NR i509 iMidterm iStudy iGuide iWeek i3
Ch. i1
● Basic iand iAdvanced iInterviewing iTechniques
Basic Interviewing Techniques
i i
● Active ilistening: iActive ilistening imeans iclosely iattending ito iwhat ithe
ipatient iis icommunicating, iconnecting ito ithe ipatient's iemotional istate,
iandiusing iverbal iand inonverbal iskills ito iencourage ithe ipatient ito iexpand
ion ihis ior iher ifeelings iand iconcerns.
Empathic iresponses: iEmpathy ihas ibeen idescribed ias ithe icapacity ito
iidentifyiw ith ithe ipatient iand ifeel ithe ipatient's ipain ias iyour iown, ithen
irespond iin ia isupportive imanner.
Guided iquestioning: iGuided iquestions ishow iyour isustained iinterest iin
itheipatient's ifeelings iand ideepest idisclosures iand iallows ithe iinterviewer
itoifacilitate ifull icommunication, iin ithe ipatient's iown iwords, iwithout
iinterruption.
Nonverbal icommunication: iNonverbal icommunication iincludes ieye icontact,
ifacial iexpression, iposture, ihead iposition iand imovement isuch ias ishaking
ior inodding, iinterpersonal idistance, iand iplacement i_of_ ithe iarms ior ilegs—
icrossed, ineutral, ior iopen.
Validation: iValidation ihelps ito iaffirm ithe ilegitimacy i_of_ ithe ipatient'siemotional
iexperience.
Reassurance: iReassurance iis ian iappropriate iway ito ihelp ithe ipatient ifeel
ithatiproblems ihave ibeen ifully iunderstood iand iare ibeing iaddressed.
Partnering: iWhen ibuilding irapport iwith ipatients, iexpress iyour icommitment
itoian iongoing irelationship.
Summarization: iGiving ia icapsule isummary i_of_ ithe ipatient's istory iduring
itheicourse i_of_ ithe iinterview ito icommunicate ithat i you ihave ibeen ilistening
icarefully.
Transitions: iInform iyour ipatient iwhen iyou iare ichanging idirections iduring
itheiinterview.
Empowering ithe ipatient: iEmpower ipatients ito iask iquestions, iexpress itheir
iconcerns, iand iprobe iyour irecommendations iin iorder ito iencourage ithemito
iadopt i your iadvice, imake ilifestyle ichanges, ior itake imedications ias
iprescribed.
Advanced iInterview iTechniques
, 2
Determine iscope i_of_ iassessment: iFocused ivs. iComprehensive:
Comprehensive: iUsed ipatients iyou iare iseeing ifor ithe ifirst
timeiin ithe i_of_fice ior ihospital. iIncludes iall ithe ielements i_of_
i
theihealth ihistory iand icomplete iphysical iexamination.
i
Is iappropriate ifor inew ipatients iin ithe i_of_fice ior
ihospital iProvides ifundamental iand ipersonalized
iknowledge iabout
the ipatient
Strengthens ithe iclinician–patient irelationship
iiHelps iidentify ior irule iout iphysical icauses irelated itoipatient
iconcerns
Provides ia ibaseline ifor ifuture iassessments
iCreates ia iplatform ifor ihealth ipromotion ithrough
education i and i counseling
Develops ipr_of_iciency iin ithe iessential iskills i_of_
iphysicaliexamination
Focused: iFor ipatients iyou iknow iwell ireturning ifor iroutine
icare, ior ithose iwith ispecific i“urgent icare” iconcerns ilike
isoreithroat ior iknee ipain. iYou iwill iadjust ithe iscope i_of_ iyour
ihistory iand iphysical iexamination ito ithe isituation iat ihand,
ikeeping iseveral ifactors iin imind: ithe imagnitude iand iseverity
_of_ ithe ipatient’s iprob- ilems; ithe ineed ifor ithoroughness;ithe
iclinical isetting—inpatient ior ioutpatient, i primary ior
isubspecialty icare; iand ithe itime iavailable.
Is iappropriate ifor iestablished ipatients, iespecially
iduringiroutine ior iurgent icare i visits
Addresses ifocused iconcerns ior isymptoms
Assesses i symptoms i restricted i to i a i specific i body
i systemiApplies iexamination imethods irelevant ito
iassessing itheiconcern ior iproblem ias ithoroughly iand
icarefully ias
possible
Being iaware i_of_ iyour ireactions ihelps idevelop iyour iclinical iskills.
Your isuccess iin ieliciting ithe ihistory ifrom idifferent itypes i_of_
ipatientsigrows iwith iexperience, ibut itake iinto iaccount i your iown
istressors, isuch ias ifatigue, imood, iand ioverwork.
Self-care iis ialso iimportant iin icaring ifor iothers. iEven iif ia ipatient iis
ichallenging, ialways iremember ithe iimportance i_of_ ilistening ito
itheipatient iand iclarifying ihis ior iher iconcerns.
Components i_of_ ithe iHealth
iHistoryiInitial iinformation
Date iand itime i_of_ ihistory-time iis iespecially iimportant iin
iemergentisituations
Identifying idata-age, igender, imarital istatus, ioccupation-identify isource
_of_ ihistory iie: ifamily imember, ifriend ietc.
, 3
Reliability-usually idocumented iat iend i_of_ iinterview iie: i“patient iis
ivagueiwhen idescribing isymptoms”.
Chief iComplaint(s)
Try ito iquote ithe ipatients
iwordsiPresent iIllness
Complete, iclear iand ichronological idescription i_of_ ithe
iproblemiprompting ithe ipatient ivisit
Onset, isetting iin iwhich iit ioccurred, imanifestations iand iany
itreatmentsiShould iinclude i7 iattributes i_of_ ia isymptom:
Locationi
Quality
Quantity ior iseverity
Timing, ionset, iduration,
ifrequencyiSetting iin iwhich iit
ioccurs iAggravating ior irelieving
ifactors iAssociated imanifestations
Differential idiagnosis iis iderived ifrom ithe i“pertinent ipositives” iand i“pertinent
inegatives”iwhen idoing iReview i_of_ iSystems ithat iare irelevant ito ithe ichief icomplaint.
Present iillness ishould ireveal ipatient’s iresponses ito ihis ior iher isymptoms iand iwhat ieffect
ithisihas ion itheir ilife.
Each isymptom ineeds iits iown iparagraph iand ia ifull idescription.
Medication ishould ibe idocumented, iname, idose, iroute, iand ifrequency. iHome iremedies, inon-
iprescriptions idrugs, ivitamins, imineral ior iherbal isupplements, ioral icontraceptives, ior
iborrowed imedications.
Allergies-foods, iinsects, ior ienvironmental, iincluding ispecific ireaction
i Tobacco iuse, iincluding ithe itype. iIf isomeone ihas iquit, inote ifor ihow ilong
Alcohol iand idrug iuse ishould ialways ibe iinvestigated iand iis i_of_ten ipertinent ito
itheiPresenting iIllness.
Past ihistory
Childhood iIllness: imeasles, irubella, imumps, iwhooping icough,
ichickenpox, irheumatic ifever, iscarlet ifever, iand ipolio. iAlso iinclude
ianyichronic ichildhood iillness
Adult iillnesses: iProvide iinformation iin ieach i_of_ ithe i4 iareas:
, 4
Medical: idiabetes, ihypertension, ihepatitis, iasthma iand iHIV;
ihospitaliations; inumber iand igender i_of_ isexual ipartners;
iandirisk itaking isexual ipractices.
Surgical: idates, iindications, iand itypes i_of_ ioperations
iObstetric/gynecologic: iObstetric ihistory, imenstrual ihistory,
methods i_of_ icontraception, iand isexual ifunction.
Psychiatric: iIllness iand itime iframe, idiagnoses,
ihospitalizations,iand itreatments.
Health iMaintenance: iFind iout iif ithey iare iup ito idate ion
iimmunizationsiand iscreening itests.
Family ihistory
Outlines ior idiagrams iage iand ihealth, ior iage iand icause
i_of_ideath, i_of_ isiblings, iparents, iand igrandparents
Documents ipresence ior iabsence i_of_ ispecific iillnesses iin
ifamily, isuch ias ihypertension, icoronary iartery idisease,
ielevated icholesterol ilevels, istroke, idiabetes, ithyroid ior
irenal idisease, iarthritis, ituberculosis, iasthma ior ilung
idisease, iheadache, iseizure idisorder, imental iillness,
isuicide,isubstance iabuse, iand iallergies, iand isymtoms
ireported iby ipatient.
Ask iabout ihistory i_of_ ibreast, iovarian, icolon, ior
iprostateicancer
Ask iabout iGenetically itransmitted idiseases
Personal ior isocial ihistory
Describes i educational i level, i occupation, i family i _of_
i origin,icurrent ihousehold, ipersonal iinterests, iand ilifestyle
Capture ithe ipatients ipersonality iand iinterests, isources
i_of_isupport, icoping istyle, istrengths, iand iconcerns
Includes ilifestyle ihabits ithat ipromote ihealth ior icreate
i risk,isuch ias iexercise iand idiet, isafety imeasures, isexual
ipractices, iand iuse i_of_ ialcohol, idrugs, iand itobacco
Expanded i personal i and i social i history i personalizes
i yourirelationship i with i the ipatient i and ibuilds i a irapport
Review i_of_ isystems
Documents ipresence ior iabsence i_of_ icommon
i symptomsirelated i to i each i _of_ i the i major i body i systems
Understanding iand i using i Review i _of_ i Systems i questions i may
iseem ichalleng- iing iat ifirst. iThese i“yes-no” iquestions ishould
Ch. i1
● Basic iand iAdvanced iInterviewing iTechniques
Basic Interviewing Techniques
i i
● Active ilistening: iActive ilistening imeans iclosely iattending ito iwhat ithe
ipatient iis icommunicating, iconnecting ito ithe ipatient's iemotional istate,
iandiusing iverbal iand inonverbal iskills ito iencourage ithe ipatient ito iexpand
ion ihis ior iher ifeelings iand iconcerns.
Empathic iresponses: iEmpathy ihas ibeen idescribed ias ithe icapacity ito
iidentifyiw ith ithe ipatient iand ifeel ithe ipatient's ipain ias iyour iown, ithen
irespond iin ia isupportive imanner.
Guided iquestioning: iGuided iquestions ishow iyour isustained iinterest iin
itheipatient's ifeelings iand ideepest idisclosures iand iallows ithe iinterviewer
itoifacilitate ifull icommunication, iin ithe ipatient's iown iwords, iwithout
iinterruption.
Nonverbal icommunication: iNonverbal icommunication iincludes ieye icontact,
ifacial iexpression, iposture, ihead iposition iand imovement isuch ias ishaking
ior inodding, iinterpersonal idistance, iand iplacement i_of_ ithe iarms ior ilegs—
icrossed, ineutral, ior iopen.
Validation: iValidation ihelps ito iaffirm ithe ilegitimacy i_of_ ithe ipatient'siemotional
iexperience.
Reassurance: iReassurance iis ian iappropriate iway ito ihelp ithe ipatient ifeel
ithatiproblems ihave ibeen ifully iunderstood iand iare ibeing iaddressed.
Partnering: iWhen ibuilding irapport iwith ipatients, iexpress iyour icommitment
itoian iongoing irelationship.
Summarization: iGiving ia icapsule isummary i_of_ ithe ipatient's istory iduring
itheicourse i_of_ ithe iinterview ito icommunicate ithat i you ihave ibeen ilistening
icarefully.
Transitions: iInform iyour ipatient iwhen iyou iare ichanging idirections iduring
itheiinterview.
Empowering ithe ipatient: iEmpower ipatients ito iask iquestions, iexpress itheir
iconcerns, iand iprobe iyour irecommendations iin iorder ito iencourage ithemito
iadopt i your iadvice, imake ilifestyle ichanges, ior itake imedications ias
iprescribed.
Advanced iInterview iTechniques
, 2
Determine iscope i_of_ iassessment: iFocused ivs. iComprehensive:
Comprehensive: iUsed ipatients iyou iare iseeing ifor ithe ifirst
timeiin ithe i_of_fice ior ihospital. iIncludes iall ithe ielements i_of_
i
theihealth ihistory iand icomplete iphysical iexamination.
i
Is iappropriate ifor inew ipatients iin ithe i_of_fice ior
ihospital iProvides ifundamental iand ipersonalized
iknowledge iabout
the ipatient
Strengthens ithe iclinician–patient irelationship
iiHelps iidentify ior irule iout iphysical icauses irelated itoipatient
iconcerns
Provides ia ibaseline ifor ifuture iassessments
iCreates ia iplatform ifor ihealth ipromotion ithrough
education i and i counseling
Develops ipr_of_iciency iin ithe iessential iskills i_of_
iphysicaliexamination
Focused: iFor ipatients iyou iknow iwell ireturning ifor iroutine
icare, ior ithose iwith ispecific i“urgent icare” iconcerns ilike
isoreithroat ior iknee ipain. iYou iwill iadjust ithe iscope i_of_ iyour
ihistory iand iphysical iexamination ito ithe isituation iat ihand,
ikeeping iseveral ifactors iin imind: ithe imagnitude iand iseverity
_of_ ithe ipatient’s iprob- ilems; ithe ineed ifor ithoroughness;ithe
iclinical isetting—inpatient ior ioutpatient, i primary ior
isubspecialty icare; iand ithe itime iavailable.
Is iappropriate ifor iestablished ipatients, iespecially
iduringiroutine ior iurgent icare i visits
Addresses ifocused iconcerns ior isymptoms
Assesses i symptoms i restricted i to i a i specific i body
i systemiApplies iexamination imethods irelevant ito
iassessing itheiconcern ior iproblem ias ithoroughly iand
icarefully ias
possible
Being iaware i_of_ iyour ireactions ihelps idevelop iyour iclinical iskills.
Your isuccess iin ieliciting ithe ihistory ifrom idifferent itypes i_of_
ipatientsigrows iwith iexperience, ibut itake iinto iaccount i your iown
istressors, isuch ias ifatigue, imood, iand ioverwork.
Self-care iis ialso iimportant iin icaring ifor iothers. iEven iif ia ipatient iis
ichallenging, ialways iremember ithe iimportance i_of_ ilistening ito
itheipatient iand iclarifying ihis ior iher iconcerns.
Components i_of_ ithe iHealth
iHistoryiInitial iinformation
Date iand itime i_of_ ihistory-time iis iespecially iimportant iin
iemergentisituations
Identifying idata-age, igender, imarital istatus, ioccupation-identify isource
_of_ ihistory iie: ifamily imember, ifriend ietc.
, 3
Reliability-usually idocumented iat iend i_of_ iinterview iie: i“patient iis
ivagueiwhen idescribing isymptoms”.
Chief iComplaint(s)
Try ito iquote ithe ipatients
iwordsiPresent iIllness
Complete, iclear iand ichronological idescription i_of_ ithe
iproblemiprompting ithe ipatient ivisit
Onset, isetting iin iwhich iit ioccurred, imanifestations iand iany
itreatmentsiShould iinclude i7 iattributes i_of_ ia isymptom:
Locationi
Quality
Quantity ior iseverity
Timing, ionset, iduration,
ifrequencyiSetting iin iwhich iit
ioccurs iAggravating ior irelieving
ifactors iAssociated imanifestations
Differential idiagnosis iis iderived ifrom ithe i“pertinent ipositives” iand i“pertinent
inegatives”iwhen idoing iReview i_of_ iSystems ithat iare irelevant ito ithe ichief icomplaint.
Present iillness ishould ireveal ipatient’s iresponses ito ihis ior iher isymptoms iand iwhat ieffect
ithisihas ion itheir ilife.
Each isymptom ineeds iits iown iparagraph iand ia ifull idescription.
Medication ishould ibe idocumented, iname, idose, iroute, iand ifrequency. iHome iremedies, inon-
iprescriptions idrugs, ivitamins, imineral ior iherbal isupplements, ioral icontraceptives, ior
iborrowed imedications.
Allergies-foods, iinsects, ior ienvironmental, iincluding ispecific ireaction
i Tobacco iuse, iincluding ithe itype. iIf isomeone ihas iquit, inote ifor ihow ilong
Alcohol iand idrug iuse ishould ialways ibe iinvestigated iand iis i_of_ten ipertinent ito
itheiPresenting iIllness.
Past ihistory
Childhood iIllness: imeasles, irubella, imumps, iwhooping icough,
ichickenpox, irheumatic ifever, iscarlet ifever, iand ipolio. iAlso iinclude
ianyichronic ichildhood iillness
Adult iillnesses: iProvide iinformation iin ieach i_of_ ithe i4 iareas:
, 4
Medical: idiabetes, ihypertension, ihepatitis, iasthma iand iHIV;
ihospitaliations; inumber iand igender i_of_ isexual ipartners;
iandirisk itaking isexual ipractices.
Surgical: idates, iindications, iand itypes i_of_ ioperations
iObstetric/gynecologic: iObstetric ihistory, imenstrual ihistory,
methods i_of_ icontraception, iand isexual ifunction.
Psychiatric: iIllness iand itime iframe, idiagnoses,
ihospitalizations,iand itreatments.
Health iMaintenance: iFind iout iif ithey iare iup ito idate ion
iimmunizationsiand iscreening itests.
Family ihistory
Outlines ior idiagrams iage iand ihealth, ior iage iand icause
i_of_ideath, i_of_ isiblings, iparents, iand igrandparents
Documents ipresence ior iabsence i_of_ ispecific iillnesses iin
ifamily, isuch ias ihypertension, icoronary iartery idisease,
ielevated icholesterol ilevels, istroke, idiabetes, ithyroid ior
irenal idisease, iarthritis, ituberculosis, iasthma ior ilung
idisease, iheadache, iseizure idisorder, imental iillness,
isuicide,isubstance iabuse, iand iallergies, iand isymtoms
ireported iby ipatient.
Ask iabout ihistory i_of_ ibreast, iovarian, icolon, ior
iprostateicancer
Ask iabout iGenetically itransmitted idiseases
Personal ior isocial ihistory
Describes i educational i level, i occupation, i family i _of_
i origin,icurrent ihousehold, ipersonal iinterests, iand ilifestyle
Capture ithe ipatients ipersonality iand iinterests, isources
i_of_isupport, icoping istyle, istrengths, iand iconcerns
Includes ilifestyle ihabits ithat ipromote ihealth ior icreate
i risk,isuch ias iexercise iand idiet, isafety imeasures, isexual
ipractices, iand iuse i_of_ ialcohol, idrugs, iand itobacco
Expanded i personal i and i social i history i personalizes
i yourirelationship i with i the ipatient i and ibuilds i a irapport
Review i_of_ isystems
Documents ipresence ior iabsence i_of_ icommon
i symptomsirelated i to i each i _of_ i the i major i body i systems
Understanding iand i using i Review i _of_ i Systems i questions i may
iseem ichalleng- iing iat ifirst. iThese i“yes-no” iquestions ishould
