Chapter 2
Interviewing the Patient
for a Health History
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Therapeutic Communication
 Complex process of transmitting information
that is influenced by the following factors:
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•
•
•
Personal
Environmental
Cultural
Social
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Therapeutic Communication (continued_1)
 Dimensions of therapeutic, patient-centered
assessment include:
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•
•
•
•
Empathy and compassion
Unconditional regard
Genuineness
Respect
Caring
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Communicating with Patients
 Nurse-patient relationship is the foundation
of nursing practice.
 A therapeutic partnership between the
nurse and patient is established.
 Be sensitive and nonjudgmental.
 Exchange of verbal and nonverbal messages
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Interviewing
 Exchange of information, feelings, and
concerns takes place.
 Requires the nurse to prepare and plan.
 Health Insurance Portability and
Accountability Act (HIPAA) – law to maintain
patient confidentiality.
 Consider the developmental level of the
patient.
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Interview Preparation
 Review patient
record
 Allow sufficient
time
 Ensure good
lighting
 Maintain privacy
 Sit or stand at the
same eye level
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 Introduce yourself
 State how long
the interview will
approximately
take
 Reassure
confidentiality
 Encourage patient
to ask questions
ClickerCheck
You are interviewing a patient in a community
health clinic. He shares with you that he has
made some bad choices in life. You completely
support and accept the patient no matter what
he says or does. This is known as:
A.
B.
C.
D.
Empathy
Genuineness
Unconditional regard
Caring
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ClickerCheck Answer
Correct answer: C
Unconditional regard means providing complete
support and acceptance of a patient no matter
what the patient says or does.
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Two Types of Communication
Verbal
Nonverbal
 Spoken language
 Without use of spoken
language
 Body language
 Gestures
 Facial expressions
 Body positions
 Tone of voice
 Eye contact
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Therapeutic Communication (continued_2)
 Shared understanding of patient’s report
• Be clear and concise
• Keep questions simple
 Listen attentively
 Maintain eye contact
 Do not interrupt patient
 Avoid documenting excessive notes
 Be cognizant of your posture and nonverbal
body language
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Effective Communication Techniques
 Active listening
 Active observing
 Broad opening
questions
 Clarification
 Confrontation
 Empathy
 Respect
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
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

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Exploring
Facilitation
Focusing
Reflecting
Transitional statements
Silence
Summarizing
Barriers to Communication
 Leading the patient
 Asking too many
questions
 Not allowing enough
response time
 Using medical jargon
 Making assumptions
 Using clichés
 Offering false
reassurance
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 Asking “why” questions
 Changing the subject
inappropriately
 Giving opinions
 Stereotyping
 Using patronizing
language
Communicating with Patients with Special
Needs
 Hearing impaired
 Visually impaired
 Aphasiac patients
 Cognitively impaired
 Aggressive or challenging patients
 Patient with a language barrier
 Patient with low health literacy
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ClickerCheck (continued_1)
A 70-year-old female patient has suffered a stroke
with no paralysis. She cannot talk and is hard of
hearing. She follows you with her eyes and
understands you. What is the best way to
communicate with the patient?
A. Write down questions on a white board.
B. Ask for an interpreter to help you.
C. Speak slowly and loudly directly in front of the
patient.
D. Have the patient blink her eyes to questions she
understands.
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ClickerCheck Answer (continued_1)
Correct answer: A
The patient understands but is unable to talk.
Writing down questions on a white board will
allow the patient to read the questions and if
able, write down the answers.
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Cultural Considerations
 Many cultures and religions have restrictions
on:
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Eye contact
Touching
Distance
Modesty
Opposite sex provider
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Two Types of Questions
 Open-ended questions
• Explore the focused topic more broadly
 Closed-ended questions
• Help to clarify or focus on specific details
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Phases of the Interview
 Phase One: Introductory Phase
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Introduce yourself
Explain your role
Establish rapport and trust
Explain the purpose
Tell patient you will be taking notes
Estimate the time frame
Ask about comfort level
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Phases of the Interview (continued_1)
 Phase Two: Working Phase
• Collect data by using open- and closed-ended
questions
• Patient tells his or her story and history
• Stay alert to nonverbal cues
• Identify problems and goals
• Ask if there are any questions
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Phases of the Interview (continued_2)
 Phase Three: Summarization Phase
• Clarify and summarize the patient’s self report
• Restate the finding
• Confirm the goals
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ClickerCheck (continued_2)
You are working in a health clinic and are
starting a patient interview. You have
completed entering the demographic data.
What will be your next question?
A.
B.
C.
D.
“How are you doing today?”
“What brings you to the doctor today?”
“Do you feel sick?”
“What is your name and address?”
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ClickerCheck Answer (continued_2)
Correct answer: B
Ask an open-ended question so that the patient
can tell you the reason for the visit.
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Health History
 Starts with the review of systems (ROS)
 The ROS is a subjective report by the patient
about all body systems
 Patient may “report” or “deny” symptoms
 Pertinent positives
 Pertinent negatives
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Types of Health Histories
 Comprehensive
 Focused or problem-based
 Follow-up
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Two Types of Data Sources
1. Primary source is the patient.
2. Secondary sources can be family members,
significant others, or medical records.
 Always establish reliability of the source.
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ClickerCheck (continued_3)
Your patient is an 88-year-old man. He states that he
has been “hearing whistling” in both his ears. He
states that it almost sounds like a song. You need to
identify whether he is reliable. What question will
you ask?
A. “What is the name of the song?”
B. “Can you tell me where you live and your date of
birth?”
C. “What do you mean by whistling?”
D. “Have you seen an ear, nose, and throat doctor?”
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ClickerCheck Answer (continued_3)
Correct answer: B
Asking questions for which you can verify
information can help identify reliability. You can
check the patient’s chart to see if the address
and date of birth are correct.
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