Discussion Responses: Building a Health History

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.

 

To prepare:

With the information presented in Chapter 1 of Ball et al. in mind, consider the following:

·        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.

 

 

Discussion Response Assignment

Respond to two of your colleagues using one or more of the following approaches below for the following case scenario:

·        76-year-old black male with disabilities living in an urban setting

 

·        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.

Use 3 scholarly peer-reviewed resources no older than 5 years old as references for each response.

 

First Student Response to Case Scenario:

The patient is a 76-year-old male that is African American. He has disabilities and is living in an urban setting. The goal is to build a complete and thorough health history and prevent any misperceptions or misinterpretations (Ball et al., 2019). This is the first encounter with the patient, and the advanced practice registered nurse (APRN) needs to begin building a relationship with the patient and telling them that you want to know about the patient to help with treatments and that you are available to answer any questions and provide explanations for them. Ask the patient how they would like you to address them. It is important to ask open-ended questions (Ball et al., 2019). Precede by asking them how they are feeling today and what their goal is with this appointment. Holistically, it is essential to ask about their physical, emotional, spiritual, cultural, and psychosocial aspects to their diseases or disorders and how they are coping.

Some cultural considerations when asking questions about diet is to not consider foods as bad or good. Some of the foods that the APRN may consider bad could be cultural food for the patient (Pruski, 2019). The APRN should establish a trusting relationship and explain that they are interested and want to know about their cultural beliefs so together they can develop a treatment plan that meets their holistic lifestyle. Pruski (2019) explains that African Americans may be reluctant to disclose information about their personal or cultural life due to mistrust. Providing specific techniques helps the patient feel heard, comfortable, and supported while getting an adequate history. One technique when speaking with this patient, who is elderly and has disabilities focus on one question at a time, allow time for responses, and speak clearly, slowly, and at a voice level that they can hear (Ball et al., 2019).

Open-ended questions allow patients to give more information about their health, expound on their focus and expectations, and provide a sensation of being heard (Benham-Hutchins et al., 2017). Asking more detailed questions to narrow down the open responses afterward helps keep the interview focused and allows for clarification (Ball et al., 2019). The APRN should position themselves so that the elderly patient can see their face when they are speaking or asking questions (Ball et al., 2019). This patient is elderly and is disabled so speaking slow, clear, and asking if they can hear you ok or if you need to talk softer or quieter helps ensure that they can hear the questions being asked. If they are unable to hear and understand the question, the results can be skewed.

The APRN should focus on the patient while asking questions and not looking through notes, computers, or writing information gives the patient a sense that the APRN is attentive to what they are saying. Allowing time for responses also provides this sensation of having time for them. Together these techniques begin to establish a trusting patient-provider relationship. During a final review with the patient, explain to the patient that they can fill in gaps or misunderstandings that the APRN is saying. The review allows for confirmation of details and the patient to agree with the interpretation of the assessment (Ball et al., 2019).

            This patient is elderly and has a disability, so a functional risk assessment is needed. This assessment is appropriate and determines if the patient is safe and that their needs are being met. The APRN should ask about mobility, activities of daily living (ADL), instrumental activities of daily living (IADL) (Ball et al., 2019). Another instrument that the APRN should use is the Geriatric Depression Scale instrument. This tool is applicable because the patient is at higher risk for depression through the aging process and having disabilities. The instrument has fifteen yes or no questions. Certain questions should be yes, and others should be no. One point is given for each answer that is correctly answered. If the patient’s score is more than five, this points to depression (Ball et al., 2019).

The following are questions targeted directly to the patient for safety risks:

1.       Do you feel happy?

2.       Do you have a support system? How much support do they provide?

3.       Can you tell me your daily routine?

4.       What does your meal preparation and diet consist of?

5.       How do you get meal supplies?

6.       Listing each ADL, ask how these are completed (Independently/needing assistance)?

7.       Ask if they have any financial burdens or hardships? Do you complete your financials?

Questions like these allow the APRN to assess if the patient’s ADLs and IADLS are being met by the patient or others’ assistance. If this does not appear to be met, the APRN can seek out services for the patient.

References

Ball, J., Daines, J., Flynn, J., Solomon, B. & Stewart, R. (2019). Seidel’s guide to physical examination. 9th edu. [MBS Direct]. Elsevier.

Benham-Hutchins, M., Staggers, N., Mackert, M., Johnson, A. H., & deBronkart, D. (2017). “I want to know everything”: a qualitative study of perspectives from patients with chronic diseases on sharing health information during hospitalization. BMC Health Services Research17(1), 529. https://doi-org.ezp.waldenulibrary.org/10.1186/s12913-017-2487-6

Pruski, T. (2019). Cultural awareness for African Americans and health. DC Health Matters. https://wesleyseminary.edu/wp-content/uploads/2019/11/FINAL-CULTURAL-AWARENESS-OF-AFRICAN-AMERICANS-AND-HEALTH-PAGE.pdf

 

Second Student Response to Case Scenario:

Summary of the Interview

            The purpose of a patient interview is to establish or maintain a trusting professional relationship and obtain enough information about the patient to provide safe, effective, patient-centered care (Ball, Dains, Flynn, Solomon, & Steward, 2019). Interview techniques that are supportive of these goals include maintaining appropriate eye contact, body language awareness, active listening, and clarifying communications to ensure. The information obtained should include a thorough subjective patient history, which includes their chief concern, the history of their present illness, past medical history, family history, social history, and a review of systems (Ball, Dains, Flynn, Solomon, & Steward, 2019).

Communication Techniques

Communication with patients should be considerate of their needs and cultural preferences. Providing culturally competent care helps to reduce healthcare disparities, which is imperative to improving patient outcomes. Understanding, respecting, and valuing cultural differences is a vital aspect of promoting patient compliance and encouraging patients to be active participants in their care (Ball, Dains, Flynn, Solomon, & Steward, 2019). The Respect Model offers effective communication techniques that are considerate of cultural differences. This model focuses on establishing a rapport with the patient, being empathetic to their circumstances, offering support as they pursue their health goals, optimizing the patient-provider partnership through effective collaboration, providing education to improve health literacy, cultural sensitivity, and creating a trusting relationship (Ball, Dains, Flynn, Solomon, & Steward, 2019).

Risk Assessment and Targeted Questions

            One risk assessment that should be performed for the 76-year-old Black male with disabilities living in an urban setting is a functional assessment. This focuses on determining how safely and effectively he is able to perform activities of daily living (Ball, Dains, Flynn, Solomon, & Steward, 2019). One question that could be asked is how much difficulty he has with mobility and moving short distances as well as longer distances. A second question that could be asked is whether his disabilities interfere with eating, whether that be grocery shopping, cooking, or the physical act of consuming food (Ball, Dains, Flynn, Solomon, & Steward, 2019).

            A second risk assessment tool that should be utilized in this case is MeTree, which is a program that is completed by the patient through and online format to evaluate their risk for various types of cancer, cardiovascular diseases, and metabolic diseases based on their family health history (Wu & Orlando, 2015). According to a study performed by Deckx, et al. (2015), abnormal risk assessment scores in geriatric primary care patients without a history of cancer are indicative of a greater risk for functional decline and reduced quality of living after 1 year.

 

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Steward, R. W. (2019). Seidel’s guide to

physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

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

van Abbema, D. L., & 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), 1-12. https://doi.org/10.1186/s12875-015-0241-x

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

Wu, R. R., & Orlando, L. A. (2015). Implementation of health risk assessments with family

health history: Barriers and benefits. Postgraduate Medical Journal, 91(1079), 508. https://www.doi.org/10.1136/postgradmedj-2014-133195

 

 

 

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