Discussion: Building a Health History

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.

The case concerns an adolescent Hispanic/Latino boy living in a middle-class suburb. When interviewing this client, I would ask about his health concerns, including his primary reason for the visit. During the interview, I would ask the client about his health prevention and promotion activities, sexual activity, and mental health issues. I would be warm and friendly to the client, shake his hand, and make eye contact. I would also reassure the patient about the confidentiality of the information he provides (Takeuchi et al., 2021). This will help the client feel comfortable and encourage him to convey his health concerns. Furthermore, I will express interest in the client’s life, not just his medical concerns.

Effective communication techniques are crucial in eliciting information from adolescents. When discussing sexual activity, I will introduce the questions about sexual activity comfortably. If the patient expresses confusion about sexual activity, the nurse will clarify for him (Savoy et al., 2020). In addition, I will ask appropriate questions, even though the patient and I are uncomfortable. I will also acknowledge the awkwardness of the questions and normalize it by mentioning that I ask all adolescent clients these questions (Shafii et al., 2019). Furthermore, I will articulate to the client the patient’s need to be listened to and make him not feel pressured into disclosing his feelings. I would also use humor to empathize with the client, which will help get a positive response from him.

The CRAFFT questionnaire can be used for this client. It is used to screen for alcohol and substance abuse in adolescents (Ball et al., 2019). It is ideal for this patient since he is an adolescent living in a middle-class suburb, which usually has a high prevalence of adolescent alcohol and substance abuse.

Target Questions

• What health concerns do you have today?
• Other than health issues, what social or psychological problems are you experiencing?
• What factors often make you psychologically distressed?
• How is your relationship with your peers in school and at home?
• What is your sexual preference?

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.

Savoy, M., O’Gurek, D., & Brown-James, A. (2020). Sexual health history: techniques and tips. American Family Physician, 101(5), 286–293.

Shafii, T., Benson, S. K., & Morrison, D. M. (2019). Brief Motivational Interviewing Delivered by Clinician or Computer to Reduce Sexual Risk Behaviors in Adolescents: Acceptability Study. Journal of medical Internet research, 21(7), e13220. https://doi.org/10.2196/13220

Takeuchi, Y. L., Bonvin, R., & Ambresin, A. E. (2021). ‘Demystifying’ the encounter with adolescent patients: a qualitative study on medical students’ experiences and perspectives during training with adolescent simulated patients. Medical education online, 26(1), 1979445. https://doi.org/10.1080/10872981.2021.1979445

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.

This is an informative post. Building a rapport with the patient is one of the communication skills that help to attain trust when interviewing patients. In addition to the distinctive approaches mentioned, HEADSS is another risk assessment measure for this adolescent boy from a middle-class suburb. For this high-risk demographic, this tool addresses home, education, activities, drugs, sex, and suicide (Sturrock & Steinbeck, 2019). This tool helps to obtain answers on who lives with them and their connection with them. Questions about his education will help identify a drop in school achievement and their overall experience.

Adolescents with body image problems tend to withdraw from association with peers, hobbies, and extracurricular activities, leading to depression and suicide; therefore, addressing one’s eating habits and researching current weight or appetite changes might reveal more about one’s body image problems. If the patient reports bad moods, withdraws from friends and family, and mentions hurting oneself, suicide should be considered (Sturrock & Steinbeck, 2019). Finally, sexually transmitted illnesses might be indicated by sexual activity.

Additionally, maintaining confidentiality is crucial. The teenager should be offered the option of having parents or loved ones present throughout the interview. Involving family members before the evaluation may assist in acquiring their and the teenager’s trust (Barzin, 2018). However, parents or loved ones should be gently requested to depart after an initial acquaintance. Lastly, allowing the boy to ask questions after the interview will make him comfortable, allow the practitioner to address any concerns, clear up doubts, and help build a solid rapport.                                                                   

References

Barzin, A. (2018). Chronic illness care: Principles and practice. Chapel Hill, NC: Springer.

Sturrock, T., & Steinbeck, K. (2019). Adolescents and youth in adult hospitals: psychosocial assessment on admission – an evaluation of the youth care plan. Australian Journal of Advanced Nursing, 31(1), 28-35. Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspxLinks to an external site.? direct=true&db=edswsc&AN=000329977900004&site=eds-live&scope=site

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

Developing or building an accurate and detailed patient history is a cornerstone of initiating an appropriate plan of care for any patient and is a skill that is essential for the APRN. In this way, we get to know our patient’s, their past concerns and issues, and how past problems impact current functioning. A complete health history is also necessary when collaborating with other healthcare clinicians or when there is a transfer of care.

Factors such as age, gender, ethnicity, and living environment all should be considered since they greatly impact a patient’s health status. When interviewing a patient, whether it is a first encounter or follow-up care, communication, interviewing techniques, and other tools are necessary to ensure that the necessary information is gathered and understood to meet the needs of the patient. For the purpose of this discussion, the patient in question is a 14 year old biracial male living with his grandmother in a high-density public housing complex.

Whenever meeting with any patient, I prefer to use a method called AIDET which is as follows: Acknowledge and greet the patient by name, make eye contact, smile, and include any others who are present; Introduce yourself, your position, and background or experience; the Duration that the interview and exams will take; Explain what steps are next and what the patient can expect from the visit; and lastly, Thank the patient and any family or friends for their time and consideration (Studer Group, 2020).. These steps can be completely in a few sentences, take less than five minutes, and can provide reassurance to nervous patients who don’t know what to expect.

While AIDET is an appropriate tool that can be used for most patient and situations, other communication and interview techniques may differ depending on the specific patient. For example, since this patient is an adolescent, I would first let him and his grandmother know that I will be speaking with them together and privately. While the grandmother may be necessary for background information, especially when the boy was younger, most adolescents are able to give an accurate health history and may speak more freely without the guardian if they are given the opportunity.

However, adolescents may have difficulty choosing their words or may feel embarrassed so they should be given time to express themselves without confrontation, to which they do not respond well (Bell, Dains, Flynn, Solomon, & Stewart, 2019). In addition, there are specific topics that should be discussed with patients and their caregivers which are age-appropriate and referred to as anticipatory guidance (Sullivan, 2019). For example, topics to focus on for patients aged 10 to 14 years include safety issues, nutrition, dental hygiene, peer pressure, puberty, safe sex/contraception/STD prevention, safety rules with adults, communication, screen time, self-control, depression/anxiety, tobacco/alcohol/substance use, educational goals and activities, and after school activities, and supervision.

When interviewing any patient, social determinants of health should be considered and questions should be targeted towards identified areas of concern. Social determinants of health are socioecological factors such as gender, religion, ethnicity/race, sexual orientation, mental health, geographical location, education, income, employment, disabilities. Discrimination related to these factors cause disparities that negatively impact health and outcomes (Tebb, Pica, Twietmeyer, Diaz, & Brindis, 2018).

Questions for this particular patient would be aimed towards factors such as his biracial status, being reared by a grandparent, and highly crowded public housing. Specific issues related to diseases in overcrowded environments such as tuberculosis should be assessed. I would also carefully monitor growth, milestones, and dietary habits since many individuals in urbanized areas live in food deserts without ready access to fresh, healthy, unprocessed foods.

When assessing a patient’s risk factors, especially once disparities in social determinants of health are identified, it is helpful to have a specific screening tool tailored to the demographic in question. For example, studies show that adolescents tend to have more social risks than medical ones. Therefore, tools such as The Guidelines for Adolescent Preventative Services (GAPS) was developed that targets primary and secondary interventions to prevent adolescent morbidity and mortality by improving health-care delivery (Sullivan, 2019). Risk taking behaviors in teens are identified, such as smoking, drinking, or unprotected sex, by 24 topics that examine health guidance, screening, immunizations, and health-care delivery. Another tool that was developed to assess drug and alcohol use in adolescents is the CRAFFT Questionnaire. CRAFFT refers to car, relax, alone, forget, friends, and trouble (Ball et al., 2019).

As mentioned above, adolescents tend to have more social risks than medical ones. Therefore, an assessment tool such as the HEEADSSS is helpful in obtaining an accurate psychosocial history for this age group. The acronym HEEADSSS stands for home, education/employment, eating, activities, drugs, sexuality, suicide/depression, and safety and encompasses many of the same social determinants (Sullivan, 2019).

Five specific questions targeted towards my patient to assess his health risks and build his health history are as follows: 1) Do you know anyone who has committed suicide? While suicide can be an uncomfortable subject, it is a common cause or mortality in teens, particularly in males, and should be assessed (Bell et al., 2019). This is a non-threatening question that may open the conversation and lets the teen know that this is a safe topic; 2) Are you sexually active? Adolescence is a time for experimenting and risk-taking behaviors.

Children are becoming sexually active at younger ages and should be educated regarding safe sex, contraception, and disease prevention; 3) Do you safe at home? This question is a great open-ended question that can start the conversation and lead to a variety of safety-related issues. For example, does the boy feel safe with his grandmother? Answers to the contrary could indicate abuse or neglect. Maybe he does not feel safe in his living environment due to crowding in a public housing complex; 4) Tell me what you had for breakfast this morning?

This question not only assesses the patient’s memory recall, but also may give an indication of nutrition and dietary habits; 5) Is there anything we have not talked about that you think I should know? Oftentimes the patient, especially ones who are young, may expect the clinician to guide the interview and answer questions that are posed. They may be more reluctant to initiate their own topics or concerns and this gives them to opportunity to have the floor to ask or discuss anything in a safe place.

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.

Studer Group. (2020). AIDET patient communication. Retrieved from https://www.studergroup.com/aidet#:~:text=The%20acronym%20AIDET%C2%AE%20stands,%2C%20Explanation%2C%20and%20Thank%20You.

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

Tebb, K.P., Pica, G., Twietmeyer, L., Diaz, A., & Brindis, C.D. (2018). Innovative approaches to address social determinants of health among adolescents and young adults. Health Equity, 2(1), 321-328. doi: 10.1089/heq.2018.0011.

Welcome to 6512!

This is your Week 1 Update!!!!  I try to do an update at least once a week, to make announcements, share information, and discuss overall class issues and activities.  It is my goal to keep you informed in order to decrease your anxiety, and also make this a very enjoyable learning experience!!

This is my 8th year at Walden University.  I taught this same course each semester…….so rest assured……my job is to make sure that we are all successful in completing this course!!  Your job is to stay informed, and ask questions as they arise!

1.  Class Cafe:  If you haven’t already introduced yourself….please do so!  We want to hear your past work experience, your goals, your family, your pets, and what you intend to do after completing your NP degree!!  Post pictures….it is always great to place a face with a name!  We will be spending alot of time together the next 11 weeks!!!  Also, use this forum to ask your classmates questions.  Many times, your classmates are experiencing the same issues as you are……so this helps everybody out if you post your issues and can troubleshoot together!

2.  Weekly discussions:  Since we do not get to see each other on a weekly basis…..this is the place where you share your knowledge, and challenge your colleagues to think deeper about the topic.  Be sure to follow the grading rubric as you develop your Main Discussion and your replies to Colleagues.  This is how you will be graded.  Pay close attention to the dates and times in which you post…..points are deducted if you are not posting on the required timelines.  When posting your main discussion,  please post like this  Your last Name- Main Post Week 1.  This way, myself and your colleagues will be able to follow your discussion thread.  I am looking for your posts to have scholarly citations, outside of your required texts, when possible, and also that your in-text and reference lists are all listed in APA format.  Here are some resources to assist you with APA formatting, outside of the APA Manual:

Perdue Online Writing Lab- http://owl.english.purdue.edu/   (this is a free resource)

In Microsoft Word….There is a references tab in which you insert your citation information, and choose APA format.  This will do the formatting for you.  Best part…..it is also free!!!

3.  This Week’s Discussion Board

1.  26-year-old Lebanese female living in graduate-student housing

2.  14-year-old biracial male living with his grandmother in a high-density public housing complex

3.  38-year-old Native American pregnant female living on a reservation

4.  40-year-old black recent immigrant from Africa without health insurance

9. • 1     Last names starting with A-C
   • 2      Last names starting with D-H
   • 3      Last names starting with I-O
   • 4      Last names starting with P-Z

Please make sure that you answer all of the required info in your post:

• 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.

4.  Shadow Health– If you have not yet done so, be sure to set up your account with Shadow Health.  Beginning in Week 3 we will be having required assignments in this learning tool.

5.  Communication:  As I mentioned….I like to do weekly updates to the class.  I post this update in the Announcement area each week.  I try to keep everyone informed to the best of my ability.

I am teaching multiple sections of this course this semester.  In order to streamline communication with me, I ask that you communicate with me in the “Contact Instructor” tab of Blackboard.  If your question or issue is of a personal nature that you would prefer not posting in this section, please email or call me.  My Walden Email is  [email protected].  In the subject line of your email…..please start with your section number…..  ie:  D-4 Olszewski Discussion Question.  This will be able to track the issue in a more expedient manner.  I try to check email daily, but if you need to speak with me urgently, please call my cellphone.

For many of you this may be one of your first online courses.  Please do not hesitate to ask questions!!  For problems with Blackboard or the website, please contact FrontLine [email protected].  I will not be able to help you with any technical questions.  For course content questions, please contact me directly.

I know that all of you are now on information overload!!  Take a deep breath, and get ready for a fast paced, and information packed 11 weeks!!  Please take time to review the syllabus and Academic Integrity policy for this course.  I intend to make this course as interactive and enjoyable as possible…..and I really look forward to being part of your educational journey at Walden!!

What’s Coming Up in Module 2?

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

Next Module

To go to the next module:

Module 2

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