Fundamentals of Nursing and Midwifery 2e

Unit III Thoughtful practice and the process of care

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TABLE 15-3 Personal variables that can negatively influence an interview and suggested responses

Personal variables

Effect on interview

Nursing and midwifery response

Normalise anxiety: ‘Many people find it difficult to talk about their health and become anxious’; approach the person gently, speak slowly and softly; underscore the importance of the person sharing what they are experiencing so you can be of help. Do everything possible to make the person comfortable before the interview, including obtaining an order for, and administering, pain medication; if pain persists, obtain only vital data and defer the remainder of the interview until the person is more comfortable. Speak clearly (do not raise your voice) using simple language; whenever possible, obtain the assistance of an interpreter (a family member may help, but it is preferable to have a healthcare interpreter, especially if the personal data are confidential) ‘I know other people who have had a tough time with healthcare professionals or the system … life isn’t perfect … but how about giving us a chance this time to show you what you can do?’ Communicate competence and respect for the person. Communicate clearly that no-one knows or understands the person as well as they know and understand themselves, and invite them to become involved in their own care: ‘No two people are alike, and unless you tell me a little more about yourself and how you are feeling, there is no way we’ll be able to plan good care.’

High anxiety

The person may speak rapidly or incoherently and may jump from one topic to another; the person may deny or misrepresent what they are experiencing. The person offers clipped responses and ‘yes’ or ‘no’ answers whenever possible; overriding concern is pain relief.

Pain

Vital personal data will not be communicated; the person may mistakenly be labelled ‘indifferent’ or ‘non-communicative’

Language difficulty (the person is not fluent in the interviewer’s language because the person speaks a different language, has limited education or fears saying the ‘wrong thing’) Previous negative experience with healthcare professionals or healthcare delivery system

The person is aloof, unwilling to participate in the interview and has the general attitude: ‘Why should I waste my time telling you anything … it won’t do me any good.’ The person expects healthcare professionals to magically know everything about them and to ‘take care’ of them; ‘surrenders’ themselves to the system—‘you know best’ attitude.

Unrealistic expectations of health professionals

Termination The successful interview is concluded carefully. The person should be advised that the interview is coming to an end. It is helpful to summarise the interview, highlighting key points. All parties involved in the interview should be satis- fied that the important data are recorded. A helpful strategy is to ask the person after the summary: ‘Is there anything else you would like us to know that will help to plan your care?’ This gives the person an opportunity to add data you did not think to include. Before terminating the interview, it is helpful to alert the person to what to expect. The person should also know when you will re-establish contact; for example, ‘Thank you for answering these questions, Miss Jones. Please feel free to keep us informed of anything you think we should know. I’ll be leaving soon, but when I return tomorrow morning,

we will discuss your plan of care. This afternoon will be busy for you—some blood tests and a chest X-ray have been ordered. Your evening will probably be quiet. Do you have any questions? Is there anything else I can do for you before I leave?’ Physical health assessment Physical health assessment is the examination of the person for objective data that may better define the person’s condition and help in planning care. The physical assess- ment normally follows the health history and interview, and may verify data gathered during the history or yield new data. Doctors traditionally have performed the initial phys- ical assessment, which commonly is the mechanism of entry into the healthcare delivery system as well as the basis for medical treatment. Some nurses and midwives in