NURS 6512 Building a Health History Example

NURS 6512 Building a Health History Example

NURS 6512 Building a Health History Example

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NURS 6512 Week 1 Discussion

How would your communication and interview techniques for building a health history differ with each patient?

Communication and interviewing techniques will differ with each individual due to multiple factors such as socio-economic background, age, gender, cognitive ability, culture, learning, language barriers, and environmental factors. According to (Ball et al., 2019) effective health assessment and patient interviewing will help to identify and support positive health behaviors and choices that will positively impact patient health experience and present them with the opportunity to receive care and make better choices NURS 6512 Building a Health History Example. During the health assessment and interviewing of a patient it is necessary to appropriately assess both verbal and non-verbal behavior, cues, and communication. This process calls for an environment where the patient feels safe and comfortable, therefore it is necessary to create and establish trust between the provider and patient and give them the ability to express themselves freely without having feelings of judgment or shame (Ball et al., 2019).

According to the patient’s health needs, background, and circumstances, (Sullivan, 2019) explains as a healthcare provider one should inquire about and acknowledge the patients’ cultural and social beliefs regarding healthcare that is unique to them. This form of inquiry and curiosity is essential because it makes the patient feel comfortable and understood, and it contributes to individualized patient assessment and subsequent care.

How might you target your questions for building a health history based on the patient’s social determinants of health?

I would ensure that the patient is comfortable and safe. I would ask him open-ended questions about college life in general. For example, I would ask about what program he or she is studying, social relations, and activities that he or she participates in. This will give me a general understanding of the individual as well as help them relax, build trust and open up for a more in-depth discussion which includes sensitive or personal information. I would ask questions using a framework with social determinants to be included for discussion. These include gender, sex, religion, mental health, education, geographical location and access to healthcare, income, employment, and or disabilities (Ball et al., 2019).

It is important to consider using therapeutic communication and include information that will yield data that is relevant to the patient’s condition. This can be achieved by practicing active listening and exploring aspects related to socio-economic, psychosocial, financial, behavioral, and financial elements while also exploring a serious condition that is patent to the health assessment.

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?

According to (Ball et al., 2019) the U.S. Preventive Health Task Force recommends depression screening of adults with the self-administered Patient Health Questionnaire (PHQ). This tool is an assessment tool that can be used to screen for mood and feelings of depression and hopelessness. I chose this because Filipino families practice catholicism which advocates for sex in marriage, therefore, this student can have conflicts regarding his culture and living the life of his choice, this situation can be exacerbated by the added pressure of college and fitting in therefore leading to feelings of despair and depression Levis, Benedetti, and Thombs (2019).

Identify any potential health-related risks based upon the patient’s age, gender, ethnicity, or environmental setting that should be taken into consideration.

Engaging in sexual activities during college has some social and health risks such as contracting a sexually transmitted disease and Human Immunodeficiency Virus(HIV). It also contributes to or increased negative outcomes in other areas such as relationships, it can lead to legal and financial difficulties and increases the chances of pregnancy or other diseases such as cancer of the cervix, mouth, anal, vagina, and vulva (Mirzaei et al., 2016).

Five targeted questions I would ask your selected patient to assess his or her health risks and begin building a health history.

-Are you sexually active?

-How old were you when you first became sexually active?

-How many sexual partners have you had?

-What kind of protection do you use when having sexual relations?

-Do you have access to resources for healthcare?

-Is there anything that we have not talked about that you would like to discuss with me?

References

Bell, J., & Condren, M. (2016). Communication Strategies for Empowering and Protecting Children. The journal of pediatric pharmacology and therapeutics: JPPT: the official journal of PPAG, 21(2), 176–184. https://doi.org/10.5863/1551-6776-21.2.176

Levis, B., Benedetti, A., & Thombs, B. D. (2019). Accuracy of patient health questionnaire-9 (PHQ-9) for screening to detect major depression: Individual participant data meta-analysis. BMJ, l1476. https://doi.org/10.1136/bmj.l1476

Mirzaei, M., Ahmadi, K., Salad, S. H., & Ramezani, M. A. (2016). INSTRUMENTS OF HIGH RISK SEXUAL BEHAVIOR ASSESSMENT: A SYSTEMATIC REVIEW. Material socio-medica, 28(1), 46–50. https://doi.org/10.5455/msm.2016.28.46-50

Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.

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.

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.

Response 1

Great post. I would agree with you that as a provider, we need to ensure that we are individualizing our assessment and treatment plan. Every patient is different and unique.

According to Al Ali & Elzubair (2016), in provider-patient communication, establishing rapport is a crucial step that has a positive impact on patient satisfaction and overall clinical outcomes. Appropriate communication aids in obtaining an appropriate diagnosis, establishing trust with patients, enhancing treatment adherence, patient satisfaction, therapeutic outcome, and preventing litigation. This is considered an indispensable component of high-quality health care.

I believe that your patient profile is a  21-year-old Filipino college student living in a dorm wanting to know what birth control is (Group C). According to Ball et al. (2016), a healthcare provider with cultural competence adjusts to the specific demands of patients from diverse origins and cultures. It is very important to understand the patient’s cultural background, if the patient was born or raised in the Philippines, and religious background. You see, I was born and raised in the Philippines. Taking birth control and sex education is frowned upon. Being sexually active prior to marriage is considered inappropriate in our culture. I believe that being empathic, and building rapport is very important in this situation so that your patient will be more open as to why he/she is inquiring about birth control. Also note, it is also confusing when the post mentioned “Filipino college student.” In our country (Philippines), Filipino is considered a male and Filipina is female. I was confused why the Filipino college student was inquiring about birth control. The first question that came into mind without knowing the gender of the patient is that, is the patient wanting to transition gender from male to female?

Al Ali, A. A., & Elzubair, A. G. (2016). Establishing rapport: Physicians’ practice and attendees’satisfaction at a Primary Health Care Center, Dammam, Saudi Arabia, 2013. Journal offamily & community medicine, 23(1), 12–17. https://doi.org/10.4103/2230-8229.172224

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s Guide to Physical Examination (9th ed.). Elselvier.

 

NURS 6512 Building a Health History Example sample 2

Building a Comprehensive Health History

As a nurse practitioner, building a health history for my patient will be my priority and understanding the potential risks that currently affect this patient is my concerned. According to Sullivan (2019), “The comprehensive H&P is typically obtained when a provider sees a patient for the first time in a general medical setting, or when a patient is admitted to the hospital.” The purpose of this discussion is to explain how I would conduct an interview to obtain a perfect comprehensive health history. The assigned patient is an 85-year-old white female living alone with no family and declining health. The responsibility of a nurse practitioner is to assess the patient’s quality of life, financial status, support systems, socioeconomic status, and to check for any family, relatives, or friends.

This 86 years old patient is considered to be an older adult which requires cognitive assessment to be done. Functional impairments and cognitive problems are prevalent among older patients and can be improved with early recognition and treatment (Deckx et al., 2015). The nurse practitioner must check for level of orientation, memory, and to make sure that the patient is not in a confuse stage.

Communication Techniques

According to Ball, et al., (2019), it says that effective communication measures allow for the exchange of health information which varies in persons as it relates to age, mental status, education, gender, beliefs, and ethnicity. The Nurse practitioner can gather the patient’s information to form a data which can be use initiate accurate diagnosis and treatment measures. As a health care provider, it is necessary to give room with quiet environment, and must speak with calm voice. Every professional person must maintain eye contact and make use of open-ended questions for better understanding and to identify any questions that needs to be addressed (Ball, et al., 2019).

Risk Assessment Instrument

Geriatric screening tools are very helpful in the current practice to predict a decline in patient’s functional status and quality of life (Deckx et al., 2015). A functional assessment is particularly useful in elderly patients and those with documented disabilities. It helps to provide an understanding of an individual’s ability to perform activities of daily living. Any presence of physical, cognitive, or emotional limitations can lead to restriction or difficulties for an individual to be independent (Ball et al.,2019). Also, geriatric depression scale (GDS) is mostly used among elder patient due to an increased risk of depression in the geriatric population. In the case study, the patient’s decline in health status and aging can lead to depression or mental illness.

Targeted Questions

During the interview it is very important for the nurse practitioner to ask suitable questions and avoid labeling the patient (Ball et al., 2019). Many targeted questions are very helpful for the clinician in understanding the needs of the patient. It is very crucial to document the current problem in which the patient is facing and always use the patient’s own words for better understanding (Sullivan, 2019). Once I have opened a rapport with my patient, I would use open-ended and targeted questions in the following manner.

1. What has brought you into the clinic today?

2. Is there any specific concerns that you have or needs at home?

3. Do you have any chronic medical conditions?

4. Do you have a support system?

5. Do you recall having a Pneumococcal Pneumonia immunization?

NURS 6512 Building a Health History Example

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.). Elsevier Mosby.

Deckx, L., van den Akker, M., Daniels, L., De Jonge, E. T., Bulens, P., Tjan-Heijnen, V. C. G.,

Buntinx, F. (2015). Geriatric screening tools are of limited value to predict a decline in

functional status and quality of life: Results of a cohort study. BMC Family Practice, 16,

1–12. https://doi-org.ezp.waldenulibrary.org/10.1186/s12875-015-0241-x

Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). F. A. Davis.

NURS 6512 Building a Health History Example response

I enjoyed reading your discussion post on obtaining a health history for the 85-year-old white female living alone with no family whose health is declining. Proper communication is vital when assessing older adults due to changes in knowledge, cognitive abilities, and personality that occur with aging (Ball et al., 2019). It is important to be aware of potential barriers to the interview such as hearing loss or memory loss. I would recommend using short, uncomplicated questions when interviewing older adult patients as some may have difficulty recalling personal information. It is also important to take as much time as you need to gather information on their complex health history.

As you stated in your response, declining health can have additional effects on patients such as mental health problems. Health generally declines with age and perceived poor health status has been found to be a risk factor for depression in older adults (Liu et al., 2021). NURS 6512 Building a Health History Example Assessing mental health risks is an essential part of obtaining a health history, especially in the older adult population. One assessment tool that would be beneficial for this patient is The Geriatric Depression Scale-15 (GDS-15). This screening tool is for older adults aged over 65 years and consists of 15 questions regarding the patient’s satisfaction with life. These questions are then scored based on the answers and added up for a total score to determine the severity of depression. The GDS-15 is an accurate risk assessment tool and is recommended for use in primary care settings as a first strategy for screening for depression in older adults (Park & Kwak, 2021). The patient’s age and current lack of social support are indications to use this risk assessment tool during the patient interview.

Liu, J., Wei, W., Peng, Q., & Guo, Y. (2021). How does perceived health status affect depression in older adults? roles of attitude toward aging and social support. (2), 169–180. https://doi.org/10.1080/07317115.2019.1655123

NURS 6512 Building a Health History Example sample post 3

Diagnosing and treating patients always begins with assessment. Practitioners need to understand their patients’ medical and social risk factors to treat them effectively. The use of risk assessment tools can assist in discovering important patient details related to their treatment. A thorough patient interview is vital and should be conducted in a comfortable and private setting. When conducting patient interviews, practitioners must be culturally competent and provide a safe, welcoming environment as they gather the patient’s history. An in-depth understanding of a patient allows practitioners to create effective treatment plans to reach the patient’s goals.

A 21-year-old Filipino college student living in a dorm wants to know what birth control is. The interview with this patient should be conducted in a private environment free of interruptions. After introductions, I would remind the patient that the interview is routine and confidential. I would then begin to learn more about the patient’s sexual history by asking about their current living situation and if they are sexually active NURS 6512 Building a Health History Example. It is vital to assess the patent’s gender identity and sexual orientation using direct questions. The Philippines is facing a rapidly growing HIV epidemic with a 174% increase in HIV incidence between 2010 and 2017 (Alibudbud, 2021). It is crucial to thoroughly assess Filipino men on their sexual history because they are disproportionately affected by HIV. I would also assess the patient’s personal and family health history. Some contraceptives are contraindicated in patients with a history of diabetes, migraine headaches, high blood pressure, blood clots, or other blood disorders. If the patient is female, I would educate them on the several types of contraceptives available for them as well as their efficacy. Young adults, ages 18 to 24 years, have higher unintended pregnancy rates than other age groups (Blunt-Vinti et al., 2018). Contraceptive counseling is vital for finding the best option for each patient. “In the Philippines, one in four pregnancies are unintended” which Nagai et al. (2019) found to be related to insufficient contraceptive counseling (p. 9). If the patient wants to be on birth control, then I would further assess their medical and social history to determine the best treatment option. I would also educate this patient on the use of condoms as both a contraceptive and prevention of sexually transmitted infections (STIs). If the patient is sexually active, it would also be important to assess if they have been tested for STIs and if so, the frequency of testing. I would complete the interview by asking the patient if they have any questions or concerns about what we discussed.

Proper communication is essential during patient interactions and should be conducted with courtesy and comfort. Techniques such as knocking before entering the room, formally addressing the patient, and maintaining eye contact are ways to provide respectful communication. Maintaining privacy and ensuring confidentiality is also important especially when assessing sexual history which can be uncomfortable for some patients. One assessment tool I would use during this patient interview is the Five P’s of a Sexual History: Partners, Practices, Protection from STIs, and Past History of STIs. This tool is an easy reminder for crucial details you need to assess a patient’s sexual history. Using the 5 P’s, you will discover more about the patient such as sexual orientation, gender identity, and use of STI prevention and testing NURS 6512 Building a Health History Example. Even if the patient is not currently sexually active, they may have been in the past so, it is still important to take a sexual history (Centers for Disease Control and Prevention, 2022).

• Are you currently sexually active? If so, in what way?
• Do you currently use any methods to prevent pregnancy?
• Do you have any medical conditions such as diabetes, migraine headaches, high blood pressure, blood clots or other blood disorders?
• Does anyone in your family have a history of cardiovascular disease, high blood pressure, or blood clots?
• NURS 6512 Building a Health History Example
• Are you currently taking any prescribed or over-the-counter medications?
• Have you ever been tested for sexually transmitted infections? If so, how frequently?

Centers for Disease Control and Prevention. (2022). Centers for Disease Control and Prevention. Retrieved June 1, 2022, from https://www.cdc.gov/std/treatment/SexualHistory.htm

NURS 6512 Building a Health History Example response

Thank you for such a thorough discussion regarding how you addressed the case of the 21 y/o Filipino college student requesting information about birth control. As you mentioned, in the Philippines, 1 in 4 pregnancies are unintended. Nagai et al. (2019) also reported that, as a result, 610,000 unsafe abortions are performed each year. The researchers maintain that wider legal, social, political, and cultural barriers exist in the Philippines which inhibit the availability of quality reproductive health counseling, as well as availability of effective contraception. Furthermore, Melgar et al. (2018) report that, in addition to high unintended pregnancy rates and unsafe abortion rates, the current political and cultural milieu in the Philippines is contributing to the increase in HIV prevalence. Additionally, Melgar et al. (2018) report that, in addition to cultural and religious bias against effective contraception, fear of side effects is an issue NURS 6512 Building a Health History Example.

Given these barriers, in addition to the excellent targeted questions you asked this patient, I would also include open-ended questions to assess for the patient’s understanding of risk factors for each type of contraception option to ease her mind about myths she may be believing.

References

Melgar, J. L. D., Melgar, A. R., Festin, M. P. R., Hoopes, A. J., & Chandra-Mouli, V. (2018). Assessment of country policies affecting reproductive health for adolescents in the Philippines. Reproductive Health, 15(1). https://doi.org/10.1186/s12978-018-0638-9

Nagai, M., Bellizzi, S., Murray, J., Kitong, J., Cabral, E. I., & Sobel, H. L. (2019). Opportunities lost: Barriers to increasing the use of effective contraception in the Philippines. PLOS ONE, 14(7), e0218187. https://doi.org/10.1371/journal.pone.0218187

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