What factors may affect communication with this patient?

Emily, a 3-year-old toddler, presents to the pediatrician’s office for her yearly physical. Her mother and 6-month-old brother accompany her. Emily’s brother was seen first for immunizations and a checkup, and now it is Emily’s turn for an exam and immunization check. The nurse notes that Emily’s immunizations are up-to-date (she received the pneumonia vaccine in the fall, as well as her yearly flu shot). Emily’s mother reports that her daughter is doing well in preschool and has had no illnesses since the last visit. Vital signs: T 98.6 P 122 R 20 BP 90/40. Emily is clinging to her mother; she is visibly upset, crying and shouting, “Please don’t let them give me boo boo shot!”
1. How should the nurse proceed with the health interview?
2. What factors may affect communication with this patient?
3. What are the three phases of the interview process?
4. What communication techniques would be appropriate for gathering the data needed to complete the health history?