Intro HA
Intro HA
Introductory Phase
• After introducing himself 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, and assures the
client that confidential information will remain confidential.
• The nurse also makes sure that the client is comfortable (physically
and emotionally) and has privacy. It is also essential for the nurse to
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.
Conti…..
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 then 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.
2. Empathic Responses
o Empathic responses are vital to patient rapport and healing. To
express empathy, you must first recognize the patient’s feelings.
o Do not assume you know the meaning of these feelings. Empathy
may also be nonverbal—placing your hand on the patient’s arm or
offering tissues when the patient is crying.
Echoing
• A simple repetition of the patient’s last words, or echoing, encourages the
patient to expand on factual details and feelings.
5. Validation
o Another way to affirm the patient is to validate or
acknowledge the legitimacy of his or her emotional
experience. A patient who has been in a car accident but
has no physical injury may still be experiencing significant
distress.
• Example: “Being in that accident must have been very
scary.
6. Reassurance
o When you are talking with patients who are anxious or
upset, it is tempting to try to reassure them.
o The first step to effective reassurance is simply identifying
and acknowledging the patient’s feelings. This promotes a
feeling of connection.
• Example: "It'll be okay.“ or Everything is going to be all
right.”
7. Partnering
o When building your relationships with patients, be explicit
about your commitment to an ongoing partnership. Make
patients feel that regardless of what happens with their
illness, you envision continuing their care.
• Example: "We'll work together on this."
8. Summarization
o Giving a capsule summary of the patient’s story during the
course of the interview serves several functions. It
communicates to the patient that you have been listening
carefully.
• Example: "Now let me make sure I have the full story..."
9. Transitions
o Patients may be apprehensive during a health care visit. To put
them more at ease, tell them when you are changing directions
during the Interview. Make clear what the patient should expect
or do next.
• Example: “Before we move on to reviewing all your medications,
was there anything else about past health problems?” “Now I
would like to examine you. I will step out for a few minutes.
Please undress and put on this gown.”
10. Empowering the Patient
o 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.
4. Timing. When did (does) it start? How long does it last? How
often does it come?
5. Setting in which it occurs. Include environmental factors, personal
activities, emotional reactions, or other circumstances that may
have contributed to the illness.
1. OLD CARTS
• Onset, Location, Duration, Character, Aggravating/ Alleviating
Factors, Radiation, Timing and severity.
2. OPQRST
• Onset, Palliating/Provoking Factors, Quality, Radiation, Site, and
Timing.
3. SOCRATES
• Site, Onset, Character, Radiation, Associated symptoms,
Time/Duration, Exacerbating and Relieving factors and severity.
4. COLDSPA
• Character, onset, Location, Duration, Severity, Pattern and
Associated factors
The Guiding Style of Motivational
Interviewing
• “Ask” open-ended questions—invite the patient to consider
how and why they might change.
Nonmaleficence
Beneficence
Autonomy
Confidentiality
The Tavistock Principles
• Rights: People have a right to health and health care.
• Balance: Care of the individual patient is central, but the
health of populations is also our concern.
• Comprehensiveness: In addition to treating illness, we have
an obligation to ease suffering, minimize disability, prevent
disease, and promote health.
• Cooperation: Health care succeeds only if we cooperate
with those we serve, each other, and those in other sectors.