The interview
The purpose of the interview is to collect subjective data(i.e. what the person says about himself or herself)
The interview is the best time chance a person has to tell you what he or she perceives the health state to be.
Successful interviews allow you
Communication
Exchanging information so each person clearly understands the other.
-If you do not understand one another, if you have not conveyed meaning, no communication has occurred
Verbal Communication
The words you speak, vocalization, the tone of voice
Non-Verbal Communication
Body language, posture, gestures, facial expression, eye contact, foot tapping, touch, even where you place you your chair
Receiving
The receiver uses his or her won interpretations on your words. These interpretations are based on past experiences, culture, and self concept. Physical and emotional states also play a role in a persons interpretations
Internal Factors
Internal factors are those specific to you, the examiner. As you cultivate your communication skills, you need to focus on the four inner factors of liking other empathy, and the ability to listen, and self awareness.
-Empathy - Viewing the world from the
External Factors
Prepare the physical setting. The setting may be in a hospital room, an examination room in an office or clinic, or the person's home. In any location optimal conditions are important to have a smooth interview.
-Ensure privacy - Aim for geographic privac
Introducing the Interview
Address the person using his or her surname and shake hands if appropriate. Unless the client directs you otherwise, avoid using the first name during the interview. Introduce your self and state your role in the agency (if you are a student, say so). If
Working Phase
The working phase 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. You will likely use a combination of open-ended and closed-ended questi
Open-Ended Questions
The open-ended questions asks for narrative information. It states the topic to be discussed but only in general terms. Use it to begin the interview, to introduce a new section of questions, and whenever the person introduces a new topic
Ex. "Tell me how
Closed or Direct Questions
Closed or direct questions ask for specific information. They elicit a short, one, or two word answer, a "yes" or "no" or a forced choice. Whereas the open ended questions allows the client to have a free rein, the direct question limits his or her answer
Verbal Responses-Assisting the Narrative
There are nine types of verbal responses. The first 5 responses ( facilitation, silence, reflection, empathy, clarification) involve your reactions to the facts or feelings that the person has communicated.
Ten Traps of Interviewing
- providing false assurance or reassurance - a pregnant woman says I've been spotting on and off all day and haven't felt the baby kick I just know I'm going to miscarry. your automatic response may be to provide reassurance don't worry. I'm sure you and
Giving Unwanted Advice
Do not make decisions for you client. Providing answers shifts accountability to you instead of the client. The women must work out her own decision. So what do you do?
Response: What are your concerns about the recommendation?
Woman: Im terrified of bein
Using Authority
Using authority should be avoided. Although you may have more professional knowledge than the client, you both have equally important roles since the client must make the final decision about his or her health.
Using Avoidance Language
Using euphemisms promotes avoidance of reality and allows people to hide their feelings. Not talking about uncomfortable topics doesn't make them go away but instead makes them even more frightening. The best way to deal with frightening or uncomfortable
Distancing
Health professionals use distancing to soften reality =, but in actuality it may communicate that you are afraid of the procedure or disease. Clients use distancing to avoid admitting that they have a problem: "My doctor told me that the prostate was enla
Using Professional Jargon
The medical professional is fraught with jargon that sounds exclusionary and paternalistic. It is important that you can adjust your vocabulary to ensure understanding without sounding condescending. Just because your client uses medical jargon don't assu
Using Leading or Biased Questions
Make sure that your questions are unbiased and do not lead clients to a certain "correct" answer. Better questions are: "Do you smoke?" or "When you have sexual intercourse, do you use any type of protection?
Talking to much
A good rule for every interviewer is to listen more than you talk
Interrupting
Leave at least a second of space between the end of the client speaking and you next statement. This ensures that the person is finished
Using "Why" Questions
Children ask why questions constantly. Why is the sky blue? Why cant I have a cookie for dinner? Their motive is an innocent search for information. The adults use of "why" questions usually implies blame and condemnation; it puts the person on the defens
Nonverbal Skills
Nonverbal modes of communication include physical appearance, posture, gestures, facial expressions, eye contact, voice, and touch.
Physical Appearance
professional uniforms can create a positive (expertise or ease of identification) or a negative (distance or formality) image. Whatever your personal choice in clothing or grooming is, the aim should be to convey a competent, professional image and should
Posture
On beginning the interview note the clients posture. Make sure that you are aware if your own posture. Assuming a calm, relaxed posture conveys interest
Gestures
Nodding the head openly turning out the hand shows appreciation, attention, or agreement; whereas wringing the hands or picking the nails often indicates anxiety. Hand gestures can also reinforce descriptions of pain. When describing crushing substernal c
Facial Expressions
Typically the face and facial expressions are some of the first things we notice when we meet someone. Avoid expressions that may be construed as boredom, disgust, distraction, criticism, or disbelief. A negative facial expression can severely damage your
Eye Contact
Lack of eye contact suggests that the person is shy, withdrawn, confused, bored, intimidated, apathetic ,or depressed. This applies to examiners too. You should aim to maintain eye contact, but do not "stare down" the person. Do not have a fixed, penetrat
Voice
The tone of voice may show sarcasm, disbelief, sympathy, or hostility. People who are anxious often speak louder and faster than normal. A soft voice may indicate shyness or fear, whereas a loud voice may indicate that the person is hearing impaired.
Even
Touch
Do not use touch during the interview unless you know the person well and are sure how it will be interpreted. In summation, an examiner's nonverbal messages that show attentiveness and unconditional acceptance are productive and help build rapport. Defea
Closing the Interview
The session should end gracefully. An erupt or awkward closing can destroy rapport and leave the person with a negative impression of the interaction. To ease into the closing. Ask the person:
"Is there anything else you would like to mention?"
"Are there
Interviewing the Parent of Caregiver
When your client is a child, you must build rapport with two people, the child and the accompanying caregiver. Greet both by name, but with a younger child (1 to 6 years old) focus more on the caregiver. Ignoring the child temporarily allows him or her to
Communicating with an Infant
Respond quickly to changes in infant communication. If a baby begins to cry, respond the communication. Use gentle handling and a quiet, calm voice. Face infants directly. They are fascinated by adult faces and enjoy looking at them,but remember that eyes
Communicating with The Toddler
Language progresses from a vocabulary of about two words at 1 year to a spurt of about 200 words by 2 years. Then the 2-year old begins to combine words into simple two-word phrases, "all gone," "me up," "baby crying." This is telegraphic speech, which is
Communicating with The Preschooler
A 3 to 6 year old is egocentric. He or she sees the world mostly from his or her own point of view. Everything revolves around him or her. A 3 year old uses more complex sentences with more parts of speech. Between 3 and 4 years of age the child uses thre
Communicating with The School-Age Child (7-12 years)
A child 7-12 years old can tolerate and understand others viewpoints. This child is more objective and realistic. At this age children are beginning to recognize that things they do can affect others. It is very important that you are nonjudgmental. The s
Communicating with The Adolescent
Adolescence begins with puberty is a time of dramatic physiologic change. It includes a growth spurt, rapid growth in height, weight, and muscular development; development of primary and secondary sex characteristics; and maturation of the reproductive or
Communicating with The Older Adult
Always addressed the person by his or her proper surname, and avoid using the first name. Some older adults resent being called by their first name by younger people and think that it demonstrates a lack of respect. Above all, avoid "elderspeak," which co
Interviewing the Hearing Impaired
As the population ages, you will encounter more people who are deaf or hard of hearing. They see themselves as a linguistic minority, not as disabled. People who are hearing impaired may feel marginalized by professionals and think that their intelligence
Interviewing The Acutely Ill People
Emergent situations require combining the interview with the physical examination. In this case focus the interview on pertinent information only, including history of present illness, medications,allergies, last meal, and basic health state. Subjective i
Interviewing People Under the Influence of Street Drugs or Alcohol
When interviewing a person currently under the influence of alcohol or illicit drugs, ask simple and direct questions. Take care to make your manner and questions nonthreatening. Avoid confrontation while the person is under the influence and avoid displa
Personal Questions
Occasionally people will ask you questions about your personal life or opinions. Try directing your response back to the person's frame of reference. But always answer their questions if appropriate.
Sexually Aggressive People
On some occasions personal questions extend to flirtatious compliments, seductive innuendo, or sexual advances. Some people see illness as a threat to their self esteem ans sexual adequacy; this feeling creates anxiety that makes them act out in sexually
Crying
When you say something that "makes the person cry" do not think you have hurt the person. You have just broached a topic that is important. Do not go on to a new topic. It is important that you allow the person to cry and express his or feelings fully bef
Anger
Don't take the anger personally; it typically doesn't relate to you. The person is showing aggression as a response to his or her own feelings of anxiety or helplessness. Do ask about the anger and hear the person out. Deal with the angry feelings before
Threats of Violence
Red-flag behaviors of a potentially disruptive person include fist clenching, pacing back and forth, a vacant stare, confusion, statements out of touch with reality or that do not make sense, a history of recent drug use, or perhaps a recent history of in
Anxiety
This is normal response to being sick. It makes some people aggressive and others dependent. Appearing unhurried and taking the time to listen to all of the client's concerns can help diffuse some anxiety. Avoiding the traps to interviews and using therap
Cultural Considerations on Gender
Ask the person about culturally relevant aspects of male-female relationships at the beginning of the interview. When gender differences are important to the patient, try strategies such as offering to have a third person present. If a family member or a
Cultural Considerations on Sexual Orientation
Heterosexism refers to the belief that heterosexuality is the only natural choice and assumes that everyone is or should be heterosexual. Heterosexism is a form of homophobia and leads to discrimination. Most admitting and health history forms are heteros
Working With (and Without) an Interpreter
Clients with language barriers experience many negative health outcomes, especially if an interpreter is not used. Non English-speaking clients have longer hospital stays, receive fewer preventive services, and are less satisfied. Clients who need but do
Health Literacy
Refers to the ability to understand instructions, navigate the health care system,and communicate concerns with the health care provider
Oral Teaching
When discussing medical information with clients, keep it simple,use short sentences and words containing no more than two syllables (when possible), limit the number of messages you are giving the client, be sure to tell the person what they will gain by
Written Materials
When preparing or using written materials, make sure to assess the appropriateness of the materials. Written materials should be at the 5th grade reading level or below. Reading level can be determined with a variety of formulas that use number of syllabl
Teach Back
Teach back is simple and free. It allows you to assess whether the person understands and to immediately correct misconceptions. Many health care professionals ask, "Do you understand?" or "Do you have any questions?" throughout the teaching sessions. Jus