Discussion: NURS 6512 Building a Health History

Discussion: NURS 6512 Building a Health History

Thanks for your interesting and thorough response.  The patient has a number of poor health choices that are reinforcing his angina.  Part of the assessment could be to determine if the patient understands that his nicotine use is contributing to his angina and whether the patient is motivated to quit.  Sadly the patient may value smoking more than the quality of his health and may be determined to make no changes.  Contrarily we may discover the patient feels helpless in his ability to quit tobacco, but strongly desires to, and we may be able to provide options for cessation.

Kaufman et al. (2020), offers a useful article on using interview questions to measure a patient’s perceived risk of smoking.  In this case the patient has a worsening cardiac condition that is causing pain and contributing to a low quality of life.  It would be useful to understand how the patient perceives smoking in relation to their poor health and if that could be a motivator for change.  Below are examples of general questions that could be used in a provider health assessment to determine the patient’s perception of their own risk. 

“If you continue smoking the same number of cigarettes every day, how likely do you think it is that you will…,” 

“If you stay quit, how likely do you think you will…,” 

“If you never start smoking, how likely do you think you will…”

This could then give opportunity for health teaching and referral to/prescribing of cessation options.  For example, nicotine patches or cognitive behavior therapy for smoking cessation.  Importance of using specific language, for example, harm versus cancer versus lung cancer is emphasized by the authors.  People are more likely to rate their risks higher if language is more specific and will provide more motivation to change behaviors.  Additionally there may be a large difference in how people perceive the risk of smoking in general (to the general population) and to themselves. 

The authors state a general trend of overestimating risk to the general population and underestimating their own risk.  What also can be useful to assess the patient’s perception of their risk is to pull in questions from the affective domain (involving their values), for example using the question “how worried are you that you will ….” based on a scenario where the patient does not quit smoking.  The article is a useful one to download for future use.  If we ever have an assignment where we have to design a comprehensive interview the suggestions the authors make are quite adaptable to a wide range of health topics.

Olenik and Mospan (2017) provides a summary of various tools that may help the interviewer determine how motivated a patient will be to quit smoking.  For example, the Transtheoretical Model for Readiness to Change would suggest that when a patient is not ready to quit smoking questions like stated previously can be used to ascertain if gaps in knowledge exist (precontemplation stage).  We can then provide accurate information so the patient can make an informed decision.  Whereas if the patient is motivated to quit (preparation stage) the practitioner may help the patient actively order cessation measures.  In this case the patient’s experience of angina may be sufficient motivation to want to quit.  The article also offers a summary on the pharmacological options available.  A useful tool for those interested in health promotion with patients who smoke and to look at individual options more closely.  For example the safety and efficacy of bupropion as a smoking cessation tool.  

 

References 

Kaufman, A., Twesten, J., Suls, J., McCaul, K.,  Ostroff, J., Ferrer. R., Brewer, N., Cameron, L.,  Halpern-Felsher, B., Hay, J., Park, E., Peters, E., Strong, D., Waters, E., Weinstein, N., Windschitl, P., Klein, W. (2020).  Measuring Cigarette Smoking Risk Perceptions.  Nicotine & Tobacco Research, 22(11), 1937-1945.

Olenik, A. & Mospan, C.  (2017).  Smoking cessation:  Identifying readiness to quit and designing a plan.  American Academy of Physician Assistants, 30(7), 13-19.

Adolescent white male without health insurance seeking medical care for STI.
With every patient being unique in their own way makes communication strategies different as well. Knowing that individual illness is influenced by factors like age, gender, ethnicity and environmental settings calls for a provider to be sensitive to these aspects. (Ball, et, al 2019). With my patient being adolescent white male without health insurance seeking medical care for STI calls for my attention in building a trust from my patient so that I can determine the best way to treat him.

This will be achieved by exploring his concerns, exploring the expectation of his
encounter in terms of treatment and how confidential his visits will be kept. Also
identifying any underlying worries that he might have will be explored by asking him if the answers and mode of treatment were satisfactory and if there were any other areas that he wanted to explore in detail which could be how does one get STD and ways to avoid contracting STDs.

With this visit, chances to provide education about STD will be provided which will begin by emphasizing to this patient that our conversation will be kept confidential. I will be keen to notice any body language gestures or any hesitancy to answer questions as I should be aware according to (Liu, et, al, 2022) that there will be occasions that I will experience silence and at times sheepish conversations might prevail during the visit.

The risk assessment instrument that will be used with my patient’s scenario is the
five Ps of sexual history. According to (Ball, et, al, 2019) the five Ps stands for
partners, practices, protection from STIs, past history of STIs and prevention.
Some of the health-related risks based on this patient’s age group and gender
according to (Widman, et, al 2018) could be peer pressure, poor school
performance, nonparticipation in school extracurricular activities like sports and
finally susceptibility to the internet and social media during and after school which could be the reason why the patient contracted STD.

Some of the questions that will be asked to assess his health risk according to

(Ball, et, al,2019) include number and variety of partners, protections used against STI, sexually transmitted disease history, STI knowledge, their feelings and thought after getting STD, how many sexual partners have you had so far, how did you feel after finding out you had STD? what measures are you thinking that will help you in reducing chances of getting STD in the future, does your partner know that she/he has STD? if so has she had treatment? Future safer sex practices.

Reference,

Liu, H., Ke, W., Chen, H., Liang, C., & Yang, L. (2022). The perceptions of sexuality
and sexually transmitted diseases (STDs) among adolescent STD patients: A

qualitative study. Journal of Pediatric Nursing, 66,
e54–e60. https://doi.org/10.1016/j.pedn.2022.05.018

Links to an external site.
Widman, L., Golin, C. E., Kamke, K., Burnette, J. L., & Prinstein, M. J. (2018).
Sexual Assertiveness Skills and Sexual Decision-Making in Adolescent Girls:
Randomized Controlled Trial of an Online Program. American Journal of Public
Health, 108(1), 96–102. https://doi.org/10.2105/AJPH.2017.304106

Links to an
external site.
Ball, J., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019).
In Seidel's Guide to Physical Examination: An interprofessional approach (pp. 7–19).
essay, Mosby.

Click here to ORDER NOW FOR AN ORIGINAL PAPER ASSIGNMENT:   Discussion: NURS6512 Building a 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

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?
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

Next Module

To go to the next module:

Module 2

Module 2: Functional Assessments and Assessment Tools

What’s Happening in This Module?

Module 2: Functional Assessments and Assessment Tools is a 2-week module, Weeks 2 and 3. In this module, you consider the impact of functional assessments, diversity, and sensitivity in conducting health assessments. You also explore various assessment tools and diagnostic tests that are used to gather information about patients’ conditions and examine the validity and reliability of these tests and tools. Finally, you examine assessment techniques, health risks and concerns, and recommendations for care related to patient growth, weight, and nutrition.

What do I have to do?
When do I have to do it?
Review your Learning Resources.

Days 1–7, Weeks 2 and 3

Discussion: Diversity and Health Assessments

Post by Day 3 of Week 2, and respond to your colleagues by Day 6 of Week 2.
Case Study Assignment: Assessment Tools and Diagnostic Tests in Adults and Children
Submit your Case Study Assignment by Day 6 of Week 3.
DCE: Health History Assessment
You are encouraged to work on your DCE every week. However, this Assessment is not due until Day 7 of Week 4.

Go to the Module’s Content

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 symptoma