NURS 6512 Building a Comprehensive Health History

Walden University NURS 6512 Building a Comprehensive Health History-Step-By-Step Guide

 

This guide will demonstrate how to complete the Walden University NURS 6512 Building a Comprehensive Health History assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

 

How to Research and Prepare for NURS 6512 Building a Comprehensive Health History                     

 

Whether one passes or fails an academic assignment such as the Walden University NURS 6512 Building a Comprehensive Health History depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

 

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

 

How to Write the Introduction for NURS 6512 Building a Comprehensive Health History                     

The introduction for the Walden University NURS 6512 Building a Comprehensive Health History is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

 

How to Write the Body for NURS 6512 Building a Comprehensive Health History                     

 

After the introduction, move into the main part of the NURS 6512 Building a Comprehensive Health History assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

 

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

 

How to Write the Conclusion for NURS 6512 Building a Comprehensive Health History                     

 

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

 

How to Format the References List for NURS 6512 Building a Comprehensive Health History                     

 

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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A Sample Answer For the Assignment: NURS 6512 Building a Comprehensive Health History

Title: NURS 6512 Building a Comprehensive Health History

NURS 6512 Building a Comprehensive Health History

NURS 6512 Building a Comprehensive Health History

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

Sample Answer for NURS 6512 Building a Comprehensive Health History Included

According to a 2011 Gallup poll, nurses are ranked as the most trusted professionals in the United States. One of the most admired nursing skills is the ability to put patients at ease. When patients enter into a healthcare setting, they are often apprehensive about sharing personal health information. Caring nurses can alleviate the hesitance of patients and encourage them to be forthcoming with this information.

The initial health history interview can be an excellent opportunity to develop supportive relationships between patients and nurses. Nurses may employ a variety of communication skills and interview techniques to foster strong bonds with patients and to effectively facilitate the diagnostic process. In conducting interviews, advanced practice nurses must also take into account a range of patient-specific factors that may impact the questions they ask, how they ask those questions, and their complete assessment of the patient’s health.

This week, you will consider how social determinants of health such as age, gender, ethnicity, and environmental situation impact the health and risk assessment of the patients you serve. You will also consider how social determinants of health influence your interview and communication techniques as you work in partnership with a patient to gather data to build an accurate health history.

Learning Objectives

Students will:

• Analyze communication techniques used to obtain patients’ health histories based upon social determinants of health
• Analyze health-related risk
• Apply concepts, theories, and principles related to patient interviewing, diagnostic reasoning, and recording patient information
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Learning Resources

Required Readings (click to expand/reduce)

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.
• Chapter 1, “The History and Interviewing Process”
This chapter explains the process of developing relationships with patients in order to build an effective health history. The authors offer suggestions for adapting the creation of a health history according to age, gender, and disability.

• Chapter 5, “Recording Information”
This chapter provides rationale and methods for maintaining clear and accurate records. The authors also explore the legal aspects of patient records.
Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.
• Chapter 2, “The Comprehensive History and Physical Exam” (pp. 19–29)

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 decline in functional status and quality of life: Results of a cohort study. BMC Family Practice, 16, 1–12. https://go.openathens.net/redirector/waldenu.edu?url=https://doi.org/10.1186/s12875-015-0241– x

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.

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

Jardim, T. V., Sousa, A. L. L., Povoa, T. I. R., Barroso, W. K. S., Chinem, B., Jardim, L., … Jardim, P. C. B. V. (2015). The natural history of cardiovascular risk factors in health professionals: 20-year follow-up. BMC Public Health, 15(1111), 1–7. https://doi-org.ezp.waldenulibrary.org/10.1186/s12889-015-2477-8

Shadow Health Support and Orientation Resources

Use the following resources to guide you through your Shadow Health orientation as well as other support resources:

Frey, C. [Chris Frey]. (2015, September 4). Student orientation [Video file]. Retrieved from https://www.youtube.com/watch?v=Rfd_8pTJBkY

Shadow Health. (n.d.). Shadow Health help desk. Retrieved from https://support.shadowhealth.com/hc/en-us

Document: Shadow Health. (2014). Useful tips and tricks (Version 2) (PDF)

Document: Shadow Health Nursing Documentation Tutorial (Word document)

Optional Resource

LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw- Hill Medical.
• Chapter 2, “History Taking and the Medical Record” (pp. 15–33)

Required Media (click to expand/reduce)

Welcome and General Course Guidelines

Dr. Tara Harris reviews the overall guidelines and the expectations for the course. Consider how you will manage your time as you review your media and Learning Resources throughout the course to better prepare for your Discussions, Case Study Lab Assignments, Digital Clinical Experience (DCE) Assignments, and your Midterm and Final Exams (14m).

Module 1 Introduction

Dr. Tara Harris reviews the overall expectations for Module 1. Please pay special attention to the registration requirements for your use of Shadow Health for your Digital Clinical Experience (DCE) Assignments as well as the criteria for the DCE Assignments (3m).
Building a Comprehensive Health History – Week 1 (19m)
________________________________________

Assignment: Course Acknowledgement

This mandatory assignment is an acknowledgement that you fully understand the course guidelines.

By Day 3 of Week 1

Submit your Assignment.
Submission and Grading Information
Submit Your Assignment by Day 3 of Week 1.

To complete this assignment, follow the link below and answer the questions provided.

Week 1 Assignment

________________________________________

Discussion: Building a Health History

Effective communication is vital to constructing an accurate and detailed patient history. A patient’s health or illness is influenced by many factors, including age, gender, ethnicity, and environmental setting. As an advanced practice nurse, you must be aware of these factors and tailor your communication techniques accordingly. Doing so will not only help you establish rapport with your patients, but it will also enable you to more effectively gather the information needed to assess your patients’ health risks.
For this Discussion, you will take on the role of a clinician who is building a health history for a particular new patient assigned by your Instructor.

Photo Credit: Sam Edwards / Caiaimage / Getty Images

To prepare:

With the information presented in Chapter 1 of Ball et al. in mind, consider the following:
• By Day 1 of this week, you will be assigned a new patient profile by your Instructor for this Discussion. Note: Please see the “Course Announcements” section of the classroom for your new patient profile assignment.
• How would your communication and interview techniques for building a health history differ with each patient?
• How might you target your questions for building a health history based on the patient’s social determinants of health?
• What risk assessment instruments would be appropriate to use with each patient, or what questions would you ask each patient to assess his or her health risks?

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• Identify any potential health-related risks based upon the patient’s age, gender, ethnicity, or environmental setting that should be taken into consideration.
• Select one of the risk assessment instruments presented in Chapter 1 or Chapter 5 of the Seidel’s Guide to Physical Examination text, or another tool with which you are familiar, related to your selected patient.
• Develop at least five targeted questions you would ask your selected patient to assess his or her health risks and begin building a health history.

By Day 3 of Week 1

Post a summary of the interview and a description of the communication techniques you would use with your assigned patient. Explain why you would use these techniques. Identify the risk assessment instrument you selected, and justify why it would be applicable to the selected patient. Provide at least five targeted questions you would ask the patient.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
Read a selection of your colleagues’ responses.

By Day 6 of Week 1

Respond to at least two of your colleagues on 2 different days who selected a different patient than you, using one or more of the following approaches:
• Share additional interview and communication techniques that could be effective with your colleague’s selected patient.
• Suggest additional health-related risks that might be considered.
• Validate an idea with your own experience and additional research.
Submission and Grading Information
Grading Criteria

To access your rubric:

Week 1 Discussion Rubric

Post by Day 3 of Week 1 and Respond by Day 6 of Week 1

To Participate in this Discussion:
Week 1 Discussion

What’s Coming Up in Module 2?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images
In Module 2, you explore the impact of functional assessments, diversity, and sensitivity in conducting health assessments. You also examine various assessment tools and diagnostic tests used to gather information about patients’ conditions and examine their validity, reliability, and impact in conducting health assessments.
Next week, you will specifically examine functional assessments as they relate to diversity and sensitivity

Registration for Shadow Health
Throughout this course, you will participate in digital clinical experiences using the online simulation tool Shadow Health. The Shadow Health digital clinical experience provides a dynamic, immersive experience designed to improve nursing skills and clinical reasoning through the examination of digital standardized patients. Using Shadow Health you will participate in health histories, focused exams, and a comprehensive assessment.
There will be four Shadow Health assessment components that you will need to complete in Module’s 2 and 3:
• Health History Assessment (Week 3 & 4)
• Focused Exam: Cough (Week 5) for a pediatric patient presenting with cough
• Focused Exam: Chest Pain (Week 7) for an adult patient presenting with chest pain
• Comprehensive (Head-to-Toe) Physical Assessment (Week 9)
Before you can participate in these simulations, you will need to register for a Shadow Health account. To do this:
• Go to the Walden Bookstore and purchase access to Shadow Health and the required texts.
• Once Shadow Health has been purchased, an access code will be emailed to you from the bookstore.
• Review this video explaining how to register in Shadow Health: https://vimeo.com/275921826/c12d50ee6e
• Use the Shadow Health link located in the navigation menu on the left in the Blackboard course.
• Follow the prompts to register in Shadow Health. You will need the access code provided from the bookstore to register. Once registered, Shadow Health should always be accessed via the link in Blackboard.
• Use only Google Chrome when accessing Shadow Health and make sure all other programs are turned off on your computer. Other browsers do not work well and will not allow the Shadow Health speech to text function to work.
• Once registered, complete the Shadow Health Orientation in the Shadow Health website/program and review the videos designed to assist with navigating and completing assignments.
• Read the Shadow Health Nursing Documentation Tutorial located in the Week 1 Learning Resources.
Note: As nurses you typically use the word assessment to mean completing the physical exam. However, in the SOAP Note format, assessment means diagnosis so start getting in the habit of calling the physical exam exactly that.

Week 2 Case Studies

In Week 2, your Instructor will assign you a case study related to your Discussion by Day 1 of the week. Please make sure to review the “Course Announcements” area of the course to verify your assigned case study. Please plan ahead to ensure you have time to review your case study and your Learning Resources so that you can complete your Discussions and Assignments on time.

Photo Credit: Getty Images/iStockphoto

Practicum – Upcoming Deadline

In the Nurse Practitioner programs of study (FNP, AGACNP, AGPCNP, and PMHNP) you are required to take several practicum courses. If you plan on taking a practicum course within the next two terms, you will need to submit your application via Meditrek .
For information on the practicum application process and deadlines, please visit the Field Experience: College of Nursing: Application Process – Graduate web page.
Please take the time to review the Appropriate Preceptors and Field Sites for your courses.
Please take the time to review the practicum manuals, FAQs, Webinars and any required forms on the Field Experience: College of Nursing: Student Resources and Manuals web page.
• Field Experience: College of Nursing Quick Answers

• Field Experience: MSN Nurse Practitioner Practicum Manual
• Student Practicum Resources: NP Student Orientation
Next Module

To go to the next module:
Module 2

SUBJECTIVE DATA:

Chief Complaint (CC): “I got a scrape on my foot a while ago, and I thought it would heal up on its own, but now it’s looking pretty nasty. And the pain is killing me!”

History of Present Illness (HPI): Ms. Jones claimed that one week ago, she was walking on stairs outside when she tripped and fell, causing her right ankle to twist and the ball of her foot to scrape. She went to the emergency room of the nearby hospital, where she received negative results from the x-rays and was given tramadol for the pain she was experiencing. She has been cleaning the wound twice. She has been treating the wound with an antibiotic medication and bandaging it.

She adds that the pain and swelling in her ankle have subsided, but that the bottom of her foot is becoming increasingly uncomfortable. She describes the pain as throbbing and sharp when she is forced to bear weights. She reports that her ankle “ached” but it is better now. After taking the most recent dose of tramadol, the level of pain has decreased to a 7 out of 10. The degree of pain when bearing weight is a 9.

She says that the ball of foot has become swelled and more red over the previous two days and that yesterday, she noticed discharge pouring from the wound. She also says that the swelling has gotten worse. She claims that there is no smell coming from the wound. Her shoes appear to be too small. She has been seen wearing shoes that are without laces. Last night, she reported a temperature of 102. She denies recent illness. An increased appetite is reported alongside with an accidental weight loss of ten pounds that occurred over the course of the month. Denies making any changes to their diet or amount of physical activity.

Medications: Acetaminophen 500 to 1000 mg PO as needed (headaches). Ibuprofen 600 mg PO twice daily as needed (menstrual cramps). Tramadol 50 mg PO BID prn (foot pain). Albuterol 90 mcg/spray MDI 2 puffs Q4H prn (Wheezing while neat cats, most recent administration: three days ago)

Allergies: Rash caused by penicillin, Allergic to cats and dust but not food or latex sensitivities. She claims that being among allergens causes her to experience runny nose, itchy and swollen eyes, and an increase in the severity of her asthma symptoms.

Past Medical History (PMH): At the age of 2 and a half, the asthma was identified. When she is in an environment with cats or dust, she utilizes the albuterol inhaler that she carries with her. Two of three times a week, she makes use of her inhaler. Three days ago, she was around cats, and she had to use her inhaler once to get some respite from the symptoms that were bothering her. Her last asthma related hospitalization was when she was in high-school. Never had an intubation.

Diabetes type 2 was discovered at the age of 24. She had been taking Metformin in the past but stopped doing so three years ago, citing the fact that the drugs caused her to have gas and that “it was stressful taking pills and testing my sugar”. She does not keep an eye on her sugar levels. In the hospital’s emergency room, the patient’s sugar levels were high the week before last. No surgeries. Hematologic: Acne has been a problem for her ever since she hit adolescence and she also gets bumps on the backs of her arms if her skin is dry. Complains of a darkening of the skin on her neck as well as an increase in the hair on her face and body. She has noted that she has a few moles, but no noticeable alterations to her hair or nails.

Past Surgical History (PSH): No history of past surgery.

Sexual/Reproductive History: Menarche, age 11. First sexual experience at the age of 18, which encounters were with men, and the individual identifies as straight. Never pregnant. It’s been three weeks since her last menstruation. During the last year, her menstrual period has been quite erratic, occurring every 4-6 weeks and she has had heavy bleeding that lasts 9-10 days. She does not have a partner currently. She used oral contraceptives when she was younger. She claims that she did not use condoms when she was sexually active. Never had an HIV/AIDS test done. No record of previous sexually transmitted infections or signs of STIs. When she was last teste, four years have elapsed.

Personal/Social History: Never married and does not have any children. Since the age of 20, has lived on her own, and since her father passed away a year ago, they now share a home with their mother and a sister in a single family dwelling in order to support the family. Currently working as a supervisor at Mid-American Copy and Ship for a total of 32 hours per week. She was just elevated to the position of shift supervisor, which she thoroughly enjoys. She attends school on a part-time basis and is currently in her final semester of work toward obtaining a bachelor’s degree in accounting.

She has her sights set on becoming an accountant for the company she currently works for. She is well off as she owns a car, a cellphone and a computer. Even though she is covered by the employer’s basic health insurance, she avoids seeking medical attention because of the out-of-pocket expenses involved. She takes pleasure in socializing with her friends, going to Bible study, being active in the ministry of her church and dancing. Tina has a solid family and social support structure and she is also involved in her local church community. She describes feeling stressed as a result of the death of her father, as well as the responsibilities of her job and education and her financial situation.

She states that coping with the stress has been easy because of her family and the church. No tobacco usage. Cannabis use on an irregular basis between the ages of 15 and 21. She denies ever having used cocaine, methamphetamines, or heroine. Utilizes alcoholic beverages “when out with pals, two or three times a month.” and claims to consume no more than three drinks throughout each occasion. She consumes four beverages containing caffeine and diet soda daily. No foreign travel. No pets. She is not in an intimate relationship currently but she completed a significant monogamous relationship that lasted for three years two years ago. It is in her future intentions to start a family by getting married and having children.

Health Maintenance: The most recent Pap smear was performed in 2014. The last eye exam was conducted when she was a child. The last time she had a dental exam was a couple of years ago. PPD test was negative less than two years ago. No workout. 24-hour diet recall: She admits that she skipped her breakfast the day before and that she normally consumes baked good for breakfast, sandwich for lunch and either meatloaf or chicken for dinner. However, she did not have any of these foods yesterday. Her munchies are either usually either pretzels of French fries.

Immunization History: Regarding immunizations, a tetanus booster shot was administered during the past year; however, a flu shot and vaccine against human papillovirus were not given nor received. She states that she feels that she is up to date on all of her childhood vaccines and that she received the meningococcal vaccine while she was in college. Safety: She does not ride a bike, possesses smoke alarms at home, and always puts on seatbelt whilst driving. Does not use sunscreen. The home has firearms that once belonged to her father and are currently secured in the room used by her parents.

Significant Family History: The mother is 50 years old and has hypertension and high cholesterol. Father died in a car accident a year ago at the age of 58; he has hypertension, high cholesterol, and type 2 diabetes. Brother (Michael, age 25), suffers from obesity Sister (Brittany, age 14) struggles with asthma Grandmother on the maternal side passed away at the age of 73 as a result of stroke; she had a history of hypertension and excessive cholesterol.

Grandfather on the maternal side passed away at the age of 78 as a result of a stroke; he had a history of hypertension and excessive cholesterol. Grandmother on the father’s side is still alive and has hypertension despite being 82 years old. Grandfather on the father’s side passed away at the age of 65 from colon cancer, family history of type 2 diabetes. Negative for mental illness other malignancies, unexpected death, kidney disease, sickle cell anemia, and thyroid disorders. An uncle on the father’s side had a problem with alcoholism.

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

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

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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