Is the health history usually a formal or informal interview? What does it involve?
Formal- using professional selves therapeutically
CONFIDENTIALITY- patient needs to know
How can appearances make a difference during an interview?
Slovenly- can make a patient not trust you
Too formal can make a patient uncomfortable
neither above statements are always true, but a balance helps
Professional neat dress
Messages you should send to patient
good eye contact
Good nonverbal communication involves
What is it about touch? space?
deeply related to culture, gender, learned roles, try to learn what makes the patient comfortable
usually sit about 5 feet from patient but again this is culturally influenced
Goodness of Fit in Nursing
Generally liking people
accepting their strengths and weaknesses
being optimistic about people
Viewing from other's frame of reference, but remain true to own self
understanding from other's frame of reference
Ability to Listen
Note what they are saying, and what is not being said
patient in street clothes if possible
note taking (patient expects some, but try not to break eye contact too often...impedes nurse noting patient's demeanor, be careful about writing down sensitive information
Date collection should be...
open ended (tell me about that, tell me about your children, what brings you to the hospital)...open ended questions elicit feelings, opinions, ideas...get good at this.
Closed or Direct (use for specific information, ask only one direct question at a time. Speak patient's language)
What does facilitation involve?
2. shows interest- continue, go on, umhmm
3. silence- try to develop comfort with this (if patient is silent it does not seem nearly so long to the patient as it does to you, don't fill a silence with words)
4. Reflection- saying some of the words back to the patient, very effective method of communication
5. Empathy- caring
6. Clarification- now as I understand it...
Facilitation- perspective changes back to nurse
7. confrontation- you can be gentle- "you sound angry about this"
8. Interpretation- nurse may be wrong but will keep communication going because patient will correct
9. Explanation- Giving facts
Traps of an interview
Providing false reassurance or assurance (use reflective questioning)
Authority- speaking down to patient
Using avoidance language- tells patient you don't want to talk about it
Distancing- using impersonal words
Using medical jargon- if patient uses, don't assume they know what it means
Leading or biased questions- "you're not like those teenagers are you?"
Talking too much
Using why questions-instead, say "what makes you say that?"
How to close interview
Open-ended again- "is there anything else you want to talk about?"