The Patient Interview

Published on 23/05/2015 by admin

Filed under Pulmolory and Respiratory

Last modified 23/05/2015

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The Patient Interview

Chapter Objectives

After reading this chapter, you will be able to:

• Describe the major items found on a patient history form.

• Explain the primary tasks performed during the patient interview.

• Describe the internal factors the practitioner brings to the interview.

• Discuss the external factors that provide a good physical setting for the interview.

• Differentiate between open-ended questions and closed or direct questions.

• Describe the following nine types of verbal responses:

• Facilitation

• Silence

• Reflection

• Empathy

• Clarification

• Confrontation

• Interpretation

• Explanation

• Summary

• Describe why the following are nonproductive verbal messages:

• Providing assurance or reassurance

• Giving advice

• Using authority

• Using avoidance language

• Distancing

• Professional jargon

• Asking leading or biased questions

• Talking too much

• Interrupting and anticipating

• Using “why” questions

• List positive and negative nonverbal messages of the interview, including:

• Physical appearance

• Posture

• Gestures

• Facial expression

• Eye contact

• Voice

• Touch

• Describe how to close the interview.

• Define key terms and complete self-asessment questions at the end of the chapter and on Evolve.

Key Terms

Patient History

A complete patient assessment includes the patient interview. The purpose of the patient history is to gather pertinent subjective and objective data, which in turn can be used to develop a more complete picture of the patient’s past and present health. In most clinical settings the patient is asked to fill out a printed history form or checklist. The patient should be allowed ample time to recall important dates, health-related landmarks, and family history. The patient interview is then used to validate what the patient has written and collect additional data on the patient’s health status and lifestyle. Although history forms vary, most contain the following:

• Biographic data (age, gender, occupation)

• The patient’s chief complaint or reason for seeking care, including the onset, duration, and characteristics of the signs and symptoms

• Present health or history of present illness

• Past health, including childhood illnesses, accidents or injuries, serious or chronic illnesses, hospitalizations, operations, obstetric history, immunizations, last examination date, allergies, current medications, and history of smoking or other habits

• The patient’s family history

• Review of each body system, including skin, head, eyes, ears and nose, mouth and throat, respiratory system, cardiovascular system, gastrointestinal system, urinary system, genital system, and endocrine system

• Functional assessment (activities of daily living), including activity and exercise, work performance, sleep and rest, nutrition, interpersonal relationships, and coping and stress management strategies

Patient Interview

The interview is a meeting between the respiratory care practitioner and the patient. It allows the collection of subjective data about the patient’s feelings regarding the condition. During a successful interview, the practitioner performs the following tasks:

Interview skills are an art form that takes time—and experience—to develop. The most important components of a successful interview are communication and understanding. Understanding the various signals of communication is the most difficult part. When understanding (conveying of meaning) breaks down between the practitioner and the patient, no communication can occur. Communication cannot be assumed just because two people have the ability to speak and listen. Communication is about behaviors—conscious and unconscious, verbal and nonverbal. All these behaviors convey meaning. The following paragraphs describe important factors that enhance the sending and receiving of information during communication.

Internal Factors

Internal factors encompass what the practitioner brings to the interview—a genuine concern for others, empathy, understanding, and the ability to listen. A genuine liking of other people is essential in developing a strong rapport with the patient. It requires a generally optimistic view of people, a positive view of their strengths, and an acceptance of their weaknesses. This affection generates an atmosphere of warmth and caring. The patient must feel accepted unconditionally.

Empathy is the art of viewing the world from the patient’s point of view while remaining separate from it. Empathy entails recognition and acceptance of the patient’s feelings without criticism. It is sometimes described as feeling with the patient rather than feeling like the patient. To have empathy the practitioner needs to listen. Listening is not a passive process. Listening is active and demanding. It requires the practitioner’s complete attention. If the examiner is preoccupied with personal needs or concerns, he or she will invariably miss something important. Active listening is a cornerstone to understanding. Nearly everything the patient says or does is relevant.

During the interview the examiner should observe the patient’s body language and note the patient’s facial expressions, eye movement (e.g., avoiding eye contact, looking into space, diverting gaze), pain grimaces, restlessness, and sighing. The examiner should listen to the way things are said. For example, is the tone of the patient’s voice normal? Does the patient’s voice quiver? Are there pitch breaks in the patient’s voice? Does the patient say only a few words and then take a breath?

Techniques of Communication

During the interview the patient should be addressed by his or her surname, and the examiner should introduce himself or herself and state the purpose for being there. The following introduction serves as an example: “Good morning, Mr. Jones. I’m Mrs. Smith, and I’m from Respiratory Care. I want to ask you some questions about your breathing so that we can plan your respiratory care here in the hospital.”

Verbal skills and techniques used by the examiner to facilitate the interview may include open-ended questions, closed or direct questions, and responses.

Open-Ended Questions

An open-ended question asks the patient to provide narrative information. The examiner identifies the topic to be discussed but only in general terms. This technique is commonly used (1) to begin the interview, (2) to introduce a new section of questions, or (3) to gather further information whenever the patient introduces a new topic. The following are examples of open-ended questions:

The open-ended question is unbiased; it allows the patient freedom to answer in any way. This type of question encourages the patient to respond at greater length and give a spontaneous account of the condition. As the patient answers, the examiner should stop and listen. Patients often answer in short phrases or sentences and then pause, waiting for some kind of direction from the examiner. What the examiner does next is often the key to the direction of the interview. If the examiner presents new questions on other topics, much of the initial story may be lost. Ideally, the examiner should first respond by saying such things as “Tell me about it” and “Anything else?” The patient will usually add important information to the story.

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