Chapter 2 – Therapeutic Communication and Interviewing
You should review the client’s existing health record/chart (if applicable) so that you have a general overview of the client’s main health needs/reason for seeking care and health history. If the client is already admitted, this review will not only give you an overview of the health history, but also their last 24 hours. This is an important first step for several reasons:
- It conveys your interest and competence as a provider.
- It allows you to follow up on missing data.
- It saves the client from repetition.
- It allows you to identify any changes in the client’s health status.
You should also consider how to leverage the environment of the interview location and your position within the space. The client interview is often conducted in locations such as clinic rooms, hospital rooms, emergency rooms, and community spaces such as the client’s home. You should attend to the following principles:
- Create a quiet location so that both you and the client can hear and communicate. Some possible strategies to reduce sound may include closing the room door, closing the curtains, and turning off radios and televisions.
- Establish a welcoming environment, which may include offering the client a place to sit and avoiding physical barriers between you and the client such as a desk.
- Attend to the client’s physical comfort, which may include offering them a drink of water and inviting them to take their coat off or have a place for them to put their bag/purse. Additionally, if they are in bed, you should ensure that they are comfortable and ask if they want to sit up, if they are permitted.
- Create an inclusive space in which care partners are invited to be part of the interview based on the client’s wishes.
- Ensure a private space so that the client feels comfortable to share personal information and that this information is kept confidential. Sometimes it will not be possible to ensure a completely private space, such as when a curtain is the only barrier. In this case, try to avoid using the client’s name and other client information loudly so that others can’t overhear.
- Maintain professional boundaries (CNO, 2019a) this facilitates a trusting and therapeutic relationship between nurse and client. You must understand your professional role and ensure that your relationship with the client does not become personal (e.g., meeting the client outside of work hours, disclosing personal information, or accepting/exchanging gifts).
In preparation for the client interview, you must first be aware of the legislation and nursing standards concerning privacy and confidentiality. The Personal Health Information Protection Act (2004) states that clients have the right to have their personal health information kept private, and healthcare professionals are legally required to keep this information confidential. You must emphasize that client data is kept confidential and only shared with relevant members of the healthcare team directly involved in the client’s care. You may want to re-emphasize confidentiality when addressing sensitive interview topics such as trauma and violence, sexual health, and substance use. The client owns their personal health information; as a custodian of this information, you must request permission before disclosure (CNO, 2019b). However, there are certain situations where consent for disclosure is not required (e.g., “to eliminate or reduce a significant risk of harm to a person” [CNO, 2019b, p. 7]).
Abuse and neglect
In certain conditions, a nurse must disclose personal health information. You are legally required to report suspected child abuse or neglect, and elder abuse when the person lives in a retirement or a long-term care home in Ontario. You must report to a children’s aid society “if you have reasonable grounds to suspect that a child is or may be in need of protection” (Ontario Ministry of Children, Community, and Social Services, n.d.). For a client in a retirement home, you must report to the Registrar of the Retirement Homes Regulatory Authority; and for a client in a long-term care home, report to the Director at the Ministry of Health and Long-Term Care (Community Legal Education Ontario, 2019). You must also report to the College of Nurses of Ontario (2020) if a client discloses or you observe a “nurse who poses a serious risk of harm to patients” (sexual abuse, incompetent care, physical or mental incapacity to provide safe care, or professional misconduct).
Activity: Check Your Understanding