WEEK 4 MODULE; HEALTH ASSESSMENT

HOW TO PROPERLY CONDUCT INTERVIEW AND ASSESS CLIENT

LEARNING OBJECTIVES

At the end of the lesson the students will be able to:

1. Identify the guidelines of an effective interview during health assessment of a client.
2. Explain the phases of client’s interview in health assessment.
3. Enumerate the techniques in health assessment interview.
4. Identify the special considerations related to age, culture and emotional variations in
conducting interview to a client.

Duration: 1 ½ hours

Methods/Instructional Technique
Synchronous / Asynchronous Mode
Modular Instruction
Video clips
Quiz (long & short)

Materials
Paper and Pen, Power Point Presentation Laptop

Content Outline
(Please refer on the NURS 02 OBE Course Syllabus as your guide)

Topics: How to properly conduct interview and assess client

- Guideline of an Effective Interview and Health History
- Phases
- Types of communication
- Special considerations related to age, culture and emotional variations

Guideline of an Effective Interview and

Health History

INTERVIEWING

Obtaining a valid nursing health history requires

professional, interpersonal, and interviewing
skills. The nursing interview is a communication
process that has two focuses:

1. Establishing rapport and a trusting relationship with the client to elicit accurate and
meaningful information.
2. Gathering information on the client’s developmental, psychological, physiologic,
sociocultural, and spiritual statuses to identify deviations that can be treated with nursing and
collaborative interventions or strengths that can be enhanced through nurse–client
collaboration.

Phases of the Interview

1. Introductory Phase
After introduction to the client, the nurse:
 Explains the purpose of the interview,
 Discusses the types of questions that will be
asked,
 Explains the reason for taking notes,
 Assures the client that confidential
information will remain confidential. makes
sure that the client is comfortable (physically and emotionally) and has privacy.
 Develop trust and rapport at this point in the interview.
 This can begin by conveying a sense of priority and interest in the client. Developing
rapport depends heavily on verbal and nonverbal communication on the part of the
nurse.

2. Working Phase
During this phase,
 The nurse elicits the client’s comments about major biographic data, reasons for seeking
care, history of present health concern, past health history, family history, review of body
systems for current health problems, lifestyle and health practices, and developmental
level.
 The nurse listens, observes cues, and uses critical thinking skills to interpret and validate
information received from the client.
 The nurse and client collaborate to identify the client’s problems and goals.
 The facilitating approach may be free-flowing or more structured with specific questions,
depending on the time available and the type of data needed.

3. Summary and Closing Phase

During the summary and closing,
 The nurse summarizes information obtained during the working phase and validates
problems and goals with the client.
 Identifies and discusses possible plans to resolve the problem (nursing diagnoses and
collaborative problems) with the client.
 Finally, the nurse makes sure to ask if anything else concerns the client and if there are
any further questions.

TECHNIQUES IN HEALTH ASSESSMENT INTERVIEW.

1. Active listening
Nurses must do more than simply listen when conducting a health
history assessment—they must actively listen.
  Active listening involves fully comprehending what a patient is communicating through
both verbal and nonverbal cues (such as body language), as well as the patient’s
emotional state.
 Complete concentration is essential during a nursing assessment.
 Listen carefully, using verbal and nonverbal prompts to encourage the patient to expand
on his or her symptoms and the circumstances surrounding them.

2. Adaptive questioning
Also referred to as guided questioning,
 adaptive questioning helps to encourage a patient to fully communicate without
interrupting the flow of his or her narrative.
 start with general questions, making them more specific as you move through the
interview.
 Health assessments in nursing require questioning that elicits a graded response versus
a yes or no reply.
 A series of questions, asked one at a time, often helps patients open up, as does
offering multiple choices for answers.
 Request additional information when necessary by asking the patient to clarify their
statements.
 Repeating his or her statements (a technique called echoing) is also helpful, as is using
verbal and nonverbal continuers, such as nodding your head or saying things like “go
on.”

3. Nonverbal communication
 Nursing assessments also require that you be in tune with a patient’s nonverbal
communication, such as posture, eye contact, facial expression, and the like.
 Reading and understanding these nonverbal cues help nurses understand patients more
fully, and using nonverbal communication of their own—such as mirroring a patient’s
position or using therapeutic physical contact.
 for example, placing a hand on the patient’s arm, can further augment the health history
assessment.

4. Empathy, validation, and reassurance

Empathy is key in nursing health assessments,
 it demonstrates that you understand and care about what a patient is experiencing and
helps establish a trusting nurse–patient relationship.
 Empathic responses during a health history assessment interview can be both verbal (“I
understand”) and nonverbal (such as offering a tissue if the patient is crying).
 Beyond being empathic, be sure to validate patients’ feelings to help reassure them that
their emotions are natural and reasonable and their problems are understood and will be
fully addressed.

5. Partnering and summarization

Another essential element of a nursing health assessment is expressing to the patient that you
are committed to forging a continuing partnership dedicated to his or her wellness.
 Even if you’re still enrolled in a nursing program—such as a Bachelor of Science in
Nursing or RN program—as a student, this support can make a tremendous difference in
a patient’s life.
  As you conduct your interview, summarizing what the patient has said is also helpful, as
it demonstrates that you’ve been listening and can fill in holes in the patient’s story.

6. Transitions and empowerment

Health problems can elicit feelings of anxiety in patients. One
way to put their fears at ease is
 to use transitions during their health history assessment to let them know what they should
expect next, such as a change in subject matter or a physical examination. Patients also
feel vulnerable when they’re experiencing health problems,
 making it essential to empower them with the idea that their participation in the process
and working closely with their medical team can make a positive difference in their
outcomes.

Communication During the Interview

The client interview involves two types of communication—nonverbal and verbal. Several
special techniques and certain general considerations will improve both types of communication
and promote an effective and productive interview.

Nonverbal Communication

Nonverbal communication is as important as verbal communication. Your appearance,

demeanor, posture, facial expressions, and attitude strongly influence how the client perceives
the questions you ask. Never overlook this type of communication or take it for granted.

Non verbal communication

1. APPEARANCE
Be professional, the client is expecting to see a health professional; therefore, you should look
the part.
 Wear comfortable, neat clothes and a laboratory coat or a uniform.
 Be sure your name tag, including credentials, is clearly visible.
 Your hair should be neat and not in any extreme style; some nurses like to wear long
hair pulled back.
 Fingernails should be short and neat; jewelry should be minimal.

2. DEMEANOR
Your demeanor should also be professional.
 display poise when you enter a room to interview a client
 focus on the client and the upcoming interview and assessment.
 do not enter the room laughing loudly, yelling to a coworker, or muttering under your
breath.
 This appears unprofessional to the client and will have an effect on the entire interview
process.
 greet the client calmly and focus your full attention on her.
 do not be overwhelmingly friendly or “touchy”; many clients are uncomfortable with this
type of behavior.
 maintain a professional distance.
3. FACIAL EXPRESSION
 Facial expressions are often an overlooked aspect of communication. facial expression
often shows what you are truly thinking (regardless of what you are saying)
 keep a close check on your facial expression - no matter what you think about a client or
what kind of day you are having)
 keep your expression neutral and friendly
 if your face shows anger or anxiety, the client will sense it and may think it is directed
toward him or her.
 if you cannot effectively hide your emotions, you may want to explain that you are angry
or upset about a personal situation.

4. ATTITUDE
One of the most important nonverbal skills to develop as a health care professional is a
nonjudgmental attitude.
 All clients should be accepted, regardless of beliefs, ethnicity, lifestyle, and health care
practices.
 Do not act superior to the client or appear shocked, disgusted, or surprised at what you
are told.
 Being nonjudgmental involves not “preaching” to the client or imposing your own sense
of ethics or morality on him.
 These attitudes will cause the client to feel uncomfortable opening up to you and
important data concerning his or her health status could be withheld.
 Focus on health care and how you can best help the client to achieve the highest possible
level of health.
For example, if you are interviewing a client who smokes,
 avoid lecturing condescendingly about the dangers of smoking
 avoid telling the client he or she is foolish or portraying an attitude of disgust. 
This will only harm the nurse–client relationship and will do nothing to improve the client’s
health.
 The client is, no doubt, already aware of the dangers of smoking. Forcing guilt on him is
unhelpful. Accept the client, be understanding of the habit, and work together to improve
the client’s health.
 This does not mean you should not encourage the client to quit; it means that how you
approach the situation makes a difference. Let the client know you understand that it is
hard to quit smoking, support efforts to quit, and offer suggestions on the latest methods
available to help kick the smoking habit.

5. SILENCE
 Another nonverbal technique to use during the interview process is silence. Periods of
silence allow you and the client to reflect and organize thoughts, which facilitates more
accurate reporting and data collection.

6. LISTENING
Listening is the most important skill to learn and develop fully in order to collect complete and
valid data from your client. To listen effectively,
 maintain good eye contact, smile or display an open, appropriate facial expression,
  maintain an open body position (open arms and hands and lean forward). keep an open
mind.
 avoid preconceived ideas or biases about your client
 avoid crossing your arms, sitting back, tilting your head away from the client, thinking
about other things, or looking blank or inattentive.
 Becoming an effective listener takes concentration and practice.
 In addition, several nonverbal
affects or attitudes may hinder
effective communication. They
may promote discomfort or
distrust.

Verbal Communication

Effective verbal communication

is essential to a client interview.
The goal of the interview process is to
elicit as much data about the client’s
health status as possible. Several types of questions and
techniques to use during the interview

1. OPEN-ENDED QUESTIONS
 Open-ended questions are used to elicit the client’s feelings and perceptions.
 They typically begin with the words “how” or “what.”
An example of this type of question is “How have you been feeling lately?”
These types of questions are important
 they require more than a one-word response from the client 
encourage description.
Asking open-ended questions may help to reveal significant data about the client’s health
status. The following example shows how open-ended questions work.
 Imagine yourself interviewing an elderly male client who is at the physician’s office
because of diabetic complications. He mentions casually to you, “Today is the
twomonth anniversary of my wife’s death from cancer.” Failure to follow up with
an open-ended question such as “How does this make you feel?” may result in
the loss of important data that could provide clues to the client’s current state of
health.

2. CLOSED-ENDED QUESTIONS
Use closed-ended questions to obtain facts and to focus on specific information. The client can
respond with one or two words. The questions typically begin with the words “when” or “did.”
An example of this type of question is:
“When did your headache start?”
Closed-ended questions are useful in keeping the interview on course. They can also be used
to clarify or obtain more accurate information about issues disclosed in response to open ended
questions.
For example, in response to the open ended question “How have you been feeling lately?” the
client says, “Well, I’ve been feeling really sick at my stomach and I don’t feel like eating
because of it.”
You may be able to follow up and learn more about the client’s symptom with a closed-ended
question such as “When did the nausea start?”

3. LAUNDRY LIST
Another way to ask questions is to provide the client with a choice of words to choose from in
describing symptoms, conditions, or feelings.
This laundry list approach helps you to obtain specific answers and reduces the likelihood of the
client’s perceiving or providing an expected answer.

For example,
“Is the pain severe, dull, sharp, mild, cutting, or
piercing?”
“Does the pain occur once every year, day, month, or
hour?”
Repeat choices as serious illness?”

4. WELL-PLACED PHRASES
 Client verbalization can be encouraged by
wellplaced phrases from the nurse.
 If the client is in the middle of explaining a
symptom or feeling and believes that you are
not paying attention, you may fail to get all the necessary information.
 Listen closely to the client during his or her description and use phrases such as “um-
hum,” “yes,” or “I agree” to encourage the client to continue.

5. PROVIDING INFORMATION
 Another important thing to consider throughout the interview is to provide the client with
information as questions and concerns arise. Make sure you answer every question as
well as you can.
 If you do not know the answer, explain that you will find out for the client.
 The more clients know about their own health, the more likely they are to become equal
participants in caring for their health.
 As with nonverbal communication, several verbal techniques may hinder effective
communication

Special Considerations during the Interview

Three variations in communication must be considered as you interview clients:
 gerontologic,  cultural
 emotional.

These variations affect the nonverbal and verbal techniques you use during the interview.
 Imagine, for example, that you are interviewing an 82-year-old woman and you ask her to
describe how she has been feeling. She does not answer you and she looks confused.
This older client may have some hearing loss. In such a case, you may need to modify
the verbal technique of asking open ended.
Gerontologic Variations in Communication
• Age affects and commonly slows all body systems to varying degrees. However, normal
aspects of aging do not necessarily equate with a health problem, so it is important not
to approach an interview with an elderly client assuming that there is a health problem.
• Older clients have the potential to be as healthy as younger clients.
 When interviewing an elderly client, you must first assess hearing acuity.
 Hearing loss occurs normally with age, and undetected hearing loss is often
misinterpreted as mental slowness or confusion.
 If you detect hearing loss, speak slowly, face the client at all times during the
interview, and position yourself so that you are speaking on the side of the client
that has the ear with better acuity.  Do not yell at the client.
• Older clients may have more health concerns than younger clients and may seek health
care more often.
• Many times, older clients with health problems
feel vulnerable and scared.

Cultural Variations in Communication

Ethnic/cultural variations in communication and

selfdisclosure styles may significantly affect the
information obtained
 Be aware of possible variations
in the communication styles of yourself and
the client.
 If misunderstanding or difficulty in communicating is evident, seek help from an expert,
what some professionals call a “culture broker.” (someone who is thoroughly familiar not
only with the client’s language, culture, and related health care practices but also with
the health care setting and system of the dominant culture).

Frequently noted variations in communication styles include:

 Reluctance to reveal personal information to strangers for various culturally-based

reasons
 Variation in willingness to openly express emotional distress or pain
 Variation in ability to receive information (listen)  Variation in meaning conveyed by
language.
 For example, a client who does not speak the predominant language may not know what
a certain medical term or phrase means and, therefore, will not know how to answer your
question.
 Use of slang with non-native speakers is discouraged as well. Keep in mind that it is hard
enough to learn proper language, let alone the idiom vernacular. The non-native speaker
will likely have no idea what you are trying to convey.

Emotional Variations in Communication

Not every client you encounter will be calm, friendly, and eager to participate in the interview
process.
  Clients’ emotions vary for a number of reasons.
• scared or anxious about their health or about disclosing personal information,
• angry that they are sick or about having to have an examination,
• depressed about their health or other life events,
• ulterior motive for having an assessment performed.
 Clients may also have some sensitive issues with which they are grappling and may turn
to you for help.

COMPLETE HEALTH HISTORY

 The health history is an excellent way to begin the assessment process because it lays
the groundwork for identifying nursing problems and provides a focus for the physical
examination.
 The importance of the health history lies in its ability to provide information that will assist
the examiner in identifying areas of strength and limitation in the individual’s lifestyle and
current health status.
 Data from the health history also provide the examiner with specific cues to health
problems that are most apparent to the client.
 The complete health history is modified or shortened when necessary.

 For example, if the physical assessment will focus on the heart and neck vessels, the
subjective data collection would be limited to the data relevant to the heart and neck
vessels.
 Taking a health history should begin with an explanation to the client of why the
information is being requested, for example, “so that I will be able to plan individualized
nursing care with you.” This section of the chapter explains the rationale for collecting
the data, discusses each portion of the health history, and provides sample questions.

The health history has eight sections:

• Biographic data
• Reasons for seeking health care
• History of present health concern
• Past health history
• Family health history
• Review of body systems (ROS) for current health problems
• Lifestyle and health practices profile
• Developmental level

Activity:

Watch a video; link https://www.youtube.com/watch?v=gRpHoR-lDY0

DO AN INTERVIEW
1. Subject: Member of the family, classmate, friends, etc.
2. Follow the eight sections in health history
3. Write your output in words document
4. Submission date; follow the OBE Course Syllabus
References:
• Nursing Health Assessment, A Best Practice Approach Third Edition, Sharon Jensen
• Kozires & Erb’s Fundamentals of Nursing Tenth Edition
• www.google.com