Transcript Interviewing-Techniques

Therapeutic
Communication
Prepared by Sally McDonald
Revised by Tim Corbett
Helping vs Social
Relationships
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HELPING
Care
Trust
Growth
Purposeful/intention
al
Unequal sharing
Focus on Client’s
needs
Time limited
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SOCIAL
Care
Trust
Growth
Spontaneous
Usually equal or
near equal sharing
Focus on needs of
both individuals
Ongoing
Locus of Control
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GIVING HELP
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Feeling
Feeling
Feeling
Feeling
Feeling
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important
useful
powerful
gratified
happy
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NEEDING HELP
Feeling unimportant
or inadequate
Feeling useless or
depressed
Feeling powerless
Feeling frightened
or embarrassed
Feeling sad
or angry
Phases of Helping
Relationships
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Orientation Phase
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Working Phase
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Termination Phase
Orientation Phase
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“getting to know you” phase
setting the tone
making introductions
establishing roles
reaching agreement on goals
developing trust
Working Phase
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“problem solving” phase
attending to client’s needs
Nurse in role of teacher/counselor
encouraging active participation by client
gathering further data
assisting client in decision making
facilitating change
Evaluate problems & goals
Termination Phase
reviewing & summarizing goals met
and progress made
 acknowledge feelings of loss
 reassuring clients with issues such as,
“How will this problem/disease affect
my life ?” or
“What do I need to change ?”
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Communication
Techniques
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Validating/Clarifying
Reflecting
Sequencing
Sharing observations
Acknowledging feelings
Avoid
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Arguing
Minimizing
Challenging
Giving false
reassurance
Interpreting or
speculating on the
dynamics of the
client’s problems
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“Selling” client on
accepting treatment
Probing sensitive
areas
Participating in
criticism of any staff
member
Joining any attacks
led by the client
Attentive Listening Scale
-THINGS TO AVOID
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Lack of eye contact
Responding before the other finishes speaking
Finishing other people’s sentences
Talking so much that others cannot respond
Continuing to work while someone is talking to you
Repeat a point just made
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Allow your mind to wander during a conversation
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Active Listening
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3 Phases
restatement involves repeating or
paraphrasing the words of the client
reflection is verbalizing both the content
and the implied feelings of the client’s
message
clarification is summarizing the client’s
thoughts & feelings & resolving confusion
Active Listening
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STOP TALKING
demonstrate that you want to listen
remove distractions
be patient
STOP TALKING
Assertive Communication
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“I” Statements allow people to ‘own’
(take responsibility for) their own
thoughts & feelings
assertiveness involves taking a risk
NONVERBAL CUES
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professional attire
sit arm’s length away
relaxed but attentive posture
NONVERBAL CUES
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facial expressions and tone
should be friendly & interested
use direct eye contact & match your
eye contact with the patient’s eye
contact
pay attention to body language of
patient as well as your own body
language
Interviewing Techniques
INTERVIEWING
TECHNIQUES
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the purpose of the interview is to obtain
accurate & thorough information
put your client at ease as they may feel
uncomfortable about revealing sensitive
information to you
explaining your format helps clients accept
& understand the purpose of the interview
INTERVIEWING
TECHNIQUES
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in general, use open-ended questions
however, to obtain specific information,
closed-ended questions are preferable
validate information
clarify responses
use reflective questions/comments
& paraphrasing
Progression of
the Interview
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Broad Openings- such as
“Tell me about yourself” are designed
to allow the client to relate his or her
story in a way that is comfortable
Progression of
the Interview
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Open-Ended Questions
encourage the client to elaborate or
give explanations (for example,
“What happened yesterday?”)
they provide direction & keep the
conversation focused
Progression of
the Interview
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Closed-Ended Questions
can be answered with 1-2 words and
can be useful in obtaining specific
types of information, such as
“What is today’s date?”
EFFECTIVE
INTERVIEWING
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as a professional nurse, you will spend
about half of your time obtaining
information from clients & colleagues
excellent communication as well as
interviewing skills are fundamental,
yet require years of practice
WHY, WHAT, HOW
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why do you need the information?
how will the information I am seeking
direct me in helping my client?
how will you phrase your questions?
Who to Ask?
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if the client is able to speak, ask him/her
family perspectives may also be important
written consent may be required to question
concurrent/previous healthcare providers
be courteous and respectful
never forget client confidentiality
“Why” Questions
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offensive misuse of ‘why’ appears
threatening and confrontational and
puts clients on the defensive
they can interfere with developing a
therapeutic relationship & are seldom
considered therapeutic
Conveying
Upsetting Information
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The SPIKES Model developed by
Radziewicz & Baile (2001)
Setting
Perception
Invitation
Knowledge emotions
Summary
Setting
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private & comfortable
invite others, such as family members
Perception
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refers to what client and others
already know useful in uncovering
misinformation
Invitation
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For example, the statement,
“Would you like me to explain more
about what happened?’
Knowledge
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gradually dispense information
assessing client’s ability to cope with it
The family may insist that the client
not be told difficult news
Emotions
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let client vent while you remain calm
keep in mind Stages of Grief & Loss
may need to set limits on
inappropriate /harmful behavior
Summary
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review all important information with
the client and family
may need to repeat information more
than once
AVOID
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clichés
poor listening
closed questions
intimidating how/why questions
obvious probing questions
advice
leading questions (that suggest the response
that you want)
judgmental comments
diverting
false assurance
COMMON ERRORS
Blocks to Communication
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Failure to respect
client
Failure to listen
Minimizing feelings
Inappropriate
comments &
questions
Excessive questions
Clichés
Yes/no questions
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Probing
Changing the subject
Leading questions
Advice
Judgments
False reassurance
Giving
approval/disapproval
Self-Disclosure
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Use self disclosure to help clients open up
to you – not to meet your own needs
Keep disclosures brief
Don’t imply that your experience is exactly
the same as the client’s
Only self-disclose about situations that you
have mastered
Self-Disclosure
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Monitor your own comfort with
self-disclosure
Respect your client’s needs for privacy
Remember that there are cultural
variations in the amount of selfdisclosure considered appropriate
Identify risks and benefits of self
disclosure
Therapeutic Versus
Nontherapeutic Communication
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THERAPEUTIC
- Facilitates transformation of working
nurse-patient relationship
- Relationship allows for adequate &
accurate data collection & assessment
- Performed with & not for patient
Therapeutic Versus
Nontherapeutic Communication
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NONTHERAPEUTIC
- Hinders relationship formation
- Prevents patient from becoming
mutual partner & relegates him/her to
passive recipient of care