NURS 6512N Discussion: Building a Health History
Sample Answer for NURS 6512N Discussion: Building a Health History Included After Question
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.
A Sample Answer For the Assignment: NURS 6512N Discussion: Building a Health History
Title: NURS 6512N Discussion: Building a Health History
Comprehensive health and risk assessment in the adolescent population is challenging, given the multiple issues manifesting during this developmental stage. Moreover, adolescents do not readily share personal information because they barely trust people and tend to be defiant, making them resist any intervention efforts in their lives. When conducting interviews to build health history with adolescents, important communication principles include trust, confidentiality, and a nonjudgmental attitude.
In the scenario, a white adolescent male seeks medical care for STI. With adolescent patients, it is crucial to make them feel comfortable first. I would achieve this by building rapport using compliments such as on dressing. I would also initiate small talk and ask the patient about home life and favorite past-times. Once I establish rapport, I will use open-ended questions and encourage the adolescent to talk freely. The communication techniques that will guide my interview include avoiding criticism, showing respect and genuine concern, giving friendly responses, and ascertaining privacy and confidentiality (Diamond-Fox, 2021). Additionally, adolescents have great independence and do not want to be treated like children; thus, I will address the patient as if I am having a conversation with an adult.
The patient does not have health insurance pointing to the possibility of coming from a vulnerable population of low socioeconomic background. I would assess the patient’s childhood background and educational background to understand the socioeconomic factors that might influence their health (Ball et al., 2019). I would also ask about the family’s statusand whether both parents are present. I would assess challenges in accessing health services, basic needs, and also get information about the neighborhood (Srinath et al., 2019). I would also inquire about the kind of people he hangs out with; if they are involved in substance abuse and criminal activities. Furthermore, I will assess the possibility of substance use in the family (parents) and experiences of abuse and neglect.
The screening tools appropriate for adolescents are Rapid Assessment for Adolescent Preventive Services (RAAP), used to identify health risks, and HEeADSSS Assessment, which evaluates risk and protective factors to enable effective intervention. In addition, the CRAFFT Screening Test is also used with the adolescent population to identify problems and risks associated with drug use.
Based on the patient’s age, one of the major risks he is exposed to is substance abuse. According to the National Center for Drug Abuse Statistics (2022), 50% of teenagers have abused drugs and alcohol at least once. Teenagers are vulnerable to substance use because of peer pressure, the urge to experiment, ignorance about the effects, and involvement in criminal activities. For adolescents from low socioeconomic status, the risk of substance abuse is even higher (Farley, 2020). The second risk that the patient is exposed to is infectious diseases. The patient presents with the problem of STI, which means he engages in behavior that exposes him to the risk of sexually transmitted infections and can lead to contracting HIV and other chronic infections. Finally, the patient may be exposed to psychosocial issues common with adolescents.
The risk assessment instrument I would use is HEADSS, an interview instrument used to evaluate issues in an adolescent’s life. The instrument evaluates several components, including home, education/employment, activities, drugs use, sexuality, and mental health concerns (Ball et al., 2019).
Targeted Questions
- Do you live at home with your parents? Are both your parents together?
- What kind of people do you hang out with most?
- Have you ever tried alcohol, marijuana, and any other hard substance?
- Have you ever witnessed or been a victim of abuse in the past and present?
- Do you use protection when engaging in intercourse with your girlfriend?
- What do you know about sexually transmitted infections?
- Have you ever felt like harming yourself or someone else?
- Have you ever run into problems with law enforcement, leading to incarceration?
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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.
Diamond-Fox, S. (2021). Undertaking consultations and clinical assessments at advanced level. British Journal of Nursing, 30(4), 238–243. https://doi.org/10.12968/bjon.2021.30.4.238.
Farley, H. R. (2020). Assessing mental health in vulnerable adolescents. Nursing, 50(10), 48-53. doi: 10.1097/01.NURSE.0000697168.39814.93.
National Center for Drug Abuse Statistics. (2022). Drug use among youth: Facts &statistics. Retrieved from National Center for Drug Abuse Statistics: https://drugabusestatistics.org/teen-drug-use/
Srinath, S., Jacob, P., Sharma, E., & Gautam, A. (2019). Clinical practice guidelines for assessment of children and adolescents. Indian journal of psychiatry, 61(Suppl 2), 158–175. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_580_18.
A Sample Answer 2 For the Assignment: NURS 6512N Discussion: Building a Health History
Title: NURS 6512N Discussion: Building a Health History
Your case was quite an interesting one to research. Omenka, Watson, and Hendrie (2020) conducted a scoping review of African immigrants’ health disparities. Scoping studies are a type of research to identify available evidence or gaps on a subject of interest (Munn et al., n.d.). With that said, Omenka, Watson, and Hendrie (2020) found little research has been specifically conducted on African immigrants; instead, the researchers found African immigrants were being grouped in research studies conducted on African Americans. On that note, I find it important to differentiate the health and spiritual beliefs of both cultures so that, as clinicians, we can provide culturally competent care.
I agree with your statement on creating a safe zone for the patient before conducting sexual history assessment; this will build trust and the patient will be willing to openly share personal health history. According to Omenka, Watson, and Hendrie (2020), African immigrants view HIV as a spiritual problem and are more likely to seek medical attention when a disease is in its advanced stages. Hence, the importance of early intervention is important.
Additional interview questions that may be of value in this situation may be to ask, “can you tell me how you view illness?” and Ball et al. (2019) suggests asking, “what do I need to know as your clinician to provide care for you?” Likewise, Ball et al. (2019) suggest not pressing an issue when communicating with patients. Great post.
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.
Munn, Z., Peters, M. D. J., Stern, C., Tufanaru, C., McArthur, A., & Aromataris, E. (n.d.). Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Medical Research Methodology, 18. https://doi-org.ezp.waldenulibrary.org/10.1186/s12874-018-0611-x
Omenka, O. I., Watson, D. P., & Hendrie, H. C. (2020). Understanding the healthcare experiences and needs of African immigrants in the United States: a scoping review. BMC Public Health, 20(1), 27. https://doi-org.ezp.waldenulibrary.org/10.1186/s12889-019-8127-9
A Sample Answer 3 For the Assignment: NURS 6512N Discussion: Building a Health History
Title: NURS 6512N Discussion: Building a Health History
Effective communication with a healthcare provider is essential to building a relationship with the patient and using sound clinical judgment in patient care (Pearl, 2022). A good patient rapport can allow for trust and, by doing so, allows for better communication between the patient and healthcare provider. Building a health history differs for each individual because I would need to address specific targeted questions for each patient. The targeted questions of a patient’s social determinants would include a patient’s age, educational level, language barriers, socioeconomic status, and lastly, use of aids if needed in helping to develop the care plan better. For example, I was assigned an adolescent Hispanic/Latino boy living in a middle-class suburb. The use of communication techniques needs to be focused on the individuals’ needs. When building a health history with this patient, I need to address any language barriers or any need for interpretation aid. In the patient interview, I would first address the patient by introducing myself and shaking his hand first, then his parents to give him a sense that he is the priority and an individual. I next would gather any patient health history, medications, or any specific concerns that the patient had with parents present. Once that is addressed, I would ask the parents to step out of the room with consent from the patient parents to begin my assessment.
Risk Assessment Instruments
Adolescents are a vulnerable population between children and adults due to curiosity and susceptibility to the peer pressure of risky behaviors, self-identity, parent relationships, and exposure to media (Ball et al., 2017). The risk assessment instruments I would use with an adolescent Hispanic/Latino boy living in a middle-class suburb would need to focus on mental health, sexual/physical abuse, substance use, and sexuality and safety (Ball et al., 2017). Examples of risk assessment tools would include the PACES (Parents/peers, Accidents/Alcohol/drugs, Cigarettes, Emotional issues, and School/Sexuality) and HEEADSSS (Home environment, Education/employment, Eating, Activities/affect, Drugs, Sexuality, Suicide/depression, and Safety from injury/violence) are tools used to evaluate teenagers.
Potential Health-Related Risks and One Risk Assessment To Use on Patient
The potential health-related risks that the patient could be his age due to being an adolescent place him at higher risk of behaviors and falling into peer pressure. Additionally, the patient’s ethnicity could place him at risk of having a language barrier and not fully understanding what the healthcare provider would be asking. Lastly, the patient’s environmental setting of growing up in a middle-class suburb could place him at a higher risk of being exposed to drugs/alcohol than if he lived in a rural area. The assessment risk assessment I would use on this patient would be HEEADSSS (Home environment, Education/employment, Eating, Activities/affect, Drugs, Sexuality, Suicide/depression, and Safety from injury/violence). The HEEADSSS would be the risk assessment tool I would use because it would minimize stress on the adolescent and move from less-threatening questions to more personal ones (Jarvis & Eckhardt, 2020).
Five Targeted Questions
The leading targeted questions I would ask an adolescent I was presented with would be:
How is the school year going for you?
What do you like to do for fun?
How are things at home?
Do you ever use tobacco, alcohol, or recreational drugs?
Are you sexually active?
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.
Jarvis, C., & Eckhardt, A. (2020). Physical examination & health assessment. (8th ed.). St. Louis, Saunders, an imprint of Elsevier Inc.
Peart, P. (2022). Clinical History Taking. Clinics in Integrated Care, 10(1), 100088. https://doi.org/10.1016/j.intcar.2021.100088Links to an external site..
A Sample Answer 4 For the Assignment: NURS 6512N Discussion: Building a Health History
Title: NURS 6512N Discussion: Building a Health History
Thanks for your interesting and thorough response. The patient has a number of poor health choices that are reinforcing his angina. Part of the assessment could be to determine if the patient understands that his nicotine use is contributing to his angina and whether the patient is motivated to quit. Sadly the patient may value smoking more than the quality of his health and may be determined to make no changes. Contrarily we may discover the patient feels helpless in his ability to quit tobacco, but strongly desires to, and we may be able to provide options for cessation.
Kaufman et al. (2020), offers a useful article on using interview questions to measure a patient’s perceived risk of smoking. In this case the patient has a worsening cardiac condition that is causing pain and contributing to a low quality of life. It would be useful to understand how the patient perceives smoking in relation to their poor health and if that could be a motivator for change. Below are examples of general questions that could be used in a provider health assessment to determine the patient’s perception of their own risk.
“If you continue smoking the same number of cigarettes every day, how likely do you think it is that you will…,”
“If you stay quit, how likely do you think you will…,”
“If you never start smoking, how likely do you think you will…”
This could then give opportunity for health teaching and referral to/prescribing of cessation options. For example, nicotine patches or cognitive behavior therapy for smoking cessation. Importance of using specific language, for example, harm versus cancer versus lung cancer is emphasized by the authors. People are more likely to rate their risks higher if language is more specific and will provide more motivation to change behaviors. Additionally there may be a large difference in how people perceive the risk of smoking in general (to the general population) and to themselves. The authors state a general trend of overestimating risk to the general population and underestimating their own risk. What also can be useful to assess the patient’s perception of their risk is to pull in questions from the affective domain (involving their values), for example using the question “how worried are you that you will ….” based on a scenario where the patient does not quit smoking. The article is a useful one to download for future use. If we ever have an assignment where we have to design a comprehensive interview the suggestions the authors make are quite adaptable to a wide range of health topics.
Olenik and Mospan (2017) provides a summary of various tools that may help the interviewer determine how motivated a patient will be to quit smoking. For example, the Transtheoretical Model for Readiness to Change would suggest that when a patient is not ready to quit smoking questions like stated previously can be used to ascertain if gaps in knowledge exist (precontemplation stage). We can then provide accurate information so the patient can make an informed decision. Whereas if the patient is motivated to quit (preparation stage) the practitioner may help the patient actively order cessation measures. In this case the patient’s experience of angina may be sufficient motivation to want to quit. The article also offers a summary on the pharmacological options available. A useful tool for those interested in health promotion with patients who smoke and to look at individual options more closely. For example the safety and efficacy of bupropion as a smoking cessation tool.
References
Kaufman, A., Twesten, J., Suls, J., McCaul, K., Ostroff, J., Ferrer. R., Brewer, N., Cameron, L., Halpern-Felsher, B., Hay, J., Park, E., Peters, E., Strong, D., Waters, E., Weinstein, N., Windschitl, P., Klein, W. (2020). Measuring Cigarette Smoking Risk Perceptions. Nicotine & Tobacco Research, 22(11), 1937-1945.
Olenik, A. & Mospan, C. (2017). Smoking cessation: Identifying readiness to quit and designing a plan. American Academy of Physician Assistants, 30(7), 13-19.
A Sample Answer 5 For the Assignment: NURS 6512N Discussion: Building a Health History
Title: NURS 6512N Discussion: Building a Health History
Thank you for your question. Based on the findings of my research, adolescents and the elderly can both be very challenging to connect with, but for different reasons. For example, with adolescence, they do not trust easily because they are afraid of being judged by their parents and especially by their peers. They believe to avoid being judged, they should withdraw from their parents, and cleve to their younger counterparts/friends. They may engage or overindulge in alcohol consumption and use of illicit drugs. That over-indulgence then leads to low self-esteem and emotional imbalances that further leads to withdrawal from regular social activities, aggression, depression, and mistrust. Ball et al (2019) concurred, during middle adolescence negative social experimentation with risky behaviors, immature decision-making, and withdrawal from parents can occur which may lead to poor communication between the patient and provider/APRN during the patient interview. A strategy to break the communication barrier and start building trust is by speaking with the adolescence privately.
Communicating with the elderly can also be challenging too. For instance, if they are a believer in herbal remedies and strongly oppose conventional medicines, that can greatly limit the quality of care we as APRNS can provide (University of Washington Medical Center, 2007). Additionally, they may be currently taking herbal remedies but refuse to communicate that because they do not want to be judged. As a result, drug interactions with these herbal remedies can occur which further predisposes the patient to harmful drug interactions that can be deadly to the patient.
As APRNs, we should be aware of our body language, and our choice of words when interviewing our patients to help build their trust in us. Additionally, we should be knowledgeable about our patients’ cultural and age-related differences because that can make a difference in how information is understood and perceived by the patients.
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.
The University of Washington Medical Center (2007). Communicating with your Latino Patient. Retrieved from
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