response to health assessment

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.

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

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.

1- Respond to colleague one scenario:

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

The patient in the assigned scenario is described as a 76-year-old African American male with disabilities living in an urban setting. Having a detailed health history and physical exam can help practitioners to make appropriate healthcare decisions that improve patient outcomes. Advanced Practice Nurses must use interview and communication techniques that are specific to the patient being interviewed. Establishing a positive patient relationship depends on communication built on courtesy, comfort, connection, and confirmation (Ball, Dains, Flynn, Solomon, & Stewart, 2019).

Interview and Communication Technique

For this interview it is best to use the patient centered interview technique. While it is important to utilize traditional clinical interview techniques, it is best practice to include both traditional and patient centered interview techniques. Having a patient-centered interview technique has been associated with higher patient satisfaction, improved compliance and outcomes (Lappen, 2011). Interviewing those who are aging can be challenging. Although the patients may or may not be effective historians, practitioners must always respect them and remember that their perspectives and attitudes matter (Ball et al., 2019). When interviewing elderly patients’ practitioners must consider the cognitive and physical changes that occur with aging. Although consideration of disabilities is important, one must not assume that all older adults experience the same changes, at the same rate, and some abilities may not decline with age (Ball et al., 2019). Communication techniques must also be tailored to meet the physical or sensory impairments of the patient. For example, those with hearing loss would benefit from interviewers speaking clearly, slowly, and always facing the patient while talking (Ball et al., 2019).

Risk Assessment

For the geriatric population it is especially important to perform risk assessments. Risk assessments identify conditions from the history and physical examination or circumstances that threaten the wellbeing of the patient (Ball et al., 2019). For this patient a functional assessment tool would be utilized. This tool is best to use to assess the needs of aging patients who are limited by disease or disability. Functional assessments aim to understand the patient’s ability to achieve basic activities of daily living (Ball et al., 2019). Geriatric Screening tools can also be used in conjunction with other risk assessment tools to provide valuable information and prompt physicians to consider different aspects of functioning (Deckx, et al., 2015).

Targeted Questions

As part of the interview, the advanced practiced nurse may ask targeted questions of the patient. These questions will be asked as part of the assessment to help practitioners understand risk, gather a strong health history, and guide care. For this patient the following questions will be asked: How have you been feeling, is there anything that has been going on that has caused you concern or pain? Tell me about your medical history, do you have in chronic diseases such as High Blood Pressure? Have you been prescribed medication, for any chronic diseases? If so, are you able to take them as prescribed? Having any side effects?

Do you need help from others to perform everyday activities such as eating, getting dressed, grooming, bathing, walking, or using the toilet? Do you have a family member or friend that helps take care of you or that lives close by? Do you feel safe in your current home? Have you had any recent falls?

Colleague 2 Scenario:

Adolescent Hispanic/Latino boy living in a middle-class suburb

Accurate health assessment is vital to gather information about patient health issues and determine the patient's risk. Practical communication skills assist in collecting the correct data that is needed to treat the patient holistically. The case that will be assessed in this discussion is building the health history of a Hispanic/Latino boy living in a middle-class suburb. Adolescence is a challenging time for children as they go through different events ranging from hormonal, emotional, physical, and environmental change. It is not unusual to witness some teens being overwhelmed by these change that seems uncontrollable to them (Doukrou & Segal, 2018). Before starting the health assessment, the provider should acknowledge some issues that can be on the ground. Some of those issues are language barriers, peers pressure, risky and unhealthy behaviors.

At the beginning of the assessment, this nurse will make sure there are no language barriers. If there are any barriers, an interpreter service should be used to bridge that gap per facility protocol. The utilization of professional interpreters affects the quality of care provided to patient that has language barriers. According to Hu (2018), the patient's parents should be educated on the necessity of conducting the assessment without their presence for privacy issues. The Hispanic culture should be considered as most parents have language barriers and rely on their kids to do well in school to assist them to live well in American society.

Risk Assessment Tool

The assessment tool that will be utilized in this case is the "HEEADSSS screening tool for adolescents" (Ball et al., 2019, p.18). The areas of focus are as follows

• Home environment

• Education, employment

• Eating

• Activities (peer-related), affect, ambitions, anger

• Drugs

• Sexuality

• Suicide/depression

• Safety from injury and violence

(Ball et al., 2019, p. 18)

The HEEADSSS assessment tool allows the provider to cover all areas of concern in a nonjudgmental manner. The assessment tool will detect risky behavior and address challenges that can be present by promoting conversation (Smith & McGuinness, 2017). The assessment allows prescreening questions that allow the teens to write some issues that the teen finds uncomfortable addressing verbally. (Smith & McGuinness, 2017).

Target questions

Five target questions that will be asked for health story building are as follows

1-Tell me about your living situation, do you feel safe at home?

2-Tell me about your school how is your grade looking like?

3-What do you normally do with your friend for fun? How will you describe your overall mood?

4-Do you know anyone that uses drugs or alcohol? Have you ever used any illegal drug or drink alcohol with your friends?

5- Are you sexually active? How often do you have sex? Do you protect yourself during sex?

The provider will use the template offered by the HEEADSSS screening tool to formulate open-ended questions. The use of prescreening questionnaire will help the teen that can be shy to put in writing information that he does not feel comfortable verbalizing.