Interviewing Skills and Health

History
Ms. Gulshan Umbreen
Nursing Instructor, SNC
BSN (Post RN), M.Phil (Epidemiology &
Public Health
Objectives:

By the end of the unit, learners will be able to:

• 1. Explain the purpose, process & principles of
interviewing.
• Describe Content and format used to obtain a
Health History
 Purpose of Interviewing
• The health history interview is a conversation with a
purpose.
• As a clinician, you will draw on many of the
interpersonal skills that you use every day, but
with unique and important differences. Unlike
social conversation, in which
you express your own needs and interests with
responsibility only for yourself.
• The primary goal of the clinician–patient
interview is to improve the well-being of the
patient.
• The purpose of conversation with a patient is
three fold:
• To establish a trusting and supportive relationship.
• To gather information, and to offer information.
• Communicating and relating therapeutically with
patients are the most valued skills of clinical care.
As a beginning clinician, you will focus your
energies on gathering information. At the same
time, by using techniques that promote trust and
communication.
 Cont.…
• You will allow the patient’s story to unfold in its
most full and detailed form. Establishing a
supportive interaction enhances information-
gathering and itself becomes part of the
therapeutic process of patient care.
 Process of Interview
• Interviewing process differs significantly from the
format for the health history.
• Both are fundamental to your work with patients,
but each serves a different purpose. The health
history
• format is a structured framework for organizing
patient information in written or verbal form: it
focuses the clinician’s attention on specific pieces
of information that must be obtained from the
patient.
• The interviewing process that actually generates
these pieces of information is more fluid.
• It requires knowledge of the information you need
to obtain, the ability to elicit accurate and detailed
information, and interpersonal skills that allow you
to respond to the patient’s feelings.
The Process or sequence of interview:
• Greeting the patient and establishing rapport
• Inviting the patient’s story
• Establishing the agenda for the interview
• Expanding and clarifying the patient’s story;
generating and testing diagnostic hypotheses
• Creating a shared understanding of the problem(s)
• Negotiating a plan (includes further evaluation,
treatment, and patient education)
• Planning for follow-up and closing the interview.
 Principles of interviewing
Fundamentals of skilled interviewing
• Active listening
• Adaptive questioning
• Nonverbal communication
• Facilitation
• Echoing
• Empathic responses
• Validation
• Reassurance
• Summarization
• Highlighting transitions
Active Listening:
• Active listening is the process of fully attending to
what the patient is communicating, being aware of
the patient’s emotional state, and using verbal and
nonverbal skills to encourage the speaker to
continue and expand.
Adaptive/Guided Questioning:
• There are several ways you can ask questions that
add detail to the patient’s story yet facilitate the
flow of the interview.
 Types of Guided Questioning

1.◗ Moving from open-ended to focused questions

2.◗ Using questioning that elicits a graded response
3.◗ Asking a series of questions, one at a time
4.◗ Offering multiple choices for answers
5.◗ Clarifying what the patient means
6.◗ Encouraging with continuers
7.◗ Using echoing
1. Moving from open-ended to focused questions
Proceed from the general to the specific. Directed
questions should not be leading questions that call
for a “yes” or “no” answer: not “Did your stools
look like tar?” but “Please describe your stools.”
2. Using questioning that elicits a graded response
Ask questions that require a graded response rather
than a single answer. “What physical activity do
you do that makes you short of breath?” is better
than “Do you get short of breath climbing stairs?”
3. Asking a series of questions, one at a time
Be sure to ask one question at a time. Try “Do you
have any of the following problems?” Be sure to
pause and establish eye contact as you list each
problem.
4. Offering multiple choices for answers
Sometimes patients seem unable to describe
symptoms. Offer multiple-choice answers.
5. Clarifying what the patient means
For patients using words that are ambiguous,
request clarification, as in “Tell me exactly what
you meant by ‘the flu.’”
6. Encouraging with continuers
Posture, actions, or words encourage the patient to
say more but do not specify the topic. Nod your
head or remain silent. Lean forward, make eye
contact, and use continuers like “Mm-hmm,” “Go
on,” or “I’m listening.”
7. Using echoing
Repetition and echoing of the patient’s words
encourage the patient to express both factual
details and feelings.
Nonverbal Communication
• Communication that does not involve speech
occurs continuously and provides important clues
to feelings and emotions.
• Becoming more sensitive to nonverbal messages
allows you to both “read the patient” more
effectively and to send messages of your own.
Pay close attention to eye contact, facial
expression, posture, head position and
movement.
 Cont…
Facilitation:
• You use facilitation when, by posture, actions, or
words, you encourage the patient to say more but
do not specify the topic. Pausing with a nod of the
head or remaining silent, yet attentive and relaxed,
is a cue for the patient to continue.
Echoing:
• Simple repetition of the patient’s words
encourages the patient to express both factual
details and feelings, as in the following example:
• Patient: The pain got worse and began to spread.
(Pause)
• Response: Spread? (Pause)
• Patient: Yes, it went to my shoulder and down my
left arm to the fingers. It was so bad that I thought
I was going to die. (Pause)
• Response: Going to die?
Empathic Responses:
• Conveying empathy is part of establishing and
strengthening rapport with patients. As patients
talk with you, they may express—with or without
words—feelings they have not consciously
acknowledged.
• These feelings are crucial to understanding their
illnesses and to establishing a trusting
relationship.
Validation:
• Another important way to make a patient feel
accepted is to legitimize or validate his or her
emotional experience. A patient who has been in
a car accident but has no significant physical
injury may still be experiencing distress.
Reassurance:
When you are talking with patients who are anxious
or upset, it is tempting to reassure them. You may
find yourself saying “Don’t worry. Everything is
going to be all right.”
Summarization:
Giving a capsule summary of the patient’s story in
the course of the interview can serve several
different functions. It indicates to the patient that
you have been listening carefully.
• It can also identify what you know and what you
don’t know. “Now, let me make sure that I have
the full story. You said you’ve had a cough for 3
days, it’s especially bad at night, and you have
started to bring up yellow phlegm.
Highlighting Transitions:
Patients have many reasons to feel worried and
vulnerable. To put them more at ease, tell them
when you are changing.
Obtaining and Recording a Client
Health History

Phases of taking Health History:

Two phases:-
The interview phase
The recording phase
Guidelines for Taking Nursing
History
Private, comfortable, and quiet environment.
Allow the client to state problems and expectations
for the interview.
Orient the client the structure, purposes, and
expectations of the history.
Communicate and negotiate priorities with the
client
Listen more than talk
Observe non verbal communications e.g.
"body language, voice tone, and
appearance".
Review information about past health history
before starting interview.
Clarify the client's definitions (terms &
descriptors) .
Avoid yes or no question (when detailed
information is desired).
Write adequate notes for recording?
Record nursing health history soon after
interview.
Types of Nursing Health History:

Complete health history: taken on initial visits

to health care facilities.
Interval health history: collect information in
visits following the initial data base is collected.
Problem- focused health history: collect data
about a specific problem
Content and format used to obtain a
Health History
• Biographical data
• Reason for Seeking Care
• History of Present Illness
• Past Health
• Accidents and Injuries
• Hospitalizations and Operations
• Family History
• Review of Systems
• Functional Assessment ( Activities of Daily Living)
• Perception of Health
1-Biographical Data: This includes
Full name & Gender
Address and telephone numbers (client's
permanent contact of client)
Birth date and birth place
Religion and race.
Marital status.
Social security number.
Occupation (usual and present)
Source of referral.
Usual source of healthcare.
Source and reliability of information.
Date of interview.
 2- Chief Complaint:
“Reason For Hospitalization”.
Examples of chief complaints:
Chest pain for 3 days.
Swollen ankles for 2 weeks.
Fever and headache for 24 hours.
Pap smear needed.
Physical examination needed for camp.
3-History of present illness:
Gathering information relevant to the chief complaint,
and the client's problem, including essential and
relevant data, and self medical treatment.
 Attributes of Every Symptom
• The Seven Attributes of Every Symptom
• Location
• Quality
• Quantity or severity
• Timing, including onset, duration, and frequency
• Setting in which it occurs
• Aggravating and relieving factors
• Associated manifestations
Component of Present Illness:
Introduction: "client's summary and usual
health".
Investigation of symptoms: "onset, date,
gradual or sudden, duration, frequency,
location, quality, and alleviating or aggravating
factors".
Negative information.
Relevant family information.
Disability "affected the client's total life".
4- Past Health History:
The purpose: (to identify all major past health
problems of the client)
This includes:
Childhood illness e.g. history of rheumatic
fever.
History of accidents and disabling injuries
History of hospitalization (time of admission,
date, admitting complaint, discharge diagnosis
and follow up care.
History of operations "how and why this done"
History of immunizations and allergies.
Physical examinations and diagnostic tests.
5-Family History :
The purpose: to learn about the general health of
the client's blood relatives, spouse, and children
and to identify any illness of environmental
genetic, or familiar nature that might have
implications for the client's health problems.
Family history of communicable diseases.
Heredity factors associated with causes of some
diseases.
Strong family history of certain problems.
 Health of family members "maternal, parents,
siblings, aunts, uncles…etc.".
Cause of death of the family members "immediate
and extended family".
6-Environmental History:
purpose
"to gather information about surroundings of the
client", including physical, psychological, social
environment, and presence of hazards, pollutants
and safety measures."
7- Current Health Information :
The purpose is to record major, current, health
related information.
Allergies: environmental, ingestion, drug, other.
Habits "alcohol, tobacco, drug, caffeine"
Medications taken regularly "by doctor or self
prescription
Exercise patterns.
Sleep patterns (daily routine).
The pattern life (sedentary or active)
9- Review of Systems (ROS):
Collection of data about the past and the present of
each of the client systems.
(Review of the client’s physical, sociologic, and
psychological health status may identify hidden
problems and provides an opportunity to indicate
client strength and liabilities
10. Nutritional Health History
 11- Assessment of Interpersonal Factors
This includes :-
Ethnic and cultural background, spoken language,
values, health habits, and family relationship.
Life style e.g. rest and sleep pattern
Self concept perception of strength, desired
changes
Stress response coping pattern, support system,
perceptions of current anticipated stressors.

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Reference

• Bickly, L. S. (2017). Bates’ Guide to Physical

Examination and History Taking (12th ed).
Philadelphia: J. B. Lippincott.
• Wilson, S. F; Giddens J. F. (2001). Health assessment
for nursing practice (2nd ed). St. Louis: Mosby.