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.