Week 1: Building a Comprehensive Health History

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. NURS 6512 Building a Health History Discussion

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

Learning Resources

Required Readings (click to expand/reduce)

Required Media (click to expand/reduce)

Discussion: Building a Health History

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? NURS 6512 Building a Health History Discussion
• 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. NURS 6512 Building a Health History Discussion

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!

Week 1 Discussion

COLLAPSE

For this week’s discussion, I wanted to select the patient that I have had the least amount of clinical experience with. Therefore, I’ve selected the 4 y.o. biracial male patient currently living with his grandmother in a high-density public housing complex. As a Case Manager, my role is centered around assisting patients with navigating public resources and obtaining referrals for care/services, however, clinically I do not have much experience with children at all.

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Because this patient is so young, my interview would rely heavily on building trust with him and his grandmother as she will be my primary source for information. It would be important to gather a complete health history as well as a social history with specific focus on who lives with the patient and his grandmother, if he is in school or daycare and how many days a week he attends. It is also important to note family relationships as they pertain to the patient, who his primary caregiver is, what active medical issues he has and his immunization history.

As this family currently resides in a high-density public housing unit, I would assess their access to sanitation supplies and personal protective equipment to slow the spread of COVID-19. Public housing residents are uniquely susceptible to COVID-19 because many people work still and are essential workers and have to work through the lockdown (Anderson, 2020). NURS 6512 Building a Health History Discussion

Starting at age 7 years, children can be dependable reporters on aspects of their health (Ball, Dains, Flynn, Solomon & Stewart, 2019). Although this patient is 4, he can still contribute to his assessment if asked age appropriate direct questions. I will rely on his grandmother for the majority of the assessment and health history.

 

The 5 Questions I would Ask My Patient:

1. Who is here with you today?
2. Does anything hurt? Can you point to where?
3. What do you like to do during the day? What’s your favorite thing to do?
4. Can you go to the bathroom by yourself or do you still need help sometimes? Do you have accidents?
5. Is there anyone that makes you feel scared at home?

These are direct, important questions that will help me to understand my patient from his 4 y.o. point of view. For instance, it is explained that he lives with his grandmother, however, he may view her as a mother or other figure. It is important to regard her just as he does.

 

References:

Anderson, C. (2020). Mutual aid fund provides COVID-19 supplies to public housing residents. UWIRE Text.

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.

Read a selection of your colleagues’ responses. NURS 6512 Building a Health History Discussion

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.