NURS 6512 Week 1 Discussion: Building a Health History

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NURS 6512 Week 1 Discussion: 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 assigned by your Instructor.NURS 6512 Week 1 Discussion: Building a Health History

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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?NURS 6512 Week 1 Discussion: Building a Health History
  • 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.NURS 6512 Week 1 Discussion: Building a Health History

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:NURS 6512 Week 1 Discussion: Building a Health History

  • 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.

Rubric Detail

 

Select Grid View or List View to change the rubric’s layout.

Content

Name: NURS_6512_Week_1_Discussion_Rubric

NURS 6512 Week 1 Discussion: Building a Health History

Excellent Good Fair Poor
Main Posting
Points Range: 45 (45%) – 50 (50%)
“Answers all parts of the Discussion question(s) with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources. Supported by at least three current, credible sources. Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.NURS 6512 Week 1 Discussion: Building a Health History
NURS 6512 Week 1 Discussion: Building a Health History
Points Range: 40 (40%) – 44 (44%)
“Responds to the Discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module. At least 75% of post has exceptional depth and breadth. Supported by at least three credible sources. Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
Points Range: 35 (35%) – 39 (39%)
“Responds to some of the Discussion question(s). One or two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Post is cited with two credible sources. Written somewhat concisely; may contain more than two spelling or grammatical errors. Contains some APA formatting errors.
Points Range: 0 (0%) – 34 (34%)
“Does not respond to the Discussion question(s) adequately. Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible sources. Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style.NURS 6512 Week 1 Discussion: Building a Health History
Main Post: Timeliness
Points Range: 10 (10%) – 10 (10%)
Posts main post by Day 3.
Points Range: 0 (0%) – 0 (0%)
N/A
Points Range: 0 (0%) – 0 (0%)
N/A
Points Range: 0 (0%) – 0 (0%)
Does not post main post by Day 3.
First Response
Points Range: 17 (17%) – 18 (18%)
“Response exhibits synthesis, critical thinking, and application to practice settings. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of Learning Objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.
NURS 6512 Week 1 Discussion: Building a Health History
Points Range: 15 (15%) – 16 (16%)
“Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.
Points Range: 13 (13%) – 14 (14%)
“Response is on topic and may have some depth. Responses posted in the Discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
NURS 6512 Week 1 Discussion: Building a Health History
Points Range: 0 (0%) – 12 (12%)
“Response may not be on topic and lacks depth. Responses posted in the Discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.NURS 6512 Week 1 Discussion: Building a Health History
Second Response
NURS 6512 Week 1 Discussion: Building a Health History
Points Range: 16 (16%) – 17 (17%)
“Response exhibits synthesis, critical thinking, and application to practice settings. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. NURS 6512 Week 1 Discussion: Building a Health History
Demonstrates synthesis and understanding of Learning Objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.
Points Range: 14 (14%) – 15 (15%)
“Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.
NURS 6512 Week 1 Discussion: Building a Health History
Points Range: 12 (12%) – 13 (13%)
“Response is on topic and may have some depth. Responses posted in the Discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.NURS 6512 Week 1 Discussion: Building a Health History
Points Range: 0 (0%) – 11 (11%)
“Response may not be on topic and lacks depth. Responses posted in the Discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Participation
Points Range: 5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days.NURS 6512 Week 1 Discussion: Building a Health History
Points Range: 0 (0%) – 0 (0%)
N/A
Points Range: 0 (0%) – 0 (0%)
N/A
Points Range: 0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on three different days.NURS 6512 Week 1 Discussion: Building a Health History
Total Points: 100

Name: NURS_6512_Week_1_Discussion_Rubric

week 1 post

Building a plan of care must start with targeted questioning to gain the most useful and highest yielding information. This information must be obtained in an organized format so that interpretation of the assessment can produce enough information to formulate a holistic treatment plan for the patient. I will be using the Problem-Oriented Medical Record Format which is utilized during an initial assessment to gather the patient’s baseline medical history and current ailments (Ball, 2019)NURS 6512 Week 1 Discussion: Building a Health History. For any acute issues, I will utilize SOAP notes. This tool stands for subjective (the patient’s chief complaint) objective (vital signs, lab work, imaging), assessment (the diagnosis from the provider) and plan (the medical plan of action) (Podder, 2021). These two tools will aid me in treating any acute issues and formulating a comprehensive medical history for my patient.

My interview questions would be patient specific in an effort to drive an individualized treatment plan. This week, my patient is a 35-year-old white male who is morbidly obese with disabilities of unknown origin, and he lives in a rural setting. Although this patient has health deficits, it is less likely that he makes regular health appointments because due to the geographical setting (Singh, 2017)NURS 6512 Week 1 Discussion: Building a Health History. My five targeted questions would be as follows:

  1. Do you have any pertinent past medical history or pertinent family medical history (hypertension, diabetes, cancer, blood disorders, asthma, cardiovascular disease etc)?
  2. What current medications are you taking?
  3. Are you in any pain, and do you have any acute medical problems bothering you today?
  4. What disabilities or deficits do you currently have?
  5. Do you have any allergies to any medications or foods?

I would utilize the information provided during the patient interview process along with basic diagnostic tests (vital signs, CBC, CMP, UA, lipid panel) to formulate an individualized plan of care for the patient. At this point, I would provide education regarding proper nutrition and exercise to manage his obesity. This collaboration is the best approach that will not only improve my patient’s health, it will also improve compliancy.

NURS 6512 Week 1 Discussion: Building a Health History

 

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). chapter 5. In Seidel’s Guide to physical examination an interprofessional approach. essay, Elsevier.

Podder, V. (2021, September 2). Soap notes. StatPearls [Internet]. Retrieved February 28, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK482263/

Singh, G. K., Daus, G. P., Allender, M., Ramey, C. T., Martin, E. K., Perry, C., Reyes, A. A. D. L., & Vedamuthu, I. P. (2017). Social Determinants of Health in the United States: Addressing major health inequality trends for the nation, 1935-2016. International journal of MCH and AIDS. Retrieved February 28, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5777389/

RE: week 1 post

You outlined the  Problem-Oriented Medical Record Format.  However, what specific communication techniques would you use to collect the patient’s health history. Did you identify a risk assessment instrument that would be appropriate for this patient?

RE: week 1 post

i would utilize open ended questions and active listening techniques. i believe that screening this patient for suicide risk would be a great course of action. Sstatistics have shown that 1 in 8  patients with chronic disease are 13 percent more likely to contemplate or attempt suicide ( Onyeka,, 2020). i would utilize questions the tool i would use is  the Ask Suicide-Screening Questions (ASQ) tool. this tool is developed to asses the patents risk for suicide attempt and will allow me the opportunity to intervene for the patients benefits( U.S. Department of Health and Human Services, 2022 ). opening those doors of communication and allowing a patient the opportunity to communicate about the stressors of their illness could yield valuable information for a provider.

NURS 6512 Week 1 Discussion: Building a Health History
References

 

U.S. Department of Health and Human Services. (2022, February 6). Ask suicide-screening questions (ASQ) toolkit. National Institute of Mental Health. Retrieved March 4, 2022, from https://www.nimh.nih.gov/research/research-conducted-at-nimh/asq-toolkit-materials

 

Onyeka, I. N., Maguire, A., Ross, E., & O’Reilly, D. (2020, July 8). Does physical ill-health increase the risk of suicide? A census-based follow-up study of over 1 million people. Epidemiology and psychiatric sciences. Retrieved March 4, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7372180/

Response 2

Thank you for an insightful and informative post. Filipinos have a unique assemblage of consistent ideologies, moral codes, ethical practices, etiquette, and culture. Filipino culture is family-oriented (Choi et al., 2018). I don’t know much about them, but I believe the student ask about birth control because of her environment. In college, many things happen, and due to peer pressure, an individual can easily mess with the decisions they make. According to Wentzel and Ramani (2016)NURS 6512 Week 1 Discussion: Building a Health History, negative peer pressure leads teens in the wrong direction because they can get engaged in drugs, skip school, have sex, and engage in other behaviors that put their health at risk. Also, it makes them insecure about their friendships and the fear of being left alone. Hence, in this scenario, the female might have been forced by her peers to do what she doesn’t like, and she might have been innocent thus asked what birth control is. The five Ps of sexual history is vital because they will enable you to develop an effective care plan, guide her, and offer more information to enhance her knowledge.

References

Choi, Y., Kim, T. Y., Noh, S., Lee, J., & Takeuchi, D. (2018). Culture and family process: Measures of familism for Filipino and Korean American parents. Family Process, 57(4), 1029-1048.

Wentzel, K., & Ramani, G. (2016). Peer Influence on Students’ Motivation, Academic Achievement, and Social Behavior K AT H RY NR. WENTZEL AND K AT HERINE MUENKS. In Handbook of social influences in school contexts (pp. 23-40). Routledge.NURS 6512 Week 1 Discussion: Building a Health History

Discussion: Building a Health History

The patient is an 85-Year-old white female who lives alone. She has no family members to support her while her health is declining. Based on this patient’s factors, such as her age, gender, and ethnicity, the patient needs a respectful and professional approach. Then, the provider should take the patient’s health history, including mental status, language preference, hearing or sight difficulties, cultural, ethnic background, and educational level, to help with choosing which communication strategies to use. Then the provider should start conversing with the client in a simple, slow, and clear way to make the conversation more straightforward understandable. Instead of using complex words, simple word choice is more necessary. The provider should be respectful, use proper titles such as Ms. or Mrs., provide a comfortable atmosphere, avoid rushing, interrupting, and use medical terms during communication (National Institute of Aging, 2017)NURS 6512 Week 1 Discussion: Building a Health History. Using such techniques is because elderly patients have common aging characteristics such as hard of hearing, poor eyesight, joint from arthritis, COPD, diabetes, depression, and dementia (WHO, 2021). Since the client lives alone with no family members, the client is the one who makes medical decisions at this time while her mental health is still sound. The provider should assess the patient’s health belief and availability of advanced directives and living will while obtaining health information from the patient. The provider should determine if the patient’s mental status is safe for the patient lives alone at her age and find out if she is willing to move to other settings such as Nursing Homes or Assisted Living Facilities. The provider should focus on assessing fall risk, mental status, and nutritional assessment. Poor nutrition increases fall risk in elderly patients. Assessment tools such as TUG, Times Up and Go, chair test, and Morse fall risk assessment are excellent assessment tools for geriatric patients (Nail et al., 2020). Five targeted questions I should ask this patient would be about her memory, fall history in the past year, trouble with hearing or vision, weight loss of more than 10 lbs in the past six months, and feelings of sadness or depression (the University of Illinois, n.d.) to gather most needed health information. NURS 6512 Week 1 Discussion: Building a Health History

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References

 

Naim, A. N., Abd-El-Gawad, W. M., & Abou-Hashem, R. (2020). Relationship between malnutrition and different fall

risk assessment tools in a geriatric in-patient unit. Aging Clinical and Experimental Research, 32(7), 1279-1287. doi:http://dx.doi.org/10.1007/s40520-019-01309-0

 

National Institute of Aging. (2017). Talking with your older patient. Tips for improving

communication with older patients. Retrieved

from https://www.nia.nih.gov/health/tips-improving-communication-older-patients#:~:text=Talk%20slowly%20and%20clearly%20in,or%20pick%20up%20visual%20clues.

 

The University of Illinois. (n.d.). Checklist for interviewing and screening older

adults for common problems.

Retrieved on March 1st, 2022, from https://www.med.illinois.edu/depts_programs/sciences/clinical/internal_med/Document/Interviewchecklist.pdf

 

World Health Organization. (2021). Aging and health. From https://www.who.int/news-room/fact-sheets/detail/ageing-and-health#:~:text=Common%20health%20conditions%20associated%20with,%2C%20diabetes%2C%20depression%20and%20dementia.

NURS 6512 Week 1 Discussion: Building a Health History
RE: Discussion: Building a Health History
I agree with you when interviewing an 85 yo. it should be simple, slow, and clear way to make the conversation more straightforward understandable. Instead of using complex words, simple word choice is more necessary. Various appropriate strategies are used to obtain information from the assigned patient in order to develop a good health history. The first method is to establish a positive rapport with the patient. It is vital since patients frequently disclose personal information about themselves in exchange for the trust of the person caring for them. Another option is to respect the patient’s privacy. As a result, for some challenging questions, it is critical to consider privacy. Theeranut, Ninbanphot, and Limpawattana NURS 6512 Week 1 Discussion: Building a Health History(Theeranut, Ninbanphot, & Limpawattana, 2021)Patients grow increasingly vulnerable to various health risks as they get older. I would complete the Function Assessment assessment at each of my patient’s visits because she is an 85-year-old woman who does not have relatives to help her. This instrument allows the doctor to assess a patient’s ability to complete daily activities. Balance issues, which can lead to a fall and a broken bone, difficulty holding objects owing to joint disorders, and how they eat, as the older are more prone to constipation and dehydration, are all health risks that can affect the elderly. When it comes to putting up the safest and most successful treatment plan for this patient, this risk assessment tool can open a lot of doors. The plan includes a wide range of topics.(Ball, 2019). 

 

 

References:

Theeranut, A., Ninbanphot, S., & Limpawattana, P. (2021). Comparison of four pressure ulcer risk assessment tools in critically ill patients. Nursing in Critical Care, 26(1), 48-54.

NURS 6512 Week 1 Discussion: Building a Health History

Ball, E. a. (2019). Physical Examination: An Interprofessional Approach. St. Louis, Missouri: Elsevier.

RE: Discussion: Building a Health History

Excellent summary of the risk assessment for this patient. I agree it is imperative to assess fall risk; preventing falls and fall-related injuries is a public health concern. Falls in the elderly population and the associated medical care cost the U.S. healthcare system $50 billion a year (CDC.gov, 2021). Another resource that could be used to assess this patient’s fall risk is the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) tool. The STEADI tool is an evidence-based algorithm that was designed to allow providers to assess fall risk during each clinical visit, determine risk and execute appropriate interventions and/or referrals (Lohman et al., 2017). This would be helpful information to possess to communicate to the individuals responsible for locating any required resources. Great post!

References

CDC. (2021). Older adult falls. Centers for disease contol and prevention. Retrieved March 3, 2022, from https://www.cdc.gov/falls/index.html

Lohman, M. C., Crow, R. S., DiMilia, P.NURS 6512 Week 1 Discussion: Building a Health History R., Nicklett, E. J., Bruce, M. L., & Batsis, J. A. (2017). Operationalisation and validation of the stopping elderly accidents, deaths, and injuries (steadi) fall risk algorithm in a nationally representative sample. Journal of Epidemiology and Community Health, 71, jech–2017-209769. https://doi.org/10.1136/jech-2017-209769

Week One Initial Health History

Health History

Building a health history is an important concept in healthcare because it gives accurate and detailed information about the patient health and family history. Certain factors can influence the patient’s health, such as age, gender, ethnicity, and environment. Automated medical history taking can improve the quality of care and increase patient satisfaction; patients can document their medical history without any interference or time constraints, and H.C.P.s can prepare for consultations in a time-efficient manner (Nilsson et al., 2021)NURS 6512 Week 1 Discussion: Building a Health History.

Communication and Interviewing

This week’s post is about a 35-year-old white male with a history of morbid obesity with disabilities in a rural setting. The patient is called Mr. S. He arrived at the clinic for his appointment, and the provider introduced himself to the patient and established a rapport with the patient. The provider will ask open-ended questions such as How are you feeling today? The open-ended questions allow the patient to talk about his health problems instead of a yes or no answer. Mr. S. will be able to elaborate on his health concerns. The provider will use effective communication techniques by listening to the patient without interrupting him and making good eye contact. Effective doctor-patient communication is a prerequisite for a successful and robust healthcare delivery system. It helps the doctor earn the patient’s trust and confidence and improves patients’ overall satisfaction and compliance with treatment (Baitha et al., 2019)NURS 6512 Week 1 Discussion: Building a Health History. The next phase of the interview is past medical history, family history, social and personal history.

Target Questions for Building Health History and Social Determinants

Social determinants relating to health care include low income, poverty, illiteracy, and racism. These factors play a major role in health care, leading to healthcare inequities. However, poor education, lack of access to healthcare, affordable food, unsafe communities, and other underlying determinants has much broader effects (Fielding et al., 2017). The provider will ask the patient-specific questions about his living conditions, employment, activities of daily living, food sources, and transportation. The health information is acquired by the nurse practitioner (NP) during a health assessment, and it is part of the social health history. The N.P. will ask the patient personal health questions, for instance:

  1. Do you smoke, drink alcohol, or take illegal drugs?
  2.  How is your home life, and do you have adequate running water, heating, and air?
  3. Do you have adequate transportation, or do you ride the city transportation services?
  4. What do you do for a living?NURS 6512 Week 1 Discussion: Building a Health History

The Risk Assessment

Mr. S.’s social determinant has impacted his overall health, and he has limited access to healthcare, employment, and food. He has unhealthy eating habits, which contribute to morbid obesity. He lives in a rural area with a corner store with adequate well-balanced meals or fruits and vegetables. He goes to the corner store to purchase his food because he has no transportation, and the store sells a lot of processed food and junk food. The healthcare professional can discuss with Mr. S. ways to improve his disabilities in a rural area and weight management. The provider referred the patient to the nutritionists for weight management and meal planning.

The provider will ask the patient-specific questions about his activities of daily living, and do you have trouble bathing, dressing, walking, or feeding yourself?NURS 6512 Week 1 Discussion: Building a Health History Mr. S., have you fallen within the last six months? The patient replied, yes, I have trouble walking, bathing, and dressing, and I am out of breathing just completing these simple tasks. Do you have trouble climbing stairs? He replied yes. The best risk assessment tool for this patient is the functional risk assessment tool because the patient has difficulty climbing stairs, dressing, walking, and bathing himself. Risk assessment is a precision medicine technique that can enhance population health when applied to prevention. Several barriers limit the uptake of risk assessment in health care systems, and little is known about the potential impact of systematic risk assessment for screening and prevention in the primary care population (Orlando et al., 2020). The fall risk assessment can also be used because he has fallen within the last six months. Falls and loss of autonomy are often attributed largely to musculoskeletal impairments in adults (Johnson et al., 2021).

Identify Potential Health-Related Risk

Mr. S. has several factors which contribute to an unhealthy lifestyle and inadequate food supply, which causes him to be morbidly obese. Obesity can lead to diabetes, heart disease, and hypertension. Given that obesity is linked to several health concerns, including heart disease and diabetes, national efforts have been formed to reduce obesity rates among these populations (Sadhu et al., 2020)NURS 6512 Week 1 Discussion: Building a Health History. The patient ethnicity and environmental setting influence obesity. Rising obesity rates among adults are linked to increased food insecurity, lower median household income, and lower perceived health status (Sadhu et al., 2020).

Described Five Targeted Questions

  1. What brings you to the clinic today?NURS 6512 Week 1 Discussion: Building a Health History
  2.  What are your health concerns?
  3. What kind of symptoms or problems do you have today?
  4. When did the problem start, and how long have you had this specific problem?
  5. Where is the pain located, and is it dull, aching, or sharp pain, and what makes the pain better or worse?

 

 

Conclusion

The patient’s health history and interview are vital tools for finding the root cause of a particular problem or illness and using specific risk assessment tools. The patient’s past and current health history can help the provider make a diagnostic evaluation of the problem.NURS 6512 Week 1 Discussion: Building a Health History

 

References

 

Baitha, U., Ranjan, P., Sarkar, S., Arora, C., Kumari, A., Sada, N. D., . . . Jamshed, N. (2019).

Development of a self-assessment tool for resident doctors’ communication skills in india. Journal of Educational Evaluation for Health Professions, 16 doi: http://dx.doi.org/10.3352/jeehp.2019.16.17

Fielding, Jonathan E, MD, M.P.H., M.B.A., & Teutsch, Steven,M.D., M.P.H. (2017). Social

determinants of health: Building wide coalitions around well-honed messages. American Journal of Public Health, 107(6), 870-871. doi: http://dx.doi.org/10.2105/AJPH.2017.303794

Johnson, N. F., Hutchinson, C., Hargett, K., Kosik, K., & Gribble, P. (2021). Bend Don’t break:

Stretching improves scores on a battery of fall assessment tools in older adults. Journal of Sport Rehabilitation, 30(1),NURS 6512 Week 1 Discussion: Building a Health History 78-84. doi: http://dx.doi.org/10.1123/jsr.2019-0246

Nilsson, E., Sverker, A., Bendtsen, P., & Eldh, A. C. (2021). A human, organization, and

technology perspective on patients’ experiences of a chat-based and automated medical History–Taking service in primary health care: Interview study among primary care patients. Journal of Medical Internet Research, doi: http://dx.doi.org/10.2196/29868

Orlando, L. A., Wu, R. R., Myers, R. A., Neuner, J., McCarty, C., Haller, I. V., . . . Ginsburg, G.

S. (2020). At the intersection of precision medicine and population health: An implementation-effectiveness study of family health history based systematic risk assessment in primary care. B.M.C. Health Services Research, 20, 1-10. doi: http://dx.doi.org/10.1186/s12913-020-05868-1NURS 6512 Week 1 Discussion: Building a Health History

Sadhu, R., Souza, M., & Borges, C. (2020). The effect of food insecurity on the prevalence of

adult obesity in new jersey counties. European Journal of Public Health, 30 doi: http://dx.doi.org/10.1093/eurpub/ckaa166.231

RE: Week One Initial Health History-

Your discussion post is very informative and educational.  For you assigned patient a  35-year-old white male with a history of morbid obesity with disabilities in a rural setting. A primary objective is to discover the details about a patient’s concern, explore expectations for the encounter, and display genuine interest, curiosity, and partnership. Identifying underlying worries, believing them, and trying to address them optimizes your ability to be of help. You need to understand what is expected of you. If successful, the unique and intimate nature of the interview and physical examination will be reinforced. You will savor frequent tender moments with patients when you recognize that your efforts are going well and that trust is there. We want to help ensure those moments occur.Much has been written about technology replacing the history and physical examination in some part, but personal- ized care of patients goes far beyond the merely technical. Appropriate care satisfies a need that can be fully met only by a human touch, intimate conversation, and the “laying on of hands.” Personal interactions and physical examination play an integral role in developing a meaningful and therapeutic relationships with patients (Kugler and Verghese, 2010).NURS 6512 Week 1 Discussion: Building a Health History

Flexibility, respect, and confidentiality are key; otherwise, little productive discussion will result. On occasion, the patient may ask to talk with someone of the same gender, and this should be facilitated if possible.Open-ended conversations about home, school, jobs,activities, and friends can suggest the areas that may trouble the adolescent (e.g., sex, drugs, bullying, suicidal ideation). Talk does not always flow easily as the adolescent transitions from dependency to independency, from parent/guardian to peer group, and ultimately to self, but you can help.

References:

Kugler J, Verghese A: The physical exam and other forms of fiction, J Gen Intern Med 25(8):756–757, 2010.

Goldenring JM, Rosen DS: Getting into adolescent heads: an essential update, Contemp Pediatr 21(1):64–90, 2004.

 

RE: Week One Initial Health History-NURS 6512 Week 1 Discussion: Building a Health History

I agree that the primary objective is that the patient needs be addressed during the health assessment to improve patient outcomes and eliminate the patient’s fears and concerns. It is plausible that health is improved, for a given clinical quality, when patients report better experience with access to primary care and interactions with primary care staff (Feng & Gravelle, 2021).

Effective communication can help improve patient-to-physician relationships and restore a trusting relationship with healthcare professionals. Effects of healthcare technologies on outcomes are partially mediated by improved communication with physicians and nurses (Buckman et al., 2022).

NURS 6512 Week 1 Discussion: Building a Health History

References

Buckman, J. R., Woutersen, T., & Hashim, M. J. (2022). Avoidable mortality: The mediating

role of communication in health IT. Decision Support Systems.

https://doi.org/10.1016/j.dss.2022.113764

Feng, Y., & Gravelle, H. (2021). Patient Self-Reported Health, Clinical Quality, and Patient

Satisfaction in English Primary Care: Practice-Level Longitudinal Observational Study. Value in Health, 24(11), 1660–1666. https://doi.org/10.1016/j.jval.2021.05.019

RE: Week One Initial Health History-

Thank you for your post. Your research on the importance of medical history to providing quality care is incredible. Every healthcare practitioner gathers medical history from the patient or the patient’s family members to create an effective treatment plan that will promote health conditions, minimize chronic health issues and address acute health problems (Kim, 2020). You have clearly outlined an excellent technique of obtaining objective data by clinicians. Additionally, subjective data reported by the patient regarding signs and symptoms is critical. At times, subjective data provide information that others cannot quickly notice but is provided by the patient (Voukelatou et al., 2021).NURS 6512 Week 1 Discussion: Building a Health History

Your choice of target questions will help in the in-depth assessment of the patient. The general questions will provide adequate data on the social health history of the patient, which will later be used in health risk assessment. A patient’s history should always come first for clinicians and other healthcare professionals to provide quality care.

References

Kim, K. Y. (2020). A case of ingested multiple magnetic beads: the importance of suspicion based on medical history. Pediatric Emergency Medicine Journal, 7(1), 41-44.DOI:

10.22470/pemj.2020.00080

Voukelatou, V., Gabrielli, L., Miliou, I., Cresci, S., Sharma, R., Tesconi, M., & Pappalardo, L. (2021). Measuring objective and subjective well-being: dimensions and data sources. International Journal of Data Science and Analytics, 11(4), 279-309.DOI: 10.1007/s41060-020-00224-2

WEEK 1 DISCUSSION.NURS 6512 Week 1 Discussion: Building a Health History

Main Post

Building a Health History

Communication is very crucial in healthcare and life. According to Shea (2016), effective communication is needed to transmit knowledge and information from one person to another and relate to each other through relationships, organizations, and families. Therefore, in healthcare, effective and successful communication helps in enhancing strong therapeutic interpersonal relationships with our clients, which is the main component that enhances the development of positive clinician-patient relationships Kornhaber et al. (2016). Moreover, therapeutic interpersonal relationships transform and boost the patient experience; clinicians must develop a rapport with their clients, especially during their first encounter.NURS 6512 Week 1 Discussion: Building a Health History

According to Ball et al. (2019), a first impression is vital during the first meeting with clients because it determines the successful outcome of the partnership between patients and the practitioner. At this stage, the clinician informs the patient of their role as practitioners, which is to be flexible open and to address and explain any concerns that they may have.NURS 6512 Week 1 Discussion: Building a Health History

Interview and Communication Techniques

The patient is an 85-year-old white woman living alone with no family in declining health.

Older people without families have diminished capacity and cannot adequately take good care of themselves as they age. In most instances, they may not be able to drive, walk, on performing basic activities; thus, it becomes even difficult for them to arrange and attend important doctor’s appointments.

Since the patient is all alone, there is privacy and confidentially from the start because we are all alone, giving us room to discuss her health and how she has been fairing. Starting the interview relaxed enables the patient to describe her daily experiences and activities Ball et al. (2019)NURS 6512 Week 1 Discussion: Building a Health History. Thus, this is a crucial technique. Secondly, making the patient comfortable by giving her a comfortable seat will enable her to feel relaxed as we help in filling the forms where necessary. Therefore, they must get help in exam rooms, offices, restrooms, and waiting rooms thus should be checked often. Another technique is to build good rapport whereby I introduce myself and speak at least at a slow pace as I explain my role so that the patient can share their concerns because I have shown interest.

Besides, I will not rush her because older adults tend to have an issue following rapid-fire questioning or much information. Therefore, speaking slowly will help her process what is asked and said. It will also help me gather the information that aids in improved cooperation and treatment. Finally, demonstrating empathy with old patients enhances patient satisfaction, understanding, and adherence to treatment.NURS 6512 Week 1 Discussion: Building a Health History

Reasons for Selecting these Techniques

The use of effective communication techniques helps in building more satisfying relationships with older patients. Thus it will aid me in becoming more skilled at managing the care of older adults, improving their health outcomes, and strengthening the patient-provider relationship.

Risk Assessment Tool

The risk assessment tool that will benefit her is ‘The Katz ADL scale.’

‘Katz ADL scale’ is a tool used to assess the functional status of the client’s ability to perform activities of daily living independently. It assesses the major primary and psychosocial functions such as bathing, dressing, going to the toilet, transferring, feeding, and continence (Pashmdarfard and Azad, 2020). Therefore, this tool is vital in monitoring the prognosis and treatment of older adults’ chronically ill people.NURS 6512 Week 1 Discussion: Building a Health History

Five Targeted Questions to Ask the Patient

Home Environment

  1. Can you tell me about your home environment and whether or not there are any safety concerns

Activities of Daily Living

  1. Tell me how you manage your daily activities as you need help in shopping, cooking, finances, and home maintenance

Safety issues

  1. How do you cope with financial vulnerability, exploitation, falls, and driving concerns

Medical and Health Issues

  1. How do they cope with chronic conditions that require monitoring and medication while all alone

Legal and Financial issues

  1. How do they cope since, at their age, they lose the capacity to manage certain types of financial or legal affairs

NURS 6512 Week 1 Discussion: Building a Health History

 

 

 

 

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.

Kornhaber, R., Walsh, K., Duff, J., & Walker, K. (2016). Enhancing adult therapeutic interpersonal relationships in the acute health care setting: an integrative review. Journal of multidisciplinary healthcare, 9, 537.

Pashmdarfard, M., & Azad, A. (2020). Assessment tools to evaluate Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) in older adults: A systematic review. Medical journal of the Islamic Republic of Iran, 34, 33.NURS 6512 Week 1 Discussion: Building a Health History

Shea, S. C. (2016). Psychiatric interviewing E-Book: The art of understanding: A practical guide for psychiatrists, psychologists, counselors, social workers, nurses, and other mental health professionals. Elsevier Health Sciences.

RE: WEEK 1 DISCUSSION.

Thank you for sharing your strategies to assess this patient. I agree with you that good communication is one of the most critical aspects of developing a trusting relationship with patients to reach the optimal patient outcome. I like all your communication strategies, such as ensuring privacy, providing comfortable environments, and speaking slowly. Additional communication techniques include facing the patient directly to assist with communication if the patient is a lip reader and using simple words instead of medical terms or complex expressions (National Institute of Aging, 2017).NURS 6512 Week 1 Discussion: Building a Health History

Additionally, there are Morse’s fall risk assessment (Agency for Healthcare Research and Quality, 2021) and Mini-cog test (Alzheimer’s Association, n. d ) to assess mental status and fall risk, the most common health-related risks for elderlies. I have always used these two assessment tools for initial assessment with elderly patients, and results were useful, time saving and straight forward from my own experience.

 

References

 

Agency for Healthcare Research and Quality. (2021). Preventing falls in hospitals. From https://www.ahrq.gov/patient-safety/settings/hospital/fall-prevention/toolkit/morse-fall-scale.html

 

Alzheimer’s Association. ( n.d.). Medical tests for diagnosing Alzheimer’s. Retrieved on March 4th, 2022, from https://www.alz.org/alzheimers-dementia/diagnosis/medical_tests?#mental

 

National Institute of Aging. (2017). Talking with your older patient. Tips for improving

Communication with older patients. Retrieved

from https://www.nia.nih.gov/health/tips-improving-communication-older-patients#:~:text=Talk%20slowly%20and%20clearly%20in,or%20pick%20up%20visual%20clues.

 

RE: WEEK 1 DISCUSSION.

Good discussion post overall; however, please consider that not all elderly patients that live alone without families have diminished capacities. Some actually are very active, independent, contribute to their communities, and have developed relationships with friends. I actually see elderly patients in my practice that meet these criteria. It is important that we do not stereotype our patients. NURS 6512 Week 1 Discussion: Building a Health History

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RE: WEEK 1 DISCUSSION.

Response 2

Good morning!  This is a very enlightening post to read on this Saturday, and I especially liked the part where you thought of the financial aspect of it.  Many elderly patients who receive care at home rely on unpaid family members to help them (Johnson & Wang, 2019).  Unfortunately, this elderly adult has no family, so if they need help at home it will come with a price.

Sometimes as healthcare professionals we feel that elderly patients are frail and need help, and that assumption is not always accurate.  This patient may have diminished health, but we should not assume that she needs assistance.  It is important to recognize that some elderly patients keep their same abilities through the aging process and offering help when they do not need it can be offensive (Ball, et. al., 2019).

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination (9th ed.). Mosby.

Johnson, R. W., & Wang, C. (2019). The financial burden of paid home care on older adults: Oldest and sickest are least likely to have enough income. Health Affairs, 38(6), 994–1002. https://doi.org/10.1377/hlthaff.2019.00025

NURS 6512 Week 1 Discussion: Building a Health History
RE: WEEK 1 DISCUSSION.

I feel that the risk assessment tool of Katz ADL scale that you chose for this patient is a great place to start. In order to determine how to help this patient, it is important to ask the questions that you listed such as how she is managing ADLs as well as medications. And building rapport with this patient is vital so that she will be comfortable confiding in you. Ideally she will talk to you about how she functions day to day, if she is involved in any social activities as well as things that she enjoys doing to pass the time. There is a home health agency where I live that offers a senior companion program. The way this works is via referrals. For instance in the case of this patient, such a program may be an option for her. There are also online resources and ways to apply for an elderly companion program. A companion program would allow for her to have some assistance if needed but also a friend (“AmeriCorps Seniors Senior Companion Program”, 2022)NURS 6512 Week 1 Discussion: Building a Health History. She could even choose male or female that would just allow her a friend to check on her frequently, go grocery shopping with her or for her, garden with her or sit and watch tv with her. I feel that this is a great resource for elderly patients that are living alone and without family. In home nursing to provide medication set ups may also be an option depending on her level of functioning and independence (Hoyt, 2022). I think with the information given, your plan of communication would be effective in learning exactly what the patient’s needs are.NURS 6512 Week 1 Discussion: Building a Health History

References

AmeriCorps Seniors Senior Companion Program. AmeriCorps. (2022). Retrieved 5 March 2022, from https://americorps.gov/serve/fit-finder/americorps-seniors-senior-companion-program.

Hoyt, J. (2022). Growing Old Without Family | Elder Orphans Aging Without Family Support. SeniorLiving.org. Retrieved 5 March 2022, from https://www.seniorliving.org/health/aging/no-family/.

RE: WEEK 1 DISCUSSION, reply

Nice post. Communication drives the transfer of knowledge as well as daily activities. I thought your risk assessment tool to be effective but your questions seemed general to me. Instead of asking how she gets around, one could ask her point blank if she lives in a one story house, or has stairs. Does she drive? She might have friends that help her out. The practitioner could set her up to see a case manager through the county where she lives to help her with ADLs and perhaps meals on wheels. I think it paramount to see if she is mentally stable and cognizant of her surroundings. She may need to be moved to an assisted living facility. NURS 6512 Week 1 Discussion: Building a Health History

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PRAC 6540: Advanced Practice Care of Older Adults Practicum NRNP 6540 Week 1 Discussion : Assessment of Older Adults
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