NURS 6512 Case B 14-year-old biracial male living with his grandmother in a high-density public housing complex

Sample Answer for NURS 6512 Case B 14-year-old biracial male living with his grandmother in a high-density public housing complex 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.

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

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.

Next Module

To go to the next module:

Module 2

NURS 6512 Case B 14-year-old biracial male living with his grandmother in a high-density public housing complex

Building a Health History

For this Discussion, you will take on the role of a clinician who is building a health history for one of the following new patients:

76-year-old Black/African-American male with disabilities living in an urban setting

Adolescent Hispanic/Latino boy living in a middle-class suburb

55-year-old Asian female living in a high-density poverty housing complex

Pre-school aged white female living in a rural community

16-year-old white pregnant teenager living in an inner-city neighborhood

To prepare:

With the information presented in Chapter 1 in mind, consider the following:

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 age, gender, ethnicity, or environment?

What risk assessment instruments would be appropriate to use with each patient?

What questions would you ask each patient to assess his or her health risks?

Select one patient from the list above on which to focus for this Discussion.

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 26 of the course 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

Post a description of the interview and communication techniques you would use with your selected 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.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two 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 6512 Case B 14-year-old biracial male living with his grandmother in a high-density public housing complex

Title: NURS 6512 Case B 14-year-old biracial male living with his grandmother in a high-density public housing complex

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

Whom do you live with at home?

What is your relationship with the parents and siblings?

What is it that makes you happy about your family?

Who is your best friend?

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- HillMedical.

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

A Sample Answer 2 For the Assignment: NURS 6512 Case B 14-year-old biracial male living with his grandmother in a high-density public housing complex

Title: NURS 6512 Case B 14-year-old biracial male living with his grandmother in a high-density public housing complex

Your post has a lot of valuable information about communication with older adults. I may add that it may be beneficial to write down or print out takeaway points for the patient. Older adults with more than one medical condition or health concern benefit especially from having clear and specific written notes or printed handouts (Ridley et al., 2019). In my experience, patients get quiet when they don’t understand the information provided to them about their condition. As providers, it is important to watch their body language and their engagement. Make sure to give the patient plenty of time and opportunities to ask questions. I would be concerned if this eighty-year-old patient did not ask one question during our appointment. My strategy would then be for this patient to relay back to me the plan of care we spoke about to assess his understanding of the diagnosis and treatment.

Every year, three million older adults are treated in the emergency department for injuries related to falling (Vaishya & Vaish, 2020). This is normally due to gait and balance disorders caused by arthritis or orthostatic hypertension. The patient’s angina is another added risk factor that can cause a fall. It would be appropriate for the case manager to schedule an appointment for a home safety and hazard assessment. This will reduce the probability of a fall in a person who has not fallen. The nurse will go through the entire home and check for appropriate lighting, floors surfaces, and place handrails where deemed necessary.

The goal for this patient is to provide all the resources necessary to manage their health at home. This includes preventative measures and equipment to monitor vitals. Specific medication may also be prescribed if this patient has another episode of angina or a full myocardial infarction. This may buy the patient more time to get to the hospital either by private transportation or ambulance.

Resources

Jack, K., Ridely, C., & Turner, S. (2019). Effective communication with older people. International Journal of Older People Nursing, 12(2), 201-210. https://doi:10.7748/nop.2019.e1126

Vaishya, R., & Vaish, A. (2020). Falls in older adults are serious. Indian Journal of Orthopaedics, 54(1), 69-74. https://doi:10.1007/s43465-019-00037-x

A Sample Answer 3 For the Assignment: NURS 6512 Case B 14-year-old biracial male living with his grandmother in a high-density public housing complex

Title: NURS 6512 Case B 14-year-old biracial male living with his grandmother in a high-density public housing complex

“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

Name: NURS_6512_Week_1_Discussion_Rubric

Excellent

Good

Fair

Poor

Main Posting

Points Range: 45 (45%) – 50 (50%)

“Answers all parts of the Discussion question(s) with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources. Supported by at least three current, credible sources. Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

Points Range: 40 (40%) – 44 (44%)

“Responds to the Discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module. At least 75% of post has exceptional depth and breadth. Supported by at least three credible sources. Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

Points Range: 35 (35%) – 39 (39%)

“Responds to some of the Discussion question(s). One or two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Post is cited with two credible sources. Written somewhat concisely; may contain more than two spelling or grammatical errors. Contains some APA formatting errors.

Points Range: 0 (0%) – 34 (34%)

“Does not respond to the Discussion question(s) adequately. Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible sources. Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style.

Main Post: Timeliness

Points Range: 10 (10%) – 10 (10%)

Posts main post by Day 3.

Points Range: 0 (0%) – 0 (0%)

N/A

Points Range: 0 (0%) – 0 (0%)

N/A

Points Range: 0 (0%) – 0 (0%)

Does not post main post by Day 3.

First Response

Points Range: 17 (17%) – 18 (18%)

“Response exhibits synthesis, critical thinking, and application to practice settings. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of Learning Objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.

Points Range: 15 (15%) – 16 (16%)

“Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.

Points Range: 13 (13%) – 14 (14%)

“Response is on topic and may have some depth. Responses posted in the Discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

Points Range: 0 (0%) – 12 (12%)

“Response may not be on topic and lacks depth. Responses posted in the Discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.

Second Response

Points Range: 16 (16%) – 17 (17%)

Points Range: 14 (14%) – 15 (15%)

Points Range: 12 (12%) – 13 (13%)

Points Range: 0 (0%) – 11 (11%)

Participation

Points Range: 5 (5%) – 5 (5%)

Meets requirements for participation by posting on three different days.

Points Range: 0 (0%) – 0 (0%)

N/A

Points Range: 0 (0%) – 0 (0%)

N/A

Points Range: 0 (0%) – 0 (0%)

Does not meet requirements for participation by posting on three different days.

Total Points: 100

Name: NURS_6512_Week_1_Discussion_Rubric