HOW TO CONDUCT THE INTERVIEW
The nurse should conduct the psychosocial assessment in an
environment that is comfortable, private, and safe for both the client and the
nurse. An environment that is fairly quiet with few distractions allows the
client to give his or her full attention to the interview. Conducting the
inter-view in a place such as a conference room ensures the cli-ent that no one
will overhear what is being discussed. The nurse should not choose an isolated
location for the inter-view, however, particularly if the client is unknown to
the nurse or has a history of any threatening behavior. The nurse must ensure
the safety of self and client even if that means another person is present
during the assessment.
If family members, friends, or caregivers have accompa-nied the
client, the nurse should obtain their perceptions of the client’s behavior and
emotional state. How this is accomplished depends on the situation. Sometimes
the client does not give permission for the nurse to conduct separate
interviews with family members. The nurse should then be aware that friends or
family may not feel comfortable talking about the client in his or her presence
and may provide limited information. Or the client may not feel comfortable
participating in the assessment with-out family or friends. This, too, may
limit the amount or type of information the nurse obtains. It is desirable to
conduct at least part of the assessment without others, especially in cases of
suspected abuse or intimidation. The nurse should make every effort to assess
the client in pri-vacy in cases of suspected abuse.
The nurse may use open-ended questions to start the assessment .
Doing so allows the client to begin as he or she feels comfortable and also
gives the nurse an idea about the client’s perception of his or her situation.
Examples of open-ended questions are as follows:
What brings you here today?
Tell me what has been happening to you.
How can we help you?
If the client cannot organize his or her thoughts, or has
difficulty answering open-ended questions, the nurse may need to use more
direct questions to obtain information. Questions need to be clear, simple, and
focused on one specific behavior or symptom; they should not cause the client
to remember several things at once. Questions regarding several different
behaviors or symptoms—“How are your eating and sleeping habits and have you
been taking any over-the-counter medications that affect your eating and
sleeping?”—can be confusing to the client. The following are examples of focused
or closed-ended questions:
How many hours did you sleep last night?
Have you been thinking about suicide?
How much alcohol have you been drinking?
How well have you been sleeping?
How many meals a day do you eat?
What over-the-counter medications are you taking?
The nurse should use a nonjudgmental tone and lan-guage,
particularly when asking about sensitive informa-tion such as drug or alcohol
use, sexual behavior, abuse or violence, and childrearing practices. Using
nonjudgmental language and a matter-of-fact tone avoids giving the client
verbal cues to become defensive or to not tell the truth. For example, when
asking a client about his or her parent-ing role, the nurse should ask, “What
types of discipline do you use?” rather than, “How often do you physically
punish your child?” The first question is more likely to elicit honest and
accurate information; the second ques-tion gives the impression that physical
discipline is wrong, and it may cause the client to respond dishonestly.