Walden University Communication Techniques Discussion

CC: “I fell down the other day I was so tired. I just feel drained”

Interviewing your patient is an important step in gathering information needed for ongoing care. Goals that are to be obtained during this process include, building a rapport with your patient, learning the patient’s own beliefs, culture, and personality, and accurately collecting their medical data. A practitioner who is good at the interview process will be able to diagnose their patients effectively and accurately. The interview process although well defined should be easily adaptable to each patient and situation. The interviewer needs to be an effective active listener. This ability allows the patient to describe in their own words what their symptoms present as. Active listening also allows the nurse to view the nonverbal cues that the patient may be presenting. The interviewer also needs to ask questions that are open-ended encouraging the patients to elaborate upon symptoms and feelings. Asking for clarifying statements that are unclear and repeating the patients’ answers back also gives the patient the connection to the practitioner noting that they are understanding and taking in the responses.

Each patient who presents in the office is unique. Each comes from different backgrounds, cultures, and living conditions and has individual social determinants to their health including, social isolation, interpersonal violence, access to housing, transportation, or access to food that changes the way a practitioner may target their questions in the health history. (Gruß et al., 2021). Knowing patient living arrangements or housing status will focus on questions that may revolve around abuse or social isolation problems and or access to running water or healthy food. Although each patient will come in with varied SDH and risk factors the nurse practitioner will need to choose a comprehensive risk assessment instrument to assess these factors. This topic has come into light since 2012 when the Affordable Care Act directed the Centers for Medicare & Medicaid Services (CMS) to require that a health risk assessment (HRA) be completed as part of the Medicare annual wellness visits. Since its inception debate on whether this program was effective in preventative screenings has been studied. In a 2017 study by Camacho et al., 2017 it was concluded that one of the main benefits of its implementation was its reduction of disparities in preventive services, such as cancer screenings and vaccinations, especially in disadvantaged groups which tend to lack prior preventive services.

One risk assessment instrument that I am familiar with is the Hurt Insult Threat Scream HITS tool. This is a simple tool with a Likert scale (1= “Never”; 5=“Frequently”). Scores 11–20 are considered “positive” for safety concerns. In my interview, I will review the use of this tool in the below interview summary (Rabin et al., 2009)

K: Hi Margert can you tell me what brings you into my office?

Open-ended questions allow for the patient to freely communicate their concerns.

M: I am here because I am tired, and my mood has been low lately.

K: Can you tell me why you think you are tired and feeling low?

Repeating the answer back to the patient allows them to know you heard what they said and also asking for clarification can elicit more details.

M: I haven’t slept well lately. I am worried about so many things going on.

K: That sound like it can be rough. What are some things that are concerning you?

Empathizing with the patient’s feelings begins to build a trusted rapport and could lead to more honest answers.

M: My husband drinks a lot and when he drinks, he gets angry.

At this point in the interview, I would ask the HITS questions which include the following, How often does your partner, Physically hurt you? Insult you or talk down to you? Threaten you with harm? Scream or curse at you? These are rated 1-5 from never to frequently. If the score adds up to 11-20 the practitioner should be aware that this indicates a positive risk questionnaire. Additional questions that the NP could ask include if the patient has any help or family they talk to for help. Do you feel safe at home? Since this issue is widespread national effort has gone into offering hotlines that can be found online for assistance. The National Domestic Violence Hotline run through the US department of human health services is one such website that offers hotline numbers for crisis intervention, educational materials, and offers referrals to counselors.

Whether you are assessing for violence, or other SDH the practitioner has to start with a thorough and detailed history. This should aid in building a trusting relationship and offering a safe space for your patient to share their concerns and medical issues.

References

Camacho, F., Yao, N., & Anderson, R. (2017). The effectiveness of medicare wellness visits in accessing preventive screening. Journal of Primary Care & Community Health, 8(4), 247–255. https://doi.org/10.1177/2150131917736613

Gruß, I., Bunce, A., Davis, J., Dambrun, K., Cottrell, E., & Gold, R. (2021). Initiating and implementing social determinants of health data collection in community health centers. Population Health Management, 24(1), 52–58. https://doi.org/10.1089/pop.2019.0205

Rabin, R. F., Jennings, J. M., Campbell, J. C., & Bair-Merritt, M. H. (2009). Intimate partner violence screening tools. American Journal of Preventive Medicine, 36(5), 439–445.e4. https://doi.org/10.1016/j.amepre.2009.01.024