Define the goals of the clinical interview. Describe the principles of setting a

therapeutic tone. Describe the key techniques to use in a

structured interview. Identify methods to assist the patient to

describe the problem. Identify the phases within the interview. Identify how to provide closure.

Interview

Establishing rapport and a trusting relationship with the client to elicit accurate and meaningful information

Gathering information

Introductory Working Summary

Phases

Purpose nterviewGather

Establish

rapport

Introductory

Working

Sum

mar

y

The content and direction of the

clinical interview are decided by the

client. The client leads

Nurse employs communication skills and active listening

client feels understood and comfortable identify and explore problems relating to

others discuss healthy ways of meeting

emotional needs experience a satisfying interpersonal

relationship

Constant practice and observation Anxiety during first meeting Concerns on how to begin the interview

and how to do in response to specific client behaviors

Can happen anywhere Establish a setting that enhances feelings of

security Privacy When done in the home, it will give opportunity

for the nurse to assess the person in the context of everyday life

Seating Arrange chairs such that conversation can take

place in normal tones of voice and eye contact can be comfortably maintained

Same height, avoiding a face-to-face stance when possible, side-by-side position may be less intense.

Avoid settings without ready access to door Avoid desk barrier between the nurse and client

Introductions Orientation phase – name, school, purpose, time

of meeting Confidentiality Ask how the client would like to be addressed:

conveys respect, gives client a direct control over an important ego issue

How to Start After introductions, start with open-ended

statements. e.g. “Tell me a little about what has been going on with you.”

Offer leads (“Go on…”) Make statements of acceptance

(“Uh-huh”) Avoid barriers to communication

Nonverbal

Verbal

Appearance Demeanor Facial expression Attitude Silence Listening

Open-ended Questions Closed-ended Questions Laundry List Rephrasing Inferring Providing Information

Excessive or insufficient eye contact Distraction and distance Standing Biased or leading questions Rushing through the interview Reading the questions

Helpful guides Speak briefly When you do not know what to say,

say nothing When in doubt, focus on feelings Avoid advice Pay attention to nonverbal cues Keep the focus on the client

Commun

icat

ion

StartingPhas

esPurpose nterview

Gather

Establish

rapport

Introductory

Working

Sum

mar

ysettingseating

verbal

nonverbal

Gerontologic Cultural Emotional

“You seem ready to cry.” “You are still upset about your

brother’s death.” “What are you thinking right now?”

offer tissue

“I cannot make that promise. It might be important for me to share it with other staff.”

The client decides whether to share information

“I will wait for you here for 15 minutes, until our time is up.”

The nurse does not engage in any conversation

When the time is up, the nurse approaches the client, tells him or her the time is up, and restates the day and time the nurse will see the client again.

“I am with Mr. Rob for the next 20 minutes. At 10 AM, after our time is up, I can talk to you for 5 minutes.”

“This is very serious Mr. Lamb. I do not want any harm to come to you. I will have to share this with other staff.”

“It’s alright. I would like to spend time with you. We don’t have to talk.”

“Our 5 minutes is up. I’ll be back at 10am and stay with you for 5 minutes more.”

“Our time is up now, Mr. Jones. This would be a good place to start our next session, which is on Wednesday at 10am.”

“Thank you but it is our job to care for our clients. Are you concerned that some aspect of your care will be overlooked.”

Client: “Are you married?”Nurse: “Yes. Do you have a spouse?”

Client: “Do you have any children?”Nurse: “This time is for you – tell me about yourself.”

Client: “You can just tell me if you have any children.”Nurse: “this is our time to focus on your concerns. Tell me something about your family.”

Purpose Content: Nurse, Client, Analysis (with

reference), student’s thoughts and feelings

Weber J., Kelley, J. (2007) Health Assessment in Nursing (3rd edition) Philadelphia: Lippincott Williams and Wilkins.

Vacarolis, E., Carson V., & Shoemaker N. (2006). Foundations of Psychiatric Mental Health Nursing A Clinical Approach(5th edition)St. Louis Missouri: Elsevier Inc.