Building a Health History Discussion Essay
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?
- 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.
My patient is a 76-year-old black male with disabilities living in an urban setting. To begin my interview, after knocking on the door and getting his permission to enter, I would formally address the patient followed by introducing myself by name and my role in his care. If he is accompanied by anyone, it would be important to courteously ask their relationship to the patient and establish their degree of participation. Before I begin the interview process, I would ask my patient if he will be okay with their presence in the room during the interview. As I begin the interview process, it would be important to assess the patient for any potential communication barriers, such as difficulty hearing, seeing, and understanding basic questions.
The communication techniques I would use are giving the patient good eye contact, my full attention, and I would adjust my volume to ensure that the communication is effective and allow ample time for the patient to talk about his concerns without interrupting. I fully understand that I will need to establish trust with my patient. (Hansen et al., 2016) reports that current research continues to show that African American patients report that they are less valued by health care providers, that providers consider their illnesses as less deserving of treatment, and that a lower standard of health care is routinely provided to them.
Because of his age and history of disabilities, I would use the fall risk assessment and identify which stage of the assessment he is in. One third of adults 65 and older fall each year in the United States, and among the elderly, falls are the leading cause of injury-related death (Sirkin & Rosner, 2015).
The five patient-centered questions I would ask him would be: What is your understanding of your diagnosis? Do you believe treatment will help? Are you troubled by financial questions about your medical care? Do you have anyone that you can talk to about your illness? How are you coping with your illness? The latter question would be important in the event the patient drinks alcohol or uses any substances to cope. According to (Assari et al., 2019), smoking and drinking may serve as coping mechanisms with financial difficulty, especially among African American older adults.
References
Assari, S., Smith, J., Mistry, R., Farokhnia, M., & Bazargan, M. (2019). Substance use among economically disadvantaged african american older adults; objective and subjective socioeconomic status. International Journal of Environmental Research and Public Health, 16(10), 1826. https://doi.org/10.3390/ijerph16101826
Hansen, B. R., Hodgson, N. A., & Gitlin, L. N. (2016). It’s a matter of trust. Journal of Applied Gerontology, 35(10), 1058–1076. https://doi.org/10.1177/0733464815570662
Sirkin, A. J., & Rosner, N. G. (2015). Hypertensive management in the elderly patient at risk for falls. Journal of the American Academy of Nurse Practitioners, 21(7), 402–408. https://doi.org/10.1111/j.1745-7599.2009.00418.x
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.
Responses
Thank you for the informative discussion post, I enjoyed reading it. It is interesting learning about how to do interviews and health histories for our patients as advanced practice registered nurses (APRNs). There are many ways to do them, and it is very important to identify the age groups and cultural diversity of our patients, as well as their living arrangements and healthcare needs.
When addressing the culture of the patient, it is important to learn and be sensitive to the patient’s age (male who is elderly at 76-years-old), heritage, socioeconomic status (potentially poverty if the gentleman is disabled), ethnicity (African American), and cultural background. It is also important to address cultural humility, or the ability of the provider to see their own ability to open to new perspectives and reflect on knowledge limitations rather than assuming stereotypes about the patient’s culture or background. By doing so, the relationship between provider and patient becomes more balanced and beneficial (Ball et al., 2019). Culture plays an important role in the daily lives of people, and it is very important to not only be respectful, but to incorporate it into our care of the patient and to be sensitive and understanding of their overall needs. African American culture can also influence all aspects of the person’s life, and it would be important to address things such as family integrity, to see if the elderly gentleman in this scenario lived independently or was involved with a family or guardian. For example, things like access to social activities, senior centers for meals, and even reminiscing with fellow African American elders at a family reunion are all important ways that an African male elder might feel valued, appreciated and help stave off depression and anxiety during the aging process (McCoy, 2020). In any culture, family means a great deal, and it would be important to ensure that this gentleman had family and loving support, especially as he has disabilities and may need extra care and assistance with access to healthcare, even in an urban setting.
Elderly disabled patients may require more complex health care and the assistance of additional resources for the APRN to use, as well. It is important to assess things such as speech, vision, gait, and whether the patient has the proper assistive devices. Addressing if the patient lives independently with family or has a guardian who can accompany them to appointments is crucial. Ensuring their safety at all times, especially if mentally or physically disabled, is a must. With this patient, the importance of a comprehensive geriatric assessment (CGA) is shown to be also an important risk assessment tool in addition to the fall risk assessment. Core components of the CGA include assessment of functional capacity, cognition, mood, polypharmacy, advance care preferences, nutrition, urinary continence, vision/hearing, dentition, living situation, and activities of daily living (ADLs), to name a few (Ward & Reuben, 2020). There is so much to think about and assess with elderly and disabled patients as an APRN.
Again, you did a great job with your discussion post this week, and I look forward to reading more posts from you. I hope that you have a great holiday weekend, and good luck this quarter!
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.
McCoy, R. (2020). African American elders, cultural elders, cultural traditions, and the family reunion. https://generations.asaging.org/african-american-elders-traditions-family-reunion
Ward, K. T. & Reuben, D. B. (2020). Comprehensive geriatric assessment. UptoDate. Retrieved September 3, 2021, from https://www.uptodate.com/contents/comprehensive-geriatric-assessment#H7
Response 2
thank you for your discussion post, I enjoyed reading your take on gaining a health history for this population. I have been a labor and delivery nurse my entire career, so this perspective was very informing. After reviewing some literature, I found similar data, in relationship to how the male African American population believe they have been received by the healthcare system. Rightly so, this has greatly influenced their trust and acceptance of support and recommendations regarding their own health.
Connell et al. (2019), noted that many African American men believe that historically, they have not been treated well, have experienced racism, oppression or even harm related to accepting help from healthcare providers. Overcoming this historic and factual belief is a challenge to all providers and should be recognized as an obstacle to improving the health of this population. Systemic racism is real and is a detriment to the health of our population. It is essential for providers to understand the extent that this negative history has impacted so many people. According to Noonan et al, (2016), African Americans are the least healthy group of people in our country. The lasting effects of racism in this country can start to be mitigated by healthcare providers who understand the sensitive nature of our work and move forward with purposeful efforts that will eliminate this health disparity.
References
Connell, C. L., Wang, S. C., Crook, L. S., & Yadrick, K. (2019). Barriers to healthcare seeking and provision among african american adults in the rural mississippi delta region: Community and provider perspectives. Journal of Community Health, 44(4), 636–645. https://doi.org/10.1007/s10900-019-00620-1
Noonan, A. S., Velasco-Mondragon, H. E., & Wagner, F. A. (2016). Improving the health of African Americans in the USA: An overdue opportunity for social justice. Public Health Reviews, 37(1). https://doi.org/10.1186/s40985-016-0025-4
