BUILDING A HEALTH HISTORY: COMMUNICATING EFFECTIVELY TO GATHER APPROPRIATE HEALTH-RELATED INFORMATION

BUILDING A HEALTH HISTORY: COMMUNICATING EFFECTIVELY TO GATHER APPROPRIATE HEALTH-RELATED INFORMATION

To prepare:

• Reflect on your experience as an advanced practice nurse and on the information provided in the Week 1 Learning Resources on building a health history and the Week 2 Learning Resources on diversity issues in health assessments.
• By Day 1 of this week, your Instructor will assign a case study for this Assignment. Note: Please see the Course Announcements section of the classroom for your Case Study Assignment.
• Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of your assigned patient.
• Consider how you would build a health history for the patient. What questions would you ask? How might you target your questions based on the patient’s social determinants of health? How would you frame the questions to be sensitive to the patient’s background, lifestyle, and culture?
• Identify any potential health-related risks, based on the patient’s age, gender, ethnicity, or environmental setting, which should be taken into consideration.
• What risk assessment instruments would be appropriate to use with this patient?
• What questions would you ask to assess the patient’s health risks?
• Select one (1) risk assessment instrument discussed in the Learning Resources, or another tool with which you are familiar, related to your selected patient.
• Develop five (5) targeted questions you would ask the patient to build their health history and to assess their health risks.
• Think about the challenges associated with communicating with patients from a variety of specific populations. What communication techniques would be most appropriate to use with this patient? What strategies can you as an APRN employ to be sensitive to different cultural factors while gathering the pertinent information?

Assignment: Building a Health History With Cultural and Diversity Awareness  

Include the following:

• Explain the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. Be specific.
• Explain the issues that you would need to be sensitive to when interacting with the patient, and why.
• Describe the communication techniques you would use with this patient. Include strategies to demonstrate sensitivity with this patient. Be specific and explain why you would use these techniques.
• Summarize the health history interview you would conduct with this patient. Provide at least five (5) targeted questions you would ask the patient to build their health history and to assess their health risks. Explain your reasoning for each question and how you frame each for this specific patient.
• Identify the risk assessment instrument you selected, and then justify why it would be applicable to your assigned patient. Be specific.

Building a health history: Effective communication in gathering appropriate health information

The purpose of constructing a patient-centered health history is to comprehend the demographic, social, cultural and spiritual characteristics of individual patients and their means of expressing themselves. Because of these patients’ individual characteristics, it is crucial for the APRN to adapt his/her communication style in order to build trust and obtain the necessary health information. When it comes to WH, a recent immigrant Chinese male aged 62 with low English language proficiency, culturally sensitive strategies are obligatory. WH’s cultural heritage, the language, and the organization of his family, where he had to count on his daughter for translation and support, are all aspects that define his health care process. Therefore, while implementing the communication strategies such as professional interpretation, the APRN has to put into consideration the above factors and the effects of culture on building a health history. This approach will improve the nurse-patient relationship and help WH follow the recommended treatment and long-term health goal.

Socioeconomic, Spiritual, Lifestyle, and Cultural Factors

Socioeconomic status of WH depends on his living standards as well as family strength. Living alone after the death of his spouse, having an adult daughter and a 13-year-old grandchild as caretakers may also negatively impact his ability to manage his health. His daughter complained that her father does not want anyone to look after him. That could be a generational or cultural issue. It is imperative to understand that conventional Chinese mindsets usually involve the family-centered approach to caregiving as well as the reluctance to impose children. Due to WH’s limited English proficiency, communication barriers in access to health care services are enhanced, which might result in poor compliance with medical advice, medical instructions, and follow-up on taking of his medications.

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Religious beliefs may also determine WH’s health choices and routines. Some modern Chinese people place their faith in both Buddhism and Taoism, although the Confucianism is also quite popular there. These belief systems may encourage natural healing practices and even regard diseases as the lack of harmony in the energy of the body (de Vries et al., 2019). Knowledge of WH’s beliefs, which are majorly of spiritual nature, could help explain why he would agree to embrace Western medicine practices, while he may prefer traditional products such as herbs. It is also possible that he has certain cultural beliefs regarding diet, and the type of food that he should eat without compromising on the traditional Chinese foods and how they might influence his hypertension.

Sensitive Issues in Interaction

There are several issues of a rather sensitive nature that should be taken into consideration during communication with WH. First, cultural sensitivity is important, in such Asian cultures as Chinese and Japanese where older people are highly regarded. Lack of respect or perceived arrogance on the side of the healthcare providers may result in loss of trust and lack of compliance (de Vries et al., 2019). Also, WH may experience his ailment as a private affair, which may make him resist the disclosure of information.

One must also consider the possible social implication/stigma of always depending on his daughter in translation. Since his daughter is a bi-lingual young woman who stands in for his medical decisions, WH may feel ‘ashamed’ to discuss issues like mental health or sexuality/physical health complaints. Due to patient self-determination, it might be relevant to offer WH a chance to talk alone in case this is required. Moreover, it can be posited that WH may not understand how exactly to manage such conditions as hypertension in a Western context that necessitates a gentle counsel.

Communication Techniques and Sensitivity

When dealing with WH, it is crucial to consider cultural and language barriers to ensure that appropriate communication methods are used. Firstly, seeking the services of a medical interpreter rather than depending on his daughter would assist in avoiding distortion of the conversation and violation of the patient’s privacy. This approach is consistent with the general principles of minimization of medical errors and development of effective communication (Magsamen-Conrad et al., 2019).

Culturally sensitive nonverbal communication is also crucial, especially in the initial stages to establish a common ground. This means avoiding informal language with WH, avoiding unnecessary eye contact, as well as addressing WH formally by either his last name or ‘Mr.’ until he allows the use of his first name to build a rapport.

Also, it would be easier to understand information that does not include any medical terms that WH might not understand. Strategies like teach back, where WH is expected to repeat what has been said to him in order to be certain that he has understood the message would ensure that vital health information is relayed well. He may also require other visualization aids and writing documents in his preferred language to comprehend instructions on treatment.

Health History Interview

When conducting a health history interview with WH, general information about his health and well-being that would be sought include his current state of health, social support, lifestyle and cultural practices. Whenever speaking to him, respect and patience should be observed for the time required in the interpretation while bearing in mind his cultural origin. The five target questions are as follows;

Target Questions

1. How have you been feeling since you started the pressure medications?

This question enables WH to provide insight into new treatment he has been undergoing. Presenting the question in such a direct and basic way makes the patient answer freely and allows to evaluate medication compliance and possible side effects.

2. What do you know about your current state of hypertension and its management?

This question is useful in ascertaining the level of health literacy and knowledge that WH has about his condition. It would facilitate the education process because cultural beliefs or language barriers would be considered.

3. What questions do you have concerning your current medications or the traditional remedies that you are using?

This question embraces the possibility of WH using traditional Chinese medicinal component and opens up a chance to address the combination of his Chinese practices with the Western treatments.

4. What feeling do you have pertaining your daughter’s effort of helping you in healthcare?

This question touches on issues to do with family and cultural beliefs on the aspects of independence and being cared for by relatives. It can help investigate any resistance that WH may have towards it.

5. Do you have any food or practice in mind that you would like us to integrate in your treatment plan?

This is an aspect of cultural competence and will assist in establishing factors related to his hypertension concerning diets without compromising WH’s culturally appropriate values.

Risk Assessment Instrument

Considering the case of WH, the Framingham Risk Score (FRS) would be appropriate to apply since it is a well-known tool for estimating the probability of cardiovascular disease occurrence (Nyirenda, 2021). Since WH has hypertension and could have other cardiometabolic risk factors in the future due to diet and physical activity, then the FRS could assist in optimizing further management. More importantly, the constituents of the identified tool’s screening including hypertension, cholesterol, smoking, and diabetes tally with WH’s cardinal cardiovascular issues.

In a recap, establishing a complete health history for WH has to encompass his cultural, economic, and language barriers. With the help of appropriate and polite language, the use of professional translators, and correct wording of questions, an appropriate rapport between the patient and the provider is made. understanding and incorporating the cultural factor into nursing care together with an appropriate risk assessment will enhance the client’s health and compliance with the plan of care.

References

de Vries, K., Banister, E., Dening, K. H., & Ochieng, B. (2019). Advance care planning for older people: The influence of ethnicity, religiosity, spirituality and health literacy. Nursing Ethics, 26(7-8), 1946-1954. https://doi.org/10.1177/0969733019833130

Magsamen-Conrad, K., Dillon, J. M., Billotte Verhoff, C., & Faulkner, S. L. (2019). Online health-information seeking among older populations: family influences and the role of the medical professional. Health communication, 34(8), 859-871. https://doi.org/10.1080/10410236.2018.1439265

Nyirenda, M. (2021). Assessment of cardiovascular disease risks using Framingham risk scores (FRS) in HIV-positive and HIV-negative older adults in South Africa. Preventive medicine reports, 22, 101352. https://doi.org/10.1016/j.pmedr.2021.101352