Building A Health History Discussion Paper

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Building A Health History Discussion Paper

Response to Post 1            I have keenly read your post where you have presented a clear and detailed strategy that you would use to interview a middle-aged member of the LGBTQIA community. It is true that a keen consideration that one must factor in especially when interviewing a minority group is sensitivity and a non-judgmental approach. Perhaps an aspect that I should add that would help in the effectiveness of interviews with a LGBTQIA individual is incorporating reflective questioning. According to Aggarwal et al. (2023), this is important because it enables the researcher to gain a deeper understanding of the individual being interviewed and the issues they face. An even more important consideration that should be made while conducting interviews is encouraging patients to delve deeper into their thoughts and emotions. This is important especially during health assessment as doing this goes a long way in promoting the patients’ self-awareness. In their writings, Van Der Pol-Harney and McAloon (2019) wrote that the practice of prompting open exploration during interviews is valuable as it enables healthcare providers to unearth valuable insights into the mental and emotional well-being of patients.

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Going by the numerous texts read on this approach of conducting interviews, I think that a consideration that you should have also made in your analysis is widening your approach to the interviews as this would have further increased the quality and validity of data and information collected from the interviewee. According, a notable impact this has is enhancing the accuracy of the health assessment carried out and foster a therapeutic relationship. Keenly noting that the individual you interviewed is a member of the LGBTQIA community, I feel that it is necessary for me to point out that often, certain patients feel misunderstood. Drawing from this, when patients feel heard and better understood, they are more likely to share relevant information crucial for comprehensive care. Following my long experience as a nurse, I think it is necessary for routine screenings for sexually transmitted infections (STIs) to be done especially among the LGBTQIA. This is justified by the fact that members of the LGBTQIA are more likely to engage in diverse sexual practices which then necessitates for tailored preventive measures and education to promote sexual health. Building A Health History Discussion Paper

References

Aggarwal, R. A., Fields, C. D., & van Zuilen, M. H. (2023). Mental Health for LGBTQIA+ Older Adults. Clinics in Geriatric Medicine. https://doi.org/10.1016/j.cger.2023.10.003

Van Der Pol-Harney, E., & McAloon, J. (2019). Psychosocial interventions for mental illness among LGBTQIA youth: a PRISMA-based systematic review. Adolescent Research Review, 4, 149-168.

 

 

Response to Post 2            An important lesson I have learned from reading your discussion on the interview conducted is the value of using motivational interviewing techniques. According to Kitzie et al. (2022), this technique has the notable benefit of increasing the engagement by patients being interviewed. Explaining this, the researchers highlighted that this approach fosters a collaborative and empathetic communication style. Needless to say, demonstrating communication techniques such as active listening and showing empathy enables healthcare providers to elicit intrinsic motivation for behavioral change. While your interview exercise conducted employed impressive approaches which guaranteed valuable information necessary for building an impeccable health history, I should, nonetheless, highlight a few important additions that I feel should add even more value to what you have. The use of affirmative statements and reflective listening are two strategies that have emerged as smart techniques to influence interviewees to provide more information that would be helpful in building their case. According to Eres et al. (2021), exploring the impact of workplace stress on cardiovascular health and mental well-being as well as considering the potential influence that social support systems have on overall health would be beneficial in gaining even more valuable information on patients. There are unique disparities that the LGBTQIA individuals face in mental health and it is therefore important for these disparities to be addressed. This approach would help tailor healthcare interventions in ways that promote mental well-being in this population. Building A Health History Discussion Paper

References

Eres, R., Postolovski, N., Thielking, M., & Lim, M. H. (2021). Loneliness, mental health, and social health indicators in LGBTQIA+ Australians. American Journal of Orthopsychiatry, 91(3), 358. https://psycnet.apa.org/doi/10.1037/ort0000531

Kitzie, V. L., Vera, A. N., & Wagner, T. L. (2022). Understanding the Information Creation Practices of LGBTQIA+ Community Health Workers. Proceedings of the Association for Information Science and Technology, 59(1), 145-156. https://doi.org/10.1002/pra2.612

INSTRUCTIONS:
Respond to post one and post two separately and each response should have two references. My POST ABOVE is my own discussion post that will serve as a guide to respond to POST ONE and POST TWO.
• 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

NURS 6512N RESPONSE TO WEEK ONE DISCUSSION INSTRUCTIONS

 TOPIC: BUILDING A HEALTH HISTORY

MY POST

(Please, do not respond to this post. It is just a guide)

This exercise is planned with the objective of building and documenting a health history for a patient. Specifically, the exercise is a critical task of building a comprehensive health history for a 4-year-old African American male residing in a rural community within the United States. From the point of view of a clinician, the focus for creating this health history is to unearth underlying medical aspects and the social determinants of health that significantly influence the well-being of the patient. Given this, applying age-appropriate communication techniques and making use of relevant risk assessment instruments are necessary in aiding the development of an accurate health history.

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Interview Summary and Communication Techniques

The interview planned for this exercise is with a 4-year-old child and it will be necessary for creative strategies to be applied in recognition of the minor age that the child falls under. Citing Sheldrick et al. (2020)Building A Health History Discussion Paper, it will be necessary that the exercise be done between the child and the clinician but in the presence of the parent or a caregiver to help intervene or clarify some issues. The first step I would need to take in this exercise is establishing rapport and an ideal way of doing this is through friendly introductions. The use of age-appropriate language is vital at this point to help place a level playing field between the two of us. The interview would take the form of open-ended questions directed to the caregiver through which I would explore the medical history of the child and pay particular attention to any pre-existing conditions. Focusing on the child, I would incorporate play-based communication methods for example interactive games like drawing while still engaging in conversations with them. According to Sullivan (2018), the use of a proactive strategy guarantees the development of a thorough health history while at the same time upholding a comfortable experience for the child during the interview.

   Rationale for Using These Techniques

The selection of these techniques is justified by the fact that they are age-appropriate communication strategies that are vital when interacting with a 4-year-old. For example, the use of open-ended questions motivates the child to freely express themselves which is necessary in providing insights into their health history. Secondly, the use of play therapy is necessary in helping the child be in an environment they are familiar with. The benefit this has as explained by Ball et al. (2021) is promoting trust. For the caregiver or parent present in an interview, the environment helps ease potential anxiety associated with medical discussions. For the participating parent or caregiver, the use of visual aids is important in enhancing understanding, especially in areas like immunizations and dietary habits. Building A Health History Discussion Paper

   Appropriate Risk Assessment Instruments

There are a handful of risk assessment instruments that could be used in this particular case. The first one is the Ages and Stages Questionnaires (ASQ) and the second one is the Pediatric Symptom Checklist (PSC), which are suitable choices (Sheldrick et al., 2020)Building A Health History Discussion Paper. The ASQ is a risk assessment tool that looks into the developmental milestones of a child which is important in aiding the identification of potential delays or concerns. According to Sullivan (2018), this assessment aligns with the need to evaluate age-specific developmental markers. On the other hand, the PSC identifies the emotional and behavioral issues of a child. In this particular case, the instrument would consider the psychosocial context of the child. Reflecting on these two instruments, they are both culturally sensitive and are validated for diverse populations. More importantly, making use of these two guarantees a comprehensive assessment of developmental and behavioral aspects. This has the benefit of facilitating early detection of potential risks.

      Targeted Questions

  1. Please tell me about some of the things your child is able to do independently
  2. Has the child had any significant illnesses since birth?”
  3. Please describe a typical day of meals for the child. In this, please include his main preferences and notable aversions.
  4. Are there specific safety measures implemented in the house to safeguard the well-being of the child?”
  5. What is the child’s sleep routine? Do they have observable bedtime habits or difficulties falling asleep?

Before coming up with the targeted questions for the caregivers or parents majorly, and to a lesser extent the child in question, I would ensure that they are aligned with the context of the patient. Commenting on this, Ball et al. (2021) advised that taking this approach is necessary as it helps address the prevailing social determinants of health. An ideal example would be asking the child, “Who do you live with and who attends to you when you feel unwell?”, or to the parent, “How often does your child visit the doctor?”. The benefit of this nature of question is that they help probe the access to healthcare for the child and identify potential barriers to healthcare access.

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2021). Seidel’s Guide to Physical Examination-E-Book: An Interprofessional Approach. Elsevier Health Sciences.

Sheldrick, R. C., Marakovitz, S., Garfinkel, D., Carter, A. S., & Perrin, E. C. (2020)Building A Health History Discussion Paper. Comparative accuracy of developmental screening questionnaires. JAMA pediatrics, 174(4), 366-374. 10.1001/jamapediatrics.2019.6000

Sullivan, D. D. (2018). Guide to clinical documentation. FA Davis.

INSTRUCTIONS:

Respond to post one and post two separately and each response should have two references. My POST ABOVE is my own discussion post that will serve as a guide to respond to POST ONE and POST TWO.

  • 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

POST ONE

Summary of Interview and Communication Techniques- 50-year old LGBTQIA male

In conducting an advanced health assessment with a 50-year-old LGBTQIA male graduate student employed in the college bookstore, it’s imperative to establish a safe and affirming environment. To facilitate effective communication, I would employ person-centered and culturally sensitive communication techniques, recognizing the unique healthcare needs and experiences of LGBTQIA individuals (Grant et al., 2017).

Given the potential for stigmatization and discrimination within healthcare, I would adopt open-ended and non-judgmental language to encourage the patient to share their health concerns and experiences freely (Buchholz et al., 2018). Establishing rapport and trust is crucial, and I would use affirming and inclusive language to create a supportive atmosphere. Active listening, empathy, and validation would be central to understanding the patient’s perspective and building a therapeutic relationship (Bockting et al., 2018)Building A Health History Discussion Paper.

Communication Techniques Justification

Affirming Language

Using affirming and inclusive language helps create an environment where the patient feels acknowledged and respected. It fosters trust and openness, encouraging the patient to share important information about their health and well-being (Buchholz et al., 2018).

Active Listening

Active listening is essential to understand the patient’s concerns, experiences, and health goals. It demonstrates empathy and helps build a collaborative relationship, ensuring that the patient’s unique needs are considered in the assessment and care planning (Grant et al., 2017)Building A Health History Discussion Paper.

Non-judgmental Approach

A non-judgmental approach is crucial, especially for individuals from marginalized communities. This technique encourages open communication by minimizing the fear of discrimination or bias, allowing the patient to disclose relevant information without hesitation (Bockting et al., 2018)

Cultural Competence

Being culturally competent involves understanding and respecting the patient’s LGBTQIA identity. This includes knowledge of relevant health disparities, specific health needs, and the impact of societal attitudes on healthcare-seeking behavior (Buchholz et al., 2018).

Empowerment

Empowering the patient involves involving them in the decision-making process and acknowledging their autonomy. This approach is particularly important for LGBTQIA individuals, as it promotes shared decision-making and fosters a sense of control over their healthcare (Bockting et al., 2018).

Risk Assessment Instrument Selection and Justification

For this patient, I would select the Suicide Ideation Questionnaire (SIQ) as the risk assessment instrument. LGBTQIA individuals, especially those facing societal challenges or discrimination, may be at an increased risk of mental health concerns, including suicidal ideation (Blosnich et al., 2016)Building A Health History Discussion Paper. The SIQ is a validated instrument designed to assess the presence and severity of suicidal ideation, helping identify individuals at risk.

 Targeted Questions

  1. Can you share any recent changes in your mood or emotional well-being?
    – Rationale: This open-ended question allows the patient to express their feelings and provides insight into potential mental health concerns (Buchholz et al., 2018).
  2. Have you experienced any stressors or challenges related to your LGBTQIA identity recently?
    – Rationale: This question addresses potential sources of discrimination or stigma that may impact mental health and overall well-being (Bockting et al., 2018).
  3. Can you discuss your current support system, including friends, family, or community connections?
    – Rationale: Exploring the patient’s support network helps identify potential sources of resilience and areas for intervention if needed (Buchholz et al., 2018).
  4. How would you describe your experience accessing healthcare, and are there any concerns or barriers you’ve encountered?
    – Rationale: This question addresses potential disparities in healthcare access and allows for the identification of barriers that may impact the patient’s health-seeking behavior (Bockting et al., 2018).
  5. Are you currently experiencing any thoughts of self-harm or suicide?
    – Rationale: Using a direct and empathetic approach, this question aims to assess the patient’s immediate safety and provides an opportunity for intervention if necessary (Blosnich et al., 2016)Building A Health History Discussion Paper.

By employing these communication techniques and utilizing a validated risk assessment instrument like the Suicide Ideation Questionnaire, the health assessment aims to gather comprehensive information, ensuring a holistic understanding of the patient’s physical and mental health while respecting their unique identity and experiences.

References

Blosnich, J. R., Marsiglio, M. C., & Gao, Y. (2016). Mental health of transgender veterans in US states with and without discrimination and hate crime legal protection. American Journal of Public Health, 106(3), 534-540. doi:10.2105/AJPH.2015.302972

Bockting, W. O., Miner, M. H., Swinburne Romine, R. E., Hamilton, A., & Coleman, E. (2018). Stigma, mental health, and resilience in an online sample of the US transgender population. American Journal of Public Health, 108(3), 403-411. doi:10.2105/AJPH.2017.304265

Buchholz, B., Hottes, T. S., & Beauchamp, C. A. (2018). LGBTQ-specific healthcare experiences and perspectives among sexual and gender minority individuals receiving healthcare in an academic centre. Journal of Homosexuality, 65(2), 178-201. doi:10.1080/00918369.2017.1289879

Grant, J. M., Mottet, L. A., & Tanis, J. (2017). National Transgender Discrimination Survey Report on Health and Health Care. National LGBTQ Task Force. Retrieved  November 27, 2023 from https://www.thetaskforce.org/wp-content/uploads/2019/07/NTDS_Report_on_health-2.pdf Building A Health History Discussion Paper

 

POST TWO

Communication strategies should be customized to build trust, recognize diversity, and address any health risks when interviewing the assigned patient, a 50-year-old male graduate student who identifies as LGBTQIA and works at the college bookstore. Open-ended, nonjudgmental questions would be my first line of questioning to build rapport and create a relaxed atmosphere in which the patient felt comfortable sharing information (Adly et al., 2019). Effective communication would require the use of inclusive language and an affirmation of the significance of their unique experiences, given the potential sensitivity surrounding LGBTQIA identity. Building trust between a patient and a provider begins with acknowledging and respecting their identity.

Communication would need to be age-appropriate, taking into account the patient’s age, gender, and work environment, while also acknowledging the possible impact of age-related health concerns. To fully comprehend the patient’s experiences and gain a more complex understanding of their medical history, active listening techniques would be used (Adly et al., 2019)Building A Health History Discussion Paper. Paraphrasing, summarizing, and providing reflective answers would all be used to demonstrate empathy and guarantee correct understanding.

The Health and Retirement Study (HRS) Risk Index would be a useful risk assessment tool for this patient. This tool, intended for people 50 years of age and older, evaluates the likelihood of significant health events by taking age, gender, and health-related behaviors into account (Ball et al., 2023). It corresponds with the stage of life where specific health risks become more noticeable given the patient’s age.

Five targeted questions for this patient could include the ones listed below. With the use of these inquiries, the patient’s complete medical and mental health history, lifestyle choices, and particular concerns regarding their LGBTQIA identity will be gathered (Sullivan, 2019)Building A Health History Discussion Paper. While the targeted focus ensures that important aspects of the patient’s age, gender, and environmental setting are taken into consideration, the open-ended nature of the questions motivates the patient to disclose details that may impact their health.

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  • How would you describe your overall well-being and any changes you’ve noticed in your health over the past year?
  • Can you share your experiences managing stress, especially considering the dual roles of being a graduate student and working at the college bookstore?
  • Regarding your LGBTQIA identity, are there specific health concerns or challenges you’ve encountered that you would like to discuss or address?
  • How would you describe your daily routine, including factors like diet, exercise, and sleep patterns?
  • Given your age, have you had any recent health screenings or check-ups? Are there specific health issues you would like to prioritize in our discussions?

In conclusion, developing trust and comprehending the distinct health profile of the assigned patient require skillful communication strategies that include open-ended questions, attentive listening, and awareness of identity. The Health and Retirement Study Risk Index can offer important insights into potential health risks in accordance with the patient’s age. The chosen questions are intended to obtain a thorough medical history while honoring the unique circumstances and experiences of the patient. Building A Health History Discussion Paper

References

Adly, N. N., Abd-El-Gawad, W. M., & Abou-Hashem, R. M. (2019). Relationship between malnutrition and different fall risk assessment tools in a geriatric in-patient unit. Aging Clinical and Experimental Research, 32(7), 1279–1287. https://doi.org/10.1007/s40520-019-01309-0

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2023). Seidel’s guide to physical examination: An interprofessional approach (10th ed.). St. Louis, MO: Elsevier Mosby.

Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis Building A Health History Discussion Paper