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Reflective Analysis of Patient Interview Introduction Communication is a fundamental element of nursing, which transcends each aspect of a nurse’s professional practice (Price-Dowd, 2018). In health assessment particularly, nurses need to conduct patient interviews, where subjective information must be elicited, aside from the objective cues that can be observed. However, such data cannot be obtained accurately and thoroughly if effective communication and interviewing skills are not utilised by the nurse (Weber & Kelley, 2014). Accurate assessment data will guide nurses in planning a high quality, patient-centred and individualised nursing care, which is basically every patient’s right (Holt, 2014). With the aim of enhancing the communication skills of nursing students, a health assessment interview was recorded. Confidentiality was ensured through employing fictitious information. This essay will analyse the recorded interview, with emphasis on the essential communication skills of questioning, body language and empathy, and discuss evidence-based strategies that will improve the student nurse’s application of these interviewing techniques. Questioning Styles Questions that are discerningly worded and asked in a timely manner most often provide the good foundation for effective interviewing and exploration. Basically, there are two major questioning styles or probing skills: closed questions and open-ended questions (SteinParbury, 2017). Open-ended questions are those that need a reply of more than one word (Weber & Kelley, 2014). These questions are asked to patients and their family members to gather information about their emotions and perceptions (Raphael-Grimm, 2015). Typically, open-ended questions start with the words what, where, when, who or how. Using this type of question motivates the patient to disclose general rather than specific information (Estes, Calleja, Theobald, & Harvey, 2016). Closed questions, on the other hand, are those that limit the patient’s response, usually answerable with a yes or a no,

or just one word (Ziyaeemehr, 2016). Nurses use closed questions to elicit definite information, keep the interview on its focus, and obtain important data quickly, especially when the patient’s medical condition necessitates rapid intervention (Estes et al., 2016; Holt, 2014). However, overuse of this type of question interferes the communication. Closed questions are further sub-categorised into focused, closed questions and multiple-choice questions, wherein, the nurse’s knowledge of what is relevant to the given situation in the clinical area serves as the basis in using these questions (Stein-Parbury, 2017). Generally, open-ended questions are more useful in eliciting information though closed questions are also necessary in some situations. Nurses should therefore take into consideration the context and type of information needed, in choosing the appropriate type of question (Stein-Parbury, 2017). A good example of questioning style can be noted in the beginning of the health assessment interview when the patient was asked about what happened to her right foot, as she was seen limping in coming to the clinic. Nurse: “Tell me, what happened to your right foot?”

Patient: “Oh, I was in a hurry yesterday and when I came downstairs in the apartment, I did not notice the stairs were wet and I slipped.” (0.12) Such questioning style is appropriate because employing open-ended explorative questions during the start of the health assessment interview will give the patient the feeling that she is in control and it is her discretion as to the extent of information she is willing to share (Estes et al., 2016). Stein-Parbury (2017) explained that in responding to queries that are openended, there is more flexibility, and the patient is more enabled to highlight pertinent information. The use of open-ended questions facilitates nurse’s understanding of the patient’s primary reason for seeking medical help (Holt, 2014). This will consequently make the patient feel respected since the pressing concern was set as a priority (Estes et al., 2016).

Body Language Body language, also termed as nonverbal communication, refers to the method of communication utilising body movements, gestures, facial expression, eye contact, body posture, silence, head motion, personal space, touch and appearance (Patel, 2014). During a patient interview, these nonverbal cues of the nurse have a strong influence on how the patient will perceive the questions being asked. The facial expression needs to project a neutral expression (Weber & Kelley, 2014). Moderate eye contact must also be given, if culturally appropriate, since extremes may either bring discomfort or invoke feeling of mistrust to the patient. Some moments of silence are also beneficial to both nurse and patient, giving them time to do reflection and thought organisation, which could enhance the quality of the data collected (Weber & Kelley, 2014). Moreover, it is important to maintain a social distance during the interview so that the nurse can observe the patient’s nonverbal cues and hear patient’s voice clearly (Estes et al., 2016). Touch should also be used mindfully as not all situations warrant its applicability. In the interview, the nurse demonstrated appropriate body language as she was actively listening to the patient, with eye contact and occasional affirmative head nodding. Nurse: “And spirituality wise, what is the religion that you practice?” Patient: “Yah, I’m a Seventh-Day Adventist.” Nurse: “Oh, that’s interesting. So, as an Adventist, are there any specific needs or considerations?” Patient: “Yah, with regards to food, there are foods that we are avoiding such as pork, shrimps or crustaceans.” Nurse: “Pork, shrimps and crustaceans.” Patient: “I think that’s it.” (5.14)

This is a good example where body language was appropriately manifested by the nurse whilst attentively listening to the patient, as evidenced by eye contact and head nodding to show affirmation to what the patient was telling her. Patel (2014) cited that head movement is

significant because nods and shakes, when appropriately done, intensify the degree of communication. Furthermore, good eye contact relays sincerity and integrity, conveys open communication and indicates that feedback is needed (Phutela, 2015). In the health care setting, patients may experience anxiety, fear and worry to a significant extent that they tend to lose their self-control. To pacify their anxiety and maintain their self-control, they usually look on nurses’ nonverbal cues and rely on these behaviours on how they act and respond to questions (Estes et al., 2016). Lange (2016) pointed out that when nurses are mindful of their body language and become proficient in this aspect of communication, patients will become more confident in them too. More importantly, patients’ level of comfort, sense of control and eagerness to disclose information will also be positively influenced (Estes et al., 2016). Empathy Empathy is viewed as a basic attribute of nursing, integral to establishing a therapeutic nursepatient relationship (Petrucci, La Cerra, Aloisio, Montanari, & Lancia, 2016). It is defined as a person’s ability to discern the feelings and thoughts of another person, visualising how it feels being in that person’s circumstances (Raphael-Grimm, 2015). In the patient care context, empathy’s definition not only involves discernment of the patient’s circumstances and perceptions, but also the desire to help (ter Beest, van Bemmel, & Adriaansen, 2018). Raphael-Grimm (2015) further discussed that although nurses may have empathy, the patient will not benefit unless they have the ability and necessary skills to effectively express that empathy to the patient. To achieve this, she suggested utilising the principles of mindfulness. Using this framework, nurses initially reflect on the patient’s unique experience by looking beyond their own necessities and stepping on the patient’s shoes. In doing this step, hypotheses about the patient’s situation are developed and tested through patient interaction using open-ended questions. As the patient is guided to describe the experience, the nurse then recognises that the patient’s situation is of importance. In doing so, the patient will feel that his or her distress is fully attended to by the nurse (Raphael-Grimm, 2015). Analysing the recorded patient interview, it can be observed that the nurse exhibited lack of empathy when the nurse explored about the patient’s condition. Nurse: “That must be painful. But is it manageable?” Patient: “Yeah, but when I’m sitting, it doesn’t hurt that much, it’s tolerable. But when I’m walking, it hurts a lot.” Nurse: “Okay. So, I am Ethel, I am your student nurse. And I understand that you came here to consult with Dr. Smith. But before he will come to check you, I will just need to ask you series of questions…” (0.26) This is a poor example of empathy because the nurse seemed in a hurry to go on with the interview. Weber and Kelley (2014) stated that the patient usually notices when the nurse is in a rush and may also attempt to help hasten the interview by giving quick, incomplete and abbreviated answers. This situation may reflect that the nurse is not concerned enough with the pain complaint of the patient. In this example, the nurse could have better explored the patient’s feeling of discomfort by asking about the rate of pain and reassurance could have been given that the patient can interrupt the nurse anytime during the interview, if the pain becomes distressing and intolerable (Stein-Parbury, 2017). If empathy is effectively expressed, the patient will then experience high quality of nursing care, thus producing

enhanced self-esteem, increased satisfaction and improved health outcomes (Petrucci et al., 2016; Teófilo et al., 2019).

Conclusion In conclusion, reflective analysis of the recorded health assessment interview revealed both good and poor examples of the student nurse’s communication skills of questioning, body language and empathy. Though using open-ended questions is more effective in the data collection, appropriate use of closed questions is also necessary, especially in obtaining specific information. During a patient interview, the nurse must also be mindful of his or her body language as this could affect patient’s perception of the questions being asked. Furthermore, showing empathy to the patient during the interview process will similarly produce positive outcomes as patient feels valued and acknowledged. Applying these evidence-based strategies in the patient interview will not only yield an accurate assessment data but more importantly, provide a foundation for a meaningful nurse-patient relationship and interventions that are tailored to the patient’s unique health care needs.

References

Estes, M., Calleja, P., Theobald, K., & Harvey, T. (2016). Health assessment and physical examination (2nd ed.). South Melbourne, Victoria: Cengage Learning Australia. Retrieved from https://ebookcentral.proquest.com Holt, P. (2014). Role of questioning skills in patient assessment. British Journal of Nursing, 4(19), 1145-1146. Retrieved from https://magonlinelibrary.com Lange, C. (2016). Nursing and the importance of body language. Nursing, 46(4), 48-49. doi:10.1097/01.NURSE.0000481421.03964.34 Patel, D. (2014). Body language: An effective communication tool. IUP Journal of English Studies, 9(2), 90-95. Retrieved from https://search-proquestcom.ezproxy.ecu.edu.au/docview/1613914504 Petrucci, C., La Cerra, C., Aloisio, F., Montanari, P., & Lancia, L. (2016). Empathy in health professional students: A comparative cross-sectional study. Nurse Education Today, 41, 1-5. doi:10.1016/j.nedt.2016.03.022 Phutela, D. (2015). The importance of non-verbal communication. IUP Journal of Soft Skills, 9(4), 43-49. Retrieved from https://search-proquestcom.ezproxy.ecu.edu.au/docview/1759007009 Price-Dowd, C. (2018). Communication is a two-way street. British Journal of Nursing, 27(3), 171. doi:10.12968/bjon.2018.27.3.171 Raphael-Grimm, T. (2015). Art of communication in nursing and health care: An interdisciplinary approach. New York: Springer Publishing Company. Retrieved from https://ebookcentral.proquest.com Stein-Parbury, J. (2017). Patient and person: Interpersonal skills in nursing (6th ed). Chatswood, NSW: Elsevier. Retrieved from https://www-elsevier-elibrary-com. 8 Teófilo, T., Veras, R., Silva, V., Cunha, N., Oliveira, J., & Vasconcelos, S. (2019). Empathy in the nurse-patient relationship in geriatric care: An integrative review. Nursing Ethics, 26(6), 1585-1600. doi:10.1177/0969733018787228 ter Beest, H., van Bemmel, M., & Adriaansen, M. (2018). Nursing student as patient: Experiential learning in a hospital simulation to improve empathy of nursing students. Scandinavian Journal of Caring Sciences, 32(4), 1390-1397. doi:10.1111/scs.12584 Weber, J. & Kelley, J. (2014). Health Assessment in Nursing (5th ed.). Philadelphia: Lippincott Williams & Wilkins. Ziyaeemehr, A. (2016). Use of questioning techniques and the cognitive thinking processes involved in student-lecturer interactions. International Journal of Humanities and Cultural Studies, 3(1), 1427-1442. Retrieved from https://www.ijhcs.com/index.php/ijhcs/article/download/1432/1304...