Fundamentals of Nursing and Midwifery 2e

Chapter 15 Assessing

279

person is in bed, placing a chair at a 45°angle to the bed is helpful. If the interviewer stands at the foot or side of the person’s bed and physically talks or looks down at the person, a superior–inferior relationship is communicated and can negatively affect the interview. Whenever possible, it is best to communicate at eye level. The interview should be scheduled when both you and the person are free of concerns and distractions, so that the person concentrates on the task. Ten to fifteen minutes may be all that is necessary in some circumstances, whereas an hour or more may be required in others. Information can be gathered in several meetings, especially if you notice that the person is tiring or is in pain. Introduction The introduction to the interview is crucial because it sets the tone not only for the remainder of the interview but also for every following interaction. At the end of this phase of the interview, the person should know your name, know what care to expect, sense your competency and should also know what is expected of them in terms of developing the plan of care and participating in its execution. You initiate the interview by stating your name and status, identifying the purpose of the interview, and clarify- ing your role and that of the person. A typical introduction might run like this: ‘Good afternoon, Miss Jones. My name is Lisa Gray and I am the student looking after you today. Right now I’d like to ask you a few questions about yourself so that we can plan your care together. Feel free to respond only to those questions you feel comfortable answering, and know that your responses will be treated confidentially by the staff. This will take about 20 minutes. Is this time convenient for you? Do you need anything before we start?’ The initial impression you create is crucial, especially with people who are new to the healthcare environment. All

nurses or midwives whom the person encounters in the future may be judged in the light of this first impression. Showing genuine concern and respect will encourage the person to discuss their health problems and worries freely. The interpersonal qualities of a respectful presence, profes- sionalism and caring encourages confidence and ensures that the person feels that help is available. During the introduction, you should assess the person’s comfort and ability to participate in the interview. It is also appropriate to assure the person of confidentiality. The person should know where the data being recorded are stored, how they will be used and who has access to them. Some nurses and midwives record data on the appropri- ate form while with the person, whereas others may take notes and complete the form later. The use of bedside com- puters is now facilitating quick documentation. However, documenting data should not interfere with the sharing of information during the interview. In unusual situations there may be the requirement for an additional agreement that clearly identifies the responsibilities of the person and the nurse or midwife (e.g. a nurse practitioner or independent midwife). In this case, the terms are discussed at this time. Working phase During the working phase of the interview, you gather all the information needed to form the subjective database. The accuracy, completeness and relevance of the database depend on your use of the interviewing and basic communication techniques discussed in Chapter 7. The communication tech- niques highlighted in Box 15-3 are important guidelines for a successful interview. Personal issues may positively or negatively affect the outcome of an interview. Table 15-3 identifies personal vari- ables that can negatively influence an interview unless you respond appropriately.

BOX 15-3 Communication techniques for a successful interview

• Focus on the person during the interview, demonstrating interest and concern: use the person’s name of choice, use eye contact appropriately and avoid rushing. • Listen attentively to the person; use reflection and paraphrase to communicate that you understand what the person is saying. • Ask about the person’s main problem first, using terminology the person understands; save personal or delicate questions for later, when a rapport has been established. Defer less important questions until a later interview if the person is too ill or upset to communicate easily. • Pose questions and comments to the person in the manner best suited to produce the desired communication (see Chapter 7): — Closed questions elicit specific information. For example, yes/no answers. — Open-ended questions allow the person to verbalise freely. — Reflective questions encourage the person to elaborate on thoughts and feelings. — Direct questions can validate information, clarify information or place events into a meaningful sequence. • Avoid comments and questions that impede communication (see Chapter 7)—clichés, questions that require a ‘yes’ or ‘no’ answer only, intimidating ‘why’ or ‘how’ questions, probing questions, giving advice, using judgemental comments, changing the subject and giving false assurance. • Use silence and touch appropriately.