Jarvis: Physical Examination & Health Assessment, 2nd Canadian

Edition
Chapter 04: The Interview
Answer Key Answer to Study Guide Questions
1. Time and place of the interview and succeeding physical examination
Introduction of yourself and a brief explanation of your role
The purpose of the interview
How long it will take
Expectation of participation for each person present
Presence of any other people (such as family members, other health professionals,
or students)
Confidentiality and to what extent it may be limited
Any costs that the patient must pay
2. Ensure privacy
Refuse interruptions
For the physical environment:
Set the room temperature to a comfortable level
Provide sufficient lighting
Reduce noise
Remove distracting objects or equipment (leave professional equipment needed for
the examination)
Consider the distance between yourself and the patient, and position yourself with 1
metres (twice an arms length) between you
Arrange equal-status seatingboth should be seated comfortably, at eye level
Arrange your own seat in a face-to-face position when interviewing a patient in bed.
The patient should remain dressed in clothing, except in emergency cases.
The interviewer should be wearing conservative, appropriate clothing.
Keep note-taking to a minimum, and try to focus your attention on the patient.
3. Pros of note-taking:
It is difficult to rely on memory alone to furnish details of previous
hospitalizations or other information the patient may provide.
Cons of note-taking:
Breaks eye contact.
Shifts attention away from the person, thus reducing his or her sense of
importance.
It can interrupt the patients narrative flow.
It impedes the interviewers observation of the patients nonverbal behaviour.
When discussing sensitive issues, it may be threatening to the patient.
4. The open-ended question asks for narrative information; it states the topic to be
discussed, but only in general terms. These questions let the person express him- or
herself fully. The closed or direct question asks for specific information; it elicits a
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Answer Key Answer to Study Guide Questions

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short one- or two-word answer, such as a yes or no, or a forced choice. The direct
question limits the patients answer.
5. FacilitationThese responses encourage the patient to say more or to continue with
the story. Examples: mm-hmm, go on, continue, or uh-huh.
SilenceSilent attentiveness, especially after open-ended questions, communicates
that the patient has time to think and organize what he or she wishes to say without
interruption from the interviewer.
ReflectionThis response echoes the patients words; by repeating what the person
has just said, further attention is focused on a specific phrase, and this helps the
person elaborate on the subject. Example: see p. 50.
EmpathyAn empathic response recognizes a feeling and puts it into words. It
names the feeling and allows for it to be expressed. An empathic response helps the
patient to feel accepted, and to deal with the feeling openly. Example: see pp. 5051.
ClarificationIf the persons word choice is confusing or ambiguous, clarification
can be requested to ask for a better explanation of his or her thoughts. Example: see p.
51.
ConfrontationThe interviewer, when observing a certain action, feeling, or
statement, gives his or her honest assessment about what is seen or felt. The feedback
may focus on a discrepancy, the persons affect, or inconsistencies in the persons
story. Example: see p. 51.
InterpretationBased not on direct observation but rather on inference or
conclusion. Example: see p. 51.
ExplanationSharing factual and objective information. Example: see p. 51.
SummaryA final review of what the interviewer understands that the patient has
said. It condenses the facts, and serves as the interviewers perception of the health
problem or need.
6. (1) Providing false assurance or reassurance
(2) Giving unwanted advice
(3) Using authority
(4) Using avoidance language
(5) Engaging in distancing
(6) Using professional jargon
(7) Using leading or biased questions
(8) Talking too much
(9) Interrupting
(10) Using why questions
For examples of the ten traps of interviewing, see pp. 5253.
7. Physical appearance
Posture
Gesture
Facial expression
Eye contact
Voice
Touch

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Answer Key Answer to Study Guide Questions

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8. Answers may vary. See examples on p. 54.

9. When interviewing an older person, be alert for expressions of hopelessness or
despair about his or her present life or the future. Always address the person by the
last name, such as Hello, Mr. Simmons. Adjust the pace of the interview to the
older person; it may take longer for an older person to tell his or her story, or he or
she may require a longer response time. Do not try to hurry the interview along.
Consider that physical limitations may cause older adults to fatigue earlier. Consider
that hearing impairment may exist, and be sure to face the person fully and avoid
shouting. Touch may be a helpful nonverbal skill that is important to older persons,
and may convey empathy.
10. When working with a hearing-impaired person, first ask his or her preferred way of
communicationby sign language, lip-reading, or writing. In order to perform a
complete health history, a sign language interpreter will be needed. If the person
prefers lip-reading, be sure to face him or her squarely and have good lighting on
your face. Be aware that a beard or moustache or foreign accent may make lipreading difficult for some people. Talk normally, without shouting or exaggerating lip
movementsthese actions distort your words. Speak slowly and supplement your
voice with appropriate hand gestures. Written communication is efficient in sections
of the health history such as past history, family history, or review of symptoms.
However, for some parts of the interview, writing is very time-consuming and
laborious.
11. Responses may vary. See text, p. 58, for guidelines.
12. Communication patterns vary widely across different cultures. There are five types of
nonverbal behaviours that convey information about a person:
(1) Vocal cues
(2) Action cues
(3) Object cues
(4) Use of personal and territorial space
(5) Touch
Some behaviours that may vary widely across different cultures include smiling and
handshaking, interpretation of silence, and eye contact.
13. Refer to Table 4-3, Use of an Interpreter, p. 63.

Copyright 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. All rights reserved.