

15. Task Establish reality of separation Mutually explore feeling of rejection, loss, sadness, anger and related behavior Review progress of therapy and attainment of goals Formulate plan for meeting future therapy needs

16. Interviewing PRINCIPLES Personalize the interview Use open ended questions/ broad opening statements Provide general leads Use facilitation / continuers Use therapeutic techniques Use reflection, paraphrase Use focusing, clarifying, validating Proceed from general to specific Use graded response Offer multiple choice questions Acknowledge transitions Summarize/ review the discussion

17. Therapeutic Communication Is an interpersonal interaction between nurse and patient during which the nurse focuses on the specific needs of the client to promote an effective exchange of information between the nurse and client. (Videbeck,2004) Therapeutic communication refers to healing and curative dialogue between people. It fosters an active collaborative process that facilitates problem solving, change, learning and growth (Antai-Otong , 2003)

18. Communication Pattern: Verbal & non verbal congruence. Non Verbal components: Body Motion Eye contact Posture Distance Para Language Vocal characteristics Tone Speech Appearance Silence Touch

19. Therapeutic Communication Techniques

20. Technique Purpose Example Clarification Puts client’s ideas into a simple statements; Are you saying you want to move out of your apartment? Reflection Presents themes that have emerged through a series of interactions. “ So you start feeling depressed when no one calls you over the weekend.” Focusing Directs conversation back to an area of importance; explore a topic in depth “Let’s go back to the situation at school, where you felt uncomfortable in class .” using silence Silence help client to express their feelings Sitting quietly and listen attentively

21. Technique Purpose Example Confronting Presents contradicts and inconsistencies “You say you’re upset, but you are laughing.’ Suggesting Assists client to consider alternative options Have you thought about responding to your boss in a different way when he raises that issue with you? “Let’s try using problem solving process that was presented in group yesterday.” Restating Repeating the main thought the patient expressed. Provides feedback, letting the client know that the nurse understood the message; let the client know that the nurse is attentive. “Are you saying you were angry when your wife had to work late? You say that your mother left you when you were 5 years old?

22. Technique Purpose Example Presenting reality When the client has a misperception of the environment, the nurse defines reality “I understand that the voices seem real to you, but I do not hear any voices.” “There is no one else in room but you and me” Offering self Making oneself available on an unconditional basis, increasing client’s feeling of self-worth I’ll stay with you until it’s time for your family session I’ll be hear till 12.00 clock Give recognition Acknowledging, indicating awareness “I see you made your bed” I notice that you made picture in OT.

23. Technique Purpose Example Using touch It reinforce caring attitude towards client Putting an arm over the client’s shoulder The hand over the client hand Acknowledging Giving recognition enhance the self esteem of the patient You walked twice as far today with your walker Summarizing and planning Help client to know what has happened today and plans of further assessment and interview During past half an hour we have talked about Tomorrow morning we may explore this further

24. Ineffective communication techniques

25. Response Non therapeutic response Therapeutic response Asking excessive question Why did you leave your wife? Did you feel angry at her? What did she do to you? Are you going back to her? Tell me situation between you and your wife? Giving advice C: I do not know what to do about my brother. He is so lost N: You should call him up today and explain to him you can’t support him any longer, and he will have to go on welfare.. What do you see as some possible actions you can take. (problem solving ) Giving False Reassurance Don’t worry, things will get better. What specifically are you worried about “Why” Questions Why don’t you leave him if he is so abusive? Why didn’t you take your medications? What are the main reasons you stay in this relationship?

26. Response Non therapeutic response Therapeutic response Changing the topic Client: I’d like to die. Nurse: Did you have visitors this weekend. Nurse: Tell me about that Defending Your doctor is a good doctor. He would never say that What has you upset about your doctor? Criticism of others Client: The staff members on the evening shift let me smoke cigarettes Nurse: The evening shift is always breaking the rules. On this shift we follow the one cigarette Nurse: The policy is one cigarette, which we will follow. Probing Tell me how your father abused when you were a child. Tell me how you feel toward your father now that she is dead. The nurse should be aware of client’s response and discontinue the interaction at the first sign of discomfort.

27. Testing Who do you think you are? How you are feeling explain in detail Stereotyping Women's are always Complainers Men don’t cry Is there any issue regarding your diet can we talk about it Using denial Client: I’m nothing Nurse: Of course you’re some thing. Every body is somebody You are feeling like no one cares about you right now.

28. Communication principles Personalize the interview Use open ended questions/ broad opening statements Provide general leads Use facilitation / continuers Use therapeutic techniques Use reflection, paraphrase Use focusing, clarifying, validating Proceed from general to specific Offer multiple choice questions Acknowledge transitions Summarize/ review the discussion

29. Don'ts of therapeutic communication Avoid leading Avoid judgmental / stereotyped responses Avoid asking “why” questions Avoid asking two question at a time Avoid jargons Avoid changing topic Avoid false reassurance Avoid agreeing, disagreeing, approving & disapproving Avoid interrupting the client Avoid rushing

30. Health History

31. Health History & Physical Assessment Subjective database Objective database

32. Health History Demographics Chief concern COLDERRAA Present illness Past illness Family history (Genogram) Lifestyle/health practices -FHP Review of systems ( ROS)

33. Functional health pattern FHP Elimination Sexuality reproductive Activity exercise Role relationship Cognitive perceptual Health Perception & Management Self perception Self concept Nutrition Metabolic Sleep rest Value belief Coping stress Tolerance

34. History: Follow positive findings or symptoms C : Characteristics O : Onset L : Location D : Duration E : Exacerbation R : Radiation R : Relief A : Antecedent A : Associated

35. ROS (Review of System) General Skin Head Eyes Ears Nose and Sinuses Mouth and throat Neck Breasts Respiratory Cardiac Gastrointestinal Genitoreproductive Peripheral Vascular Musculoskeletal Neurologic Hematological Endocrine Psychiatric

36. THANK YOU