UNIVERSITY OF THE VISAYAS

MASTERS OF ARTS IN NURSING MAJOR IN MEDICAL SURGICAL NURSING (MAN-MS)

NSG 511 HEALTH ASSESSMENT

Communication
Introduction:
To assess, you must be able to communicate and communicate well. The relationship you establish with
your patient directly affects your ability to collect data.
Communication is a process of sharing information and meaning, of sending and receiving messages.
Types of Communication:
1. Nonverbal communication
Nonverbal behaviour includes vocal cues or paralinguistics, action cues or kinetics, object cues, personal
space, and touch.
a. Vocal Cues or Paralinguistics
Vocal cues describe the quality of your voice and its inflections, tone, intensity, and speed when
speaking. These voice characteristics usually reflect underlying feelings.
b. Action Cues and Kinetics
Action cues or kinetics are body movements that convey messages. Posture, arm position, hand
gestures, body movements, facial expressions, and eye contact all convey a message.
c. Object Cues
Your patients dress and grooming reflect his or her identity and how he or she feels about himself or
herself. Poor grooming or dishevelled clothing may indicate a psychological problem such as depression.
d. Personal Space
Personal space is the territory surrounding a person that she or he perceives as private or the physical
distance that needs to be maintained for the person to feel comfortable. When our personal space is
invaded, we feel uncomfortable and anxious, often backing away to regain control of our territory.
e. Touch
Touch is a means of communication. An array of feelings, including anger, caring, and protectiveness,
can be conveyed through touch.

REPORTERS: NINA HAMILI G. PIAO

MARY MYZEL VILLAGONZALO
2. Verbal Communication
Effective verbal communication is essential to a client interview. The goal of the interview process is to
elicit as much data about the clients health status as possible.
Communication Techniques
1. Affirmation/Facilitation. Acknowledge your patients responses through both verbal and nonverbal
communication to reassure him that you are paying attention to what he is saying.
2. Silence
Periods of silence allow your patient to collect her or his thoughts before responding and help prevent
hasty responses that may be inaccurate. Silence is usually more uncomfortable for you than for your
patient.
3. Clarifying
If you are unsure or confused about what your patient is saying, rephrase what she said and then ask the
patient to clarify.

4. Restating
Restating the patients main idea shows him that you are listening, allows you to acknowledge your
patients feelings, and encourages further discussion.

5. Clarifying
If you are unsure or confused about what your patient is saying, rephrase what she said and then
ask the patient to clarify.

4. Restating
Restating the patients main idea shows him that you are listening, allows you to acknowledge your
patients feelings, and encourages further discussion.

5. Active Listening
Pay attention, maintain eye contact, and really listen to what your patient tells you both verbally and
nonverbally.

6. Broad or General Openings

This technique is effective when you want to hear what is important to your patient.Use open-ended
questions such as,What would you like to talk about?

7. Reflection
Reflection allows you to acknowledge your patients feelings,encouraging further discussion.When
your patient expresses a thought or feeling, you echo it back, usually in the form of a question.

8. Humor
Humor can be very therapeutic when used in the right context.

9. Informing
Giving information allows your patient to be involved in his or her healthcare decisions.

REPORTERS: NINA HAMILI G. PIAO

MARY MYZEL VILLAGONZALO
10. Redirecting
Redirecting your patient helps keep the communication goal-directed. It is especially useful if
your patient goes off on a tangent.

11. Focusing
Focusing allows you to hone in on a specific area, encouraging further discussion. Examples include:
You said your mother and sister had breast cancer?

12. Sharing Perceptions

With this technique, you give your interpretation of what has been said in order to clarify things and
prevent misunderstandings.

13. Identifying Themes

Identifying recurrent themes may help your patient make a connection and focus on the
major theme.

14. Sequencing Events

If your patient is having trouble sequencing events, you may need to help her or him place the events in
proper order. Start at the beginning and work through the event until the conclusion. You might say,
What happened before the problem started? Then what happened? How did it end?

15. Suggesting
Presenting alternative ideas gives your patient options. This is particularly helpful if the patient is having
difficulty verbalizing his or her feelings. Suggesting is also a good teaching tool. For example, if the
patient says, Ive tried so hard to lose weight, but I cant, you might say, Have you tried combining
diet and exercise?

16. Presenting Reality

If your patient seems to be exaggerating or contradicting the facts, help her or him re-examine what has
already been said and be more realistic. For example, if she or he says, I waited all day for someone to
answer my call light, you might respond, All day?

17. Summarizing
Summarizing is useful at the conclusion of a major section of the interview. It allows the patient to
clarify any misconceptions you may have. For example, you might say, Let me see if I have this correct:
You came to the hospital with chest pain, which started an hour ago, after eating lunch.

Interviewing

Obtaining a valid nursing health history requires professional, interpersonal, and interviewing skills. The
nursing interview is a communication process that has two focuses:
1. Establishing rapport and a trusting relationship with the client to elicit accurate and meaningful
information.
2. Gathering information on the clients developmental, psychological, physiologic, sociocultural, and
spiritual statuses to identify deviations that can be treated with nursing and collaborative interventions
or strengths that can be enhanced through nurseclient collaboration.

REPORTERS: NINA HAMILI G. PIAO

MARY MYZEL VILLAGONZALO
PHASES OF THE INTERVIEW
Preintroductory Phase

The nurse reviews the medical record before meeting with the client. This information may assist the
nurse with conducting the interview by knowing some of the clients biographical information that is
already documented.

Introductory Phase
After introducing himself to the client, the nurse explains the purpose of the interview, discusses the
types of questions that will be asked, explains the reason for taking notes, and assures the client that
confidential information will remain confidential.

Working Phase
During this phase, the nurse elicits the clients comments about major biographic data, reasons for
seeking care, history of present health concern, past health history, family history, review of body
systems for current health problems, lifestyle and health practices, and developmental level. The nurse
then listens, observes cues, and uses critical thinking skills to interpret and validate information received
from the client.

Summary and Closing Phase

During the summary and closing, the nurse summarizes information obtained during the working phase
and validates problems and goals with the client.

INTERACTING WITH CLIENTS WITH VARIOUS EMOTIONAL STATES

WHEN INTERACTING WITH AN ANXIOUS CLIENT

Provide the client with simple, organized information in a
structured format.
Explain who you are, along with your role and purpose.
Ask simple, concise questions.
Avoid becoming anxious like the client.
Do not hurry, and decrease any external stimuli.

WHEN INTERACTING WITH AN ANGRY CLIENT

Approach this client in a calm, reassuring, in-control manner.
Allow him to ventilate feelings. However, if the client is out
of control, do not argue with or touch the client.
Obtain help from other health care professionals as needed.
Avoid arguing and facilitate personal space so that the
client does not feel threatened or cornered.

WHEN INTERACTING WITH A DEPRESSED CLIENT

Express interest in and understanding of the client and
respond in a neutral manner.
Do not try to communicate in an upbeat, encouraging
manner. This will not help the depressed client.

REPORTERS: NINA HAMILI G. PIAO

MARY MYZEL VILLAGONZALO
WHEN INTERACTING WITH A MANIPULATIVE CLIENT
Provide structure and set limits.
Differentiate between manipulation and a reasonable request.
If you are not sure whether you are being manipulated,
obtain an objective opinion from other nursing colleagues.

WHEN INTERACTING WITH A SEDUCTIVE CLIENT

Set firm limits on overt sexual client behavior and avoid
responding to subtle seductive behaviors.
Encourage client to use more appropriate methods of coping
in relating to others.

WHEN DISCUSSING SENSITIVE ISSUES

(E.G., SEXUALITY, DYING, SPIRITUALITY)
First, be aware of your own thoughts and feelings regarding
dying, spirituality, and sexuality; then recognize that
these factors may affect the clients health and may need to
be discussed with someone.
Ask simple questions in a nonjudgmental manner.
Allow time for ventilation of clients feelings as needed.
If you do not feel comfortable or competent discussing
personal, sensitive topics, you may make referrals as appropriate,
for example, to a pastoral counselor for spiritual
concerns or other specialists as needed.

REPORTERS: NINA HAMILI G. PIAO

MARY MYZEL VILLAGONZALO