Physical Examination and Health Assessment, 8th Edition Chapter 03- The Interview PDF

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Jarvis: Physical Examination and Health Assessment, 8th Edition Chapter 03: The Interview Answer Keys: Study Guide and Lab Manual 1.

Eight items for communication: 1) 2) 3) 4) 5) 6)

Time and place of the interview and succeeding physical examination. Introduction of yourself and a brief explanation of your role. The purpose of the interview. How long it will take. Expectation of participation for each person. Presence of any other people (such as family members, other health professionals, or students). 7) Confidentiality and to what extent it may be limited. 8) Any costs that the patient must pay. 2.

Points to consider: • Ensure privacy. • Refuse interruptions. • For the physical environment: Set the room temperature to a comfortable level. Provide sufficient lighting. Reduce noise. Remove distracting objects or equipment (leave professional equipment needed for the examination). o Consider the distance between yourself and the patient, and place yourself 4 to 5 feet (twice arm’s length) between you. o Arrange equal-status seating—both should be seated comfortably, at eye level. o Arrange face-to-face position when interviewing the bedridden patient. o o o o

• The patient should remain in dress clothes, except in emergency cases. • The interviewer should be wearing conservative, appropriate clothing. • Keep note-taking to a minimum, and focus your attention on the patient.

3.

Pros of note-taking: • It is difficult to rely on memory alone to furnish details of previous hospitalizations or other information the patient may provide. • Cons of note-taking: • • • • •

Breaks eye contact. Shifts attention away from the person, thus reducing his or her sense of importance. It can interrupt the patient’s narrative flow. It impedes the interviewer’s observation of the patient’s nonverbal behavior. When discussing sensitive issues, it may be threatening to the patient.

4. The open-ended question asks for narrative information; it states the topic to be discussed but only in general terms. These questions let the person express himself or herself fully. The closed or direct question asks for specific information; it elicits a short, one- or twoword answer, such as a yes or no, or a forced choice. The direct question limits the patient’s answer. 5. Please refer to page 33 in text for specific examples. Examiner responses include the following: 1) Facilitation—These responses encourage the patient to say more or to continue with the story. Examples: “mm-hmm, go on, continue, uh-huh.” 2) Silence—Silent attentiveness, especially after open-ended questions, communicates that the patient has time to think and organize what he or she wishes to say without interruption from the interviewer. 3) Reflection—This response echoes the patient’s words; by repeating what the person has just said, further attention is focused on a specific phrase, which helps the person elaborate on the subject. 4) Empathy—An empathic response recognizes a feeling and puts it into words. It names the feeling and allows for it to be expressed. An empathic response helps the patient to feel accepted and to deal with the feeling openly. 5) Clarification—If the person’s word choice is confusing or ambiguous, clarification can be used to better explain his or her thoughts. 6) Confrontation—The interviewer, when observing a certain action, feeling, or statement, gives his or her honest assessment about what is seen or felt. The feedback may focus on a discrepancy, on the person’s affect, or on inconsistencies in the person’s story. 7) Explanation—Sharing factual and objective information. 8) Summary—A final review of what the interviewer understands that the patient has said. It condenses the facts and serves as the interviewer’s perception of the health problem or need.

6.

Traps of interviewing include the following: 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 “why” questions.

7.

Nonverbal behaviors include the following: 1) 2) 3) 4) 5) 6)

Physical appearance. Posture. Gesture. Facial expression. Eye contact. Voice.

9. When interviewing the older person, be alert for expressions of hopelessness or despair about the patient’s present life or the future. Always address the person by his or her last name, such as “Hello, Mr. Simmons.” Adjust the pace of the interview to the older person; it may take longer for an older person to tell his or her story, or the person may require a longer response time. Do not hurry the interview along. Consider that physical limitations may cause the older person to fatigue earlier. Consider that hearing impairment may exist, and be sure to face the person fully and avoid shouting. Touch may be a helpful nonverbal skill that is important to older persons and may convey an empathetic message. 10. When working with a hearing-impaired person, first ask his or her preferred way of communication—by sign language, lip reading, or writing. To perform a complete health history, a sign language interpreter will be needed. If the person prefers lip reading, be sure to face him or her squarely and have good lighting on your face. Be aware that a beard or mustache or foreign accent may make lip reading difficult for some people. Talk normally, without shouting or exaggerating lip movements—these actions distort your words. Speak slowly and supplement your voice with appropriate hand gestures. Written communication is efficient in sections of the health history such as past history, family history, or review of symptoms. However, for some parts of the interview, writing is time consuming and laborious....