HA CH 3

The __ is the most important part of data collection.

interview

What the person says about himself or herself.

Subjective data

What you obtain through physical examination

Objective data

A close and harmonious relationship in which the people or groups concerned understand each other's feelings or ideas and communicate well.

Rapport

Successful interviews allow you to:

1. Gather complete accurate data
2. Establish trust
3. Teach the person about his/her health
4. Build rapport
5. Discuss health promotion and disease prevention

Contract terms include:
- Time and place of __ and __ examination
- Introduction of and explanation of health care provider's __
- __ of interview
- How long it will take
- Expectation of __ for each person
- __ of others, e.g., family, etc.
- __ and to w

- interview, physical
- role
- purpose
- participation
- Presence
- Confidentiality

If you do not understand one another, if you have not conveyed __, no communication has occurred.

meaning

Your words and gestures must be interpreted in a specific __ to have meaning.

context

Receiving:
- __ of messages you send is only part of process
- Receiver attaches meaning determined by his or her past __, __, __, and current physical and emotional __.
- Patients' __ intensify communication because patients depend on you to get better
-

- Awareness
- experiences, culture, self-concept, state
- health problems

Internal factors to communication:

- Liking others
- Empathy
- Ability to listen

Viewing the world from the other person's inner frame of reference while remaining you.

Empathy

Active __ is the route to understanding.

listening

External factors to communication:

- Ensure privacy
- Refuse interruptions
- Physical environment
- Dress
- Note taking
- Tape and video recording
- Electronic Health Record (EHR)

Standing does two things:

1. It communicates your haste
2. It assumes an authority figure.

Establish __ before asking the person to change into a gown.

rapport

Challenges of note-taking:
- Breaks __ too often
- Shifts attention away from person, diminishing his or her sense of __
- Interrupts patient's __
- Impedes observation of patient's __ behavior
- May be __ to patient's discussion of sensitive issues

- eye contact
- importance
- narrative flow
- nonverbal
- threatening

Address the person using his or her __ and shake hands if appropriate.

surname

Is the data-gathering phase. Verbal skills for this phase include your ability to form questions appropriately and your responses to the answers given by the client.

Working Phase

Asks for narrative information; states the topic to be discussed but only in general terms.

Open ended question

Ask for specific information, elicit a short, one or two word answer, "yes" or "no", or a forced choice.

Closed needed (direct) question

- Encourages client to say more
- Shows person you are interested
(Mmm-hmmm got , uh huh)

Facilitation (general leads, minimal cues)

- Communicates that client has time to think
- Can be uncomfortable for novice examiner
- Provides you with change to observe client and note nonverbal cues.
(Waiting for response without interruption)

Silence

- Echoes clients words by repeating part of what person has just said.
- Can help express feelings behind words
- Mirroring clients words can help person elaborate on problem
(You feel worried and anxious about your children?)

Reflection

- Names a feeling and allows its expression
- Allows person to feel accepted and strengthens rapport
- Useful in instances when client hasn't identified the feeling or isn't ready to discuss it.
(It must be very hard for you)

Empathy

- Useful when persons word choice is ambiguous or confusing.
- Summarize persons words, simplify the statement, and ensure that you are on the right track.
(It stops when you rest, is that correct?)

Clarification

- Clarifying inconsistent information
- Focusing clients attention on an observed behavior, action, or feeling
(When I press here you grimace, but you said it doesn't hurt)

Confrontation

- Links events, makes associations, and implies cause
- Not based on direct observations but instead on inference or conclusion
- Your interpretation may be incorrect but helps promo further discussion
(It seems that every time you feel the stomach pain,

Interpretation

- Informing person
- Sharing factual and objective information
(You may not eat or drink for 12 hours before your blood test because the food may change the result)

Explanation

- Condenses facts and validates what was discussed during the interview
- Signals that termination of interview is imminent
- Both client and examiner should be active participants
(Review pertinent facts)

Summary

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
9. interrupting
10. Using

Trap:
"Don't worry. Im sure you and the baby will be fine

Providing false assurance or reassurance

Trap:
"If I were you...

Giving unwanted advice

Trap:
"Your doctor/nurse knows best

Using authority

Trap:
"Has gone to a better place"
(to avoid the reality of dying)

Using avoidance language

Trap:
"There is a lump in the left breast"
(using "the" instead of "your")

Distancing

Trap:
Using "hypertensive)

Using professional jargon

Trap:
"You don't smoke do you

Using leading or biased questions

Trap:
"why did you take so much medications

Using "why" questions

Nonverbal skills:

1. Physical appearance
2. Posture
3. Gestures
4. Facial expression
5. Eye contact
6. Voice
7. Touch
8. Closing the interview

Birth to 12 months:
- Nonverbal communication is the primary method of communication

Infant

12 to 36 months:
- Beginning to develop communication skills
- Limited vocabulary

Toddler

Talking in two word phrases.
"Me up"
"Baby crying"
"All gone

Telegraphic speech

3 to 6 years:
- Egocentric
- Direct, concrete, and literal communication

Preschooler

Sentences containing only essential words

Telegraphic sentences

7 to 12 years:
- More objective and realistic
- Limited reasoning capacity
- Able to recognize that things they do can affect others

School age child

Consider all sides of a situation to form a conclusion.

Decenter

- Begins with puberty
- Growth spurt
- Think that no adult can understand them
- More sensitive to nonverbal communication

The Adolescent

- Has the developmental task of finding the purpose of his or her own existence and adjusting to the inevitability of death.
- Have a longer story to tell
- Touch is a nonverbal skill that is very important

Older adult

Interviewing people with special needs:

- People who are hearing-impaired
- People who are acutely ill
- People under influence of street drugs or alcohol
- People who must be asked personal questions
- People who are sexually aggressive
- People who are crying
- People who are angry and threat

Cross cultural care:
- Probability of __ increases with two people from different cultural backgrounds
- Cultural __ of both health care professional and patient influence verbal and nonverbal communications

- miscommunication
- backgrounds

Five types of nonverbal behaviors convey information about person:
__ cues: pitch, tone, and quality of voice, including moaning, crying, and groaning
__ cues: posture, facial expression, and gestures
__ cues: clothing, jewelry, and hair styles
__: interp

- Vocal
- Action
- Object
- Personal space
- Touch