NURS 6512 Advanced Health Assessment and Diagnostic Reasoning

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NURS 6512 Advanced Health Assessment and Diagnostic Reasoning

I was assigned Case E: Adolescent Hispanic/Latino boy living in a middle class suburb for this discussion. I will discuss how my communication and interview questions will differ with my patient, how I will target history taking questions based on social status, what risk assessment tools or questions will be used, identify health related risks based on age and socioeconomic status, select one risk assessment tool related to the patient, and develop five targeted health questions specific to my patient to develop a health history. NURS 6512 Advanced Health Assessment and Diagnostic Reasoning

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According to Ball, Drains, Flynn, Solomon, and Stewart (2019, pg. 17), adolescents are often reluctant to talk and seek confidentiality. I would make sure to enter the room acknowledging the patient first in order to build a trusting relationship, if an adult is present. It is important for me to talk to the patient in private to guarantee all history is obtained honestly and accurately, so I would inform the parent or caregiver that a portion of the exam needs to be conducted in private. I would avoid confrontational questions and offer support to my patient so that he can freely discuss his health history with me. There are several questionnaires that can be completed by the patient prior to the exam so that I will know the patient’s needs and cares.

Ball, Drains, Flynn, Solomon, and Stewart (2019, pg. 18) list adolescent concerns including bedwetting, concern with height, concern with penis size, worry about sexual preference, concern about gender identity, interpersonal violence, sex, HIV, AIDS, gambling, smoking, substance use and abuse, parents’ attitudes and demands, friends and their pressures, bullying, school, future, and suicidal ideation. I would target these questions to collect a history using an unforced approach. It is best to ask open-ended questions to avoid judgement. NURS 6512 Advanced Health Assessment and Diagnostic Reasoning

Screening tools for adolescents include HEEADSSS, PACES, and CRAFFT. According to Smith and McGuinness (2017), the HEEADSSS screening tool is a way to freely discuss concerns with an adolescent focusing on home, education/employment, eating, activities, drugs and alcohol, sexuality, suicidality, and safety. PACES is a screening tool concerning parents, peers, accidents, alcohol and/or drugs, cigarettes, emotional issues, school, and sexuality. The CRAFFT screening tool identifies concerns involving substance use and abuse. Knight, Shrier, Bravender, Farrell, Bilt, Shaffer, Kelly, O’Grady, Gryczynski, Mitchell, Kirk, and Schwartz (2017) state that the CRAFFT tool is effective in screening for substance abuse in adolescents and should be used to address care and preventative teaching topics.

All of the above mentioned screening tools would be appropriate to use with my patient since he is an adolescent male living in the middle class suburbs, but I would begin with the HEEADSSS Risk Assessment since he is Hispanic. It is important to discuss the home environment and get the most detailed risk assessment, and I believe HEEADSSS addresses all areas adequately and appropriately. NURS 6512 Advanced Health Assessment and Diagnostic Reasoning

Five targeted questions I would ask my patient include the following: Tell me about your living situation. How are things at home? How are things at school? Tell me about your friends and what you do when you are together. What are you good at? I believe these five questions will help me determine what areas I need to focus on the most as long as the patient is willing to discuss these matters with me in an honest way.

I conclude that it is important to conduct the history taking portion of my [patient’s exam in private, so that topics can be discussed honestly. It is also important that I ask open-ended questions in a non-threatening way, so that the patient feels safe discussing the matters with me. I think the HEEADSSS risk assessment tool will give me the most information specific to my patient. I discussed five open-ended questions that would help me successfully conduct the history taking portion of my exam specific to my patient’s age and social status. NURS 6512 Advanced Health Assessment and Diagnostic Reasoning

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.

Knight, J. R., Shrier, L. A., Bravender, T. D., Farrell, M., Bilt, J. V., Shaffer, H. J., Kelly, S. M., O’Grady, K. E., Gryczynski, J., Mitchell, S. G., Kirk, A., & Schwartz, R. P. (2017). CRAFFT Questions. Substance Abuse, 38(4), 382–388.

Smith, G. L., & McGuinness, T. M. (2017). Adolescent Psychosocial Assessment The HEEADSSS. JOURNAL OF PSYCHOSOCIAL NURSING AND MENTAL HEALTH SERVICES, 55(5), 24–27. https://doi-org.ezp.waldenulibrary.org/10.3928/02793695-20170420-03

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 Advanced Health Assessment and Diagnostic Reasoning

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

Assignment: Course Acknowledgement

This mandatory assignment is an acknowledgement that you fully understand the course guidelines.

By Day 3 of Week 1

Submit your Assignment.

Submission and Grading Information

Submit Your Assignment by Day 3 of Week 1.

To complete this assignment, follow the link below and answer the questions provided. NURS 6512 Advanced Health Assessment and Diagnostic Reasoning

Week 1 Assignment

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 Advanced Health Assessment and Diagnostic Reasoning

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?
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 Advanced Health Assessment and Diagnostic Reasoning

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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:

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.

As future advanced practice registered nurses (APRNs), it is important to understand every patient is unique. Every patient expresses different health concerns and needs. Their health is influenced by genetics, age, environments, education, lifestyle choices and more. When establishing a patient relationship, effective communication skills are essential. APRNs must also use appropriate communication skills for every patient. This will allow APRNs and patients to develop positive relationships. The purpose of this discussion is to provide communication skills and risk assessment tools used with the 14-year-old patient.

Meeting the patient for the first time is an important moment as it determines the tone of the patient relationship (Ball et al., 2019). The patient is a 14-year-old biracial male who lives with his grandmother in a high-density public housing complex. Providers caring for adolescents must use appropriate communication skills and consider what they endure during that time period. Adolescents are enduring many changes, physically, emotionally, mentally, and socially. During adolescence, teenagers are exposed to risky behaviors and mental health concerns develop (Thompson et al., 2016). By thoroughly assessing adolescents and implementing prevention strategies, providers can help decrease risky behaviors and mental health concerns (Ginsburg, 2001). This validates the importance of health risks assessments.

When talking to the patient, they may be hesitant to share their thoughts (Ball et al., 2019). As their provider, one must communicate it is a safe place and their boundaries will be respected. If a patient is pushed too much, they may shut down and not want to talk. Providers should also give adolescents the opportunity to share things in private (Ball et al., 2019). At times, adolescents may not want their parents/guardians to know some things. These techniques would be used to build trust and a positive relationship with the patient.

The HEEADSSS is an adolescent screening tool that helps identify issues (Ball et al., 2019). It is a screening tool that address the home environment, education, employment, eating, activities, drugs, sexuality, suicide/depression, and safety from injury and violence (Ball et al., 2019). It HEEADSSS screening tool addresses many factors that significantly impact an adolescents life. It is also simple to remember. Below are the five targeted questions this author would use:

How are things at school?
What do you do at home?
What do you like to do for fun?
Are you in a relationship?
Tell me about your friends.

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 Mosby.

Ginsburg, K. R. (2001). Setting the stage for effective communication with the adolescent patient.

Common Health, 25 – 27. https://www.aiha.com/wp-content/uploads/2015/07/25-Setting-the-Stage-for-Effective-Communication-with-the-Adolescent-Patient.pdf

Thompson, L. A., Wegman, M., Muller, K., Eddleton, K. Z., Muszynski, M., Rathore, ., De Leon, J., &

Shenkman, E. A. (2016). Improving adolescent health risk assessment: A multi-method pilot study. Maternal & Child Health Journal, 20, 2483 – 2493. https://doi.org/10.1007/s10995-016-2070-5.

response

Great post. I agree with your method to collect an accurate health history, the risk assessment used, and your five target questions are appropriate for the patient’s age. According to Ball, Drains, Flynn, Solomon, and Stewart (2019, pg. 17), adolescents are often reluctant to talk and seek confidentiality. I would make sure to enter the room acknowledging the patient first in order to build a trusting relationship, if an adult is present. I would avoid confrontational questions and offer support to my patient so that he can freely discuss his health history with me. Ball, Drains, Flynn, Solomon, and Stewart (2019, pg. 18) list adolescent concerns including bedwetting, concern with height, concern with penis size, worry about sexual preference, concern about gender identity, interpersonal violence, sex, HIV, AIDS, gambling, smoking, substance use and abuse, parents’ attitudes and demands, friends and their pressures, bullying, school, future, and suicidal ideation. I would target these questions to collect a history using an unforced approach. It is always best to ask open-ended questions to avoid judgement. NURS 6512 Advanced Health Assessment and Diagnostic Reasoning

Screening tools for adolescents include HEEADSSS, PACES, and CRAFFT. According to Smith and McGuinness (2017), the HEEADSSS screening tool is a way to freely discuss concerns with an adolescent focusing on home, education/employment, eating, activities, drugs and alcohol, sexuality, suicidality, and safety. I agree that the HEEADSSS risk assessment would be the proper tool to use with this patient. I would ask more questions related to the patient’s home environment, since he lives in high-density public housing. Some examples include: Tell me about your living situation. How are things at home? How are things at school? What do you and your friends do when you are together?

In my own experience with pediatric patients, I have noticed that adolescents in high-density living situations often engage in risky behaviors. Make sure to address all areas including substance use and abuse. It is best to educate the patient on a variety of different situations related to his age and living arrangements to prevent risky behavior. I think you did a great job covering this in your initial post.

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.