NURS 6512 Discussion Building a Health History
Sample Answer for NURS 6512 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.
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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 6512 Discussion Building a Health History
Title: NURS 6512 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.
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A Sample Answer 2 For the Assignment: NURS 6512 Discussion Building a Health History
Title: NURS 6512 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 6512 Discussion Building a Health History
Title: NURS 6512 Discussion Building a Health History
As advanced practice registered nurses (APRNs), it is imperative to obtain a thorough health history from the patient interview process. The history is vital to guiding the physical examination and to interpreting physical exam findings ( Ball et al., 2019). One way to effectively build a health history during the interview process is to develop a rapport or relationship with the patient. Establishing a positive patient relationship depends on effective communication built on courtesy, comfort, connection, and confirmation (Ball et al., 2019). Each patient is unique and must be treated as such. Communication and interview techniques for building a health history can differ with each patient based on age, learning abilities, and the patients’ reading level. The purpose of this discussion is to identify techniques in building a health history with an adolescent white male with no insurance seeking medical care for an STI.
Crucial factors of consideration
According to the World Health Organization (WHO), adolescence is the phase of life between childhood and adulthood, from ages 10 to 19. It is a unique stage of human development and an important time for laying the foundations of good health (2022). Even through the adolescent years, there are significant diseases/illnesses and injuries. During this phase, adolescents establish patterns of behaviour – for instance, related to diet, physical activity, substance use, and sexual activity – that can protect their health and the health of others around them, or put their health at risk now and in the future (WHO, 2022). During the adolescent phase, it is important to provide correct age-appropriate sexual activity information.
Assessment
The collection and analysis of information regarding an individual’s current and overall health is a health assessment and is provided by the patient subjectively (Ball et al., 2019). Considering this patient is coming to the appointment for concerns for an STI, it is imperative for the APRN to not be judgemental. This will allow the patient to feel comfortable sharing information such as signs and symptoms of the probable STI, number of partners, past history of an STI, and their gender identity. The physical assessment is just as important as obtaining a health history. Physical exams should include inspection, auscultation, percussion, and palpation of the patient to verify the patient’s report objectively (Ball et al., 2019). As part of the physical assessment, the APRN may also conduct a male genitalia examination and obtain cultures of fluid to test for certain STIs such as, chlamydia, gonorrhea, and syphilis. Labs may also be ordered to check for those certain STIs.
At the end of the examination, targeted needs would be beneficial to address. For example, this patient does not have medical insurance. Since the patient is an adolescent, one would assume they are on their parent’s medical insurance as a dependent. Sometimes, adolescents are too afraid and uncomfortable to tell their parents and/or guardians any reproductive issues. Oftentimes, adolescents come into clinics secretly and say they do not have medical insurance so their parents/guardians do not find out about the visit once billed. Asking questions such as why don’t you have insurance? Do your parents/guardians have medical insurance? Do they know about your visit to the clinic today? Can help identify any patterns or concerns without being assumptive. Providing support and comfort can help alleviate any hesitancy in answering the above questions. Finding and establishing important resources can help make sure the patient is getting the care they need outside of the clinic.
Specific targeted questions
Asking appropriate questions and avoiding stereotypes is essential to providing care that is tailored to the individual patient (Ball et al., 2015). With this particular patient, sexual information should be obtained in a non-judgemental manner. Targeted questions such as 1) What brings you to the clinic today? 2) How many partners do you currently have? 3) What are your current sexual practices (anal, oral, vaginal)? 4) What protection do you use to prevent STIs? 5) Have you had any STIs in the past? 6) What are your symptoms? And when did they start? Utilizing the screening tool PACES would also be beneficial for this patient. PACES stands for parents/peers, accidents/alcohol/drugs, cigarettes, emotional issues, and sexuality/school (Ball et al., 2019). PACES identifies these categories specifically for adolescents because oftentimes they are what is important to this age group.
Conclusion
A successful health assessment and interview process between an APRN and their patients requires a good rapport/relationship as the foundation. Identifying considerations and tailoring specific targeted questions to individual patients can be beneficial. Patient-centered care is an important contributor to a positive patient care experience (Dang et al., 2017). Actively engaging and listening to each patient is important. This will help the patient feel more comfortable expressing their concerns and needs.
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.
Dang, B. N., Westbrook, R. A., Njue, S. M., & Giordano, T. P. (2017). Building trust and rapport early in the new doctor-patient relationship: a longitudinal qualitative study. BMC medical education, 17(1), 1-10.
World Health Organization. (2022). Adolescent health. Retrieved from https://www.who.int/health-topics/adolescent-health#tab=tab_1