Asking questions

1. Discuss the importance of the skill of asking effective questions

2. Identify six points to keep in mind when asking questions

3. Identify common errors in asking questions and strategies to avoid them

4. Participate in exercises to assess and build skills in asking questions

A fool may ask more questions in an hour than a wise man can answer in 7 years.

Importance of asking questions effectively in nursing

The word question is derived from the Latin quaerere (to seek), and this is the very power of good questions. When you take the time to ask questions you demonstrate interest and respect (Gallagher, 2009). Asking questions effectively is fundamental to nursing assessment and to building the helping relationship. For example, if you ask a client if he has chest pain, a closed question, you will receive less data than if you ask him to describe any discomfort he is experiencing (Kleiman, 2002). As you make initial contacts with clients, consider that they are performing their own assessments to see if you measure up to their expectations (Sundeen et al, 1998). Illness often makes clients feel vulnerable; they are forced to depend on an unfamiliar person to initiate the process of sustaining themselves through a frightening life experience on the journey to healing. The client needs to trust that information you seek will be used appropriately and with discernment for promotion of health, dignity, and privacy (Carter, 2009; Matiti and Trorey, 2008). As a professional nurse, you will spend about half of your working time asking questions of clients and colleagues. Pay careful attention to building this skill. Remember to listen for what is said and what is left unspoken.

Adeptness at asking questions is a fundamental requirement for competent and considerate nursing. The more effective you are in asking questions, the more time you save yourself and others, the more pertinent and useful the information you collect, and the more effective your interviewing experience. Effective questioning ensures that you collect the data you need to provide quality nursing care. As you become accustomed to asking questions about nursing practice, you build a foundation for contributing to the profession by posing the questions that stimulate research to support evidence-based practice (Knoll and Leifso, 2009).

Moments of Connection. . .

Questions to Help Move beyond the Obvious

“I was working with a 31-year-old woman with myelitis who was in tremendous pain. As I was doing the morning assessment and we were discussing her pain, she began to cry. Upon further exploration, the client revealed that it was not the pain that was her worst concern. With support, she began to tell me about her grandfather, who was dying, and her grandmother, whose cancer was no longer in remission. She was afraid she would never see her grandfather again to be able to tell him what he had meant to her. She touched me deeply because I had had a similar experience. To help her regain some control of her situation, I helped her place a call to her grandfather, and she was able to find closure.”

From the time your clients enter your care until the completion of your helping relationship, you will be asking them questions. You will ask them about the nature of their concerns so that you can agree on a nursing diagnosis. Finding out what they hope to achieve with the help of your nursing services requires effective questioning. You will discover their preferences for a treatment plan and frequently check with them about its effectiveness. Determining their readiness for the termination of your relationship and their readiness to take care of their own health concerns after discharge demands that your questioning skills be clear and focused. Remember, too, that helping clients learn how to ask questions of you, their physicians, and other healthcare team members is an essential part of being an active part of their own team (Sobczyk and Shulman, 2002). A study on how clients’ communication styles affect physicians’ communication concluded that physicians engaged in significantly more client-centered communication when interacting with clients who actively participated in their care by asking questions and providing information (Cegala and Post, 2009).

You might be thinking that the client–nurse relationship is composed primarily of questioning. Well, to a great extent it is. Therefore, it is crucial that you attain proficiency in this fundamental nursing communication behavior.

In your role as a nurse, the main reason for asking questions is to secure data that are essential to providing quality care to your clients. Six questions need to be answered to ensure that you obtain the facts you need.

WIT&Wisdom

When you have asked all the questions you need to ask, pause, and ask, “Are there any other questions I should be asking at this time?” You might be surprised at how much additional information you might acquire.

Why, what, how, who, when, and where of asking questions

If obtaining the information you want is important, then it is worthwhile to spend the time planning the strategy that is most likely to secure these facts.

Why of asking questions

Before you make any inquiries, you should be sure about why you need the information. Irrelevant questions send the message that you are unfocused (Gallagher, 2009). Questions rooted in personal curiosity may offend your clients. Before you speak, silently answer this question: “How will the information I am seeking direct me in helping my clients?” If you can justify the question, then ask it!

If there is any doubt as to whether your clients will understand your reasons for asking, then explain those reasons in advance. Consider this example.

In your investigations of your client’s fall off a ladder, you want to learn about his safety habits in general to determine if he is in danger of future home accidents. Before barraging him with what might seem to be unrelated or even nosy questions, you can clarify your objective by saying something like the following:

I’d like to ask you some questions about your safety precautions with the ladder and about your home safety measures in general. About 80% of accidents occur in the home. My questions might trigger some ideas that could make your home a safer place in which to work and live. Are you agreeable to exploring this area with me?

Here is another example:

Within the past year, your 79-year-old client has been brought to the emergency department three times after fainting. The cause of the fainting has not been discovered, and your observations about her thinness and lack of vitality make you wonder whether inadequate nutrition might be at the root of her fainting. The following statement can clarify the purpose of your questions:

We still don’t know what is causing your fainting, Mrs. Jones, and we want to investigate every likely source. One possible cause could be a lack of the nutrients essential to keep you going. I’d like to ask you some questions about your diet to determine whether you are getting all you need from the foods you eat. Is that OK with you?

Both of these examples illustrate how you can prepare your clients for your line of questioning. When clients understand your purpose, they are more likely to be open and to reveal information, rather than being guarded because they are uneasy about your intentions.

What and how of asking questions

What you ask and how you ask it are the next considerations in your strategy. When you have determined why you require the information, then you must plan what to ask to ensure that you are clear in your intentions and know how to phrase your question in a way that invites your client to respond.

What you say must be phrased clearly, and a logical progression to your questions is helpful. They should be worded in a way that shows your respect for your clients’ privacy and personal information. Any judgments you have about the responses should remain unspoken.

For example, imagine that you require some information about a client’s overall activity level and day-to-day schedule to help him fit in his colostomy hygienic care. Having explained your purpose and secured his permission, your next step is to proceed with your inquiry. You choose to proceed in a systematic order starting with the following:

Let’s begin with your mornings. Could you outline what you do, hour by hour, on a typical weekday morning, from the time you get up until lunchtime?

This question outlines for your client exactly what you want to know. He can focus on the mornings, and it is apparent that you will proceed to other times in his weekly schedule.

Consider another example:

You are completing a health history on a client who has just arrived in an outpatient surgical center. He will be receiving an anesthetic, and you need information about his past health status, past illnesses, and family health history. Your facility employs a concise preoperative assessment tool to efficiently obtain this extensive material from clients. Having secured your client’s permission, after explaining the purpose of your line of questioning, you proceed with the following:

As you know, this is a lot of material to cover. To streamline things I’m going to use this guideline our unit has developed. It’s a good checklist to ensure that we cover everything. Please ask me if there’s anything I say that isn’t clear to you. Beginning with your childhood, did you ever have diphtheria? . . . or whooping cough? . . . or rheumatic fever?

Explaining your format helps clients accept what might otherwise seem like a barrage of unrelated questions.

Any material that clients provide is of a personal nature, and some areas are more sensitive than others. For some clients, talking about sexual activity or birth control practices may be difficult. For others, talking about personal hygiene or alcohol consumption may be embarrassing. Some clients do not feel comfortable revealing their self-care practices. Others hesitate to reveal family issues or job-related information. You cannot know in advance which topics might be difficult for your clients, so you must keep in mind that any information clients reveal about themselves, their significant others, or their healthcare practices might be sensitive for them.

As a nurse you can take certain steps to put your clients at ease and to make them feel more comfortable in revealing this information. One thing you can do is to reassure them about the confidentiality of your relationship. This step should be taken at the beginning of an interview or at the earliest point possible in your relationship. If you wait until later, you may lose opportunities for uncovering important information.

Confidentiality has a wide range of meanings, and you must be honest and clear with all your clients so that they understand exactly what the parameters are. Does confidentiality mean that you will not repeat what your clients have said? Does it mean that you will verbally pass the information along to a trustworthy colleague but not put it in writing? Does it mean that you will convey information to team colleagues at client-care conferences? Or does it mean that confidential information will be written on a chart for other team members to read? Exactly what your clients reveal will likely be determined by what you intend to do with the information they contemplate telling you.

It is essential that you and your clients have an identical understanding of the meaning of confidentiality. Sundeen and colleagues (1998) remind us that clients may feel betrayed if they have been under the impression that client–nurse relationships are confidential and then discover that you have revealed what they consider personal information to another health team member or have written it on their charts.

Another way you can increase your clients’ comfort is to treat all areas you discuss respectfully and professionally. Making the effort to ensure that your clients have privacy and the time to respond unhurriedly facilitates their replying openly and fully. Being equally relaxed and straightforward, whether you are discussing sexual matters, family health history, bowel habits, or exercise patterns, contributes to putting your clients at ease. If you flush, wriggle in your chair, lose eye contact, or lower your voice, your clients quickly get the message that this topic is a sensitive one for you, and they may feel even more embarrassed. To improve your ability to be at ease when asking questions in a variety of areas, you may find rehearsal with friends or colleagues helpful.