Eliciting assessment data from the patient who is difficult to interview.

The patient interview is an essential part of the assessment phase of the nursing process. Ensuring a productive interview involves controlling, as much as possible, the interview environment as well as the nurse's verbal and nonverbal communication. Patients who are cognitively impaired, angry, anxious, depressed, manipulative, or seductive can make this interview process more challenging. Working individually with each of these possible patient dynamics in a calm, controlled, and knowledgeable way can help facilitate the interview process and pave the way for fewer problems in the future. Frequently, the interview may involve the discussion of sensitive topics such as terminal illness, suicide, or sexuality. Gathering information and developing a comfort level in broaching these issues with patients are important goals for nursing professionals. Reading, attending workshops, consultation with professionals, and most important, self-assessment of these sensitive topics are all useful tools in obtaining those goals.

Anxiety disorders and psychiatric referral in the general medical emergency room.

A retrospective chart review of patients seen in the medical emergency room between July 1983 and July 1984 indicated that only one third of the patients who received a final diagnosis that included anxiety were referred for psychiatric follow-up. This was in sharp contrast to the referral pattern from the ER of depressed or psychotic patients. In the present study, referred and nonreferred patients were compared on 17 variables to determine those factors that influenced decision to refer. Among the five factors that discriminated between the criterion groups were age, depression, and lack of concomitant medical findings.