NUR 3068 PHYSICAL ASSESSMENT AND HEALTH CARE EXAM 1

NUR 3068 PHYSICAL ASSESSMENT AND HEALTH CARE EXAM 1 CHAPTER 3: THE INTERVIEW • Physical Environment Considerations: o “Defining the environment so as to foster communication” ■ Ensure Privacy - aim for “geographic” privacy but ensure “psychological” privacy as well. ■ Avoid Interruptions - Concentrate and establish rapport; minimize and/or refuse. ■ Physical Environment - “Equal status” seating (sitting at the same level), placing client 4 to 5 feet away from you. ■ Dress - Client should remain in street clothes for interview. Gown causes power differential and may make client feel exposed. Build rapport before asking client to change into gown. Your appearance should be professional and avoid extremes. Promote professional image for self. ■ Note-taking - keep to a minimum, offer focused attention. Jot notes down, but also keep non-verbal communication up to par. ● Verbal / Non-Verbal Communication: o Verbal Communication: • Patient Perspective (Reaction—Patient leads): ▪ Facilitation: Encourages patient to say more and shows them you are interested. ▪ Silence: Directed attentiveness; provides chance to observe client and note non- verbal cues. ▪ Reflection: Echoing patient’s words to help elaborate problem. ▪ Empathy: Names a feeling and allows its expression. ▪ Clarification: Asking for confirmation and summarizing patient’s words. • Interviewer Perspective (Your thoughts—Nurse leads): ▪ Confrontation: Clarifying inconsistent information. ▪ Interpretation: Makes association to identify cause or conclusion. ▪ Explanation: Informing person by sharing factual and objective information. ▪ Summary: Provides conclusion based on verified information which in turn, identifies that the interview process is closing. o Nonverbal Communication: (Body language helps to provide cues which may be correlated with truer feelings) • Physical appearance: Image as initial perception. “First impression”. • Posture: Interpretation of body language can impact engagement with client. • Gestures: Gestures send messages so be aware of your own, as well as the client’s. • Facial expression: Reflects emotion and culture. Pay attention to your own facial expressions as well. • Eye contact: Maintain within the realm of interest, but be mindful of cultural diversity. Lack of eye contact may show the client may be shy, withdrawn, confused, bored, intimidated, etc. • Voice: Be aware of tone, intensity, and rate of speech. • Touch: Interpretation is influenced by age, gender, cultural background, past experience, and current setting. * Recognize importance of unconscious messages * When verbal and nonverbal messages are congruent, the verbal message is reinforced. * When they are incongruent, nonverbal message is viewed as the true one as it is under unconscious control * Can be viewed as either positive or negative therapy promoting the importance of self-awareness in order to promote communication. o For people with special needs: * Consider key elements that will address vulnerable populations • Acutely ill, drug/alcohol abuse, sexually aggressive, emotionally distraught (crying), angry and or threatening violence and anxious * Use appropriate resources as they relate to the context of the situation * Be alert to “personal questions” queries as they may indicate ulterior motives: • Provide appropriate response based on personal ethics o Types of questions : * Open ended - asks for narrative information * Closed ended - asks for specific information leading to a forced choice (yes/no) AVOID: -leading or biased questions -use “why” questions ● Therapeutic Responses: ▪ Build rapport and continue therapeutic relationship and using therapeutic touch. Use therapeutic touch to provide empathy. • Language Barriers: o Potential exists f