Chapter 2: Interviewing and Therapeutic Communication

Chapter 2: Interviewing and Therapeutic Communication · All nursing practice revolves around the nurse-patient relationship, which is built upon verbal and non-verbal communication within a specific setting ↳ its foundation is the therapeutic use of self through verbal and nonverbal communication skills Communication Process · communication is a complex, ongoing process that forms the basis for building interpersonal relationships ↳ with people with aphasia, use yes-or-no questions or simple choices to reduce frustration · Therapeutic communication: a basic tool that is used in the caring relationship with patients, the interaction focuses on the patient and the patient's concerns ↳ caring: encompasses empathy for and connection with a patient. It also includes the ability to demonstrate emotional characteristics such as compassion, sensitivity, and patient-centered care ↳ empathy: means the ability to perceive, reason, and communicate understanding of another person's feelings without criticism. It includes being able to see and feel the situation from the patient's perspective ↳ self-concept: is essential to be aware of your own biases, values, personality, cultural background(s), and communication style. It is important to build this awareness through self-reflection and listening to and understanding feedback from others Nonverbal Communication Skills · Nonverbal communication is as important as, if not more important than, verbal communication ↳ physical appearance, facial expression, posture, eye contact, voice, touch (permissive) · position yourself at eye level, watch patient's nonverbal cues carefully Nontherapeutic Responses · failure to listen · false reassurance · being judgemental · changes of subject · distractions · technical or overwhelming language · interrupting · sympathy · giving advice Verbal Communication Skills · Speech should be at a moderate pace and volume with clear articulation. A too-soft voice might indicate embarrassment or discomfort, and a too-loud voice may be powerful and controlling. Speech that is too fast may make them feel rushed, and speech that is too slow may make them feel stupid. ↳ active listening, reflection, elaboration, summarizing, silence, focusing, clarification Professional Expectations · It is important to establish clear professional boundaries, becoming too involved with patients leads to burnout and decreased job satisfaction · Nonprofessional involvement occurs when the boundaries of professional relationships are crossed and a social, personal, or economic relationship with a patient is established ↳ too much personal conversation is unprofessional, as well as visiting patients beyond the role of a nurse Intercultural Communication · During intercultural communication, you must be aware that different cultures have different verbal and nonverbal communication styles. Certain gestures, expressions or phrases may appear rude, unprofessional, or with other meaning than we (or they) may intend. · Communication etiquette: refers to the code of conduct and good manners that show respect for others Patients with Limited Language Understanding · When communicating with patients with limited language proficiency, remember the following principles: ↳ limitations in language skills are not a reflection of intellectual functioning ↳ patients may be highly literate in a different language than English ↳ patients may delay responses due to thinking + translating in their native language ↳ patients interpret the message that reflects their cultural beliefs, often changing the intent ↳ written information in the native language supports verbal communication · The need for an interpreter should be established during the patient's first contact with the health care agency ↳ using children in the family, other relatives, or close friends as interpreters is not recommended because patients may not want to share personal information with others, or they may misinterpret medical information or terminology Phases of the Interview Process ① Preinteraction phase ↳ before meeting with patients, collect data from the patient health record, including previous history of illnesses or surgeries, current medication list, and list of concerns ② Beginning phase ↳ begin the interview by greeting and introducing yourself by name and stating the purpose of the interview ↳ ask patients by what name they would like to be called and correct pronunciation ↳ privacy is important, close curtains or doors before starting the interview to try to make them comfortable ③ Working phase ↳ during the working phase, collect data by asking specific questions (close-ended or open-ended) ↳ close-ended or direct questions are best for specific information that yields yes-or-no answers, such as "Do you have a family history of heart disease" - these types of questions are helpful for people with communication challenges or limited English ↳ open-ended questions require patients to give more than yes-or-no answers. They are broad and permit responses in the patient's own words ↳ document the patient's history and health issues, and balance both listening and documenting ④ Closing phase ↳ end the interview by summarizing and stating what the 2-3 most important points might be, and possibly letting the patient know the next steps ↳ give the patient a final opportunity to express any concerns and make them feel heard, and thank them for taking the time to provide information - - - - Lifespan Issues · parents, legal guardians, or other adult representatives serve as primary interview sources of health care information when patients are children · When interviewing a child or an adult with a guardian, be sure to address the patient as well as the guardian · Nonverbal communication is important with young children, who have limited language skills Special Situations · Patients with hearing impairment ↳ If you suspect that a patient has new or previously unsubstantial hearing loss, ask "Just to be sure that you understand, please repeat what I said. " ↳ small things could help, like making sure hearing aids are working, closing the door to prevent noise, give thorough explanations and supplying written information ↳ many deaf patients communicate through a combination of methods, such as signing, writing, using speech and moving the lips. Do what you can to understand the patient and have them understand you · Patients with altered level of consciousness ↳ they may be unable to communicate to provide answers to interview questions. In this case, rely on family members and previous documentation to gather necessary information · Patients with Cognitive impairment ↳ often they have word-finding difficulties. It is important to allow these patients time to process as much as possible to avoid a one-sided conversation ↳ patients with closed-headed injuries commonly have difficulties related to attention and social skills. They may need redirection and coaching on the organization and appropriateness of their communication · Patients with mental health issues ↳ they often have difficulty attending to and sequencing communication. They may process communication better if it contains clear, short phases that require one step in thinking rather than complex directions. ↳ It may be helpful to use restatement, reflection, or focusing to redirect conversation to the health topic · Patients with anxiety ↳ behaviours that indicate anxiety are nail-biting, foot-tapping, sweating, and pacing. A voice may quiver, speech may be rapid, and language or tone may be defensive ↳ use active listening, honesty, and a calm and unhurried manner to reduce anxiety · Patients who are crying ↳ When sensitive situations arise, use therapeutic communication techniques rather than progressing with additional interview questions ↳ show empathy, and provide support through silence, acknowledging feelings, or offering a tissue · patients who are angry ↳ When a patient is angry, listen for the associated themes and avoid becoming defensive or personalizing the situation ↳ validate and encourage patients to express their feelings. They may not be angry at you but rather the situation or a group of factors · Patients under the influence of alcohol or drugs ↳ patients with chemical impairment have difficulty answering complex questions, so use direct and simple questions instead ↳ Interview questions include the type of drug, amount ingested, and date and time of the last drink/dose. ↳ Be aware that they may be impaired, and their history might change due to confusion from withdrawal, or fear of judgment