Building A Comprehensive Gynecologic Health History Assignment Paper

Components of a Comprehensive Gynecologic Health History

According to De Nicola et al. (2022), a comprehensive gynecologic health history encompasses various components. It is imperative to consider special populations, including LGBTQ+ individuals for a well-woman appointment. The components include:

1. Demographic Information:

1. 1. Name, age, ethnicity, and sexual orientation.
   2. LGBTQ+ considerations: Affirming language and open-ended questions to ensure inclusivity (Wingo et al., 2018)Building A Comprehensive Gynecologic Health History Assignment Paper.
      

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1. Menstrual History:

1. 1. Menstrual cycle regularity, duration, and flow.
   2. LGBTQ+ considerations: Explore menstrual experiences in transgender individuals (Wingo et al., 2018).

1. Obstetric and Gynecologic History:

1. 1. Number of pregnancies, deliveries, and complications (Schuiling & Likis, 2020).
   2. Gynecologic surgeries and outcomes.
   3. LGBTQ+ considerations: Address unique needs like fertility concerns for same-sex couples.

1. Contraceptive History:

1. 1. Current and past contraceptive methods.
   2. Satisfaction with current methods.
   3. LGBTQ+ considerations: Discuss contraceptive options relevant to sexual practices.

1. Sexual History:

1. 1. Number of sexual partners, sexual practices, and satisfaction (Schuiling & Likis, 2020).
   2. History of sexually transmitted infections (STIs).
   3. LGBTQ+ considerations: Open discussion about sexual health in LGBTQ+ individuals.

1. Screening and Prevention:

1. 1. Pap smear history, mammogram screenings, and vaccinations (Gardasil).
   2. LGBTQ+ considerations: Tailor screening recommendations based on individual risk factors (Wingo et al., 2018)Building A Comprehensive Gynecologic Health History Assignment Paper.

1. Menopausal History:

1. 1. Age of menopause onset, symptoms, and management.
   2. LGBTQ+ considerations: Address specific concerns like hormone replacement therapy in transgender individuals (Wingo et al., 2018).

1. Social Determinants of Health (SDOH):

1. 1. Housing stability, transportation, and neighborhood safety.
   2. Experiences of racism, discrimination, and violence.
   3. Education, job opportunities, and income.
   4. Access to nutritious foods and physical activity opportunities.
   5. Environmental factors like air and water quality.
   6. Language and literacy skills.

Health Maintenance Guidelines:

1. Initial assessments should include baseline screenings like Pap smears, mammograms (based on age and risk factors), bone density tests, and relevant vaccinations (American Academy of Family Physicians, 2021).
2. Follow-up assessments should consider the frequency of screenings, addressing any abnormalities found in previous tests, and adjusting preventive measures based on changing health needs (Schuiling & Likis, 2020)Building A Comprehensive Gynecologic Health History Assignment Paper.

Building a Health History: Asking Difficult Questions – Script

Introduction

“Hello, I will be guiding you through our well-woman appointment today. Confidentiality is paramount in our discussions. My primary goal is to provide personalized care that meets your unique needs.”

Menstrual and Reproductive History

“Let us begin by discussing your experiences with your menstrual cycle. This insight is crucial for understanding your reproductive health. For LGBTQ+ individuals, it is essential to cover aspects related to your sexual and reproductive well-being to ensure our care is comprehensive. Can you share details about the regularity, duration, and any concerns related to your menstrual cycle?”

Contraceptive and Sexual History

“Now, let us talk about contraception and your sexual experiences. I understand these topics may be sensitive, but an open conversation is critical to tailoring the most suitable care. Are you currently using any contraceptive methods? If you are comfortable, please share your sexual history. You can include the number of partners, and any concerns you might have.” Building A Comprehensive Gynecologic Health History Assignment Paper

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STI History

“Moving on, discussing STIs is a routine part of our health history. Your honest responses are crucial for guiding us in providing appropriate preventive measures. Have you had any sexually transmitted infections in the past, and do you believe you are currently at risk? Please feel free to share any concerns you may have regarding STIs.”

Social Determinants of Health

“As we explore social determinants of health, I would like to gain insights into various aspects of your life. This includes your living situation, experiences with discrimination, educational and job opportunities, and access to healthy foods and physical activity. Understanding these factors is vital as they significantly affect your overall well-being. Can you provide information on your current living conditions, any instances of discrimination, and your access to education, job opportunities, nutritious foods, and physical activity?”

Reflection on Building a Health History Script

Experiences in Script Development and Implementation

Writing the script for gathering a health history was exciting and challenging, especially when it included asking difficult questions. The goal was to start a conversation that considers each patient’s individual needs while also promoting openness and trust.

Finding the ideal balance between professionalism and empathy was the first difficulty. It takes considerable effort to write language that is both sensitive and educational. Using the script in a simulated health history scenario made it clear how important it is to pace and modify the conversation according to the patient’s comfort level. The script served as a guide, ensuring that no critical aspect of the health history was overlooked. Building A Comprehensive Gynecologic Health History Assignment Paper

Difficulties Encountered and Insights Gained

Determining the patient’s level of comfort during conversations concerning their sexual and reproductive history was one significant challenge. Since these are naturally personal topics, the difficulty is establishing a setting where the patient feels comfortable disclosing personal information. It became evident that building rapport and projecting a nonjudgmental attitude were essential prerequisites for the implementation to be successful.

They realized the importance of using inclusive language and acknowledging various perspectives, which led to new insights. Although the script took LGBTQ+ issues into account, it was clear that self-education regarding the changing healthcare scenario for these people is essential. Healthcare professionals must maintain a constant state of awareness regarding the varied requirements of their communities to practice cultural competency. Building A Comprehensive Gynecologic Health History Assignment Paper

Areas for Improvement

Looking back, there are sections in the script that would improve the patient-provider relationship more if they placed more of an emphasis on building rapport before asking delicate questions. More candid discussion could be facilitated by a longer initial phase that focuses on making the patient feel comfortable. Incorporating more open-ended inquiries may also encourage patients to speak candidly about their issues.

NP Community Initiatives for Social Determinants of Health

As a Nurse Practitioner, community engagement is pivotal for addressing Social Determinants of Health (SDOH). Implementing resources and assistance programs can significantly impact community well-being:

1. Educational Initiatives: Develop workshops and seminars in the community to raise awareness about SDOH. This could include information on housing stability, discrimination, and access to education and job opportunities (Gomez et al., 2021).
2. Collaboration with Local Organizations: Establish partnerships with local organizations to provide resources such as job training, affordable housing programs, and support for those facing discrimination (Holt-Lunstad, 2022).
3. Healthcare Access Points: Ensure that healthcare facilities in the community are accessible and culturally sensitive. This includes providing information in multiple languages and offering services that consider the unique needs of diverse populations (Holt-Lunstad, 2022)Building A Comprehensive Gynecologic Health History Assignment Paper.
4. Nutrition and Physical Activity Programs: Introduce community gardens, nutrition education programs, and physical activity initiatives to address disparities in access to nutritious foods and opportunities for exercise (Gomez et al., 2021).

References

American Academy of Family Physicians. (2021, August). Adult preventive health care schedule: recommendations from the USPSTF. Links to an external site. American Family Physician. https://www.aafp.org/dam/AAFP/documents/journals/afp/USPSTFHealthCareSchedule2021.pdf

DeNicola, N., Grossman, D., Marko, K., Sonalkar, S., Tobah, Y. S. B., Ganju, N., … & Lowery, C. (2020). Telehealth interventions to improve obstetric and gynecologic health outcomes: a systematic review. Obstetrics and gynecology, 135(2), 371. https://doi.org/10.1097/aog.0000000000003646

Gomez, C. A., Kleinman, D. V., Pronk, N., Gordon, G. L. W., Ochiai, E., Blakey, C., … & Brewer, K. H. (2021). Practice full report: addressing health equity and social determinants of health through healthy people 2030. Journal of Public Health Management and Practice, 27(6), S249. https://doi.org/10.1097%2FPHH.0000000000001297

Holt-Lunstad, J. (2022). Social connection as a public health issue: The evidence and a systemic framework for prioritizing the “social” in social determinants of health. Annual Review of Public Health, 43, 193-213. https://doi.org/10.1146/annurev-publhealth-052020-110732

Schilling, K. D., & Likis, F. E. (2020). Gynecologic Health Care: With an Introduction to Prenatal and Postpartum Care: With an Introduction to Prenatal and Postpartum Care. Jones & Bartlett Learning.

Wingo, E., Ingraham, N., & Roberts, S. C. M. (2018). Reproductive Health Care Priorities and Barriers to Effective Care for LGBTQ People Assigned Female at Birth: A Qualitative Study. Women’s Health Issues, 28(4), 350–357. https://doi.org/10.1016/j.whi.2018.03.002 Building A Comprehensive Gynecologic Health History Assignment Paper

Much of an archeologist’s work is done under the mantra “proceed with caution.” Archeologists must dutifully secure permissions to access sites. They also must exercise extreme caution when excavating or analyzing in a lab to avoid potential damage to historical artifacts.

Likewise, nurse practitioners must proceed with caution when building a patient’s health history. Important questions can be difficult for both nurse and patient. Care must be taken to approach such questions with dignity, tact, and respect to create an environment conducive to productive conversations.

More importantly in today’s society, the possible Social Determinants of Health for each of our patient’s also needs to be taken into consideration

For this Assignment, you will develop a make-believe script to be used when you first encounter a patient for a well woman appointment.

To prepare:

• Review the screening tools found in the Learning Resources and consider how you might use an app or tool to assist in screening.
• Review the media programs related to a vaginal exam, pap test, and breast exam.
• Review the health history guide presented in Chapter 7 of the Schilling & Likis (2022) text and consider how you would create your own script for building a complete health history. (Note: You will also find the Health History Form in Chapter 7)
• Provide all the components of a complete gynecologic health history. Include considerations for special populations such as LGBTQ+ individuals.
• What health maintenance guidelines should be included for initial and follow up might be needed for follow-up assessments?  (i.e., bone density test, Gardasil vaccine, pap smear, Mammogram, etc.)?
• Using the 5 areas of the Social Determinants of Health:
  (Examples of SDOH include but not limited to)
  • Safe housing, transportation, and neighborhoods
  • Racism, discrimination, and violence
  • Education, job opportunities, and income
  • Access to nutritious foods and physical activity opportunities
  • Polluted air and water
  • Language and literacy skills
  • SDOH also contribute to wide health disparities and inequities.
  • What questions would you consider in your patient’s complete health history? Building A Comprehensive Gynecologic Health History Assignment Paper
• Develop your own script for building a complete health history and as you create your script, consider the difficult questions you want to include in your script. There is no sample template to provide to you. (Utilize chapter 7 of your Schilling textbook to provide guidance). You are the one to develop the script. Think of it as you are writing a movie and you need to write the script for the movie. What lines would you provide for the actor to utilize when sitting down with a patient to perform a COMPLETE Medical History which also entails those DIFFICULT GYN questions. You do not need to provide the answers to the questions however, if you find that beneficial, you may do so.

Assignment: (1- to 2-page reflection)

• In addition to your script for building a health history for this assignment, include a separate section called “Reflection” that includes the following:
  • A brief summary of your experiences in developing and implementing your script during your health history.
  • Explanations of what you might find difficult when asking these questions. What you found insightful and what would you say or do differently.
  • As a NP, what could you implement in your community to provide resources/assistance of the Social Determinants of Health.

Reminder Links to an external site.: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting. Building A Comprehensive Gynecologic Health History Assignment Paper

RESOURCES:

• Schuiling, K. D., & Likis, F. E. (2022). Gynecologic healthcare (4th ed.). Jones and Bartlett Learning.
  • Chapter 6, “Gynecologic Anatomy and Physiology” (pp. 87–98)
  • Chapter 7, “Gynecologic History and Physical Examination” (pp. 99–124) (Previously read in Week 1)
  • Chapter 9, “Periodic Screening and Health Maintenance” (pp. 149–164)
  • Chapter 12, “Sexuality and Sexual Health” (pp. 211–228)
  • Chapter 13, “Contraception” (pp. 236–266)
  • Chapter 14, “Menopause” (pp. 267–291)
  • Chapter 15, “Intimate Partner Violence” (pp. 295–307)
  • Chapter 16, “Sexual Assault” (pp. 313–329)Building A Comprehensive Gynecologic Health History Assignment Paper

SCREENING GUIDELINES

• American Academy of Family Physicians. (2021, August). Adult preventive health care schedule: recommendations from the USPSTF. Links to an external site. American Family Physician. https://www.aafp.org/dam/AAFP/documents/journals/afp/USPSTFHealthCareSchedule2021.pdf
• American College of Obstetricians and Gynecologists (ACOG). (n.d.). Well-Woman Health Care Links to an external site..https://www.acog.org/topics/well-woman-health-care?utm_source=redirect&utm_medium=web&utm_ campaign=otn
• Agency for Healthcare Research and Quality (2014). Guide to Clinical Preventive Services, 2014.Links to an external site.https://www.ahrq.gov/prevention/guidelines/guide/index.html
• S. Department of Health and Human Services, Centers for Disease Control and Prevention. (n.d.). A guide to taking a sexual history. Links to an external site.https://www.cdc.gov/std/treatment/SexualHistory.pdf Building A Comprehensive Gynecologic Health History Assignment Paper

ADULT GERONTOLOGY RESOURCES

• Shifren, J. L., & Gass, M. L. S. (2014). The North American Menopause Society Recommendations for Clinical Care of Midlife Women.Links to an external site.The Journal of The North American Menopause Society, 21(10), pp. 1-25. http://www.menopause.org/docs/default-source/2014/nams-recomm-for-clinical-care.pdf

RESOURCES FOR LGBTQ+

• Aisner, A. J., Zappas, M., & Marks, A. (2020). Primary Care for Lesbian, Gay, Bisexual, Transgender, and Queer/Questioning (LGBTQ) Patients Links to an external site.. The Journal for Nurse Practitioners, 16(4), 281–285. https://go.openathens.net/redirector/waldenu.edu?url=https://doi.org/10.1016/j.nurpra.2019.12.011
• Office of Disease Prevention and Health Promotion (ODPHP). (2020, April 18). Lesbian, gay, bisexual, and transgender health. Links to an external site.https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health
• Wingo, E., Ingraham, N., & Roberts, S. C. M. (2018). Reproductive Health Care Priorities and Barriers to Effective Care for LGBTQ People Assigned Female at Birth: A Qualitative StudyLinks to an external site.. Women’s Health Issues, 28(4), 350–357. https://go.openathens.net/redirector/waldenu.edu?url=https://doi.org/10.1016/j.whi.2018.03.002 Building A Comprehensive Gynecologic Health History Assignment Paper
  

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APPS FOR COMMON SCREENINGS

The following common screening apps will require a download or install into your personal device for you to access. Note: Should you have any technical issues, you will need to contact the rightsholder of the app itself and not Walden Student Support for any assistance.

• Alvar-Gonzalez, J. (2020). Links to an external site.https://play.google.com/store/apps/details?id=com.itiox.icontraception&hl=en_US

Note: This download is available for Android devices only.

• ITIOX Technological S.L. (2020). Links to an external site.https://apps.apple.com/us/app/icontraception/id668520861

Note: This download is available for iOS devices only.

• Agency for Healthcare Research and Quality (AHRQ). (n.d.). ePSS Electronic Preventive Services Selector. Links to an external site.https://epss.ahrq.gov/PDA/index.jsp
• Centers for Disease Control and Prevention (2020). CDC Vaccine Schedules. Links to an external site.https://www.cdc.gov/vaccines/schedules/hcp/schedule-app.html#download

Note: This webpage will provide you with downloads for both iOS and Android Devices.

• Nurse Practitioners in Women’s Health. (n.d.). Well Woman Visit Mobile App Links to an external site.. https://npwh.org/page/mobile-app Building A Comprehensive Gynecologic Health History Assignment Paper

CLINICAL GUIDELINE RESOURCES

• American College of Obstetricians and Gynecologists (ACOG).Links to an external site.(2020).  https://www.acog.org/
• American Cancer Society, Inc. (ACS). (2020). Information and Resources about for Cancer: Breast, Colon, Lung, Prostate, Skin. Links to an external site. https://www.cancer.org/
• Centers for Disease Control and Prevention. (CDC).Links to an external site.(n.d.). https://www.cdc.gov/
• American Nurses Association (ANA).Links to an external site.(n.d.). https://www.nursingworld.org/
• The American Association of Nurse Practitioners (AANP).Links to an external site.(2020). https://www.aanp.org/
• Healthy People 2030. (2020). Healthy People 2030 Framework. Links to an external site. https://www.healthypeople.gov/2020/About-Healthy-People/Development-Healthy-People-2030/Framework
• Taking a Health History
  Marianne Shaughnessy discusses one of the most critical components of the nurse/patient relationship—the health interview with the patient. She further discusses how to conduct a health history interview with demonstration (16 mins)Building A Comprehensive Gynecologic Health History Assignment Paper.
• Women’s Issues and Tough Conversations Links to an external site.
  In this interactive media program, Dr. Rebecca Lee and Cindy Nypaver describe their experiences related to women’s issues and tough conversations (5 mins).

Rubric

NRNP_6552_Module1_Assignment_Rubric

Building A Comprehensive Gynecologic Health History Assignment Paper