BUILDING A HEALTH HISTORY NURS 6512
Sample Answer for BUILDING A HEALTH HISTORY NURS 6512 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.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
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 oneof 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 fivetargeted 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 Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply!
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: BUILDING A HEALTH HISTORY NURS 6512
Title: BUILDING A HEALTH HISTORY NURS 6512
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?
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: BUILDING A HEALTH HISTORY NURS 6512
Title: BUILDING A HEALTH HISTORY NURS 6512
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.
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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.
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
A Sample Answer 3 For the Assignment: BUILDING A HEALTH HISTORY NURS 6512
Title: BUILDING A HEALTH HISTORY NURS 6512
I enjoyed reading your post about communication with an 85 year old patient. It is important to build a report with the patient so they feel comfortable speaking with you. When evaluating the patient to find out if they are mentally intact it is important to not lead them to answers. Even though the patient has a decline in her health she may be mentally still intact. Open ended questions are important because it allows the patient to express themselves. This may help you find out if they are understanding the question or are they trying to hide any deficits. Using closed ended questions can also help you identify how their memory is. Providing questions with random words to remember will help you assess this piece of brain functionality when it comes to remembering things. It is important to know where the patient is at with memory and cognitively because this can raise some red flags when it comes to safety in their home.
When I worked in home care as a care coordinator I had done many evaluations of elderly people in my community to see if they are safe to be at home or are they needing a different level of care. I was able to help family members realize safety concerns for the patient by being able to do these assessments. One question that ended up coming up a lot was will the patient remember they are cooking something or are they at risk of starting a fire. During one of my evaluations I ended up finding that the patient was not safe to cook in the home. I ended up having to unplug the stove and the other cooking devices with the help of the family members until they were able to get the patient placed with a higher level of care.
It would also be important to do a fall assessment on this patient to see if there are risks for falls and if the patient did have a fall would their be away they could alert someone if they got injured. Walking around and doing a survey of the home was part of these assessments. I also observed the patient while they went about doing their normal routine without correcting them because I would want to see what they would do if I was not there. If it became too much of a risk than I would stop and make note of findings while making sure the patient is safe. When asking the patient questions, I will not dominate the conversation. I will actively listen by providing non-verbal cues to the patient that shows that I am listening to the patient when they are speaking while not leading the patient to answers during the evaluation of their safety in their home.
References:
Ball, J., 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.
Mayo Foundation for Medical Education and Research. (n.d.). Physical Medicine and Rehabilitation. Mayo Clinic. Retrieved June 4, 2022, from
A Sample Answer 4 For the Assignment: BUILDING A HEALTH HISTORY NURS 6512
Title: BUILDING A HEALTH HISTORY NURS 6512
85-year-old white female living alone with no family in declining health
Introduction
My assignment is based on working with an 85-year-old white female living alone with no family in declining health. While working on this task, I assume the patient is my mother, and I interrogate him with empathy, knowing that she is an elderly person who is likely to be more isolated and lonelier than individuals living with their loved ones. Here, I need to create an interviewing strategy to employ in assessing this patient’s medical condition, taking into account his advanced age that his health is declining.
Communication is a difficult endeavor that requires empathy and courtesy, especially when dealing with senior individuals. It’s critical to observe, listen, and gather information when pertinent information is offered when speaking with these kinds of patients. To preserve a constant pace with the patient, the medical practitioner not only should go slowly and be very patient (Ball et al., 2019). Furthermore, by observing, the healthcare professional can connect to and be brought into the environment of the elderly. It is critical to comprehend the participant’s reality and the circumstances that may impact their responses. It’s critical for health care professionals to establish a good connection with patients in the interview session to create a favorable interaction.
The nurse tells the patient to introduce themselves to create familiarity and as the patient settles in the interview. Showing sincerity is vital while getting to know the social circle’s nature and the living condition of the patient. The questions could be personal, but they are meant to know the situation of the healthcare provider.
Target Health Question
The impact of social determinants on patient health is an important issue to consider when assessing a patient’s health. Food availability, social support, social position, and low-income levels, are all closely linked to premature death and higher incidents of sickness, based on empirical evidence. Inquiring into social determinants of health and how they affect the patient’s health can be a touchy subject (Ryan, 2019). As a result, I’d organize my queries in a way that respects the older patient while also demonstrating empathy and sincerity for their plight. Moreover, because such individuals may have difficulties communicating their conditions and ideas, I would be using effective listening skills.
Risk Assessment
The arranging of the patient’s health record through the Subjective Objective Assessment (SOAP) and Plan Problem Oriented Medical Record (POMR) would be appropriate tools for the assessment of this patient. The POMR tool is an effective instrument as it provides for a thorough recording and assessment of medical information about a patient (Pdhi.com, 2022). Furthermore, it enables the collection of data from all care team members in order to ascertain the diagnosis and develop an empirical medication regimen. POMRs often include the patient’s condition, complaints, test findings, and a care plan that enables the medical practitioner to address each issue individually, write patient records, and a review of discharge with instructions for follow-up (Feldman et al., 2021).
Health-Related Risk
Since the patient is elderly and has a declining health status, there are certain risks that are mainly linked to social health determinants. Old age put the patient at risk of falling (Abdi et al., 2019). As such, the health care provider should investigate if she has already incurred any injuries from falling.
Five Target Questions
On the first encounter, it is vital to first build a connection and therapeutic relationship with the patient to make them comfortable to open up. This way, there would be mutual understanding, which is essential in knowing the needs of the patients. Some of the questions, I would ask include;
- Do you experience any pains?
- What do you think could be the reasons for your symptoms?
- Are you under any medication?
- What do you think of your quality of life?
- Have any medications triggered any allergies in you?
References
Abdi, S., Spann, A., Borilovic, J., de Witte, L., & Hawley, M. (2019). Understanding the care and support needs of older people: a scoping review and categorisation using the WHO international classification of functioning, disability and health framework (ICF). BMC Geriatrics, 19(1). https://doi.org/10.1186/s12877-019-1189-9
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
Feldman, R., Chiu, M., Lawson, A., & Sadavoy, J. (2021). Evaluating Caregiver Risk: The Dementia Caregiver Interview Guide. Psych, 3(4), 552-561. https://doi.org/10.3390/psych3040036
Pdhi.com. (2022). What is a Health Risk Assessment? | ConXus Platform. Pdhi.com. Retrieved 2 June 2022, from https://www.pdhi.com/ncqa/what-is-a-health-risk-assessment/.
Ryan, L. (2019). Clinical Applications of a Smart Physical Examination System for the Health Management in Elderly. Case Medical Research. https://doi.org/10.31525/ct1-nct03858660
A Sample Answer 5 For the Assignment: BUILDING A HEALTH HISTORY NURS 6512
Title: BUILDING A HEALTH HISTORY NURS 6512
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
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