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16 LAYING THE FOUNDATION
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scholarly-journals/standardizing-patient-acuity-project-on-medical/
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UNIT 1
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Gonzalez, L. (2018). Teaching clinical reasoning piece by piece: A clinical
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Gordon, M. (2006). Manual of nursing diagnosis (11th ed.). Sudbury, MA:
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Hassani, P., Abdi, A., Jalali, R., & Salari, N. (2020). The perception of
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Jongen, C., McCalman, J., & Bainbridge, R. (2018). Health workforce
cultural competency interventions: a systematic scoping review. BMC
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Levett-Jones, T., Hoffman, K., Dempsey, J., Jeong, S. Y., Noble, D., Norton,
C. A., Roche, J., & Hickey, N. (2010). The ‘ve rights’ of clinical
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promote-health/cultural-safety/
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org.nz/Public/Treaty_of_Waitangi/NCNZ/About-section/Te_Tiriti_o_
Waitangi.aspx?hkey=36e3b0b6-da14-4186-bf0a-720446b56c52
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Richardson, F. (2015).An introduction to inclusive practice. InInclusive
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Matsoukas, K.,& Bylund, C, L.(2018). The effects of race and racial
concordance on patient-physician communication: A systematic
review of the literature.Journal of Racial and Ethnic Health
Disparities,5,117–40. https://doi.org/10.1007/s40615-017-0350-4
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Paradies, Y. (2019). The challenge of cultural competence in the
workplace: perspectives of healthcare providers. BMC Health
Services Research, 19, 135. https://doi.org/10.1186/s12913-019-3959-7
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the agenda for cultural competence at the University of Sydney.
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Transitions and participation in higher education: from policy to
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Hasmaden, E., & Akkus¸, Y. (2019). Intuition and emotional intelligence:
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2022 from https://www.who.int/news-room/feature-stories/detail/
who-recommends-considering-cultural-factors-to-develop-moreinclusive-health-systems
CHAPTER
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2
THE HEALTH CONSUMER INTERVIEW APPROACHES
INCORPORATING DEVELOPMENTAL CONSIDERATIONS
LEARNING OUTCOMES
By the end of this chapter you should be able to:
1 identify key considerations required for undertaking a consumer health assessment interview
2 explain the nurse’s role in assessing spiritual needs during the health interview and care encounters
3 describe personal perceptions that facilitate or hinder the interview process
4 describe effective and ineffective interviewing techniques to use in the consumer interview
5 explain key considerations for undertaking the health assessment interview for the consumer with
special needs
6 incorporate appropriate developmental theories and developmental tools associated with each life
stage into a consumer’s health assessment.
17
BACKGROUND
The nursing health assessment interview is a purposeful, time-limited verbal
interaction between the nurse and the consumer, completed on admission or rst
contact and updated with any consumer change. It is initiated to collect specic
information regarding the consumer and to explore health status. Other purposes
include validating appropriate health and illness information presented by the
consumer, and identifying the individual’s knowledge of personal health. The nurse
should also take into consideration the consumer’s culture, inclusive of spiritual
and religious orientation, to deliver appropriate person-centred care. Accurate and
complete information gained from the health assessment interview, serves as a
foundation for subsequent interactions and nursing and medical interventions. The
nurse–consumer interaction requires skill in interviewing techniques, which the
nurse learns and renes over time.
Assessing the growth and development status of consumers, adults as well as
children, is an integral part of the health assessment. All individuals, from birth to
death, pass through identiable, cyclical stages of growth and development that
determine who they are. Growth refers to an increase in body size and function to
the point of optimum maturity. Development refers to patterned and predictable
increases in the physical, cognitive, psychosocial and moral capacities of individuals
that enable them to successfully adapt to their environment. It must be noted that
although most development is patterned and predictable, you should not impose
expected patterns on a particular consumer; it is important to assess them as an
individual (Lissauer & Carroll, 2022).
18 LAYING THE FOUNDATION
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UNIT 1
THE CONSUMER INTERVIEW
The nursing health assessment interview can be differentiated from the more
traditional medically orientated interview. The medical interview typically
focuses on the physical or emotional state, while the nursing interview is more
holistic in nature and includes comprehensive information about the person.
The nursing interview includes an assessment of the physical, mental, emotional,
developmental, social, cultural and spiritual aspects of the person. Data is collected
about the person’s present and past states of health, including their family status
and relationships, cultural background, lifestyle preferences and developmental
level. Other factors considered in data collection are the person’s self-concept,
spiritual and religious afliation, social supports, burden of care, sexuality
and reproductive processes. Remember, the health assessment interview is a
goal-directed interview. It is not a social interaction.
The nurse
The nurse is often the rst person from the healthcare team to interact with the
consumer and assumes the role of intermediary to the larger healthcare system.
The nurse sets the stage for the interview and can affect the individual’s healthcare
experience and outcome. First impressions of individuals are important and imprint
long-lasting thoughts and feelings.
The nurse is the facilitator of the interview and thus collaborates with the
consumer in establishing a mutually respectful dialogue. Encouraging the consumer
to speak freely and express any concerns is essential in this process. For example,
if the consumer thinks that no one in the healthcare setting understands their
concerns and feelings, they will likely say very little. The consumer must feel
comfortable and safe enough to provide information, to ask questions, and to
express fears or concerns. Accurate data collection is the primary purpose of
the health assessment interview. The nurse can foster an atmosphere of safety
and comfort by approaching each consumer with an accepting, respectful and
non-judgemental attitude.
REFLECTION IN PRACTICE
Initial consumer impression
An 18-year-old mother with her 12-month-old child comes to the community health clinic.
You are the nurse caring for them and note they are dishevelled, their clothes are dirty, and
both have offensive-smelling body odour. What might your initial perception of the mother
and child be? How might this affect the consumer interview?
The consumer
The consumer should be an active and equal participant in the health interview
process and should feel free to openly communicate thoughts, feelings, perceptions
and factual information. Most consumers possess previous knowledge of or
experience with healthcare interactions that inuences their current perceptions
and behaviour. Understanding how individuals see their role in healthcare contexts
is vital to the successful completion of any health interview. In today’s healthcare
context, consumers are more active in their care and healthcare decisions.
Consumers are much more apt to question healthcare providers, to treat themselves,
and to demand an active role in decision making.
In some situations, an individual’s passivity is the norm in health care, and
exploring and understanding their culture (Chapters 1 and 4), spiritual and religious
orientation will assist in encouraging involvement in the interview, to ensure
provision of person-centred care. A consumer’s spiritual and religious beliefs can
inuence whether or not they will accept or decline health care (e.g. whether a
THE HEALTH CONSUMER INTERVIEW APPROACHES INCORPORATING DEVELOPMENTAL CONSIDERATIONS 19
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consumer will agree to take medication, surgery, follow a special diet or execute an
advanced health directive) and this may also impact on their healthcare outcomes.
Nurses should seek to identify what the consumer’s religious and spiritual beliefs are
so that a comprehensive understanding of their perspective is attained. Ignorance
of a consumer’s spiritual and religious beliefs and practices will hamper complete,
holistic nursing that is person-centred care.
In Australia and New Zealand, people are free to practise any religion they
choose, or they may choose to have no religious afliation. Australia is considered
a religious country, with 60% of the population belonging to an organised
religion (Australian Bureau of Statistics, 2021). In New Zealand almost 52% of the
population identies with an organised religion (Statistics New Zealand, 2020).
First Nations peoples in Australia and New Zealand have their own spiritual
belief systems; however, with European settlement and the presence of Christian
missionaries in these communities, many Indigenous people converted
to Christianity. However, it is important to recognise that many Aboriginal and
Torres Strait Islander peoples often practise both belief systems simultaneously
(Skye, 2006).
CLINICAL REASONING
Practice tip: Belief systems that may pose a risk to consumer care
> When a consumer’s spiritual or religious beliefs are assessed as possibly harmful, the
healthcare provider needs to employ a careful and considered approach. Showing
respect for the consumer’s right to his or her own belief system is still appropriate.
> Consumers should not be separated from visitors who support these difcult beliefs,
although visitors, even families, may need to be separated and have selected visiting
times in order to decrease conict.
> Nurses should avoid becoming upset with consumers and visitors who hold different
beliefs that may interrupt or require care to be adjusted, or who may even refuse certain
aspects of care. A hospital chaplain may help to mediate and assist the consumer and
healthcare team to work through the concerns.
> If the consumer has religious or spiritual beliefs that may pose a risk to them, it is
appropriate to notify the nursing supervisor or treating medical doctor, and possibly
obtain an ethics committee consultation to discuss the treatment plan.
> When a child’s health is being harmed by the parents’ religious and spiritual beliefs, it
is appropriate to invoke the overarching requirements in your area about mandatory
reporting of possible child abuse. Such reporting will ensure legal representation for the
child and move the discussion to the legal realm.
CHAPTER 2
REFLECTION IN PRACTICE
Religious practices inuencing care provided to a young child
A 3-year-old child arrives at the emergency department by ambulance. The child was
involved in a car accident, and has sustained extensive trauma to the face, as a result of
being thrown through the windscreen. The father accompanies the child in the ambulance,
and informs the paramedics that they are Jehovah’s Witnesses and, thus, do not permit
blood transfusions. You are given this information on the consumer’s arrival. The child’s
blood pressure drops from 80/40 to 50/20. You are asked to call the blood bank for two units
of blood.
> How would you respond to this request?
> Do your religious beliefs conict with this family’s beliefs?
> If you feel you cannot assist with the blood resuscitation against the wishes of the father,
would you feel comfortable asking a co-worker to step in for you?
> What is your institution’s policy?
20 LAYING THE FOUNDATION
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REFLECTION IN PRACTICE
UNIT 1
GETT Y IMAGES/ASIASELECTS
FIGURE 2.1 Religion in a hospital setting
GETTY IMAGES/N ANO
FIGURE 2.2 Rituals such as the sacrament
of the Anointing of the Sick are important
expressions of religious belief.
FIGURE 2.3 Awareness of cultural and
religious norms and customs will help
you deliver appropriate nursing care.
Islam separates the sexes in many
aspects of public life, as illustrated here.
Refusal of health care – Organ donation recipient
A consumer has end-stage heart disease and will die unless she receives a heart
transplant. However, your consumer’s religious beliefs forbid her from accepting any blood
or organ donation. The consumer tells you she would rather go home once she is stable.
> What are your thoughts about this consumer’s decision and situation?
> How would you respond to this consumer’s request?
The nurse’s role in assessing a consumer’s spiritual needs
Almost all religions attempt to explain why human beings suffer from illness
and death, and how a higher power can affect healing (
responsibility to attempt to understand various religious and spiritual practices,
so they can provide competent person-centred care. For example, a Muslim
consumer may ask which direction is west, in order to pray facing Mecca. A
Catholic may refuse to enter the operating room, even for life-saving surgery,
until they have received the rite of Anointing of the Sick (
may pace and pray. An Orthodox consumer may wish to be able to see an icon
from her bed.
When assessing health history, keep in mind that the consumer’s lifestyle
may raise spiritual and religious issues for the person. For example, the consumer
may reveal a requirement for a vegetarian diet (Hindu, New Age), or a history of
circumcision (Jews), or the fact that his or her hair has never been cut (women:
Orthodox Jews; men: Sikhs). Another consumer may reveal that he or she is
estranged from family, due to conversion to a different, even conicting, religious
or spiritual belief, or a rejection of the religious or spiritual belief of the family
of origin.
The nurse must be aware of not stereotyping a consumer or jumping to
conclusions, based on their past experiences. Don’t assume that a holy book on
the table means that the consumer is a devout believer. The book may have been
left there by a family member or friend, distributed by a missionary group, or
donated by a well-meaning volunteer. Additionally, the absence of a holy book does
not mean the consumer is not spiritual or religious, as some religions (Unitarian,
New Age) do not have holy books. Furthermore, many self-identied members
of religious faiths do not follow the teachings of their own religions. A Jew may
eat pork, for example; a Jehovah’s Witness may accept a blood transfusion, and a
Catholic may request birth control. Some consumers who are
to return to the religion of their youth in a time of crisis. Many consumers may
blend elements of one religion with those of another religion or spiritual belief.
A good understanding of religious and spiritual practices is important, and an
understanding of your consumer’s specic beliefs is crucial when undertaking the
health assessment interview (
Figure 2.3).
It is important that nurses make their consumers feel comfortable to practise
their religion and spirituality, as appropriate. Without overt permission, some
reluctant consumers can feel overwhelmed by unfamiliar healthcare environments
or by their medical treatment regimen, and may forgo prayers or rituals that might
bring them profound relief at a time of crisis. Giving permission also shows respect
for consumers’ beliefs. However, due to real obstacles to religious and spiritual
practices in the healthcare context, the nurse may need to be creative about nding
ways to provide the most appropriate care to the consumer while still respecting
their religious and spiritual needs.
Figure 2.1). Nurses have a
Figure 2.2). A Buddhist
atheists may want
THE HEALTH CONSUMER INTERVIEW APPROACHES INCORPORATING DEVELOPMENTAL CONSIDERATIONS 21
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CLINICAL REASONING
Ensuring respect for individuals’ beliefs – Actions to avoid
It is important to show respect for your consumers’ religious and spiritual beliefs. The
following actions are considered disrespectful and should be avoided.
> Do not publicise your own spiritual beliefs. You may share beliefs if the issue comes up,
but it is never appropriate to try to convert the consumer to another set of beliefs.
> Do not instruct the consumer in religious or spiritual doctrine. In a time of spiritual distress, a
consumer needs support, not instruction. Let the religious or spiritual leader take the lead in any
instruction that is required, and follow nursing interventions that will enhance spiritual wellbeing.
> Do not perform the function of a spiritual adviser for the consumer. You and the consumer
may become confused about your role.
> Do not respond to the consumer with clichés. Well-known and overused clichés such
as ‘no sense crying over spilt milk’ or ‘there’s always someone else around who’s worse
off than you’ are inappropriate because they tend to blame or diminish the anguish of
the consumer. Clichés about religion, such as ‘God helps those who help themselves’
or ‘it was God’s will’, are just as inappropriate, because they are patronising and tend
to trivialise both the sufferer’s problems and the sufferer’s religion. Additionally, most
well-known religious clichés are based on Western Judaeo-Christian culture and have
no bearing on those with other religious or spiritual beliefs. Respond instead with real,
heartfelt words or, in some cases, with silence or with touch, if appropriate.
> Avoid taking on the role of spiritual adviser, spiritual healer, minister, priest, teacher, guru
and so on. Utilise instead the consumer’s pastor, imam, priest or minister, or spiritual
support systems, family or the healthcare institutional chaplain to ll that role.
CHAPTER 2
General approach to planning for the health assessment interview
Preparing for the interview
1. Gather all available consumer information.
2. Seek out an appropriate setting for the interview.
3. Set aside a block of time for the interview.
4. Assess your emotional readiness in preparation for undertaking the interview.
5. Begin the interview with a friendly introduction.
• Introduce yourself by name and title.
• Call the consumer by formal name, for example ‘Mr’ or ‘Mrs Adams’, unless
you are asked otherwise. If asked to call the consumer by their rst name, you
should comply as this will assist in helping the consumer feel less awkward
and improve the building of rapport, as long as the nurse continues to respect
cultural, spiritual, personal and professional boundaries.
ASSESSMENT IN BRIEF
Interviewing considerations
> Be aware of personal beliefs (including cultural and spiritual)
and how these were acquired.
> Avoid imposing your beliefs on those you interview and
practise a culturally safe approach.
> Listen and observe. Attend to verbal and affective content as
well as to nonverbal cues.
> Keep your attention focused on the consumer and use active
listening skills.
> Maintain eye contact with the consumer as is appropriate for
the consumer’s culture.
> Notice the consumer’s speech patterns and any recurring
themes or issues. Note any extra emphasis that the
consumer places on certain words or topics.
> Do not assume that you understand the meaning of all
consumer communications. Clarify frequently.
> Paraphrase and summarise occasionally to help consumers
organise their thinking, clarify issues, and begin to explore
specic concerns more deeply.
> Allow for periods of silence.
> Remember that attitudes and feelings may be conveyed
nonverbally.
> Consistently monitor your reactions to the consumer’s verbal
and nonverbal messages.
> Avoid being judgemental or critical.
> Avoid the use of nontherapeutic interviewing techniques.
22 LAYING THE FOUNDATION
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UNIT 1
Considerations for interviewing
Considerations that need to be recognised prior to the interview commencing are
discussed in the next section. Establishing and addressing the consumer’s comfort
level is a key consideration before commencing.
Environment
The setting for the interview has a direct inuence on the amount and quality of
information gathered (see
conducted in a private room with controlled lighting and temperature. When a
private setting is impossible, control the environment to minimise distractions
and interruptions, and to increase the comfort level of the consumer. Utilise any
physical barriers available in the room to provide as much privacy as possible.
When all efforts to ensure even minimal privacy fail, conduct a shortened interview
to gather only immediately pertinent information. Defer the complete interview
until a later time (if possible) when privacy can be ensured.
Figure 2.4). Whenever possible, the interview should be
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FIGURE 2.4 Environment can have an impact on the consumer interview
Commencing an interview
Prior to approaching the consumer, gather all available consumer information,
admission data and past medical records, as this will signicantly inuence the time
needed for the interview. Begin the interview with an introduction, including your
name and position. Initially call the consumer by his or her formal name and ask
how they would prefer to be addressed. Simple communication utilising appropriate
names is respectful, and helps identify individuals as unique persons at a time when
they may be feeling quite anxious and vulnerable.
Providing the consumer with an explanation of what is to follow and an
approximate time frame for the interview helps in establishing trust. This
information also helps to increase the consumer’s feeling of control. The more
effective you are in establishing trust, the easier it will be to obtain information
from the consumer (Stein-Parbury, 2021), for example: ‘Good morning, Mrs Liddle,
my name is Erin Little. I’m a registered nurse. I’d like to ask you some questions
about your health situation today.’
Condentiality
Condentiality is essential in developing trust between the nurse and the consumer.
The consumer’s willingness to communicate private and personal information is
predicated on the assumption that this information will be used with discretion and
for their benet (Stein-Parbury, 2021). Your verbal assurance of condentiality often
eases the consumer’s concerns, and fosters trust in the relationship. In practice,
there are certain exceptions to maintaining absolute condentiality. (Refer to
Chapter 3 for further details.)
For example, in a teaching hospital in which a team approach is used,
information must be shared. Another important reason for sharing condential
information is when the consumer is at risk to self or others. Nurses need to be
familiar with the policies of their institution, as well as legal statutes on consumer
condentiality and the consequences of not adhering to them. It is essential to
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THE HEALTH CONSUMER INTERVIEW APPROACHES INCORPORATING DEVELOPMENTAL CONSIDERATIONS 23
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inform the consumer prior to the interview when information will be shared with
others. Frequently, consumers may have friends or family members with them.
To ensure consumer comfort and condentiality, ask the consumer whether these
people should remain in the room for the interview, although you should try not to
do this in front of these people where possible as the consumer may feel pressured
to elect to allow them to stay. Be sure to review your professional code of conduct
and code of ethics, as consumer condentiality and privacy are outlined in these
regulations.
Further information about condentiality is available from the Australian Commission
on Safety and Quality in Health Care, the Human Rights Commission in New Zealand, and
the Nursing and Midwifery Board Australia (including the endorsed International Council
of Nurses code of ethics for nurses) and Nursing Council of New Zealand (code of conduct).
REFLECTION IN PRACTICE
Breaking condentiality in the emergency department (ED)
A 22-year-old male presents to the ED and reveals to you that his extensive physical injuries
are the result of an assault. He asks you not to share this information with anyone because
he is fearful of retribution. A police ofcer attends and requests information from you about
the consumer and his injuries. What is your immediate reaction to this disclosure? What
is your institution’s policy concerning condentiality? What are your responsibilities in
this situation?
CHAPTER 2
Strategies to support accurate and timely documentation
During the health assessment interview, it is advisable to jot down (or enter into the
electronic health record) information as you proceed, although you should be aware
that the simple act of noting what the consumer says may cause some discomfort
(Figure 2.5). Early in the interview, explain the necessity of noting pertinent
information and where this will be stored. Frequently, the consumer will lead the
interview or discuss sensitive issues. When this occurs, give full attention to them
and defer formal recording of information. Ensure you review Chapter 3 for more
information about documentation.
FIGURE 2.5 The consumer interview often requires note taking. Maintain rapport and eye contact as much
as possible.
24 LAYING THE FOUNDATION
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UNIT 1
Time, length, duration
To become fully involved with the consumer, enough time must be set aside for
the interview. When scheduling an interview for the consumer, consider their
individual daily activities, and select a block of time for the interview that does not
conict with other planned activities. Also, ask the consumer what interview times
would be least disruptive to their daily routine, and try to accommodate this.
Biases and preconceptions
Personal beliefs and value systems (inclusive of cultural, spiritual and religious
practices), attitudes, biases and preconceptions of both the nurse and the consumer
inuence the sending and receiving of messages. The cultural and family contexts
of each serve as a lens for interpreting societal views on ethnicity, gender, sexual
orientation, socioeconomic status, religion and health care. Nurses’ and consumers’
views of themselves as cultured and gendered beings are highly inuential in how
they think and feel about health and illness, and have an impact on how they
respond to different clinical situations. The nurse must be sensitive to personal as
well as individual contexts in order to treat all consumers fairly and respectfully.
The nurse’s subjective impressions of the consumer may lead to incorrect
assumptions about their situation. For example, a nurse may view a consumer who
appears thin and frail as seriously ill or unable to participate in activities of daily
living when, in fact, this person may not be seriously ill or incapacitated in any way.
To counter incorrect assumptions, biases and preconceptions, continually validate
information and personal impressions through the use of careful data gathering and
effective interviewing techniques.
CLINICAL REASONING
Communicating for safety
Interviewing consumers in a safe manner recognises the importance of always maintaining
a person-centred approach and that communicating for safety is paramount. This is
reected in the Australian National Safety and Quality Health Service Standards, which
identies that effective communication is required in supporting continuous, coordinated
and safe patient care.
For further information visit: https://www.safetyandquality.gov.au/sites/default/les/
2021-05/national_safety_and_quality_health_service_nsqhs_standards_second_edition_-_
updated_may_2021.pdf
Stages of the interview process
There are three stages in the interview process: the introduction or joining stage, the
working stage, and the termination stage.
Stage I
The joining stage is the introduction or rst stage of the interview process, during
which the nurse and the consumer establish trust and get to know one another.
During this stage, work with the individual to identify the relationship and establish
goals for this and any subsequent interactions.
Stage II
The working stage of the interview process is the time during which most of the
consumer data is collected. It is a nursing responsibility to keep the interview goal
directed, including refocusing the individual and redening the goals established in
the joining stage.
Stage III
The termination stage is the last stage of the interview process, during which
information is summarised and validated. During this stage, give the consumer
THE HEALTH CONSUMER INTERVIEW APPROACHES INCORPORATING DEVELOPMENTAL CONSIDERATIONS 25
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an indication of the amount of time left in the interview, and allow them the
opportunity to give additional information and make comments or statements. For
example, ‘We have about 5 minutes more, Mrs Taylor, is there anything else you
would like to add or mention?’ Another important step in the termination stage is
planning for future interviews.
REFLECTION IN PRACTICE
Decreasing anxiety in the interview
Remember the last time that you cared for an anxious person/family member or friend. What
did you do that helped to calm them down?
Now identify some specic actions you might take to decrease a consumer’s anxiety
during the joining stage of the interview process (Stage 1). It is important to recognise that
each person-centred encounter will be different, as individuals display or cope with anxiety
in different ways.
Factors affecting communication
Elements that can affect the sending and receiving of messages are discussed in the
following sections.
CHAPTER 2
REFLECTION IN PRACTICE
Encouraging active listening
Think of a time when you attempted to talk with someone who didn’t appear to be listening.
How did that make you feel? What kind of things did you do to get your message across?
How many times have you listened to a person/family member or friend with ‘half an ear’?
What caused you to do this? Identify some specic actions that you might take to ensure
that your consumers feel heard.
Listening
Active listening, or the act of perceiving what is said both verbally and nonverbally,
is a critical factor in conducting a successful health assessment interview. According to
Stein-Parbury (2021), active listening allows the nurse to understand all aspects of what
the consumer is communicating, and is an excellent way to build trust. Be aware of how
personal characteristics, choice of communication techniques, and the manner and
timing of their use can affect communication.
REFLECTION IN PRACTICE
Nonverbal communication
Look at the nurse–consumer encounters in Figures 2.6 and 2.7. Describe the nonverbal
communication that you see in each.
FIGURE 2.6 FIGURE 2.7
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