NURS 6512 week 1 Discussion: Building a Health History

Discussion: Building a Health History

Initial Post: Patient Profiles – 38-year-old Native American pregnant female living on a reservation

Collecting a thorough assessment is pertinent to gain knowledge for the advanced practice nurse (APN) to identify the patient’s issues and gain an understanding of how to assist the patient. Gathering information on the patient’s demographics assist in determining potential health risk. Participating in active listening helps build a rapport with the patient builds a trusting relationship between the patient and APN which makes for a successful visit and ultimately a positive outcome. Building rapport begins with developing an understanding of the patient’s cultural background, speaking clearly, and giving time to the patient to answer the questions. Being aware of your body language also helps in building rapport.  NURS 6512 week 1 Discussion: Building a Health History

ORDER  HERE A PLAGIARISM-FREE PAPER HERE

With this particular patient being a 38-year-old Native American pregnant female living on a reservation, it is imperative for the APN to identify any barriers to her health care. It is important to understand where the patient is coming from. Native American women living on the reservation are more likely than Caucasian women living outside the reservation, to experience poverty, live in hazardous conditions, face food insecurity, and experience interpersonal violence. Due to these common issues of the Native American, it is important to assess any behavioral health concerns (National Partnership for Women and Families, 2019). Unfortunately, the historical mistrust of other cultures or ethnicities, it is more likely for the Native American women to not be in compliance with her healthcare which also increases the odds of not having health insurance (Truschel & Novoa, 2018). NURS 6512 week 1 Discussion: Building a Health History

Summary of the Interview

To begin the interview, the APN will knock on the exam room door, enter and introduce themselves, making eye contact with the patient. The APN should address the patient by first and last name, and confirm the reason for the day’s visit. Asking the patient to identify any current issues or concerns. Gathering a thorough health history, to include past pregnancies health concerns or emergencies, other past medical problems, and pertinent medical history of blood relatives. Identifying the patient’s daily activities, daily eating habits, and any alcohol or illicit drug use. The patient’s cultural and ethnic background will direct the health history interview process. Identifying special requests or rituals that she may want to participate in that will need to be noted. There are some traditions that are important to some Native American women, for example, keeping the placenta after birth and being able to take it home in order to bury it in the ground and plant a tree or bush over it.

Once the APN has gained a fair amount of knowledge as to the reason for the visit and any concerns the patient has, she can begin her physical assessment on the patient. The physical assessment will include a head to toe assessment and a pelvic exam. Once the APN completes the health history and physical assessment, she will determine which diagnostic tools she will order (labs, ultrasound, etc.). NURS 6512 week 1 Discussion: Building a Health History

Description of the Communication Techniques

According to Ball et al., 2015, using open-ended questions to start the interview of the patient is recommended to allow the conversation to open-up and identify why the patient is seeking healthcare. Determining the patient’s understanding of her own medical needs is a great communication technique. Having the patient explain how they understand their health situation, will assist the APN in the understanding of the patient’s needs, and their expectations. This technique will also reveal any cultural beliefs or needs (Ball et al., 2015). Paying close attention to the patient’s body language will help the APN gather an understanding of how the patient feels about her pregnancy. Her body language can help determine if it’s a planned pregnancy, her feelings toward the pregnancy, or if she is evading giving information due to unsafe circumstances (Ball et al., 2015). It is understood that Native American women believe that pregnancy is a sacred time which is often filled with cultural rituals that are intended in keeping the child (pregnancy) safe (Native American Customs of Childbirth, 2018). NURS 6512 week 1 Discussion: Building a Health History

Risk Assessment

The main purpose of using a health risk assessment is to collect detailed data regarding o

The patient’s family history which helps in identifying any risk for both common chronic conditions or any rare diseases (Wu & Orlando, 2015). The importance of using an assessment tool enables the APN to gain insightful details about the patient’s personal, social, and family history. Identifying her education level, employment status, eating habits, physical activities, drug and alcohol use, suicide and depression issues, and safety concerns. It is common for pregnant women to have emotional ups and downs due to hormonal imbalances. It is important to assess her medical history, nutrition, her beliefs in traditional therapy, and especially her views of western medicine (Hanson, 2012). Sensitively asking about alcohol and drug use is important. Due to the risk related to these issues, Native American women are at higher risk for obesity, diabetes, and alcoholism (American College of Obstetricians and Gynecologists, 2018).  Fetal Alcohol Syndrome (FAS) and Fetal Alcohol Effects (FAE) have a large impact on Native American infants (Truschel & Novoa, 2018).  It is important to ask about daily exercise types and amount if any because some tribes take pride in running long distances which can be a concern for the pregnant female in her late trimesters. It is important to ask about traditions or rituals that will be practiced and need to be respected and accommodations made (American College of Obstetricians and Gynecologists, 2018). NURS 6512 week 1 Discussion: Building a Health History

Five Targeted Questions

Having an understanding of the patient’s ethnicity, and where she lives, requires more targeted questions to identify her needs. These targeted questions should be geared towards identifying the needs, issues, and problems that need attention and prioritizing. Targeting questions toward the patient’s environmental living conditions and exposures and any safety concerns can assist in identifying any barriers to her healthcare.

The targeted questions related specifically to pregnancy would include:

1. How are you feeling today?
2. Do you have any concerns you wish to discuss with me? Any changes to your body that you wish to discuss?
3. How many pregnancies have you had to include this current one? Were those pregnancies healthy? Did you have any problems during those pregnancies?
4. Were they full-term pregnancies? Vaginal or cesarean deliveries? Were there any concerns regarding the deliveries? Are your children healthy?
5. Did you attend all your prenatal checkups? Is this your first prenatal visit for this pregnancy? How did you know that you are pregnant? NURS 6512 week 1 Discussion: Building a Health History
6. Do you work or go to school? Do you exercise or have any physical activities? What are your daily activities?
7. Do you have reliable transportation?
8. Do you consider yourself healthy? Do you have any current medical problems? Do you take medications, supplements, or herbal remedies?
9. How many meals do you consume each day? What types of foods do you eat? How are you preparing your meals? How many fluids are you drinking each day?
10. Do you smoke or vape? Do you drink alcohol? If so, how much? Do you use any illegal drugs? If so, how much; what type?
11. Are you safe at home? How many people live in your home?
12. What else can I help you with today? Is there anything you want me to know about you or your pregnancy?

References

American College of Obstetricians and Gynecologists. (2018).  Health care for urban American Indian and Alaska Native women. Committee Opinion No. 515. Obstet Gynecol, 119. 201–5. Retrieved from, https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Health-Care-for-Urban-American-Indian-and-Alaska-Native-Women NURS 6512 week 1 Discussion: Building a Health History

Ball, J. W., Dains, J. E., Flynn J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8^th ed.). St. Louis, MO: Elsevier Mosby.

Hanson J. D. (2012). Understanding prenatal health care for American Indian women in a Northern Plains tribe. Journal of transcultural nursing: official journal of the Transcultural Nursing Society, 23(1), 29–37. https://doi.org/10.1177/1043659611423826

National Partnership for Women and Families. (2019). American Indian and Alaska Native Women’s Maternal Health: Addressing the Crisis. Retrieved from, https://www.nationalpartnership.org/our-work/resources/health-care/maternity/american-indian-and-alaska.pdf

Truschel, L., and  Novoa, C. (2018). American Indian and Alaska Native Maternal and Infant Mortality: Challenges and Opportunities. Retrieved from, https://www.americanprogress.org/issues/early-childhood/news/2018/07/09/451344/american-indian-alaska-native-maternal-infant-mortality-challenges-opportunities/

Wu, R. R., & Orlando, L. A. (2015). Implementation of health risk assessments with family health history: barriers and benefits. POSTGRADUATE MEDICAL JOURNAL, 91(1079), 508–513. https://doi-org.ezp.waldenulibrary.org/10.1136/postgradmedj-2014-133195 NURS 6512 week 1 Discussion: Building a Health History

Response

You make a good point in your main post, regarding the use of clear body language during an interview. Body language or unspoken communication is an important part of communication. It is “the unspoken element of communication that we use to reveal our true feelings and emotions.” (MindTools, 2020). When interviewing a patient or a client, body language can help the person being interviewed to trust the interviewer or feel uncomfortable with the interview.

For your specific patient, the Native American woman, part of the questions the interview should cover are questions that help determine the possibility or risk of malnutrition to the patient. This is because one of the social determinants that affect the native American population includes the prevalence of food deserts on many American Indian reservations just like the one the patient lives in (Ackerman-Burger, n.d).

References

Ackerman-Burger, P. (n.d). Social determinants of health and native peoples. Retrieved from https://www.ihs.gov/california/tasks/sites/default/assets/File/GPRA/BP2018-SocialDeterminantsofHealth_Ackerman-Barger.pdf  NURS 6512 week 1 Discussion: Building a Health History

MindTools. (2020). Body language: picking up and understanding nonverbal signals. Retrieved from https://www.mindtools.com/pages/article/Body_Language.htm

response 2

Very informative post, thank you.

The patient is considered a geriatric obstetric patient due to her age.  It is also mentioned that the patient lives on a reservation.  Individuals who live in reservations have limited access to resources and therefore certain factors need to be accounted for.  Being from a different culture, the NP must embrace the fact that the client may have different ideologies and perceptions.  The patient may also have a communication barrier and lack of adequate resources and therefore the more reason the NP should form a trusting relationship with the client.  Lack of access to prenatal care could have consequences for both the unborn child and the mother. NURS 6512 week 1 Discussion: Building a Health History

American Indian women residing on Indian reservations suffer domestic violence

and physical assault at rates far exceeding women of other ethnicities and

locations according to Maxwell and Robinson (2019).  Abuse by a partner can have consequences for both the mother and unborn child.  Cases of abuse go unreported and therefore no help can be given unless the client speaks up. The abuse by a partner can cause the client to miscarry or have complications is the pregnancy.  Np’s should be attentive to the client as this can foster the beginning of a trusting relationship.  Questions to ask the client would be open ended questions to allow the client to explain.  The NP should also ask the client about the amenities available at the reservation and give resources that are easily accessible by the patient.

The risk assessment for this patient would be violence.  I would use the Hurt, Insult, Threaten, and Scream (HITS) assessment tool per Chen et al. (n.d.).  which includes asking the client questions like

1. Physically hurt you?
2. Insult you or talk down to you?
3. Threaten you with harm?
4. Scream or curse at you?

Reference

Chen, P.-H., Rovi, S., Vega, M. L., Barrett, T., Pan, K.-Y., & Johnson, M. S. (n.d.). Birth Outcomes in Relation to Intimate Partner Violence. JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, 109(4), 238–245. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jnma.2017.06.017

Maxwell, D., & Robinson, S. (2019). Safety for American Indian Women: An Indigenous-Focused Policy Analysis of Violence Against Women Act-Title IX. Advances in Social Work, 19(1), 181. NURS 6512 week 1 Discussion: Building a Health History

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.  NURS 6512 week 1 Discussion: 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.

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.

ORDER  HERE A PLAGIARISM-FREE PAPER HERE

Building a Health History

Advanced practice registered nurse (APRN) pioneers require propelled level communication abilities to give safe and effective care. Knowledge and skills in interpersonal and culturally diverse communication are significant for the APRN when providing care to patients and when working in interprofessional groups. Within this discussion post, I will discuss communication techniques, explain why these techniques would be use, identify the risk assessment and provide at least five targeted questions you would ask the patient of the assigned scenario patient is a 26-year-old Lebanese female living in graduate student housing. NURS 6512 week 1 Discussion: Building a Health History

Communication and Interview Techniques

While interviewing every patient, consideration of the patient’s degree of comprehension and culture in building a health history. The patient may, likewise have a language barrier. The key is creating a positive health history is correspondence; this is finished by developing a therapeutic rapport with the patient. The patient is agreeable enough to share data while demonstrating politeness to the patient. Another route is to ask open-finished inquiries that show restraint focused. Effective communication requires a comprehension of the patient and the encounters they express (Koukouta and Papathanasiou, 2014). Barriers could give a provider is looking to get such a history, one being society. Culture may impact the reluctancy to transparently impart without concern, regardless of whether it gave a sheltered, private setting. Social competency in a healthcare provider is being able to perceive the person’s qualities and adjusting to provide persistently focused correspondence, prompting a confiding in the connection between the provider and patient (Ball, J. W. et al., 2019). NURS 6512 week 1 Discussion: Building a Health History

Risk Assessment Instruments and Targeted Questions

A health risk assessment (HRA) is an instrument used to gather health data, commonly combined with a procedure that incorporates biometric testing to survey a person’s health status, dangers, and propensities. Alone, an HRA can do little to improve health or cut expenses. HRA also provides a chance to find opportunities to advance health, utilizing health and family history as a critical segment (Wu, R. R., Orlando, L. A., 2015).

The functional assessment tool would be suitable to use with every patient. It tests an individual’s capacity to do essential exercises of day by day living. The potential dangers could be trying different things with medications and alcohol, sexual experiences, social contrasts identified with conventional and middle eastern. NURS 6512 week 1 Discussion: Building a Health History

The risk assessment I would utilize would be Domestic Violence: HITS (Hurt, Insults, Threaten, or Scream):1. Are you compelled to get things done without wanting to? 2. Are you in a relationship? 3. Do you feel undermined in your relationship? 4. Has anybody at any point hit you? 5. Has anybody shouted or offended you?

Conclusion

The culturally competent APRN leader incorporates the patient’s way of life and spiritual inclinations, qualities, and convictions when speaking with the patient and giving consideration. Care includes health promotion/infection avoidance, just as assessments, determination, and treatment of the patient’s issues (Creech, C. et al., 2017). APRNs likewise have a multifaceted nature of other information and aptitudes, including relational and diverse relational abilities. Even though culture impacts the APRN provider-patient interaction and the APRN leader interaction with other health care providers, APRNs need to recognize that developing cultural competency is a process.

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.

Creech, C., Filter, M., Wehbe-Alamah, H., McFarland, M. R., Andrews, M., & Pryor, G. (2017). An Intervention to Improve Cultural Competence in Graduate Nursing Education. Nursing education perspectives, 38(6), 333–336. https://doi.org/10.1097/01.NEP.0000000000000163  NURS 6512 week 1 Discussion: Building a Health History

Kourkouta, L., & Papthanasiou, I. V. (2014). Communication in nursing practice. Mareria socio-medica, 26(1), 65-67. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3990376/

Wu, R. R., Orlando, L. A. (2015). Implementation of health risk assessments with family health history: Barriers and benefits. Postgraduate Medical Journal, 91(1079), 508. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.1136/postgradmedj-2014-133195

response

I enjoyed reading about your patient. It interesting because I can relate to some of the points you mentioned. This response will focus on the description of communication and interview techniques and risk assessment tools used in assessing a 26- year old Lebanese female who lives in a graduate-student housing.

As you alluded, while communicating and interviewing patients, it is essential to consider their comprehension and cultural background in building a health history. Besides communicating effectively, taking the patient’s age, gender, ethnicity, and environmental settings into consideration while building a health history is important because these factors can influence their health or illness. According to Koo et al., (2016), more than 75% of the nurse practitioners surveyed have reported that six of seven basic communication techniques used are efficient when providing care to patients. We both have the same 26-year old Lebanese patient. Hence, as you mentioned, due to her culture, she may reluctantly answer questions regardless of the comfort and privacy provided during her interview. NURS 6512 week 1 Discussion: Building a Health History

After introducing myself to the patient and since she is a student from Lebanon, thus a foreigner, I would ask if she needs an interpreter since English is not her first language. I will ask open-ended questions about her life while ensuring that I give her undivided attention with little or no interruption. Kourkouta and Papathanasiou (2015), stated that the use of verbal and non-verbal cues, listening, and asking questions with concern means to build a trustful and harmonious relationship in a modern multicultural society. Asking open-ended questions, without interrupting and providing undivided attention yields important information needed to care and treat the patient. According to Ball, J. W. et al. (2019), open-ended questions at the beginning of a conversation can allow more significant specifics. During my interview, the patient’s choices, values, opinions, and wishes will be respected and integrated into her situation (Powers, Morris, Flynn, & Perry, 2019).

Ashley, I realized that we used similar communication and interview techniques; however, we used different assessment tools to screen the patient health assessment risk. You used the Domestic Violence: HITS (Hurt, Insults, Threaten, or Scream) model while I used the CAGE questionnaire model. Your model consisted of screening for violence and safety while mine focused on assessing alcohol use. The CAGE questionnaire of alcohol use, asks questions about Cutting down, Annoyance by criticism, Guilty feeling, and Eye-openers. Your five target questions also differ from mine because you focused once more on safety and violence while I asked her about drinking and the possibility of stopping.

According to Orlando (2015), conducting a health risk assessment while using health and family history as a critical component provides an opportunity to discover areas to promote health. Using an assessment tool for the screen in an interview facilitates the process of finding out that a patient has an existing problem, which will require a thorough follow-up via assessment, leading to a better treatment outcome. NURS 6512 week 1 Discussion: Building a Health History

                                                                                                         References

Kourkouta, L., Papathanasiou, I. V. (2015). Communication in nursing practice. Mater Sociomedica, 26, 65-67. http://dx.doi.org/10.5455/msm.2014.26.65-67

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.

Koo, L. W., Horowitz, A. M., Radice, S. D., Wang, M. Q., & Kleinman, D. V. (2016). Nurse

practitioners’ use of communication techniques: Results of a Maryland oral health literacy survey. PLOS ONE, 11(1). https://doi-org.ezp.waldenulibrary.org/10.1371/journal.pone.0146545

Powers, S. C., Morris, M. H., Flynn, H., & Perry, J. (2019). Faculty-Led Role-Play

Simulation: Going Live to Teach Patient-Centered Care to Nursing Students. Journal of Nursing Education, 58(11), 665–668. https://doi-org.ezp.waldenulibrary.org/10.3928/01484834-20191021-10

Wu, R. R., Orlando, L. A. (2015). Implementation of health risk assessments with family health history: Barriers and benefits. Postgraduate Medical Journal, 91(1079), 508. doi: http://dx.doi.org.ezp.waldenulibrary.org/10.1136/postgradmedj-2014-133195

response 2

Lebanese women stay in their parent’s homes until they are married or have childrn.  Due to current lifestyle changes, the younger generation of Lebanese both men and women seldom follow this culture.   Women from this culture are raised to view men as superior.   The client lives in school housing, therefore giving us the impression that she is in school, unamarried, and without children.  Before the interview, the NP should find out if the patient spoke English or if an interpreter was needed.  The NP must also understand that the client’s culture is different and should take note of what is accepted and unaccepted in the culture per Hemberg and Vilander (2017). NURS 6512 week 1 Discussion: Building a Health History

Genuinely listening and making eye contact can put the client at ease and the client can answer questions trusting that the practitioner will assist them with their needs.   Allowing time to ask questions can also booster trust and compliance from the patient. Questions to the client should be open-ended to give room to explanations, therefore, reducing the chances of assumptions.  When using non-verbal gestures, the NP must be careful as this can bee interpreted differently among cultures.   The NP should respect the patient’s culture and values as explained by Ball et al. (2019).

A risk assessment would include a tool like a partner violence screen. (PVS).  The questions to ask would include

1. Have you beene kicked, punched or slapped her within the past year
2.  Whether she feels safe in the relationship she is in now
3.  If there was a partner from a previous relationship that is making her not feel safe.

A patient health questionnaire (PHQ-9) screen is also a risk assessment instrument that can be used to screen for patients that are at risk for suicide.  This young woman may be alone in this foreign country and with no support, ideologies of suicide can arise.  Depression that is not treated can trigger suicidal thoughts.  Questions to ask include whether the patient was experiencing feelings of depression or little pleasure or interest in doing things as Salk et al. (2017) tell us. NURS 6512 week 1 Discussion: Building a Health History

Reference

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.

Hemberg, J. A., & Vilander, S. (2017). Cultural and communicative competence in the caring relationship with patients from another culture. Scandinavian Journal of Caring Sciences, 31(4), 822-829. Retrieved from https://doi-org.ezp.waldenulibrary.org/10.1111/scs.12403.

Salk, R. H., Hyde, J. S., & Abramson, L. Y. (2017). Gender differences in depression in representative national samples: meta-analyses of diagnoses and symptoms. Psychological bulletin, 143(8), 783. NURS 6512 week 1 Discussion: Building a Health History