Interview/Helping Relationship

Question 1

Qualities in The Helping Relationship

Answer 1

• Caring - Focus is on client and his or her needs
• Trust - The client can rely on the communications and actions of their clinician.
• Mutuality - This means that the helper and client are “on the same page.” There is an agreement between the client and nurse regarding what the goals (client-centered) are and how these will be achieved.
• Empowerment - Reflects respect – the helper conveys the belief in the client’s ability and competence
• Warmth - Makes our clients feel welcome, appreciated and accepted.
• Respect - Acknowledges the fact that we value the “other”
• Genuineness - Presenting your true thoughts and feelings verbally and non-verbally with communication that is congruent
• Self-disclosure - honest communication, revealing relevant aspects of one’s experiences, including personal thoughts, feelings and values.
• Humour
• Empathy

Question 2

Ways to show respect to a patient

Answer 2

Look at your client
Provide undivided attention
Maintain eye contact
Smile
Move toward the other
Find out how the other likes to be addressed
Use the client’s name and introduce yourself
Make contact – handshake, gently touch arm
Protect confidentiality
Show interest and concern in your clients’ problems
Accept their uniqueness
Accept the client as a partner
Accommodate cultural and social differences
Be courteous and attentive
Work diligently and competently

Question 3

Genuiness

Answer 3

Presenting your true thoughts and feelings verbally and non-verbally with communication that is congruent. Being genuine means being authentic.
Means not hiding behind a role or title
Means not responding in scripted ways
Means not being defensive
Means recognizing the “equal humanness” between themselves and their clients
“Being real”

Question 4

If the helper is not genuine, the client may:

Answer 4

Distrust the helper
Become suspicious of the helper
May become confused
May question the helper’s credibility
May believe the helper is “hiding something”
This may result in a strained relationship and it blocks meaningful interaction

Question 5

Mutuality

Answer 5

• This means that the helper and client are “on the same page.” There is an agreement between the client and nurse regarding what the goals (client-centered) are and how these will be achieved.
• Partnership.
• Maintain the partnership by consistently checking in with your client. Don’t take over.
• There is a risk of taking over if nurses are overburdened, if the nurse lacks self-awareness, if the client is passive, and/or if the nurse has a more aggressive personality.

Question 6

Benifits to using humour

Answer 6

Puts people at ease
Effective way to deal with fear and anxiety
The helper appears more human and genuine
Build bridges between people
If the helper can laugh at themselves, they model the belief that no-one is perfect.

Question 7

Phases of the Therapeutic Relationship

Answer 7

1. Pre-interaction
2. Orientation
3. Working
4. Termination

Question 8

Pre-Initiation Phase

Answer 8

Period of self-reflection and preparation:

• roles
• expectations and tasks
• helping approaches
• personal values
• perceptions that you hold that may help or hinder the helping relationship

Preparation of the physical setting so it is physically and psychologically comfortable

Question 9

Orientation Phase

Answer 9

• Begins at first meeting –establish rapport and create structure.
  When you first meet:
  -Explain who you are
  -Describe what your role is
  -Identify what you will be doing
  -Indicate when and under what circumstances the relationship will take place
  -Explain why you are working with the person – define the purpose of the relationship
  -Assessment of client’s needs begins.
  -Definition of goals which are client-centered and meaningful are developed together.
  -Remember…you are creating a partnership with your client.
  -Therapeutic contract.

Question 10

Woring Phase

Answer 10

• Focus on using helping interventions, including effective interpersonal communication to resolve problems and issues, as well as to enhance self-concept
• Trust is essential to the working phase.
• Less directive – partnership is evident.
• Clinician provides information and client makes decisions regarding interventions.
• allow client to share information about self
• show interest in the client’s assessment of situation
• elicit opinion and input throughout
• discuss various ways others can be involved and involve person (e.g. goal development, “treatment” selection, referrals, etc.).
• check out your assessment with other professionals working with the client (consult with team).
• be honest/transparent with client.

Question 11

Termination Phase

Answer 11

Begin to prepare for termination during the orientation phase.
Client (and helper as appropriate) can share thoughts and feelings about termination.
Engage in mutual evaluation of goal accomplishment.
Helper says good-bye.
Follow-up interventions are identified as needed.

Question 12

Broad opening statements

Answer 12

Please feel free to discuss your concerns with me.

Tell me more about that.

Question 13

Broad opening questions

Answer 13

What would you like to discuss?
What has brought you to see me today?
Can you tell me more about that?

Question 14

Open ended questions

Answer 14

can be used at the beginning of an interaction (broad opening) or throughout the interaction, when you want more information from the client.
Require more than a minimal or one-word answer.
Places the focus on the client.
e.g. How do you think you will cope with your retirement?
What were you thinking about when you suddenly left our session last week?

Question 15

Closed questions

Answer 15

are used to obtain a brief answer, usually just “yes” or “no”.
Good for gathering specific information.
Examples:
How many brothers or sisters do you have?
Are you feeling like you want to harm yourself?

Question 16

Pharaphrasing

Answer 16

the nurse rephrases all or a portion of the client’s previous statement, in his/her own words. The basic message is not changed. Intersperse throughout the interaction. Don’t overuse.
Why do we use paraphrasing?
Lets the client know that you are hearing their message accurately.
Allows nurse to clarify/verify their understanding of the client’s comments.
Builds rapport, keeps focus on client and keeps the nurse focused

Question 17

Summarization

Answer 17

ties multiple key points of the client’s message that occur over time. Can be used throughout the interaction and at the end of the interview.
Summarization of content- rephrases two or more cognitive messages. (Cormier and Hackney, 2012)
Provides structure to the interaction. Helps to focus the discussion. Clarifies.

Question 18

Reframing

Answer 18

: helps client see the situation/person, in a different way (half-full as opposed to half-empty)
Example:
“I feel like such a failure! I can’t seem to get all my projects done!”
“Is it possible that your tendency to not set boundaries for yourself has left you overburdened?”
Also helpful when clients are using words like never, always, constantly, etc..

Question 19

ABC (Antecedent-Behaviour-Consequences) Question

Answer 19

helpful in understanding context
“Are there any people who make this behavior worse? Make it better?”
“Where and when does this usually happen?”
“Please tell me what happened immediately before you began to feel like you wanted to cut your arm.”

Question 20

Examples of non-therapeutic communication

Answer 20

1. Offering false reassurance
2. Offering approval (or disapproval)
3. Offering advice
4. Changing the subject
5. Belittling
6. Disagreeing with the client
7. Superficial comments
8. Becoming defensive
9. Infantilizing client
10. Prying

Question 21

Opening an interview

Answer 21

• If they open: meet in a private area and then just listen, keep start brief and neutral, don’t interrupt
• If you open: tell right at beginning why you wish to talk, then draw back and let the other express themselves. Make sure it doesn’t turn into a monologue.
• If you don’t know them, engage in small talk (look around the room for cues)

Question 22

What to do with Silence

Answer 22

• Somethings clients stop talking to sort out their thoughts, due to embarrassment, passive resistance, exhausted the topic
• Helper starting a new topic can be bad for interrupting the flow, and maybe start talking about something the client doesn’t want to
• Responding too fast might take away from the client, or it might cause interruptions
• Wait for client to speak or going back to an earlier topic

Question 23

Attending Skills

Answer 23

Attending: conveys warmth and concern to the client

Position

• Sit so eyes are level with the client.
• Listeners who lean forward look more attentive then sitting upright.

Eye Contact
-Way of showing attentiveness and a + attitude

Observing

• Grooming, posture gives indications of how they feel about themselves
• Feeling state, what’s the patients affect?

Listening

• Active listening encourages clients to say more
• Listen for indications of how the clients feel about themself and others, how the clients feels others perceive them
• Themes that keep coming up.
• Variations in form of speech: change in volume/speed of speech, shift in topics

Question 24

Reflecting feelings

Answer 24

help professional zeros in on the client’s feelings. Listen to content and voice inflections as well as non-verbal. Frequently use the words “you feel”. “It sounds as if”, “perhaps you feel”. If you don’t stop a client from talking the feeling might change from angry to ambivalent to positive

Question 25

Distortion

Answer 25

misinterprets the client’s words and feeds it back to the client as if it were fact.  Can be dangerous since the client may accept that as facts and think they have problems they don’t actually have

Question 26

Closing an interview

Answer 26

- We worry that we might make the resident think were rushing or cutting them off - If we go overtime, we’ll make to make it up elsewhere and it’ll distract the caregiver and they can cove off annoyance - Prepare for the close “I believe we have 5 minutes left, is there anything else you want to talk with me about?” - Summarize what you’ve gleaned from the interview, Ask if resident has any questions, recap any plans that might have been made, don’t begin new topics

Question 27

Two common approaches to interview

Answer 27

Primary care provider: the provider interviews the patient themselves. The patient is required to relate their medical history only once. Team approach: patient is interviewed more than once. The team approach may result in more thorough and complete medical record.

Question 28

Family members can help in an intervew to...

Answer 28

- communicate the patients concerns, - improve the HPC's understanding of the problem - help patients remember clinical information - assist the patient in making decisions.

Question 29

indirect statments

Answer 29

another technique that and HCP can use to obtain information without the patient feeling questioned.

Question 30

PEARLS

Answer 30

Partnership (convey that HCP and patient are in this together) Empathy (express understanding and concern for patient) Apology (Acknowledge that the HCP is sorry the patient had to wait that the procedure was painful etc.) Respect (acknowledge the patients suffering anxiety fear) Legitimization (acknowledged the patient may be angry frustrated depressed) Support (convey that you'll be there for the patient)

Question 31

Interviewing Children Adolescence

Answer 31

Infants and toddlers - Patient is usually not a participant. - Parent or Guardian provides information School aged children - Many children can contribute to the interview - Important to verify the accuracy of the information with the child's parent or guardian Adolescence - Assure the adolescent that your conversation is confidential. - Information regarding drug and alcohol use sexuality and behavior and emotional issues should be attained directly from the adolescent. - It is helpful to avoid closed questions that would tend to elicit brief responses or silence.