Chapter 3

The Interview

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 Interview Purpose
! Best chance to gain an
understanding of the
patient’s beliefs,
concerns, and
perception of their
individual health state
! Allows for compilation
of subjective data and
awareness of objective
data (physical
appearance, posture,
ability to carry on a
conversation, and
demeanor)
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 Successful Interview
Characteristics
! Gather complete and accurate data about person’s
health state including description and chronology of
any symptoms.
! Establish trust to foster acceptance and allow for
data sharing.
! Teach the person about their individual health state.
! Build rapport to continue therapeutic relationship.
! Discuss health promotion and disease prevention.

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 The Interview Contract
Terms
! Location: Time and place with follow-up for
physical exam
! Explanation: Introduction and delineation of role
! Purpose: Mutual goal is optimal health.
! Time frame: Length of time for process
! Participation: Expected participation and/or
presence of others
! Confidentiality: Reasonable and/or limited as it
applies to legal/ethical standards
! Cost: Disclosure of any financial costs
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Process of Communication:
Sending
! Verbal communication
! Words you speak—vocalization
! Tone used in conversation

! Nonverbal communication
! Body language helps to provide cues which may be
correlated with truer feelings.
! Recognize importance of unconscious messages

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 Process of Communication:
Internal Factors
! Specific to you as the health care team member
which can help you to maximize communication
skills
! Internal factors
! Liking others—using a “genuine” approach
! Empathy—develop an understanding and sensitivity
for others feeling’s
! Ability to listen—using an “active” process
! Self-awareness—be aware of “implicit bias”

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 Process of Communication:
External Factors
! Defining the environment so as to foster
communication

! External factors
! Ensure privacy—aim for “geographic” privacy but
ensure “psychological” privacy
! Avoid interruptions—minimize and/or refuse
! Physical environment—“equal status” seating
! Dress—appearance and comfort
! Note-taking—keep to a minimum, offer “focused”
attention

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 Electronic Health Record
(EHR)
! Federal government mandates so as to improve
quality and safety.

! Technology interface can affect communication in

the health care provider-patient relationships.

! Capturing of biomedical, psychological, and

emotional information may not always be captured.

! Do not allow the computer to become a “barrier” in

the communication exchange process.

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 Techniques of
Communication
! Introducing the interview—keep it short and formal
! Working phase
! Data-gathering phase
! Verbal skills include questions to patient and your
responses to what is said.
! Two types of questions
! Open-ended—asks for narrative information
! Closed—asks for specific information leading to a forced
choice (yes or no)
! Each has a different place and function in interview.

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 Verbal Responses: Assisting the
Narrative (1 of 2)
! Nine types of verbal responses that fall under
patient perspective and interviewer perspective

! Patient leads and reactions obtained from

interviewer
! Facilitation—encourages patient to say more
! Silence—directed attentiveness
! Reflection—echoes to help express meaning
! Empathy—names a feeling and allows its expression
! Clarification—asking for confirmation

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 Verbal Responses: Assisting the
Narrative (2 of 2)
! Interviewer leads and expression of own thoughts
based on obtained information
! Confrontation—clarifying inconsistent information
! Interpretation—makes association to identify cause or
conclusion
! Explanation—informing person by sharing factual and
objective information
! Summary—provides conclusion based on verified
information which in turn identifies that the interview
process is closing

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 Ten Traps of Interviewing
1. Providing false assurance or reassurance

2. Giving unwanted advice

3. Using authority
4. Using avoidance language

5. Engaging in distancing

6. Using professional jargon

7. Using leading or biased questions

8. Talking too much

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9. Interrupting
 Nonverbal Skills—
Congruency
! When verbal and nonverbal messages are
congruent, the verbal message is reinforced.

! When they are incongruent, nonverbal message is

viewed as the truer one as it is under unconscious
control.

! Can be viewed as either positive or negative thereby

prompting the importance of self-awareness in
order to promote communication

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 Nonverbal Modes of
Communication (1 of 2)
! Physical appearance
! Image as an initial perception
! Posture
! Interpretation of body language affecting
engagement
! Gestures
! Sending messages—be aware
! Facial expression
! Reflects emotion and culture
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 Nonverbal Modes of
Communication (2 of 2)
! Eye contact
! Maintain within the realm of interest but
be mindful of cultural diversity.
! Voice
! Be aware of tone, intensity, and rate of
speech.
! Touch
! Interpretation is influenced by age, gender,
cultural background, past experience, and
current setting.
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 Closing the Interview
! Ending should be
gradual thereby
allowing for
adequate closure to
allow for final
expression.
! No new topics
introduced
! Summary provided
as final statement

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Developmental Competence
! Interviewing the parent or caregiver of a child or
children
! Focus on both individuals so as to encourage
participation.
! Obtain information and relevant data.
! Address by name to help foster engagement.
! Be aware of physical relationships to promote sense
of self.
! Be aware of nonverbal behaviors so as to maintain
engagement.

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 Communicating with
Different Ages
! Use “Stages of cognitive development” as a
guideline to facilitate communication.

! Consider the maturity level of the child.

! Take into account that a health care crisis can lead
to regression as a common response.

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 Stages of Cognitive
Development
Infants Toddlers Preschoolers School-Age Adolescents
Birth to 12 12 to 36 3 to 6 years 7 to 12 years Starts with
months months old old puberty
Gentle Give one Short Ask Respectful,
handling with direction at a directions questions to honest
quiet, calm time and with concrete gather data attitude with
voice provide explanation and be focus on the
simple nonjudgment individual
explanations al

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 The Older Adult
! Developmental task of finding purpose and
evaluating existence

! Address respectfully
! Typically the interview process will take longer.
! Consider appropriate pacing
! Physical limitations
! May need increased response time to process
! May have more information to provide

! Use therapeutic touch to provide empathy.

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 Interviewing People with
Special Needs
! Consider key elements that will address vulnerable
populations.
! Acutely ill, drug/alcohol abuse, sexually aggressive,
emotionally distraught (crying), angry and/or
threatening violence and anxious

! Use appropriate resources as they relate to the

context of the situation.

! Be alert to “personal question” queries as they may

indicate ulterior motives:
! Provide appropriate response based on personal
ethics.
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 Culture and Genetics
! Gender
! Being aware of maintaining cultural norms during
interview and examination process
! Maintaining privacy and modesty
! Sexual orientation
! LGBTQ (Lesbian, gay, bisexual, and transgender)
! Maintaining neutrality r/t patient’s presentation by
being mindful of communication patterns
! Being aware of your own personal bias and baggage

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 Working with (and without) an
Interpreter
! Potential exists for language barrier to be a key
element in health care interactions due to cross-
cultural communications
! Consider both verbal and nonverbal cues in
communication pattern.

! Bilingual team member or trained medical

interpreter preference same gender

! Language alone does not imply understanding of

cultural diversity.

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 Health Literacy
! This is more than just the ability to read but rather
includes understanding and following directions that
lead to effective communication between the patient
and the health care provider.

! A patient may be literate but not have health literacy.

! Involves the use of quantitative measurement and
memory aspects

! Tools for determining literacy

! Several available vary in terms of reliability and validity and
time needed to administer
! Follow established policy and procedure in clinical practice
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 Techniques to Improve
Health Literacy
! Oral teaching
! Provide simple, easy instructions.
! Use conversational structure rather than medical
jargon.

! Written materials
! Based on standard educational levels
! Use of 12 point font, avoiding all “CAPS” with use of
bullet points

! Teach back
! Encourages verification of understanding.
! Opens the door for clarification if needed

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 Communicating with Other
Professionals
! Promoting effective interpersonal communication
! Occurs between two or more individuals of the
interdisciplinary health care team
! Creates an environment of mutual respect and enhances
collaboration

! Impact of ineffective interpersonal communication

! Linked to poor outcomes attributed to delay in treatment,
medication errors, clinical misdiagnosis, patient injury, and
death

! Maintaining open lines of communication

! Provide timely updates in an organized manner

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 Standardized Communication—
SBAR
Situation Background Assessment Recommendatio
n or Request
Provide a brief Provide State pertinent State what you
description of pertinent history assessment need or want for
pertinent patient as it directly findings the patient in
variables, relates to obtained with terms of
demographics, patient’s current interpretation of medical
clinical health status data treatment and/
diagnosis, and or assistance
location

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