Watch or Listen to the Following Media Clip
- Define the helping interview framework.
- Explore the health care administrators role in the helping interview.
- Evaluate effective and ineffective communication techniques.
- Identify blocks to effective therapeutic communication.
When people are asked if they have been on an interview, most people think they are being asked if they have been on a job interview. There are many types of interviews that go beyond employment interviews. For example, a talk-show host interviewing a famous guest or informational interviews that are sometimes referred to as coffee chats. All interviews have similar components such as a conversation between two or more people, questions that gather information, and a common interest between the people involved. Since health care involves helping people, almost everyone who works in health care is in a helping role. The helping interview refers to an interview with a person seeking help and the people providing that help. In this chapter, we will consider the client encounter and explore the components within the phases of the helping interview, the role of the health care administrator, and evaluate effective and ineffective therapeutic communication techniques and behaviours.
As you reflect upon the following questions and statements consider what you already perceive about interviews.
Phases of the Helping Interview Framework
When studying the helping interview framework it is helpful to break it into phases and evaluate the components that make up each phase. Once you have identified the components of the helping interview, you can begin to reflect upon how you can build upon the skills you already have, and develop the skills you are missing. It should be noted that there may be multiple cycles of the phases with differing helpers during a client encounter. Let’s begin by breaking the helping interview framework into the following three phases:
- Build Trust
- Identify the Need
- Resolution and Next Steps
Clients seek health care most often when they are ill or feeling unwell. Most clients trust that the health care provider (HCP) is competent due to their credentials and education. In order for clients to be honest about uncomfortable or embarrassing symptoms, the client must believe that the HCP will listen without judgement and treat the symptoms competently. The College of Nurses of Ontario (2006) list trust as one of the five components of the nurse-client relationship and state that trust is critical because clients seek care when they are vulnerable. The College of Physicians and Surgeons of Ontario (2007, page 7) states that “trustworthiness is the cornerstone of the practice of medicine”. Helpers can not help patients without trust between helper and client (CPSO, 2007). Fine & Glasser (1996) suggest that trust is a fundamental element in all helping professions. Since HCAs are part of the health care team, an extension to the HCP, and most often the first person the client or their family interacts with during an encounter, trust then begins with the HCA.
Building Trust Upon Booking Appointments
Clients arrange health care appointments on the phone, through email, or through intake forms. If the client is having a serious health issue they will typically call, or you will follow up with a request to call. It should be noted that client incoming calls are triaged and the client is directed according to the urgency of their symptoms. For example, if the client is calling about chest pain or excessive bleeding, you would keep them on the phone and call an ambulance on their behalf. If the symptoms are urgent such as a broken bone you direct them to the nearest emergency room. If their symptoms warrant an urgent booking then you schedule accordingly. It is at this time that you begin the trust-building phase of the encounter.
A client phones to make an appointment for his 3-year-old child who suffers from frequent ear infections.
HCA: Hello Dr. Vunderful’s office, Please hold
Client: Hello, Hello…. oh, they put me on hold
Five minutes later
HCA: Sorry to keep you waiting. How may I help you?
Client: Hi this is Regie Singh, that was a very long wait. I am calling about my son Jagmeet. I think he has another ear infection.
HCA: Hi Regie, Oh, I am sorry to hear that. It is very busy as you can tell from your wait. I can get Jagmeet in the day after tomorrow at 2 p.m.
Client: I don’t think he can wait that long. He is very warm and cranky. Can we come today?
HCA: Sighs heavily. Umm, not really, it is busy. Did you take his temperature? What is it?
Client: No, I don’t have a thermometer but he is super warm. I already had to take the day off work today are you sure you can’t get Jagmeet in today?
HCA: Well I am going to use an emergency spot. Come at 4 p.m. I hope he really is as sick as you claim.
Client: Thank you? (unsure questioning tone to his voice)
In the scenario above do you think that Regie trusts that Jagmeet will be taken care of? The HCA has not demonstrated compassion to Regie who has stayed home from work to take care of Jagmeet, the HCA has not displayed competence by asking more questions about Jagmeet’s state, and the HCA is disrespectful by suggesting that Regie is lying about how sick Jagmeet is. In this situation, it is likely that Regie does not trust that the HCA (and by extension the health care provider) cares about Jagmeet. This has set the tone for the encounter and trust has not been established.
Considerations to build trust on the telephone:
- Say hello and state the name of the clinic
- If you need the client to hold wait until they confirm that they will hold
- Express compassion and empathy as you listen to the client’s concerns
- Take the time to listen to the client’s concerns including those that extend beyond the reason for the visit
- Triage and book the appointment with consideration to the client’s needs
- If in doubt about the urgency while triaging, speak to the health care provider (HCP) and let the client know you are confirming with the HCP
- If you are not able to meet the client’s requests for booking then provide alternative options to the client
Building Trust at Check In
Once a client and their family have arrived at the office for their encounter they will check in with the Health Care Administrator (HCA). HCAs display competency with a warm greeting, acknowledging the client, identifying themselves, and providing an efficient check in process. A professional office has individual seating, is clean, and is set up for confidentiality. In our opening scenario, the HCA was efficient, displayed competence by following confidentiality, and then did what they could to make the client and their partner feel comfortable and trust was established. Contrarily, imagine for a moment that Regie arrives with Jagmeet to the office already feeling as if their appointment is an imposition, now they enter a chaotic office, a long line to check in, Regie can hear confidential conversations with other clients, there are not enough seats, and the office garbage pails are overflowing. Do you think that Regie will trust that Jagmeet will receive proper health care?
Considerations to Build Trust at Check In:
- Keep the office waiting room clean, tidy, and check for adequate seating
- Greet the client warmly, with a smile, and ask for their health card
- Confirm demographic information using an appropriate voice level to maintain confidentiality
- Let the client know how long the wait will be and ask them to have a seat in the waiting room
- Look at the client to demonstrate that you are actively listening to the client and acknowledge that you have had heard what the client has said to you
Identify the Help Required
In order to identify the help that the client and their family are seeking, health care administrators (HCA) can utilize a number of effective therapeutic communication techniques, and avoid ineffective communication and behaviours. You may be wondering if this is in the scope of practice of the HCA. In many health care offices, the HCA is responsible for the initial intake of the client. For example, filling in the subjective and objective components of the client encounter in a SOAP note (CPSO, 2021). In circumstances where intake is not a requirement of the HCA role, observations can be made and reported to the health care provider (HCP).
HCA should be aware of the unequal balance of power between the client, family members, and the HCA. The College of Nurses of Ontario (2006) suggests that unequal power exists because health care providers have access to information and knowledge that the client and their family do not. It is important to keep this in mind when communicating with a client, avoid misuse of this power, remain respectful to the client, and to be aware of the client’s vulnerability.
Effective Questioning and Behaviours
During the intake process, the HCA may require specific details about the client and the reason they are seeking health care. A closed question often works best in this circumstance. For example, How do you spell your last name? Is it your left arm or your right arm that you fell on? By contrast open-ended questions invite the client to expand upon the answer and provide further information. For example, What brings you in today? Clients may answer open-ended questions in a way that implies not all the information has been given. For example, they may answer the question What brings you in today with I have not been feeling myself. In this situation, you may need to use a probing question to encourage the client to share more. For example, you may respond with how would you describe not feeling like yourself? Which the client may respond with I have been exhausted and having trouble sleeping, I go to bed at 8 p.m. but I am up again at midnight. At this point, you have engaged the client in the Interaction Model of Communication discussed previously and are likely to gain a better understanding of the client’s health care needs.
Active listening is a critical behaviour in the helping interview because it communicates that the message has been listened to and understood. Open RN (n.d.) proposes that active listening communicates that we are verifying that we understand what the other person is saying to us. Consider in the Osgood-Schramm Model of Communication the role of the receiver, in receiving the message, and then providing that feedback to the sender. The HCA can demonstrate active listening by looking at the client, nodding when appropriate, and providing verbal cues that the client is being listened to. Active listening can be demonstrated by the HCA by looking at the client, nodding when appropriate, and providing verbal cues that the client is being listened to.
In health care, touch is used as a form of communication and is expressed as a light touch on a hand, arm, or shoulder. Open RN (n.d.) proposes that the communication of touch is used to express concern, compassion or comfort. Touch is used with an acute awareness of the client’s cues of acceptance, to this type of communication. If the client recoils or tells you not to touch them, then do not touch them.
The table below represents effective therapeutic communication techniques and behaviours that can be used during the helping interview. These techniques will assist to identify the health care need that the client is seeking.
|Active listening cues
|Use of nonverbal and verbal cues to encourage clients/client’s families to continue talking.
|Acknowledging that you are listening by nodding your head, saying yes, and offering general leads.
|Questions used to propel or guide the conversation forward.
|What happened next?
|Deliberately silent to give people involved in the conversation time to reflect and process what could be said next.
|Sometimes there are no words and a light touch to the top of the hand, arm, shoulder, or back conveys a caring message.
Caveat, you must look for cues that the other person will accept being touched. If they recoil do not touch them.
|A light touch to the top of a hand, arm, shoulder, or back.
|Observing a client’s demeanour or behaviour can help to open up a conversation and for the client to tell you more.
|You appear to be in pain
|Acknowledging what a client has said to be their experience builds trust.
|I agree having to wait for results can be frustrating and scary
|Repeating what the client has said for confirmation. This must be used sparingly as not to come across as patronizing.
|Client: I twisted my left ankle at soccer and it sent shooting pains to my hip.
HCA: Your left ankle and your left hip are in a lot of pain because you twisted while at soccer.
|A questioning technique that requires expansion or further clarification.
|What brings you in today?
|Closed questions can be answered simply and do not require further reflection or clarification.
|Is it your left arm or your right arm that you fell on?
Ineffective Therapeutic Communication Techniques and Behaviours
It is important to be aware of ineffective communication and behaviours that block communication, and leave the client and their family without the help that they need. The table below represents ineffective communication techniques and behaviours to be avoided.
|Ineffective Techniques or Behaviour
|Description of the Block
|Requires the client or client’s family to explain. Invalidates the client or client’s family experience and may cause them to become defensive.
|Client: I quit smoking for 6 months I didn’t feel any better. I don’t think quitting smoking will help this time either.
HCA: Why don’t you think quitting smoking will be different this time?
|Arguing with a client implies that they are lying, misinformed or uneducated. This can exacerbate an emotional response or cause the client to shut down.
|Client: The insurance company said you can bill them directly.
HCA: I can’t bill the insurance company you will have to pay and put in a claim for yourself.
Client: I emailed them and I have printed off their response.
HCA: It does not matter what you have printed I can not bill them directly
|Asking Personal questions
|It is inappropriate to ask questions that are not relevant to the situation.
|HCA: Marital Status, please.
Client: Not married.
HCA: Why aren’t you married
|Giving Personal opinions
|Giving a personal opinion takes away the client’s decision-making.
|HCA: Would you like a listing of personal home care supports for your father?Client: No thank you, I will take care of him.
HCA: Well if it was my father I would have someone come in to help us.
|Changing the Subject
|Changing the subject during a communication demonstrates a lack of empathy and will demonstrate that you don’t wish to know what the client or their family is telling you.
|Client: Do you know how much longer the wait will be? I just started a new job and can’t be late.
HCA: That is a really pretty lipstick colour you are wearing. What colour is it? Client: Um, Pink shell from the local drug store. I guess I will just sit back down.
|Generalizations minimize the client’s or their family’s experience(s) and take the focus away from the immediate concern.
|Client Family Member: My dad can’t seem to remember his phone number or answer common questions coherently. I am concerned that his new medication is causing confusion.
HCA: Oh, well as parents age they do get confused.
|Discourages further expressions of feelings
|Client: I am really worried about this upcoming procedure.
HCA: Don’t worry Dr. Smalt can do this procedure in his sleep.
|Sympathy takes the focus away from the client and attempts to move them out of their emotional state.
|Client: I can’t believe that my partner died so suddenly.
HCA: I am so sorry that your partner died. I can’t imagine what I would do if my partner died like that.
Client: Yes that would be difficult for you.
Resolution and Next Steps
The last part of the helping interview is finding a resolution to the identified health care need(s). While it is not always possible that a health care need can be resolved in one encounter, there are next steps that can be conveyed to the client. Diagnosis, prognosis, and next steps are conveyed to the client by the health care provider (HCP). After the encounter, the client will go to the health care administrator (HCA) to book the next steps such as future health care appointments, tests, receive instructions, and make payments. Thus the HCA is the last person the client and their family see and complete the helping interview. The HCA ensures that the client and their family are aware of any test preparation, appointment bookings, directions, additional costs such as parking, follow-up appointments, and insurance receipts. Utilizing effective communication techniques, avoiding ineffective communication techniques and behaviours, will ensure the client and their family leave with their health care needs met.
Check Your Understanding
In this chapter you have:
- Defined the helping interview framework.
- Explored the health care administrators role in the helping interview.
- Evaluated effective and ineffective communication techniques.
- Identified blocks to effective therapeutic communication.
Active listening: Use of nonverbal and verbal cues to encourage clients to continue talking.
Arguing: A disagreement between two or more people that may become escalated. (Merriam-Webster, n.d.)
Check In: The registration at the health provider’s office.
Closed question: A question that can be answered simply and does not require further reflection or clarification.
Compassion: A deep awareness of the suffering of another with a desire to alleviate that suffering.
Competent: The knowledge one should have in their scope of practice.
Encounter: A client visit or appointment with a provider.
General leads: Questions used to propel or guide the conversation forward.
Helping interview: An interview with a person seeking help and the people providing that help.
Objective: Signs and symptoms that can be seen, heard, felt, or measured.
Open-ended question: A questioning technique that requires expansion or further clarification.
Paraphrasing: Repeating what the client has said for confirmation.
Probing question: An exploratory question that aims to gain more information.
Scope of practice: Work within the limits of what you have been educated or trained to do.
Subjective: Signs and symptoms reported that can not be seen, heard, felt, or measured.
Sympathy: Feelings of care or feeling sorry about someone else’s sadness.
Triaged: Client appointments are prioritized based on urgency of their health concern.
Trust: Someone who is honest, good, and reliable. (Merriam-Webster, n.d.)
College of Nurses of Ontario. (2006). Practice standard: Therapeutic nurse-client relationship, revised 2006. https://www.cno.org/globalassets/docs/prac/41033_therapeutic.pdf [opens a PDF file]
College of Physicians and Surgeons of Ontario. (2007) The practice guide: Medical professionalism and college policies. https://www.cpso.on.ca/admin/CPSO/media/Documents/physician/polices-and-guidance/practice-guide/practice-guide.pdf [opens a PDF file]
College of Physicians and Surgeons of Ontario. (2021) Advice to the profession: Medical records documentation. https://www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Medical-Records-Documentation/Advice-to-the-Profession-Medical-Records-Documentation
Open Resources for Nursing (Open RN). (n.d.) Chapter 2.3: Communicating with patients. In Nursing Fundamentals. Wisconsin Technical College System. https://wtcs.pressbooks.pub/nursingfundamentals/. Licensed under a Creative Commons Attribution 4.0 International License
The last time you made an appointment to see your family Doctor, who was responsible for gathering information about your symptoms? Check all that apply.
- Health Care Administrator.
Solution: All the options are correct. The health care administrator asks you why you want to see the doctor and in some offices, the health care administrator is responsible for initial intake to learn more about intake and SOAP notes continue reading the chapter. The nurse may be responsible for gathering your symptom information and completing initial assessments. The doctor is responsible for assessing your symptoms during the examination.
Reflect upon the last time you attended a job interview. What made the interview a positive experience or a negative experience. Choose all that apply. There are really no right or wrong answers as your experience is valid.
- It was a positive experience because the interviewer made me feel welcomed, comfortable, and I knew what to expect. Continue the chapter reading to learn about building trust and what is similar to the helping interview.
- It was a negative experience because the interviewer was abrupt, I felt out of place, and didn’t know what to expect. Continue the chapter reading to learn about building trust and what is similar to the helping interview.
- What other type of experience did you have.
Solution:There are really no right or wrong answers as your experience is valid. Continue the chapter reading to learn about building trust and what is similar to the helping interview. Return to Activity
Making observations is an effective therapeutic communication technique because it can help open up a conversation with the client.
Solution: The statement is true.
Asking Why questions is an effective therapeutic communication technique because it helps the client or client’s family explain more.
Solution: The statement is false. Asking Why questions may the customer feel questioned.
Giving personal opinions is an ineffective therapeutic communication technique because it takes away the client’s decision making.
Solution: The statement is true.
Changing the subject is an effective therapeutic communication technique because it helps the client reduce stress and anxiety.
Solution: The statement is false. Changing the subject demonstrates a lack of empathy and will demonstrate that you don’t wish to know what the client or their family is telling you.
Sometimes, a light touch to the top of a hand, arm or shoulder conveys a caring message.
Solution: The statement is true.
Asking closed questions is always better than an open question in health care settings.
Solution: The statement is false. Both open and closed questions are useful in health care settings.
Which of the following statements is correct:
- The helping interview has a particular characteristic: one person seeks help, and the other provides help.
- A Health Office Administrator doesn’t need to learn about helping interviews. That is the physician’s role.
- The helping interview is the same as a job interview.
Solution: Option 1 is correct. A helping interview is different from a job interview, in which one person seeks help, and the other provides help. Health office administrators should learn about this, because communication is an essential part of the role. Return to Activity
The knowledge one should have in their scope of practice.
A client visit or appointment with a provider
Client appointments are prioritized based on urgency of their health concern.
A deep awareness of the suffering of another with a desire to alleviate that suffering.
Work within the limits of what you have been educated or trained to do.
Signs and symptoms reported that can not be seen, heard, felt, or measured.
Signs and symptoms that can be seen, heard, felt, or measured
A common method for documenting a client encounter. To learn more follow this link to the CPSO: Medical Records Documentationhttps://www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Medical-Records-Documentation/Advice-to-the-Profession-Medical-Records-Documenta
Closed questions can be answered simply and do not require further reflection or clarification.
A questioning technique that requires expansion or further clarification
An exploratory question that seeks to gain more information.
A process in which participants alternate roles of sender and receiver by incorporating feedback to communication in an interactive way.
Osgood-Schramm model of communication, one person encodes a message that is received and interpreted, then the receiver encodes a message to respond and sends that feedback back to the first person, who then interprets and may choose to respond and then ask a question to continue the conversation (Smith, 2019)
Communicates concern, compassion or comfort. A light touch to the hand, arm, or shoulder. Acute awareness to the clients reception. If the client recoils do not touch them.
Use of nonverbal and verbal cues to encourage client/client's families to continue talking
Questions used to propel or guide the conversation forward
Deliberately silent to give people involved in the conversation time to reflect and process what could be said next.
A caution, warning, qualification, or forewarning
Observe a clients demeanour or behaviour to assist you to open up the conversation for the client tot tell you more.
Acknowledging what a client has said to be their experience builds trust.
Repeating what the client has said for confirmation. This must be used sparingly as not to come across as patronizing.
Questions that require explanation
Feelings of care or feeling sorry about someone else's sadness.
To listen without distraction to what is being spoken. Confirm congruency between verbal and nonverbal communication.
A disagreement between two or more people that may become escalated (Merriam Webster, n.d).
The registration at the health provider's office.
An interview with a person seeking help and the people providing that help.
A questioning technique that requires expansion or further clarification.
Someone who is honest, good, and reliable.