Manilyn B.

Bagiao, MSN
Hyperthermia r/t dehydration
Hyperthermia r/t active fluid loss
Diarrhea r/t GIT irritation
Diarrhea r/t infectious processes
Diarrhea r/t malabsorption
Fluid volume deficit r/t active fluid loss
Maintain temperature within normal
range
Re-establish or maintain normal
pattern of bowel functioning
Maintain fluid volume at a functional
level
Monitor VS
TSB
Loosen/lessen clothing
Ensure adequate ventilation
Encourage to increase OFI
Ensure proper IVF regulation
Ensure adequate rest periods
Antipyretics as ordered
Encourage to increase OFI
Constipating diet
Avoid GI stimulating foods
Monitor I and O
Perianal care
Meds as ordered
Monitor I and O
Assess characteristic and amount of urine
Increase fluid intake
A purposeful conversation between the nurse and the
patient
Goal: to gather a complete health history, which is the
foundation which data collection and the process of
assessment are based
Consists of questions designed to elicit SUBJECTIVE
DATA
Requires nurses to be EFFECTIVE
COMMUNICATORS
Purpose:
Gather organized, complete, and accurate
data about the patient’s health state
Establish rapport and trust
Teach patient about health state so he can
participate in identifying problems and
planning for health care
Internal factors
Liking others
- An atmosphere of warmth and caring is necessary
- The patient must feel that he or she is accepted
Empathy
- “putting one’s self in the shoes of others”
- Means recognizing and accepting the other person’s
feelings without criticisms
Ability to LISTEN
- Requires the nurse’s complete attention
External factors
Ensure privacy
Physical environment
Room temperature at a comfortable level
Sufficient lighting, reduce noise
Maintain appropriate distance
Intimate distance: ~ 1.5 ft
Personal distance: 1.5-4 ft
Social distance: 4-12 ft
Public distance: 12 ft or more
Arrange “equal-status” setting – comfortably seated at eye
level
External factors
Refuse interruptions
Dress
Note – taking
Necessary to remember important information
Keep it to a minimum during the interview, pay
attention to the patient
Introductory phase
ORIENTATION PHASE
Involves establishment of rapport, clarifying roles,
and alleviating anxiety
- Introduce self, explain purpose and content of interview
- Convey a caring, interested attitude
- Observe patient’s behavior
- Explain the time frame for the relationship
- Explain how the information collected will be used and
that confidentiality will be maintained
Maintenance phase
WORKING PHASE
The nurse and patient work toward achieving the
specific task or goal agreed on the introductory phase
- time during which bulk of the patient data is collected
- keep interview goal-directed, refocus client if necessary
- listen, observe cues, and use critical thinking to interpret
and validate information
- collaborate with client to identify problems and goals.
Concluding phase
TERMINATION PHASE
- information is summarized and validated
- identify and discuss possible plans to resolve the
problem
- allow patient opportunity to give additional
information or ask questions
Open-ended questions
 Asks for narrative information
 Unbiased, leaves the person free to answer in any way
 Lets the person express himself fully
 Build and enhances rapport

- encourages patient to give general rather than focused

information
- what to say, how much to say, and how to say it depends
on the client
-begins with how, what, where
- may be time consuming
Closed or Direct Questions
Asks for specific information
Elicits a short one or two word answer (yes
or no)
Focuses the interview an pinpoints specific
areas of concern
Limits rapport and leaves interaction neutral
Facilitation of General Leads
 Encourage the patient to say more, to continue with the
story
 “go on”, “continue”
Silence
 Conveys that the patient has the time to think, to organize
what he wants to say without interruption
 Allows the patient to collect his thoughts
Reflection
 Echoes the patient’s words
Empathy
 Recognizes a feeling and puts it into words
 Makes the patient feel accepted and can deal with the
feelings openly
Clarification
 Used when the person’s choice of word is ambiguous or
confusing
Confrontation
 The nurse focuses the patient’s attention on the observed
action, feeling or behavior
 “you sound angry”, “you looked sad”
Interpretation
 Links events, makes associations or implies cause
Explanation
 Provides information to the patient
 Shares factual and objective information
Summary
 Final review of what the nurse understand the patient has
said
 Condenses the fact and presents a survey of how the nurse
perceives the health problem or need
Providing False Assurance or Reassurance
Giving unwanted advise
Using authority
Using avoidance language
Engaging in distancing
Using professional jargon
Using leading or biased questions
Talking too much
Interrupting
Using “why” questions
Parent
 Greet/refer to the parents by name
 Explore sensitive topics with the parent when he is alone
 Avoid questions that put parenting ability in question or
implying lack of parenting skill
Infant
 Nonverbal cues is important
 Crying is the infants primary expression of discomfort
 Use firm, gentle handling and quiet, calm voice
 Infants – more cooperative in the presence of parents
Pre-Schooler
 Egocentric – perceives that everything revolves around him,
only his experience is relevant
 Communication should be direct, concrete, literal and set in
the present
 Use short, simple sentences with concrete explanation
School-age child
 Can tolerate and understand other’s viewpoint
 More objective and realistic
 Wants to know how things work and why things are done
 Pose questions about school, friends or activities directly to
the child
Adolescent
 Communicate with the adolescent with respect and must be
totally honest
 Stay in character, do not try to be his peer
 Use icebreakers, focus first on the adolescent not on the
problem
 Explain every step and give the rationale
 Keep questions short and simple
 Silent periods are best avoided, adolescent is very sensitive
to nonverbal communication
 Establish rapport before addressing emotionally charge
topics
 Use positive reinforcement
Older adult
Always address the person by the last name
Adjust the pace of the interview to the aging
person, avoid trying to hurry them along
Consider physical limitations, aging person may
require shorter segments of interview
Hearing impaired
Be aware of clues of hearing deficit (staring at your
mouth and face)
Ask his preferred way to communicate(sign
language, lip reading, writing)
Do not exaggerate lip movements
Avoid shouting, speak slowly, use gestures
Be sure the patient understands your questions
Acutely Ill people
Prompt action is required, combine interviewing
with physical examination to determine lifesaving
actions
Subjective data are crucial to determine the cause
and course of emergency
Ask brief and concise questions, use closed direct
questions, focus on main area of distress
Statements should be very clear
Attend to the comfort of the patient first
People under influence of street drugs or alcohol
 Ask simple and direct questions
 Manner and questioning should be nonthreatening, avoid
confrontation
 Find out the time of the patient’s last intake and name and
amount of the substance
 Be aware of hospital security or other personnel who could
be called for assistance
 Assess for the extent of the problem and the meaning of it to
him and his family
Personal questions
If the patient asks you personal questions such as:
Are you married?
Do you have children?
Do you smoke?
Supply brief information when you feel it is appropriate
Try directing your response back to the person’s
frame of reference
No, I don’t have children, I wonder if your question is
related to how I can help you care for your baby.
Sexually aggressive people
Response must make it clear that you are a health
professional who can best care for him, and that
you cannot tolerate sexual advances, maintain
professional relationship
set appropriate boundaries by saying :
“I am uncomfortable when you talk to me that way;
please don’t. I wonder if the way you’re feeling now
relates to your illness or to being in the hospital”
Crying
Anger
 Try not to personalize the anger of the patient
 Ask about the anger and hear the patient out
Threat of Violence
 Be aware of the “red flag” behaviors of a potentially
disruptive or violent patient, TRUST YOUR INSTINCTS
Anxiety
 Allow verbalization of feelings, fears and concerns