Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_2656_Библиотеки_им_академика_М_И_Перельмана
.pdf
26 LAYING THE FOUNDATION
Copyright 2024 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-300
https://t.me/medicina_free
UNIT 1
Nonverbal cues
Nonverbal communication is communicating a message without words.
Nonverbal behaviour effectively supplements the spoken word and provides
information about both nurse and consumer. These behaviours can provide insight
into the individual’s cultural expectations, current physical and emotional states,
and perceived self-image. Nonverbal cues such as body position, nervous repetitive
movements of the hands or legs, rapid blinking, lack of eye contact, yawning,
dgeting, excessive smiling or frowning, and repetitive clearing of the throat may be
indications of the consumer’s health and feelings that they may not be comfortable
expressing verbally (Stein-Parbury, 2021). Be aware of cultural differences (see
Chapters 1 and 4 for more information).
Healthcare environments often evoke a great deal of anxiety, uncertainty or fear
in consumers. Loss of personal control is a major obstacle confronting consumers in
healthcare settings, whether they are seriously ill or not. In an attempt to maintain
some control in unfamiliar circumstances and to decrease anxiety, consumers
frequently look to nurses for cues on how to behave or how to respond to questions.
Nonverbal acts by the nurse can indicate empathy and attention or indifference and
inattention (Stein-Parbury, 2021). Such behaviour powerfully inuences consumer
comfort levels, feelings of control, and willingness to share information. Because of
this, nurses need to continuously monitor their own nonverbal behaviours.
Personal space
Personal space can be dened as the space over which a person claims ownership.
In an acute care facility, the consumer’s hospital room and bathroom are considered
the individual’s personal space. The consumer may be very protective of this space
and consider unauthorised use of it as an invasion of privacy.
REFLECTION IN PRACTICE
Assessing communication
Record a short video (use a smartphone or other device) of yourself and a colleague
role-playing taking a health history. Review the video.
> What nonverbal communication did you identify in yourself? Your colleague?
> What communication techniques did you employ? Were they effective?
> What have you learnt about communication from this exercise?
Distance
Personal space includes distance or the amount of space a person considers
appropriate for interaction with another or others. Distance is a signicant factor in
the interview process and is determined in part by cultural inuences. In Western
communities, distances are generally categorised as follows, although this can be
affected by regional context as well (personal distance in rural and remote areas is
often up to double that which is acceptable in metropolitan areas):
> Intimate distance is from the consumer to approximately 40–50cm.
> Personal distance is approximately 50cm to 1.2metres.
> Social distance is approximately 1.2–3.5 metres.
> Public distance is approximately 3.5 metres or more.
Intimate distance is the closest and involves some touching or physical contact.
Personal distance may also involve some touching or physical contact, and it
may ease communication in some instances, such as for consumers with hearing
impairment. In other instances, personal distance may be threatening or invasive
to the individual. Social distance is considered appropriate for the interview
process because it allows for good eye contact and for ease in hearing and in seeing
the consumer’s nonverbal cues. Other considerations of social distance must be
reviewed and adhered to as required. A good example of this occurred during the
THE HEALTH CONSUMER INTERVIEW APPROACHES INCORPORATING DEVELOPMENTAL CONSIDERATIONS 27
Copyright 2024 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-300
https://t.me/medicina_free
COVID-19 pandemic, where social distance was required in all public spaces. Public
distance is usually used in formal settings such as in a classroom where the teacher
stands in front of the class. It is not considered appropriate for an interview.
CLINICAL REASONING
Practice tip: The use of touch in the consumer interview
You must be mindful of the use of touch during the consumer interview. While a caring
touch, a pat on the hand or other gesture may send a message of empathy to a crying
individual, it may not be appropriate in all situations. The individual’s cultural background
may dictate what is or is not appropriate. Also, if a consumer has a history of physical abuse
or neglect, or is recovering from a skin disorder such as a burn, a well-meaning touch may
be interpreted in a hostile manner.
EFFECTIVE COMMUNICATION TECHNIQUES
Effective communication techniques facilitate or support interactions between the
nurse and the consumer and foster their continuation. These techniques encompass
both verbal and nonverbal approaches. The more skilled you are in understanding
the communication process, the more effectively you can use it in a purposeful,
goal-directed manner to meet your need for information and the consumer’s
need for attention to health concerns or problems (Stein-Parbury, 2021). Because
individuals who come to a healthcare provider are frequently anxious, effectively
communicating your interest and concern greatly enhances the interview
and interaction.
Certain specic verbal communication techniques are available to help you
facilitate this interaction. The effectiveness of these techniques will vary from
individual to individual. At rst, these techniques may feel awkward, stilted or
forced; keep in mind that communicating effectively in the healthcare context is a
learnt skill (similar to other nursing skills) and, as such, improves with practice.
CHAPTER 2
Using open-ended questions
Open-ended questions encourage the consumer to provide general rather than more
focused information (see
with open-ended questions provides the individual with a sense of control, leaving
the choice of what to say, how much to say, and how to say it up to them. These
questions indicate respect for the consumer’s ability to articulate important or
pressing health concerns and, therefore, to help set priorities.
EXAMPLES OF OPEN-ENDED QUESTIONS
> ‘What are some of your concerns about caring for your grandmother at home?’
> ‘How do you usually manage a hypoglycaemic episode at home?’
Open-ended questions that begin with the words how, what, where, when and
who are usually more effective in eliciting the maximum amount of information
than those that begin with the word why (Stein-Parbury, 2021). ‘Why’ questions
can cause consumers to become defensive and feel the need to somehow explain
or defend their ideas and behaviour, thus setting up an adversarial relationship
between the nurse and the individual. Although open-ended questions are quite
helpful in the health assessment interview, they can be time-consuming and may
not be appropriate in situations requiring rapid access to information and rapid
response by healthcare providers. Overuse of this type of question, especially with
the consumer who is confused, vague in his or her responses, or extremely talkative,
can cause the nurse to miss important information.
Figure 2.8). Beginning the health assessment interview
SHUTTERSTOCK.COM/ALEX ANDER RATHS
FIGURE 2.8 The nurse uses open-ended
questions to gather general information in
the consumer interview.
28 LAYING THE FOUNDATION
Copyright 2024 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-300
https://t.me/medicina_free
UNIT 1
In some situations, for example, when a person is anxious and unfamiliar with
the healthcare system, they may attempt to ascertain what answers the nurse wants
and what areas the nurse seems to feel are important. The consumer will then focus
on those, rather than on areas that are most important to them. With open-ended
questions, you can encourage the individual to identify what is important.
When eliciting the health history, it is usually best to let the consumer speak
uninterrupted, allowing them to complete their answer. You should then proceed
with questions or clarication.
Using closed questions
Closed questions are those that regulate or restrict consumer response. They can
frequently be answered with a ‘yes’ or a ‘no’. Closed questions can be used to focus
the interview, pinpoint specic areas of concern, and elicit valuable information
quickly and efciently.
EXAMPLES OF EFFECTIVE CLOSED QUESTIONS
> ‘Are you thinking of harming yourself?’
> ‘Do you use hearing aids??’
If used too frequently, closed questions can disrupt communication because they
limit consumer responses and interaction. Even well-directed closed questions may
take the initiative away from the consumer, giving them the impression that the
nurse is in charge of the interview, does most of the work, often knows the answer
to the question asked, and is directing the consumer’s response.
FIGURE 2.9 The nurse remains silent,
giving the consumer time to reect and
respond.
EXAMPLES OF INEFFECTIVE CLOSED QUESTIONS
> ‘Do you still feel upset and depressed?’
> ‘Are you afraid to tell your parents that you are sexually active?’
Facilitating
Once the health assessment interview has started, there may be periods when
consumers stop talking because of anxiety, uncertainty or embarrassment. You
can use a variety of both verbal and nonverbal means to encourage individuals to
continue talking. Phrases such as ‘go on’ or ‘uh-huh’, the simple repetition of key
words the consumer has spoken, or even head nods or a touch on the hand prompt
the individual to resume speaking and also indicate your continued interest
and attention.
Using silence
Silence, too, has its place in the health assessment interview. Understood and
used effectively by the nurse, periods of silence can help structure and pace the
interview, convey respect and acceptance, and, in many cases, prompt additional
data from the consumer (Stein-Parbury, 2021). Silence on the part of the consumer
may indicate feelings of anxiety, confusion or embarrassment, or simply a lack of
understanding about the question asked, or an inability to speak English. Nonverbal
cues such as these are often lost if the nurse is a persistent talker. Conversely, if
overused, silence can contribute to an awkward, disjointed interview that provides
minimal structure or direction for the consumer and little helpful data for the nurse.
Using silence effectively may seem like a difcult skill to master (see
Frequently, silences seem longer than they actually are. When silences occur, you
may feel discomfort and pressure to speak in order to be actually ‘doing’ something
therapeutic; instead, handle silences by being quiet and observing the consumer’s
behaviour for what is not being said verbally.
Figure 2.9).
Grouping communication techniques
Communication techniques often seem mechanical and articial to the beginning
nurse. One way to make them less so is to group or cluster them according to their
THE HEALTH CONSUMER INTERVIEW APPROACHES INCORPORATING DEVELOPMENTAL CONSIDERATIONS 29
Copyright 2024 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-300
https://t.me/medicina_free
primary purposes. Grouping communication strategies on the basis of purpose helps
to clarify the intent of each communication response and indicate when in the
assessment interview its use might be helpful. One simple way to group interview
techniques is to divide them into two groups: listening responses and action
responses.
Listening responses
Listening responses are attempts made by the nurse to accurately receive, process
and then respond to consumer messages (Stein-Parbury, 2021). They provide
one way for the nurse to communicate empathy, concern and attentiveness.
Listening responses provide the nurse with a means to understand the individual’s
perspective. Consumers realise they have been heard and that the nurse is working
with them to elicit and clarify health concerns. Listening responses include making
observations, restating, reecting, clarifying, interpreting, sequencing, encouraging
comparisons and summarising.
Making observations
When making observations, the nurse verbalises their perceptions about the
consumer’s behaviour, and shares them with the individual. Sharing observations
is also a way to validate consumer competency and sense of control in an
environment or situation where the consumer often feels out of control, uncertain
or overwhelmed.
CHAPTER 2
EXAMPLES OF MAKING OBSERVATIONS
> ‘Speaking about the symptoms you are experiencing seems to make you upset. I notice that you are
clenching your jaw and grimacing.’
> ‘I notice that each time you’ve been exposed to that particular problem, you’ve known how to handle
it well.’
Restating
Restating involves repeating or rephrasing the main idea expressed by the consumer
and lets the them know that you are paying attention. It promotes further dialogue
and provides the individual with an opportunity to explain or elaborate on an issue
or concern.
EXAMPLES OF RESTATING
> Consumer: I don’t sleep well anymore and I nd myself waking up frequently at night.
> Nurse: So, you’re having difculty sleeping?
Reecting
Reecting is another listening response. It focuses on the content of the consumer’s
message as well as their feelings. In reecting, the nurse directs the individual’s
own questions, feelings and ideas back to them and provides an opportunity for
the consumer to reconsider or expand on what was just said. The consumer’s point
of view is given value, and the nurse, although indicating an interest in what the
individual has to say, refrains from giving advice, passing judgement or assuming
responsibility for the person’s thoughts or feelings.
EXAMPLES OF REFLECTING
> Consumer: Do you think I should tell the doctor I stopped taking my medication?
> Nurse: Well, do you feel comfortable to tell them? Are you okay to do so?
> Consumer: Well, yes; I think that I probably should. Not taking my medication could be one of the
reasons I’m feeling so run-down. But that medication just makes me so lethargic and emotional.
> Nurse: You sound a bit emotional now. It appears that you have been thinking about this quite a lot.
> Consumer: I did tell that young doctor that I had problems with this medication, but he did not listen
to me.
> Nurse: It sounds as if you are annoyed with him.
30 LAYING THE FOUNDATION
Copyright 2024 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-300
https://t.me/medicina_free
UNIT 1
Clarifying
Clarifying is a communication technique used by the nurse to make clear
something the consumer has said or to pinpoint the message when the person’s
words and nonverbal behaviour do not agree. Be sure you understand exactly what
the consumer means before continuing, because communication may stop if the
individual feels misunderstood or not heard. Distortions or misunderstandings
about a consumer’s data can occur if the nurse interprets the individual’s statements
using only personal experiences and perceptions. Even more crucial is the fact that
making assumptions may cause the interviewer to proceed from a faulty database.
EXAMPLE OF A CLARIFYING RESPONSE
> Consumer: During certain activities, I have the most awful pain in my back.
> Nurse: Tell me what you mean about this pain; or I’m not sure that I understand what you mean about
your pain. Can you describe what your pain feels like (e.g. stabbing, throbbing, aching).
Interpreting
With interpreting, the nurse has the opportunity to share the inferences or
conclusions gathered from the consumer’s interview. Although there is always the
risk that their interpretation of the facts is incorrect, the nurse is well poised to link
events that perhaps the consumer was not able to piece together.
EXAMPLES OF INTERPRETING
> Nurse: Your painful legs seem to occur when you are in bed.
> Nurse: From what you have just told me, do you think that the stress you experience relates to your
teaching job and this is causing your headaches?
Sequencing
To effectively assess consumer needs, the nurse often requires knowledge of a
time frame within which symptoms or problems developed or occurred. One way
to acquire this information involves asking the consumer to place a symptom,
problem or event in its proper sequence. Sequencing also helps both consumer
and nurse become aware of any patterns in the individual’s behaviour that might
indicate recurring problems or issues. These can relate to feelings (depression or
anxiety), behaviour (refusal to take appropriate medications, consistently putting
self in risky situations) or experiences (being physically or verbally abused, being
hurt, being misunderstood by healthcare providers). Pattern identication provides
the nurse with clues for further assessment focus.
Encouraging comparisons
Encouraging comparisons is a technique that enables both participants in the health
assessment interview to become more aware of patterns, issues/themes, or specic
symptomatology in the consumer’s life. It also helps the consumer to deal more
effectively with unfamiliar situations by placing the symptoms or problems in the
context of something else that is familiar and, therefore, more comfortable to them.
Often an awareness of successful prior dealings with similar situations increases
consumer condence levels.
EXAMPLES OF ENCOURAGING COMPARISONS
> ‘Have you had similar experiences?’
> ‘In what way was this allergy episode different from or the same as your previous ones?’
> ‘In what way was your reaction to this medication similar or different from your reaction to other
antibiotics you’ve had?’
Summarising
Summarising is a communication technique that helps consumers to organise
their thinking. As such, summarising is a communication technique that is
THE HEALTH CONSUMER INTERVIEW APPROACHES INCORPORATING DEVELOPMENTAL CONSIDERATIONS 31
Copyright 2024 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-300
https://t.me/medicina_free
especially useful at the end of the health assessment interview. A brief, concise
review of the important points covered helps the consumer identify anything that
has been left out and provides the nurse with an opportunity to make sure that
what he or she understood the individual to say, is what was said. In addition,
summarising indicates both interest and concern, so the consumer feels they have
been heard.
EXAMPLE OF SUMMARISING
> Nurse: You have shared with me several health concerns such as a painful left calf, difculty in losing
weight and sleeplessness. The one that is most challenging for you seems to be your difculty in
losing weight. Is this correct?
Summarising also provides a means of smoothly transitioning to a new topic or
section of the health assessment interview.
EXAMPLE OF TRANSITIONING
> Nurse: You talked about your past experience with diabetes and what happened to you yesterday;
now let’s talk about why you came in today.
CLINICAL REASONING
CHAPTER 2
Practice tip: The use of humour in the consumer interview
Humour can be an effective communication technique in the consumer interview. It can
make an anxious person more at ease, diffuse tension, and make it easier for an individual
to discuss sensitive issues. However, ill-timed humour or the use of inappropriate humour
can offend individuals and make them distrustful of you. It is also important to be aware that
humour can be very different for people from various cultural backgrounds who may not
share your humorous view or perspective.
Action responses
Action responses are the second group of effective interviewing techniques.
These responses stimulate consumers to make some change in their thinking and
behaviour. Action responses include such communication techniques as focusing,
exploring, presenting reality, confronting, informing, collaborating, limit-setting
and normalising.
Focusing
Focusing allows the nurse to concentrate on or ‘track’ a specic point the consumer
has made. This technique is particularly useful with individuals whose heightened
anxiety level causes increased confusion, altered concentration, or jumping from
topic to topic. With the nurse’s assistance in focusing, the individual is able to
proceed with the health history interview in a clearer, more organised, thoughtful
and thorough manner.
EXAMPLES OF FOCUSING
> ‘Tell me more about the chest pain you experience when you begin to exercise.’
> ‘You’ve mentioned several times that your wife is concerned about your smoking. Can we talk about
your smoking habit?’
Exploring
In exploring, the nurse is attempting to develop, in more detail, a specic area of
content or consumer concern. The purpose of exploring is to identify patterns or
themes in symptom presentation or in the way the person handles problems or
health concerns.
32 LAYING THE FOUNDATION
Copyright 2024 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-300
https://t.me/medicina_free
UNIT 1
EXAMPLES OF EXPLORING
> ‘Tell me more about how you feel when you do not take your medication.’
> ‘Could you describe for me how you handle those periods in your life when you feel out of control?’
Presenting reality
This technique, while typically used with consumers with mental health issues
or individuals who are confused, is also useful in the health assessment interview
when the nurse is confronted with a consumer who exaggerates or makes grandiose
statements. Presenting reality, when done in a non-argumentative way, encourages
the individual to rethink a statement and perhaps modify it.
EXAMPLE OF PRESENTING REALITY
> Consumer: I can never get an appointment at this clinic.
> Nurse: Mr Jasper, could you explain what you mean, as I’ve seen you several times in the past four
months.
> Consumer: Well, yes, but I can never get an appointment at a time that is convenient for me.
Confronting
Confronting is a verbal response that the nurse makes to some perceived
discrepancy or incongruence in the consumer’s thoughts, feelings or behaviour.
Gently challenging an incongruence can help the individual reframe a situation in
order to see things differently. Focusing the consumer’s attention on a behaviour or
feeling that could be modied may lead to a more positive outcome in the situation.
When confronting is used in a caring, empathetic manner, rather than in a critical
or accusatory one, the person can feel encouraged to view themselves as
effective individuals.
EXAMPLE OF CONFRONTING
> Consumer: I have been working on lowering my risk for heart disease. I have been taking my blood
pressure medication and have been watching my diet.
> Nurse: Well it’s great that you have been taking your medication and being mindful of your diet.
There are, however, other factors that signicantly increase your cardiovascular risk. For example, you
smoke two packs of cigarettes a day and your blood results indicate that your triglyceride level has
doubled in the past 3 months. Let’s review your heart-health management plan and see where you
may need some further assistance.
Informing
Providing the consumer with needed information, such as explaining the nature
of or the reasons for any necessary tests or procedures, is a nursing action that can
help build trust and decrease a person’s anxiety. Giving consumers information is
appropriate when trying to assist them to navigate the options to make the best
choice for their situation.
EXAMPLE OF INFORMING:
> Consumer: Dr Leathwick told me that I need to have my gall bladder taken out.
> Nurse: Can you tell me what Dr Leathwick told you about your gall bladder surgery?
> Consumer: I didn’t understand what he said about the new technique. He said something about a
tube.
> Nurse: The technique he is going to use is laparoscopic surgery. This is where the surgeon inserts a
small scope in your abdomen to remove the gall bladder rather than making a large incision.
> Consumer: Yes, that was it, please tell me more about that.
Collaborating
In collaborating, the consumer is offered a relationship in which the nurse and
individual work together, rather than one in which the nurse is in total control of
the interaction. Use of this technique conveys the message that the consumer has
THE HEALTH CONSUMER INTERVIEW APPROACHES INCORPORATING DEVELOPMENTAL CONSIDERATIONS 33
Copyright 2024 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-300
https://t.me/medicina_free
important personal knowledge and information to share. Collaborating provides
a respectful, person-centred approach the nurse can use to encourage consumers’
active involvement in their own health care in setting goals, in gathering
information and in problem solving.
EXAMPLE OF COLLABORATING
> ‘Perhaps you and I can talk further about your heart-health management plan and discover what
specically you think you can do to reduce your cardiovascular risk.’
Limit setting
During the interview with a seductive, hostile or talkative consumer, the nurse
may nd it necessary to set specic limits on the individual’s behaviour. If, for
example, the consumer persists in asking the nurse personal questions or continues
to divert the conversation, despite frequent attempts by the nurse to focus it, it
will be difcult to obtain the information needed. This consumer behaviour may
be a manifestation of stress produced by the interview situation itself or simply
a characteristic specic to that individual. In such situations, consumers may
require some direction on how to behave. Provide guidance by calmly, clearly
and respectfully telling the consumer what behaviour is expected. Limit only the
behaviour that is problematic or detrimental to the purpose of the interview and
avoid making a ‘big issue’ about whatever it is that the consumer is doing. When
limit setting, do not argue or use empty threats or promises, but do offer the
individual alternatives.
CHAPTER 2
EXAMPLE OF INEFFECTIVE LIMIT SETTING
> Nurse: If you don’t start answering my questions about your health problems, we’ll never nish, and
you’ll never get to see the nurse practitioner.
EXAMPLE OF APPROPRIATE LIMIT SETTING
> Nurse: My role here today is to assist you with your health concerns. It appears that you are feeling
pretty unsure of talking about your personal health problems.
> Consumer: What do you mean?
> Nurse: Well, as you are asking me a lot of personal questions, I am nding it difcult to get you back
on track to talk about your health problems.
you here to the emergency department today?
So, can we focus on you and nd out what has brought
CLINICAL REASONING
Practice tip: Professional boundaries and answering personal questions
The nurse brings a lifetime of experiences and emotions to each consumer encounter; so
too does the consumer. It is only natural for the consumer to be curious about the nurse as
the healthcare provider. Sharing personal experiences makes the nurse a real person to the
consumer and helps to develop a respectful nurse–consumer interaction. The nurse needs
to be certain, however, that the information divulged to the consumer remains generic so
that they do not cross the professional boundary to form a more social interaction. Also,
remember that the consumer may ask personal questions in order to divert the interview to
avoid uncomfortable or sensitive issues.
Normalising
Very often, individuals faced with unexpected or life-threatening illnesses, or surgeries,
respond in ways that seem extreme or out of the ordinary (e.g. becoming depressed or
overly tearful). Normalising allows the nurse to offer appropriate reassurance that their
response may be quite common for this situation. This helps to decrease consumers’
anxiety and encourages them to share thoughts and feelings they might otherwise
keep to themselves for fear of being judged or misunderstood. However, if used
inappropriately or out of context, normalising may give false reassurance.
34 LAYING THE FOUNDATION
Copyright 2024 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-300
https://t.me/medicina_free
UNIT 1
EXAMPLE OF NORMALISING
> ‘It is no wonder that you’ve been feeling shocked and overwhelmed since you rst found that lump in
your breast.
Most women who have that experience react in a similar way.’
COMMUNICATION: TECHNIQUES TO AVOID
Just as there are certain communication techniques that facilitate communication
between nurse and consumer, there are also some techniques that change, distort
or block communication and should be avoided. Verbal and nonverbal behaviours
that involve inattentiveness, imposition of values, judgement, lack of interest or an
‘I know what’s best for you’ attitude hinder communication by creating distance
rather than connection. Consumers on the receiving end of these behaviours can
feel angry, defensive or incompetent, and may refuse to actively participate. Such
ineffective techniques include requesting an explanation, probing, offering false
reassurance, giving approval or disapproval, defending and advising.
Requesting an explanation
Consumers often perceive questions that begin with ‘why’ as challenging or
threatening. Such questions ask the consumer to provide a reason or justication
for personal beliefs, feelings, thoughts and behaviours and imply criticism. If
consumers are unable to provide these answers, either from lack of enough
knowledge or because the answer is not known to the individual, he or she can feel
inadequate, defensive or angry. Some questions are unanswerable and individuals
are frequently unaware of why they do some things. Asking the consumer to
describe beliefs, feelings or behaviours is preferable to asking ‘why’. Providing a
description about what happened often helps the consumer elaborate. Enlarging the
context provides opportunities for the consumer to increase self-awareness and for
the nurse to increase the store of relevant information.
EXAMPLES OF REQUESTING AN EXPLANATION
EXAMPLE 1
> Consumer: I guess I drink two or three six-packs of beer a weekend.
> Nurse: Thank you for sharing this with me. So you enjoy a good time on the weekend. Is there any
reason why this includes drinking that much beer? (judgemental)
> Consumer: That’s not very much; all my friends drink the same amount.
A more appropriate response in the preceding example might be:
> Nurse: It sounds as if you might be concerned about the amount of beer you drink. (reecting)
EXAMPLE 2
> Consumer: I’m not sure why I came to the clinic today; I just feel miserable. I don’t want to see
anyone. I just want to stay in bed with the covers pulled over my head.
> Nurse: Why do you feel that way?
> Consumer: I don’t know.
A more effective response would be:
> Nurse: ‘What happened that caused you to feel so miserable?’ (clarifying) or ‘It sounds as if you are
feeling rather overwhelmed today.’ (reecting)
Probing
Repeated or persistent questioning of the consumer about a statement or a
behaviour increases their anxiety and can cause confusion, hostility and a tendency
to withdraw from the interaction. This consumer withdrawal and the increasing
periods of silence resulting from it can escalate the nurse’s anxiety. Anxious nurses
THE HEALTH CONSUMER INTERVIEW APPROACHES INCORPORATING DEVELOPMENTAL CONSIDERATIONS 35
Copyright 2024 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-300
https://t.me/medicina_free
tend to become more active and more directive in the interview. The consumer’s
unwillingness or hesitation to discuss a certain event or health concern may
indicate the consumer’s misunderstanding, misinformation, or a major problem
area that needs further clarication or exploration.
A helpful rule of thumb for nurses to use in identifying probing is to pay
attention to their own behaviour and feelings. If, in attempting to gather
information, nurses feel frustrated or irritated, or that they have become involved
in a verbal tug of war with the consumer, then they are most likely probing. More
useful responses may include going on to the next part of the health assessment
interview, asking the consumer’s permission to return to this subject later if it
seems likely that more information will be needed, or just sitting quietly until the
consumer begins to speak.
EXAMPLE OF AN APPROPRIATE PROBING QUESTION
> Nurse: What makes you think that you have arthritis?
> Consumer: I’m not sure, I just think I do. It just seems like I have the same health problems as my
mother and she had arthritis.
> Nurse: Well, do you have pain?
> Consumer: Yes. (pause)
> Nurse: What makes you think the pain is arthritis pain?
CHAPTER 2
If nurses can be patient, identify and manage their own anxiety, and allow
silences, useful discussion usually ensues.
Offering false reassurance
False reassurances are vague and simplistic responses that question the consumer’s
judgement, devalue and block the individual’s feelings, and communicate a lack
of understanding and sensitivity on the part of the nurse. The impulse to provide
false reassurance typically originates in the nurse’s own feelings of helplessness.
Giving false reassurance is an attempt by the nurse to take care of themselves rather
than the consumer and to relieve personal feelings of anxiety. This behaviour often
increases consumer anxiety. A more valuable nursing response would be to
rst acknowledge personal feelings of anxiety and then to acknowledge the
consumer’s feelings.
EXAMPLES OF FALSE REASSURANCE
> ‘Everything will be ne.’
> ‘I wouldn’t worry about that.’
EXAMPLE OF AN APPROPRIATE RESPONSE
> ‘It must be frightening to think about the possibility of surgery.’
REFLECTION IN PRACTICE
False reassurance
Consider the following example of false reassurance.
Mr and Mrs Temple are awaiting results of diagnostic testing that will conrm or deny a
diagnosis of fetal neurological impairment. Mrs Temple says to the nurse, ‘It’s taking so long
to get the results, I’m sure that there must be something wrong with the baby.’ The nurse
replies, ‘Oh, no, you don’t need to worry. Everything will be just ne!’
> What do you believe motivated the nurse’s response?
> What impact will the nurse’s response have on the Temples?
Соседние файлы в папке Библиотека им академика М.И. Перельмана