BUILDING A HEALTH HISTORY NURS 6512

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Summary of the Interview and a Description of the Communication Techniques I would use with the Assigned Patient. Why I would use these Techniques

Building a thorough health history ensures delivery of safe, competent, and patient-centered care (Butt, 2021). Clinicians should develop comprehensive patient health history to ensure delivery of quality and holistic care. The assigned patient for this discussion is an 80-year-old white male with angina who lives on a farm 80 miles away from a healthcare center. I will use the interview to collect patient information to ensure that I understand his health needs and health risks associated with his health condition. The essence of the interview will be to collect more information about the patient to ensure formulation of interventions that will ensure positive patient experience and health outcomes (Butt, 2021).

            With the assigned I would ensure that I use age-appropriate communication techniques. The communication will courteous, emphatic, and is delivered with respect. I will ensure that the communication techniques build a connection with the patient to encourage him to be open and share all information to ensure the formulation of the most ideal interventions (Butt, 2021). I will ensure that I understand the patients’ non-verbal cues while listening attentively to the verbal expressions. Body language is just as important as speaking actual words (Ball et al., 2023). I will ensure that I uphold professional body language and set provider boundaries. I will listen compassionately to the patient and be observant to his physical appearances because this might provide cues about his healthcare needs. With the patient being elderly, I would ensure my assessment questions are tailored appropriately and delivered in a way that the patient can easily provide feedback. I will ask various types of questions such as open-ended, direct and leading questions to ensure collection of all vital patient information (Ball et al., 2023).

Risk Assessment Instrument Selected and Why it would be Applicable to the Selected Patient

Since the patient is elderly and reports angina, the most appropriate risk assessment tool would be Emergency Department Assessment of Chest Pain Score (EDACS). EDACS is appropriate for the patient because it will help to rule in or out serious or life-threatening problems that may need immediate interventions (Wang et al., 2022). EDACS is often used in patients reporting chest pain reduce patient length of stay and improve identification of low-risk patients presenting with chest pain (Wang et al., 2022). The other risk assessment instrument applicable for the patient is Abbreviated Mental Test (AMT) used to rapidly assess elderly patients for possibility of cognitive impairment (Wang et al., 2022). The instrument would be applicable to the selected patient because persistent angina symptoms are associated with chronic anxiety, depression, impaired physical functioning, and poor quality of life (Tsai et al., 2019).

Five Targeted Questions that I would ask the Patient

• Where is your pain?
• Does the pain go anywhere else?
• When did the pain start?
• How long has the pain lasted and how bad is it?
• Does anything make it better or worse?

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.). St. Louis, MO: Elsevier Mosby.

Butt, M. F. (2021). Approaches to building rapport with patients. Clinical Medicine, 21(6), e662–e663. https://doi.org/10.7861/clinmed.2021-0264

Links to an external site.

Tsai, C. C., Chuang, S. Y., Hsieh, I. C., Ho, L. H., Chu, P. H., & Jeng, C. (2019). The association between psychological distress and angina pectoris: A population-based study. PloS One, 14(11), e0224451. https://doi.org/10.1371/journal.pone.0224451

Links to an external site.

Wang, M. C., Liao, W. C., Lee, K. C., Lu, S. H., & Lin, Y. P. (2022). Validation of screening tools for predicting the risk of functional decline in hospitalized elderly patients. International Journal of Environmental Research and Public Health, 19(11), 6685. https://doi.org/10.3390/ijerph19116685

BUILDING A HEALTH HISTORY NURS 6512

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.

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

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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 

Communication

        A comprehensive history is essential to provide good care for the patient as the diagnosis and plan of care will be made from the history. Also, any other professional coming behind you to care for your patient will obtain information from the history, so it is essential to be thorough and accurate. Good communication must exist between the provider and patient to create such a database of knowledge for your patient. As the provider, you will want to gain the patient’s trust, so they are open with you and provide the necessary information. To establish trust, you must be open, honest, and direct in your questioning and answers in this initial meeting with the patient, as this will set the tone for future encounters (Ball, Dains, Flynn, Solomon, & Stewart, 2019). There will be a communication barrier for some patients if they speak a different language; a professional interpreter should be used instead of a family member in these cases (Ball, Dains, Flynn, Solomon, & Stewart, 2019). A good relationship with the patient will depend on the communication established during the taking of the health history and will be built upon courtesy, comfort, connection, confirmation, and confidentiality (Ball, Dains, Flynn, Solomon, & Stewart, 2019).

        Essential communication techniques for this patient would focus on identifying appropriate pronouns and ensuring no language barriers. It is important not to assume someone’s sexuality or gender and always inquire about a preferred name and document in their chart (Bass et al. 2021).

 

Targeting Questions to Individual Patients

        Asking questions to the individual patient is necessary as all patients are different and will have unique needs. It is ok to redirect the patient to keep the interview moving forward (Ball, Dains, Flynn, Solomon, & Stewart, 2019). The provider should always be prepared with questions appropriate to the patient’s history and chief concerns (Ball, Dains, Flynn, Solomon, & Stewart, 2019). This will include open-ended questions that allow the patient to answer and share as much information as they feel comfortable with sharing without limiting the answer (Ball, Dains, Flynn, Solomon, & Stewart, 2019). There should also be direct questions that will clarify any unclear information, such as the timing of an event or the location of an injury (Ball, Dains, Flynn, Solomon, & Stewart, 2019). It is essential to ask various questions to obtain all the information needed when taking a patient’s history. You should always ask one question at a time to avoid overwhelming the patient, which can cause them to place limits on their answers.

Risk Assessment Instruments

        For this week’s discussion, I was assigned: a 22-year-old LGBTQIA female Hispanic immigrant living in a middle-class suburb as my patient. As they recently came from Mexico, I want to provide them with the Infectious Disease Risk Screening, which asks them if they have traveled outside the United States in the last 21 days. If they answer no, the risk assessment is over, but if theyanswer yes, the evaluation continues. For the patient that answers yes, the follow-up question would be to what areas they have traveled to. The questions proceed from there to center on physical symptoms such as: have you had a high fever, headache, vomiting, abdominal pain, weakness, unexplained hemorrhage, or no symptoms? If the patient has a positive screen, they will be isolated in a private room, and the physician will be notified. It is important to use risk assessment instruments to identify the patient’s risk and allow for an individualized care plan for each patient (Wu & Orlando, 2015).

Potential Health Risks

        For my assigned patient, I want to verify if she has been screened for sexually transmitted infections, as untreated STIS can lead to cervical cancer.

        A diagnostic tool that could be especially helpful in this situation is a digital family health history tool. Obtaining a family health history is especially important to understand the risk factors of certain chronic conditions the patient could be susceptible to (Diez et al. 2019). Health disparities such as limited access to health services, linguistic barriers, and lack of translators or appropriate materials tend to affect the Latino community (Diez et al. 2019). This virtual tool could allow more telehealth appointments and possibly a more reliable family health history.

 

Five Target Questions to Assess Health Risks and Begin a Health History

What is the main reason for you coming in today?

What medications do you take daily?

What is your primary language?

Have you experienced physical, sexual, emotional, or verbal abuse?

Are you sexually active?

When were your last  pap smears?

 

 

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.

Bass B, Nagy H. Cultural Competence in the Care of LGBTQ Patients. [Updated 2021 October 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.Available from: https://www.ncbi.nlm.nih.gov/books/NBK563176/

Cerda Diez, M., E. Cortés, D., Trevino-Talbot, M., Bangham, C., Winter, M. R., Cabral, H., Norkunas Cunningham, T., M. Toledo, D., J. Bowen, D., K. Paasche-Orlow, M.,

Bickmore, T., & Wang, C. (2019). Designing and evaluating a digital family health history tool for Spanish speakers.International Journal of Environmental Research and Public Health.

Kohestani, K., Chilov, M., & Carlsson, S. V. (2018). Prostate cancer screening-when to start and, 7(1), 34–45. doi:10.21037/tau.2017.12.25

Lushniak, B. D. (2015). Surgeon general’s perspectives: family health history: Using the past to improve future health. Public Health Reports, (1), 3.

Wu, R. R., & Orlando, L. A. (2015). Implementation of health risk assessments with family health history: Barriers and benefits. Postgraduate Medical Journal, (1079), 508–513.

Reply

KALA I concur with you that a comprehensive history is essential to provide good care for the patient.  Interview allows healthcare workers to obtain health history from their patients. Interview sessions enable healthcare professionals to engage patients. The engagement provides room for healthcare workers to get reliable information about the health status of their patients (Traumer et al., 2019). However, poor interviewing skills and patient-healthcare workers interfere with the success of the interview. Healthcare workers are expected to lead successful interview sessions. The success of the engagement starts with the first impression. Healthcare workers are expected to make their patients comfortable before and during the interview session (Ardebili et al., 2021). Comfortable patients are willing to participate in the interview and other treatment routines. Good communication must exist between the provider and patient to create such a database of knowledge for the patient. Creating trust and maintaining the same through the interview is critical in determining the success of patient-healthcare worker engagement. Healthcare professionals are experts who are expected to lead successful interaction and engagement with their patients.

References

Ardebili, M. E., Naserbakht, M., Bernstein, C., Alazmani-Noodeh, F., Hakimi, H., & Ranjbar, H. (2021). Healthcare providers experience of working during the COVID-19 pandemic: A qualitative study. American journal of infection control, 49(5), 547-554. https://doi.org/10.1016/j.ajic.2020.10.001

Traumer, L., Jacobsen, M. H., & Laursen, B. S. (2019). Patients’ experiences of sexuality as a taboo subject in the Danish healthcare system: a qualitative interview study. Scandinavian journal of caring sciences, 33(1), 57-66.  https://doi.org/10.1111/scs.12600

Thank you for your very informative and well-composed post.  You did an excellent job of identifying highly pertinent questions necessary for an effective health history.  I would like to suggest an additional assessment that I think would be extremely useful in this particular clinical case.  This patient is a Native American living on a reservation, and a woman.  Unfortunately, this places her into a high risk category for domestic violence of all types, sexual assault, and likely lacking in resources to allow for safe and secure pregnancy and domesticity.   Research indicates that Native American women are more likely to be victims of violent crime than any other demographic in the United States, and that 70% of sexual assaults on Native women go unreported, meaning that the number is likely much higher.  Studies demonstrate that 70% of these violent crimes are perpetrated by persons of another race (not Native), also making Native women the largest target for interracial violent crime (Crossland et al., 2013).

It is imperative that advanced practice providers familiarize themselves with their patients’ cultural background and potential health risks that may be specific to that population, and that they screen their patients accordingly.  The risk screening tool HITS would be an appropriate and effective tool in this clinical case.  This assessment asks “In the past year, how often has your partner: Hurt you physically? Insult or talk down to you? Threaten you with physical harm? Scream or curse at you?” (Ball et al., 2019).  This assessment could be instrumental in protecting the health and safety of both the patient and her family, including her unborn child.  The provider should also include in his health screening a physical assessment for indications of physical abuse, as with all other patients seen.  Thank you again for your excellent post!

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.

Crossland, C., Palmer, J., & Brooks, A. (2013). Nij’s program of research on violence against american indian and alaska native women. Violence Against Women, 19(6), 771–790. https://doi.org/10.1177/1077801213494706

I really liked the way you presented your discussion post; it was very organized and thought out. However, as a PMHNP student, I was inclined to read through a few articles and I came across the following Risk assessment tools that would assess the psychological issues associated with one’s LGBTQIA status.

The Gender Minority Stress and Resilience Scale (GMRS) is used to measure the difficulties associated with identifying as a gender minority and protective factors for psychological well-being.The 58 items were adapted from other measures and compiled into the GMRS to measure nine different constructs, including Gender-related Discrimination, Gender-related Rejection, Gender-related Victimization, non-affirmation of Gender Identity, Internalized Transphobia, Negative Expectations for Future Events, and Nondisclosure (Shulman et al., 2017).

Strength of Transgender Identity Scale (STIS)This assesses how strongly an individual identifies as transgender and how important transitioning is to them. Although largely related to identifying transgender people, it contains items that may be relevant to understanding someone’s gender identity and how that might change in therapeutic interventions. The STIS has six questions and no factors were identified in the original validation study. Example items include “I identify as trans,” “It is important to me that people I am close to know I transitioned,” and “The fact that I transitioned is important to who I am.”

Transgender Adaptation and Integration Measure (TG AIM) measure the stresses associated with being transgender and the individual’s efforts to cope with stress. The TG AIM has 15 items, and three factors were identified in the initial validation study that is scored as subscales: Coping and Gender Reorientation Efforts, Psycho social Impact of Gender Status, and Gender-related Fears. A fourth factor, Gender Locus of Control, was also identified but was not recommended for use due to poor internal consistency. Example items of the three recommended factors include “I fear discrimination,” “I take/have taken hormones,” and “Being transgender causes me relationship problems.”

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.

Shulman, G. P., Holt, N. R., Hope, D. A., Mocarski, R., Eyer, J., & Woodruff, N. (2017). A review of contemporary assessment tools for use with transgender and gender nonconforming adults. Psychology of Sexual Orientation and Gender Diversity, 4(3), 304–313. https://doi.org/10.1037/sgd0000233Links to an external site.

Effective nursing health assessment interview techniques. (n.d.). Walden University. https://www.waldenu.edu/online-bachelors-programs/bachelor-of-science-in-nursing/resource/effective-nursing-health-assessment-interview-techniquesLinks to an external site.

To build a strong therapeutic relationship between the patient and the nurse, it is essential to obtain relevant and personal information about the patient by taking a thorough health history. According to the case study that was assigned, the 72-year-old man who was admitted to your Intensive care unit after having a severe stroke was rendered unconscious and unable to communicate. But, his wife claimed in an interview that they don’t have any advanced directives. But, she was certain that her husband would prefer not to live that way.

Their daughter, however, was convinced that her father would have preferred to be kept alive if there was a prospect for a positive outcome. The use of proper communication skills, such as the use of open-ended questions, active listening, empathy, and enabling the patient to only tell his tale once, will be required given the patient’s serious condition (Ball et al., 2019). The aforementioned communication strategies will enable the client to respond without becoming angry, frustrated, worn out, or bored.

The National Institutes of Health Stroke Scale (NIHSS) will be used because the patient has already experienced a severe stroke that has rendered him nonresponsive and unable to communicate. The scale evaluates hemi-inattention, extraocular motions, visual fields, limb strength, facial muscle function, sensory abilities, coordination, communication, and speech (Zöllner et al., 2020). The NIHSS is suitable for this patient because it will improve patient care by serving as an initial evaluation tool and by aiding in the planning of post-acute care disposition (Alkhouli & Friedman, 2019).

While the patient is unconscious, his wife will serve as the historian. The following specific inquiries will be displayed (Masci et al., 2019):

1.  Could you explain your husband’s medical history?
2. What other medical conditions is your husband dealing with? 
3. Does your husband currently take any medications?
4. Does anyone in the family experience comparable cardiovascular issues?
5. When was the last time your husband visited for a check-up or follow-up assessment?

References

Alkhouli, M., & Friedman, P. A. (2019). Ischemic Stroke Risk in Patients With Nonvalvular Atrial Fibrillation. Journal of the American College of Cardiology, 74(24), 3050–3065. https://doi.org/10.1016/j.jacc.2019.10.040

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.

Masci, A., Barone, L., Dedè, L., Fedele, M., Tomasi, C., Quarteroni, A., & Corsi, C. (2019). The Impact of Left Atrium Appendage Morphology on Stroke Risk Assessment in Atrial Fibrillation: A Computational Fluid Dynamics Study. Frontiers in Physiology, 9. https://doi.org/10.3389/fphys.2018.01938

Zöllner, J. P., Misselwitz, B., Kaps, M., Stein, M., Konczalla, J., Roth, C., Krakow, K., Steinmetz, H., Rosenow, F., & Strzelczyk, A. (2020). National Institutes of Health Stroke Scale (NIHSS) on admission predicts acute symptomatic seizure risk in ischemic stroke: a population-based study involving 135,117 cases. Scientific Reports, 10(1). https://doi.org/10.1038/s41598-020-60628-9

Building rapport with the patient

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

Sample Answer for BUILDING A HEALTH HISTORY NURS 6512

History and physical examination are at the heart of the effort to offer instruction in learning about the well and the sick as they seek care (Ball et al., 2019). While assessing an 85-year-old white female living alone with no family in declining health, I would first gather a thorough and accurate health history. I would greet the patient and introduce myself in a respectful, professional manner to give a good first impression. I would ask the patient how she would like to be addressed to establish respect. I would then provide the patient with a safe, quiet, and private environment to discuss any concerns that she may have. With age, the chance of developing hearing loss increases (National Institute on Aging, n.d.). A quiet environment eliminates distractions and challenges that the patient may have if she has impaired hearing. A safe and private environment allows the patient to feel comfortable talking freely and openly. The environment would also have adequate lighting to eliminate visual challenges. 

            The interview would be conducted slowly and without interruptions to give the patient time to process the questions or statements and disclose all their concerns. I would speak plainly and not use medical jargon/terminology to ensure the patient understands the instructions given. I would ask open-ended questions to encourage thorough responses. I would address the patient face-to-face with an open posture and body language. I would also assess for and address any language barriers, cultural differences, or religious beliefs to provide effective communication and aid in developing treatment plans. If there were language barriers, I would provide the patient with an interpreter. If the patient required written instructions, I would make sure that they are clear, and the font is large and easy to read. If the patient had visual deficits, I would provide alternatives, such as audio or pictures. These techniques would allow for effective communication and aid in gathering pertinent information regarding the patient’s age, race, gender, chief complaint, family history, past medical history, personal and social history, and review of systems. 

Risk Assessment Instrument 

            Based on the information provided about the patient, the patient is at increased risk for impaired cognition, depression, falls, polypharmacy, dehydration, infection, malnutrition, and many other health-related risks. Two risk assessment instruments that are essential for an 85-year-old white female living alone with no family in decreasing health include the Mini-Cog and the Geriatric Depression Scale. The Mini-Cog aids in identifying possible impairments in cognitive function in the elderly. As a result of aging, conditions such as Alzheimer’s disease and other dementias and complaints about memory are becoming more common (Seitz et al., 2018). The patient’s cognitive function plays an important role in the patient’s safety and ability to adhere to the prescribed treatment plan. Therefore, since the patient is elderly, it would be appropriate to assess her cognitive status. The Geriatric Depression Scale is used to assess depression in older adults. This risk assessment tool is appropriate because the patient is elderly, lives alone, has no family, and her health is declining. These risk factors increase the patient’s chances of being depressed or developing depression. Depression should be assessed because it can impact the patient’s overall health and safety. 

Targeted Questions 

The five targeted questions I would ask the 85-year-old female living alone with no family in declining health include: 

1. What brought you in today? (This question identifies the patient’s chief concern and facilitates an open-ended response). 

2. What is your understanding of your diagnosis? (This question assesses if the patient has a clear understanding of their diagnosis, its importance, and its management). 

3. How are you coping with your illness? (This question will aid in the assessment of depression, especially if the patient has risky, ineffective coping mechanisms such as drinking or substance use). 

4. Do you have people you can talk to about your illness? (This question identifies the patient’s support system). 

5. Do you have insurance or experience financial difficulties regarding your medical care? (Since the patient is elderly, lives alone, and has no family, they may be at an increased risk for financial difficulties, which can impact their health and access to healthcare). 

  

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. 

National Institute on Aging. (n.d.). Talking with your older patients.  https://www.nia.nih.gov/health/talking-your-older-patients  

Links to an external site. 

Seitz, D. P., Chan, C. C., Newton, H. T., Gill, S. S., Herrmann, N., Smailagic, N., Nikolaou, V., & Fage, B. A. (2018). Mini-Cog for the diagnosis of Alzheimer’s disease dementia and other dementias within a primary care setting. The Cochrane database of systematic reviews, 2(2), CD011415. https://doi.org/10.1002/14651858.CD011415.pub2  

Sample Response for BUILDING A HEALTH HISTORY NURS 6512

Shaneka,   

Well written and informative post.  In addition to assessing this patient for impaired cognition and depression I would also screen for falls. According to the Center for Disease Control and Prevention falls are the leading cause of injury and injury death in adults 65 and older in the United States (Keep on Your Feet, 2022).  So, this could be an opportunity to prevent or decrease the likelihood of falls by identifying risk factors. Research also reports that fragility and incontinence increase the risk for falls in women (Chow et al., 2019). So, additional questions I would ask would pertain to her urinary habits, fragility and the housing environment.  

References  

Chow, R. B., Lee, A., Kane, B. G., Jacoby, J. L., Barraco, R. D., Dusza, S. W., Meyers, M. C., & Greenberg, M. R. (2019). Effectiveness of the “Timed Up and Go” (TUG) and the Chair test as screening tools for geriatric fall risk assessment in the ED. The American Journal of Emergency Medicine, 37(3), 457–460. https://doi.org/10.1016/j.ajem.2018.06.015  

Links to an external site.  

Keep on Your Feet. (2022, June 9). Centers for Disease Control and Prevention. https://www.cdc.gov/injury/features/older-adult-falls/index.html