NURS 6512 BUILDING A HEALTH HISTORY -

Sample Answer for NURS 6512 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.

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 2 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 2 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 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

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A Sample Answer For the Assignment: NURS 6512 BUILDING A HEALTH HISTORY

Title: NURS 6512 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).

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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 For the Assignment: NURS 6512 BUILDING A HEALTH HISTORY

Title: NURS 6512 BUILDING A HEALTH HISTORY

“The patient is a 21-year-old Filipino female college student living in a dorm wanting to know what birth control is and what are good options for her. She is working as a part time waitress in an overnight bar during weekends.”

When building a health history with this patient, as a Nurse Practitioner, it’s important to establish a comfortable and non-judgmental environment. The patient’s age, cultural background, and lifestyle may influence her comfort level in discussing sensitive topics like sexual health and birth control. This is how my communication and interview techniques may vary in dealing with this patient:

Using open-ended questions to encourage her to share more information.
Being culturally sensitive. Understanding that her cultural background may influence her views on birth control, as a Filipino myself, I know most of my countrymen as conservatives, so I will be more active in listening to her concerns and passive in suggesting to her some methods based on her preferences.
Ensuring confidentiality to make her feel safe and comfortable.
Using simple, clear language to explain medical terms and procedures.

Social determinants of health are conditions in the environments in which people live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks (Walden University, n.d.). In this case, the patient’s age, occupation, and living conditions are important factors.

I will ask about her work schedule and how it might affect her ability to consistently use certain types of birth control.
I will discuss her living conditions. If she has a roommate, privacy might be a concern for methods like the birth control shot.
I will inquire about her financial situation. Some methods are more cost-effective than others.

Risk assessment would involve asking questions about the following:

Sexual Activity. I would ask about her sexual activity to assess risk of sexually transmitted infections (STIs).
Menstrual Cycle. I would Inquire about her menstrual cycle to determine the best type of birth control.
Overall Health. I would foster a discussion about her medical history. Some health conditions or medications can affect the effectiveness of certain birth control methods.

These are some potential questions:

How often do you engage in sexual activity?
Do you use protection during sexual activity?
Have you ever been tested for STIs?
What is your menstrual cycle like?
Do you have any health conditions or are you on any medications?

Based on the patient’s age, gender, ethnicity, and environmental setting, the following health-related risks should be taken into consideration:

Sexual Health Risks: As a sexually active young woman, she is at risk for sexually transmitted infections (STIs) and unplanned pregnancy (CDC, n.d.).
Occupational Risks: Working as a waitress in an overnight bar may expose her to secondhand smoke, alcohol, and potentially unsafe situations (Jones, 2022).
Mental Health Risks: The stress of balancing school, work, and personal life can lead to mental health issues such as anxiety and depression (CDC, n.d.).
Ethnicity-Related Risks: As a Filipino woman, she may have a higher risk for certain genetic conditions, such as Thalassemia (Payne, & Fanarjian, 2014).

The Gordon’s Functional Health Patterns assessment tool from Chapter 5 of the Seidel’s Guide to Physical Examination can be used for this patient. This tool assesses multiple aspects of health, including perception of health, nutritional status, sleep patterns, and sexual health, which are all relevant to this patient (Ball, & et al., 2023). These are the target-specific questions that will be highly asked based on the model.

Can you describe your current sexual activity and the methods of contraception you are using, if any?
Do you have regular menstrual cycles? Have you noticed any changes recently?
Do you have any concerns about your sexual health or reproductive health?
How often are you exposed to secondhand smoke at your workplace?
How do you manage stress from school and work? Have you noticed any changes in your mood or behavior?

These questions will help assess her health risks and begin building a health history. It is also important to approach these topics with sensitivity and respect for her privacy.

References:

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2023). Seidel’s guide to physical examination: An interprofessional approach (10th ed., Ch 2 & 5). St. Louis, MO: Elsevier Mosby.

Centers for Disease Control and Prevention (CDC). (n.d.). Sexual risk behaviors. Retrieved January 27, 2023, from https://www.cdc.gov/healthyyouth/sexualbehaviors/index.htm

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

Links to an external site.

Jones, R. (2022, October 14). 7 important worker safety considerations in the bar and brewery industry. occupational health & safety. https://ohsonline.com/articles/2022/10/14/7-important-worker-safety.aspx

Links to an external site.

Payne, C. & Fanarjian, N. (2014, October). Seeking causes for race-related disparities in contraceptive use. https://journalofethics.ama-assn.org/article/seeking-causes-race-related-disparities-contraceptive-use/

Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed., Ch. 2, pp. 19-29). Philadelphia, PA: F. A. Davis.

Walden University. (n.d.). Social determinants of health. Retrieved November 27, 2023, from https://academicguides.waldenu.edu/Library/sdoh