Feb 23, 2024 NURS 6512 Discussion Building a Health History Essay
NURS 6512 Discussion Building a Health History Essay
NURS 6512 Discussion Building a Health History Essay
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.
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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
NURS 6512 Discussion Building a Health History Essay
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
The main question post for this discussion entails building a health history regarding a pre-school-aged white female living in a rural community. I would use a patient-centered care approach with techniques that included courtesy, comfort, connection, and confirmation during the interview to develop a rapport with the parent(s) and the patient (Ball et al., 2019). The discussion will focus on communication techniques, social determinants of health considerations, risk assessment tools, and targeted questions to improve the patient and the family’s wellbeing.
Communication and Interview Techniques
I would review the pre-visit questionnaire and identify who was attending the patient before entering the exam room. Of note, if the person accompanying the child were not the parent, then I would check with my mentor the policies and procedures for my primary care setting. I would also review the patient’s History of Present Illness, Past Medical History, Surgeries, Allergies (medications, food, and environment), Current, Present, and Past Medications, and Family Health History.
The patient should be close to or held by the parent in a pediatric centered room that elicits reassurance for the pediatric patient. The room temperature should be comfortable. The furniture would be placed so that there were no barriers between the patient, parent(s), and myself (Ball et al., 2019). Decreasing physical barriers during the interview can facilitate a comfortable and engaging experience for the patient and parent(s).
I would knock before entering the room and introduce myself as a registered nurse and a student family nurse practitioner, working closely with an experienced mentor.
I would address the parent by their last name and ask how they would prefer I address their child (i.e., nickname). I would then say hello to the patient in a kind tone of voice and tell her that I am happy to meet her. My questions would be open-ended and non-leading, and I would courteously wait for them to answer the questions (Malloy & Stolzenberg, 2019).
Considerations of Social Determinants of Health
My patient is a pre-school-aged white female living in a rural community. One of my concerns would be access to health care providers. Nielson et al. (2019) report that 20% of Americans live in rural settings, but only 10% of primary care providers (PCP)provide medical service to these areas. Nielson et al. also report that the shortage of PCPs is expected to reach 25,000 by 2025 in rural communities. Another consideration would be access to urgent care or acute care facilities within a reasonable geographical area.
Is the child exposed to lead paint if the houses are old? Does the child have access to clean water? Is there a grocery near them with access to fresh fruits and vegetables? Is there a good school district for the patient? Are there parks and sidewalks and safe places for the child to play? How old are the parents? What is the educational background of the parents? The age and educational background of the parents would be significant in terms of assessing health literacy. The parents’ religious or spiritual beliefs are also important considerations.
Questions Posed to Assess Health Risks
My first question would be addressed to the parents, and I would ask what brought you in today? The following questions would revolve around the chief concern of the parents, and I would paraphrase their concern(s) and ask them if I understand their concerns. Once I established their chief concern(s), I would ask them what is their most important concern today? What do you think is going on with your child (if there is a concern)? How do you feel your child is doing? Tell me about your child? What kind of activities does she do during the day?
Potential Health Risks Based on Patient’s Age, Gender, and Ethnicity
The patient is considered vulnerable because she is of pre-school age and is dependent on caregivers. She does not have an adult’s cognitive or physical abilities and needs her primary caregivers’ protection. The patient may not be able to verbalize if someone is abusing or neglecting them. The patient is also female and may be more vulnerable to sexual abuse (Melmer & Gutovitz, 2020). Health care providers have an ethical responsibility to protect their patients. The patient is white and should be screened for common genetic anomalies that affect white populations, such as Cystic Fibrosis.
Risk Assessment Tool
The Safe Environment for Every Kid (SEEK) risk assessment tool would be mailed to the parents after the first interview. I would respectfully address any concerns raised once I reviewed the completed questionnaire (American Academy of Pediatrics, 2021). Using a risk assessment tool will help to assess the strengths and weaknesses of the parents or caregivers. Early identification of risks to the pediatric patient can be mitigated by providing the parents with educational resources the parents could use when necessary.
Targeted Risk Assessment Questions
The targeted questions that I would ask the parents would involve risk assessments: Is your child current with their vaccinations? Does your child have a car seat, and are you comfortable with how it works? What type of childproofing do you use for your home? When was the last time your child saw a dentist? How is potty training going? How would you describe your child’s sleeping pattern? How would you describe your child’s eating habits? How often does your child attend daycare or pre-school? How often do you read to your child? How much time does your child spend watching television or on computer devices?
Does she have any difficulties pronouncing words? Does anyone besides the parents take care of your daughter? I would assess if the pre-school child is meeting developmental milestones based on her age. Lastly, I would summarize the chief concern with the parent(s) and ask if there are any other questions or concerns for me before they leave. The parents would be given a written patient/parent educational handout after the visit (American Academy of Pediatrics, n.d.).
Conclusion
Building a health history with a pediatric patient involves cooperation with the family and building a strong rapport based on respect and dignity. One of the most important aspects of becoming a successful family nurse practitioner is listening to the patient (and parents) and learning. Open-ended questions that are not leading allow a greater depth of building the patient’s history. Summarizing the visit with the patient and the parent is a helpful tool that improves communication. Risk assessment tools help to prioritize a plan of care for the patient (and their family).
References
American Academy of Pediatrics. (n.d.). Bright futures tool kit, 2nd edition new.
https://brightfutures.aap.org/materials-and-tools/tool-and-resource-kit/Pages/default.aspx
American Academy of Pediatrics. (2021). Screening tools.
https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Screening/Pages/Screening-Tools.aspx
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.). Elsevier Mosby.
Malloy, L.C., & Stolzenberg, S.N. (2019, March). Editorial perspective: Questioning kids:
applying the lessons from the developmentally sensitive investigative interviewing to the research context. Journal Child Psychology Psychiatry, 60(30), 325-327. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7017956/
Melmer, M.N., & Gutovitz, S. (2020, November 20). Child sexual abuse and neglect. In:
StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470563/
Nielson, M., D’Agostino, D., & Gregory, P. (2017). Addressing rural health challenges head
Missouri Medicine, 114(5), 363-366.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140198/
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Discussion: Building a Health History
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.
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 1 Discussion Rubric
Post by Day 3 of Week 1 and Respond by Day 6 of Week 1
To Participate in this Discussion:
Week 1 Discussion
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What’s Coming Up in Module 2?
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In Module 2, you explore the impact of functional assessments, diversity, and sensitivity in conducting health assessments. You also
examine various assessment tools and diagnostic tests used to gather information about patients’ conditions and examine their validity, reliability, and impact in conducting health assessments.
Next week, you will specifically examine functional assessments as they relate to diversity and sensitivity
Registration for Shadow Health
Throughout this course, you will participate in digital clinical experiences using the online simulation tool Shadow Health. The Shadow Health digital clinical experience provides a dynamic, immersive experience designed to improve nursing skills and clinical reasoning through the examination of digital standardized patients. Using Shadow Health you will participate in health histories, focused exams, and a comprehensive assessment.
There will be four Shadow Health assessment components that you will need to complete in Module’s 2 and 3:
Health History Assessment (Week 3 & 4)
Focused Exam: Cough (Week 5) for a pediatric patient presenting with cough
Focused Exam: Chest Pain (Week 7) for an adult patient presenting with chest pain
Comprehensive (Head-to-Toe) Physical Assessment (Week 9)
Before you can participate in these simulations, you will need to register for a Shadow Health account. To do this:
Go to the Walden Bookstore and purchase access to Shadow Health and the required texts.
Once Shadow Health has been purchased, an access code will be emailed to you from the bookstore.
Review this video explaining how to register in Shadow Health: https://vimeo.com/275921826/c12d50ee6e
Use the Shadow Health link located in the navigation menu on the left in the Blackboard course.
Follow the prompts to register in Shadow Health. You will need the access code provided from the bookstore to register. Once registered, Shadow Health should always be accessed via the link in Blackboard.
Use only Google Chrome when accessing Shadow Health and make sure all other programs are turned off on your computer. Other browsers do not work well and will not allow the Shadow Health speech to text function to work.
Once registered, complete the Shadow Health Orientation in the Shadow Health website/program and review the videos designed to assist with navigating and completing assignments.
Read the Shadow Health Nursing Documentation Tutorial located in the Week 1 Learning Resources.
Note: As nurses you typically use the word assessment to mean completing the physical exam. However, in the SOAP Note format, assessment means diagnosis so start getting in the habit of calling the physical exam exactly that.
Week 2 Case Studies
In Week 2, your Instructor will assign you a case study related to your Discussion by Day 1 of the week. Please make sure to review the “Course Announcements” area of the course to verify your assigned case study. Please plan ahead to ensure you have time to review your case study and your Learning Resources so that you can complete your Discussions and Assignments on time.
Photo Credit: Getty Images/iStockphoto
Practicum – Upcoming Deadline
In the Nurse Practitioner programs of study (FNP, AGACNP, AGPCNP, and PMHNP) you are required to take several practicum courses. If you plan on taking a practicum course within the next two terms, you will need to submit your application via Meditrek .
For information on the practicum application process and deadlines, please visit the Field Experience: College of Nursing: Application Process – Graduate web page.
Please take the time to review the Appropriate Preceptors and Field Sites for your courses.
Please take the time to review the practicum manuals, FAQs, Webinars and any required forms on the Field Experience: College of Nursing: Student Resources and Manuals web page.
Field Experience: College of Nursing Quick Answers
Field Experience: MSN Nurse Practitioner Practicum Manual
Student Practicum Resources: NP Student Orientation
Next Module
To go to the next module:
Module 2
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 (9th ed.). Elsevier Mosby.
Crossland, C., Palmer, J., & Brooks, A. (2013). Nij’s program of research on violence against american indian and alaska native women. Violence Against Women, 19(6), 771–790. https://doi.org/10.1177/1077801213494706
To build a strong therapeutic relationship between the patient and the nurse, it is essential to obtain relevant and personal information about the patient by taking a thorough health history. According to the case study that was assigned, the 72-year-old man who was admitted to your Intensive care unit after having a severe stroke was rendered unconscious and unable to communicate. But, his wife claimed in an interview that they don’t have any advanced directives.
But, she was certain that her husband would prefer not to live that way. Their daughter, however, was convinced that her father would have preferred to be kept alive if there was a prospect for a positive outcome. The use of proper communication skills, such as the use of open-ended questions, active listening, empat
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