NURS 6512 Discussion: Building a Health History

NURS 6512 Discussion: Building a Health History

NURS 6512 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.

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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.

*** The assigned patient for this discussion post is a “76-year-old black male with disabilities living in an urban setting.”

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Discussion: Building a Health History

Effective communication is an important component of good interviews with patients from different age groups and diverse backgrounds. Good communication technique is a prerequisite to an effective interview and the proper application of interviewing techniques. Patients are different and so must be treated in their individual capacity with treatment or how they are handled not being generalized. A most important consideration is cultural diversity (McFarland & Wehbe-Alamah, 2019). It is important that the interviewer possess cultural competence and be culturally sensitive for them to be successful in conducting effective interviews with patient. It all begins by establishing a good nurse-patient relationship at the rapport stage and gaining the trust of the patient to enable them open up to you (Ball et al., 2019; Bickley, 2017). The purpose of this paper is to outline the building of a health history in the case of a 76 year-old African American male with disability and living in an urban setting.

The Role of Social Determinants of Health, Interviewing Techniques, and Risk Assessment

My communication and interview techniques for building a health history will differ for each patient depending on their age, ethnicity, gender, and socio-economic status amongst other factors (Ball et al., 2019). For instance, a patient from a minority ethnic community would be very sensitive to the way they are treated compared to the way they perceive the treatment offered to a White person. For this reason, one has to be exceptionally culturally sensitive and competent to avoid offending this patient. The patient in this case is a 76 year-old African American male with disability. This makes him have what I would call triple minority status – old, Black, and disabled.

Because of his age and disability it is obvious that he does not have a sufficient source of income. This is low socioeconomic status which is an important social determinant of health (SDOH). The other SDOH that apply to him are poor and unsanitary living conditions (urban poor) and lack of access to quality healthcare services (Powell, 2016). I would therefore target my questions to these SDOH by seeking to know in a tactful and respectful way their source of income, where they live, and if they have health insurance or not. A risk assessment tool that I find appropriate for this 76 year-old minority patient is the Patient Health Questionnaire or PHQ-9 (Ball et al., 2019). This is because at the old age with a disability and no steady or reliable income as an African American man the risk of depression is very real.

The potential health-related risks for this patient include neurocognitive disorders such as dementia or Alzheimer’s disease due to age, prostate cancer due to both age and gender, cardiovascular disease due to ethnicity since Blacks are at a higher risk of the same than non-Hispanic Whites (Mensah, 2018), and feco-oral infections such as gastro-enteritis (GE) due to unsanitary living conditions.

Targeted Questions

Five targeted questions applicable t this patient that I would ask him include the following:

• Does your family have a history of hypertension, coronary artery disease, or diabetes?

1. Have you ever smoked or drank alcohol?
2. Do you have any form of health insurance?
3. Can you access all the necessary basic amenities where you stay?
4. How many meals do you normally take in a day?

References

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

Bickley, L.S. (2017). Bates’ guide to physical examination and history taking, 12th ed. Wolters Kluwer.

McFarland, M.R. & Wehbe-Alamah, H.B. (2019). Leininger’s theory of culture care diversity and universality: An overview with a historical retrospective and a view toward the future. Journal of Transcultural Nursing, 9(6), 1-18. http://dx.doi.org/10.1177/1043659619867134

Mensah, G.A. (2018). Cardiovascular diseases in African Americans: Fostering community partnerships to stem the tide. American Journal of Kidney Diseases, 72(5), S37–S42. https://doi.org/10.1053/j.ajkd.2018.06.026

Powell, D.L. (2016). Social determinants of health: Cultural competence is not enough. Creative Nursing, 24(1), 5-10. http://dx.doi.org/10.1891/1078-4535.22.1.5