Feb 23, 2024 NURS 6512 Week 1 Discussion Building a Health History
NURS 6512 Week 1 Discussion Building a Health History
NURS 6512 Week 1 Discussion Building a Health History
As an advanced practitioner, it is imperative to build a therapeutic relationship with the patient to obtain the most and accurate health history of that specific patient; the medical history is a crucial information in developing an appropriate plan of care for that patient. Each patient may require different communication techniques and considerations based on their social determinants of health and health risks. In this week’s discussion, I am presented with an adolescent white male that is without health insurance and seeking medical care for a sexually transmitted infection. The purpose of this discussion is to examine communication techniques specific to my patient and at least five targeted questions to assess the health risks and building of patient’s health history.
Health History Interview
Since the patient is an adolescent male that presents with STI, my priorities would be identifying high risk behaviors such as use of illicit drugs and alcohol, risky sexual behaviors, and suicidal ideations. According to Johnston et al. (2022), data from 184 countries in nine UNICEF regions suggested that there are approximately 17 million adolescent young men who are bisexual and sell sex that needs HIV prevention services and social support. In addition, America Foundation for Suicide Prevention (2022) stated that 8.9% of youth grades 9-12 reported having at least one suicide attempt within 12 months. Therefore, my targeted questions would include:
Do you smoke or drink? If so, how many times a week?
What is your sexual orientation? (ex. heterosexual, bisexual, etc.)
Do you use any illicit recreational drugs?
How many sexual partners have you had in the last month?
Have you ever had suicidal ideations or attempts?
Communication Techniques
There are many barriers in obtaining accurate and sufficient health history; in my
NURS 6512 Week 1 Discussion Building a Health History
patient’s case, he is an adolescent teen who may be hesitant to tell the honest answer when it comes to sensitive subjects such as alcohol, recreational drug use, or sexual orientation. Many adolescents are exploring to find self-identity during this time and unfortunately, it often involves high-risk behaviors. Mental health has been more recognized in the last decade, and suicidal ideation awareness and assessment has been more widely adopted in healthcare settings. Ball et al. (2019) stated that when discussing sensitive issues, there are many essential considerations during the interview such as providing privacy, being direct and firm by avoiding leading questions, not apologizing for asking a question, not being judgmental or pushy, and using language that is understandable but not patronizing. First impression is a big factor when introducing yourself to the patient; for this patient, I would try to initially relate to the patient by talking about common hobbies that can relate to adolescents such as games or sports and build a trusting relationship. I would be firm in saying that you need to tell me the truth about alcohol or drug use, but that the information would stay confidential, and I will not purposely expose information that would get the patient in trouble with his guardians or with the law.
One assessment tool that can be used for my patient that would help with obtaining health history is the ‘CRAFFT’ questionnaire. It was developed in 2002 as a screening tool for alcohol and substance abuse in adolescents; a two or more (2 to 6) yes answers suggests a serious substance use disorder problem and the questionnaire also recommends counseling regarding many aspects such as reviewing the screening results, recommending not to use such drugs, driving risk counseling, eliciting self-motivational statements, and reinforcing self-efficacy (New Jersey Chapter: American Academy of Pediatrics, 2018). This assessment tool is important because the patient’s social background and high-risk behaviors may be correlated with patient’s sexual behaviors that led to patient having an STI.
Conclusion
Obtaining patient’s health history takes more than just interviewing the patient; it takes a lot of effort in building a trusting relationship and understanding their personal situation and poor social determinants of health such as poverty or no insurance that is constant even after they are discharged from the healthcare setting. Assessing each patient with individualized plan of care and applying the correct communication techniques that apply to different age groups/gender/ethnicity are key in building a therapeutic relationship with the patient that will yield in better health outcome.
References
American Foundation for Suicide Prevention. (2022). Suicide statistics. Retrieved November 29, 2022 from https://afsp.org/suicide-statistics/
Links to an external site.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Johnston, L., Nguyen, V., Lwamba, C., Sabin, K. (2022). Deriving and interpreting population size estimates for adolescent and young key populations at higher risk of HIV transmission: Men who have sex with men and females who sell sex. PLoS One, 17(9). https://doi.org/10.1371/journal.pone.0269780
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Links to an external site.
New Jersey Chapter: American Academy of Pediatrics. (2018). The CRAFFT Questionnaire (version 2.1). https://njaap.org/wp-content/uploads/2018/03/COMBINED-CRAFFT-2.1-Self-Admin_Clinician-Interview_Risk-Assess-Guide.pdf
Links to an external site.
Sarkisian, K., Planalp, E., Carol, V. H., & Goldsmith, H. H. (2022). Leveraging latent profile analysis to synthesize childhood and adolescent risk factors for suicidal ideation. PLoS One, 17(8). https://doi.org/10.1371/journal.pone.0272400
Being able to obtain a comprehensive health history for a patient is important in developing a treatment plan for them. The purpose of this discussion post is to discuss interview techniques I would use for an 85-year-old white female living alone with declining health. I will talk about the risk assessment instrument I would use and why. Lastly, I will list five targeted questions I would ask to assess her health to start building a health history.
The first meeting with any patient is so important to build a good relationship and partnership from the start (Ball et al., 2019). With this patient being 85 and living alone there will be a lot to consider when interviewing her. I will need to establish is she is mentally with it, if she has hearing problems, and how much she understands about her health. Older adults often assume certain problems are just normal parts of aging and not anything to be considered (Ball et al., 2019). Often, older adults can also experience agism (Garrison-Diehn et al., 2022). Even in health care settings older adults experience feelings of incompetence and being a burden (Garrison-Diehn et al., 2022). It will be important to make sure she feels comfortable speaking to me knowing there is no bias or judgement.
The risk assessment I would do for this patient is the functional assessment. This is an older lady who lives alone. It will be essential to figure out how well she is able to function on her own. One of the biggest risks for older patients is falling. Falling is associated with adverse outcomes that can lead to a patient not being able to live at home anymore along with increased mortality (Snehal et al., 2020). The functional assessment would give information regarding how well she can move around the house, is she is able to keep a clean environment, how meals are prepared, how she goes to the bathroom, and keeps good hygiene (Ball et al, 2019). All these issues are going to contribute to her overall health. It is important to gather this information to determine what assistance, if any, she will need.
After introducing myself and establishing how the patient would like to be addressed, I would start by simply asking “What brings you in today?” This is a way to find out what her chief complaint is for coming in. My second question would be “When did this start?” This brings the patient back to the beginning and prompts them to tell the whole story regarding why they came in. My third question would be “What medications do you take on a regular basis and what are they for?” In my experience patients may or may not even know what they are taking, let alone why they are taking them. It can also lead to her discussing if she is compliant with her medications.
To follow that, my fourth question would be “What medical problems do you have?” Before going through a formal review of systems, this can give a clue to what she considers to be important in her history. My last question would be “How well do you feel you are able to take care of yourself at home?” This is an open-ended question to gain some insight on the functional assessment. If the patient’s initial chief complaint is not urgent it is okay to give the patient some time while understanding the time constraints of you as the provider (Ball et al., 2019).
Establishing a relationship with patients and getting a thorough health history can be a daunting task for providers. It is key to tailor interviewing skills to meet patient specific needs. Modifying interview skills to the individual will eliminate communication barriers between the provider and patient (Bass et al., 2019). Creating a strong relationship with the patient will allow the nurse practitioner to obtain the most comprehensive health history and provide the best possible care to clients.
References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Garrison-Diehn, C., Rummel, C., Au, Y. H., & Scherer, K. (2022). Attitudes toward older adults and aging: A foundational geropsychology knowledge competency. Clinical Psychology: Science and Practice, 29(1), 4–15. https://doi.org/10.1037/cps0000043
Snehal, K., Rashmi, G., & Aarti, N. (2020). Risk factors for fear of falling in older adults in India. Journal of Public Health, 28(2), 123-129. doi:https://doi.org/10.1007/s10389-019-01061-9
Effective communication is vital to constructing an accurate and detailed patient history. A patient’s health or illness is influenced by many factors, including age, gender, ethnicity, and environmental setting. As an advanced practice nurse, you must be aware of these factors and tailor your communication techniques accordingly. Doing so will not only help you establish rapport with your patients, but it will also enable you to more effectively gather the information needed to assess your patients’ health risks.For this Discussion, you will take on the role of a clinician who is building a health history for a particular new patient assigned by your Instructor.
Photo Credit: Sam Edwards / Caiaimage / Getty Images
To prepare:
With the information presented in Chapter 1 of Ball et al. in mind, consider the following:
• By Day 1 of this week, you will be assigned a new patient profile by your Instructor for this Discussion. Note: Please see the “Course Announcements” section of the classroom for your new patient profile assignment.• How would your communication and interview techniques for building a health history differ with each patient?• How might you target your questions for building a health history based on the patient’s social determinants of health?• What risk assessment instruments would be appropriate to use with each patient, or what questions would you ask each patient to assess his or her health risks?• Identify any potential health-related risks based upon the patient’s age, gender, ethnicity, or environmental setting that should be taken into consideration.• Select one of the risk assessment instruments presented in Chapter 1 or Chapter 5 of the Seidel’s Guide to Physical Examination text, or another tool with which you are familiar, related to your selected patient.• Develop at least five targeted questions you would ask your selected patient to assess his or her health risks and begin building a health history.
By Day 3 of Week 1
Post a summary of the interview and a description of the communication techniques you would use with your assigned patient. Explain why you would use these techniques. Identify the risk assessment instrument you selected, and justify why it would be applicable to the selected patient. Provide at least five targeted questions you would ask the patient.Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!Read a selection of your colleagues’ responses.
By Day 6 of Week 1
Respond to at least two of your colleagues on 2 different days who selected a different patient than you, using one or more of the following approaches:• Share additional interview and communication techniques that could be effective with your colleague’s selected patient.• Suggest additional health-related risks that might be considered.• Validate an idea with your own experience and additional research.• Discussion Week 1•• Case G Pre-school-aged white female living in a rural community•• Summary of the interview and a description of the communication techniques you would use with your assigned patient. Five targeted questions you would ask the patient.• To provide a summary of the interview and communication techniques I would use with a preschooler age child from a rural community would be getting down to the level of the child, briefly evaluating the family dynamics and the overall support within the home. Likely the child will be accompanied by an adult or caregiver.
• Five target questions I would ask are:• 1. If there are several concerns that bring you hear today; what problem concerns you most?• 2. Can you tell me what happen?• 3. Why do you think it happened?• 4. Do you feel safe in your home?• 5. Is there anything else that you want me to know?• Explain why you would use these techniques• Many children love it when you get down on the floor to play with them. They often have anxieties and fears that must be eased (Ball et al., 2019). I would use these techniques to allow the preschool age child to feel comfortable and decrease anxiety. I would also provide the patient with a coloring paper or something to allow her to feel interested in what we were discussing. I could use this as a distraction tool while asking question to her guardian and her. At some point within the interview I would discuss safety hazards related to her age group such as falls, chocking, burns, and poisoning (Ball et al., 2019).
• Identify the risk assessment instrument you selected and justify why it would be applicable to the selected patient• Many risk assessments instruments have been developed to improve child welfare workers’ decision making (Vial et al., 2021). For this patient I would complete and organize the health record by SOAP ( subjective ,objective ,Assessment, Plan) (Ball et al., 2019). The screening tool I would use is HEEADSSS (home environment, education, eating, activities, drugs, sexuality, suicide/depression, and safety from injury/violence) (Ball et al., 2019). I would use this tool to both review with the patient as well as parent to get and overall understanding of the concerns for the visit. The collection of family health history information is part of routine healthcare interactions and can inform clinical decision making and preventive services (Lushniak, 2015). This as well would be an area to focus my assessment.
References
• Ball, J., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). In Seidel’s guide to• physical examination: an interprofessional approach (9th ed., pp. 58–59). essay, Mosby.• Lushniak, B. D. (2015). Family Health History: Using the past to Improve Future Health. Public• Health Reports, 130(1), 3–5. https://doi.org/10.1177/003335491513000102• Vial, A., van der Put, C., Stams, G. J., Dinkgreve, M., & Assink, M. (2021). Validation and• further development of a risk assessment instrument for child welfare. Child Abuse &• Neglect, 117, 1–11. https://doi.org/10.1016/j.chiabu.2021.105047• Reply Quote Email Author
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Discussion: Building a Health History
The patient in this scenario is a 14-year-old biracial male. The first step in interacting with the patient is to build a trustworthy rapport with the patient and determine his fluency in communication and speaking the English language, as any language barriers can hinder the effectiveness of the communication, it is important to ensure the client understands the language of communication (Brooks et al., 2019). Effective communication is required needed in any patient-healthcare provider interaction. The language assessment is important in making communication easier.
Communication Techniques
Furthermore, the use of verbal techniques will be ensured in the communication process (Wang et al., 2018). However, caution will be taken not to offend the client in the conversation. The meaning and interpretation of the non-verbal techniques tend to vary from one cultural group to another (Sullivan, 2019). Therefore, considering that the client is from another cultural group and young, understanding their values would be necessary to reduce the conflicts in the communication process. I will also be empathetic to the client (Ball et al., 2019).
Subsequently, active listening is also important when interacting with the patient. Listening actively help the healthcare provider to capture important information about the patients and their possible health needs (LeBlond et al., 2014). On the other hand, some clients may be too talkative and so the healthcare provider must be able to control and ensure that the relevant information is obtained from the interaction. Controlling the conversation also helps in managing the time used in the interaction. The HEEADSSS risk assessment tool will be used when interviewing the patient because it will help in understanding the client’s home environment and education experiences among other areas of interest.
Target Interview Questions
1. Whom do you live with at home?2. What is your relationship with the parents and siblings?3. What is it that makes you happy about your family?4. Who is your best friend?5. What do you like doing during your free time?
Conclusion
Finally, communication is important in the interaction between the patient and the healthcare providers. Both verbal and non-verbal communication matters in the interaction. Cultural values vary from one patient to another and this could be a major hindrance to effective interaction between the patient and the healthcare providers. Therefore, the nurses must demonstrate cross-cultural competencies and interact with their clients accordingly without judging them or looking down upon their cultural values.
References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Brooks, L. A., Manias, E., & Bloomer, M. J. (2019). Culturally sensitive communication in healthcare: A concept analysis. Collegian, 26(3), 383-391. https://doi.org/10.1016/j.colegn.2018.09.007
LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw- Hill Medical.
Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.
Wang, Y., Wan, Q., Lin, F., Zhou, W., & Shang, S. (2018). Interventions to improve communication between nurses and physicians in the intensive care unit: An integrative literature review. International Journal of Nursing Sciences, 5(1), 81-88. https://doi.org/10.1016/j.ijnss.2017.09.007
Thank you for your very informative and well-composed post. You did an excellent job of identifying highly pertinent questions necessary for an effective health history. I would like to suggest an additional assessment that I think would be extremely useful in this particular clinical case. This patient is a Native American living on a reservation, and a woman. Unfortunately, this places her into a high risk category for domestic violence of all types, sexual assault, and likely lacking in resources to allow for safe and secure pregnancy and domesticity.
Research indicates that Native American women are more likely to be victims of violent crime than any other demographic in the United States, and that 70% of sexual assaults on Native women go unreported, meaning that the number is likely much higher. Studies demonstrate that 70% of these violent crimes are perpetrated by persons of another race (not Native), also making Native women the largest target for interracial violent crime (Crossland et al., 2013).
It is imperative that advanced practice providers familiarize themselves with their patients’ cultural background and potential health risks that may be specific to that population, and that they screen their patients accordingly. The risk screening tool HITS would be an appropriate and effective tool in this clinical case. This assessment asks “In the past year, how often has your partner: Hurt you physically? Insult or talk down to you? Threaten you with physical harm? Scream or curse at you?” (Ball et al., 2019). This assessment could be instrumental in protecting the health and safety of both the patient and her family, including her unborn child. The provider should also include in his health screening a physical assessment for indications of physical abuse, as with all other patients seen. Thank you again for your excellent post!
References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach&nbs
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