Sample Answer Included After the Question
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 also enable you to gather the information needed to assess your patients’ health risks more effectively.
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.
Resources
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.
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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 Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Post Reply!
Building a Health History
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
Sample Answer For The Assignment: Building a Health History
Title: Building a Health History
As an advanced practitioner, it is imperative to build a therapeutic relationship with the patient to obtain the most and accurate health history of that specific patient; the medical history is crucial information in developing an appropriate plan of care for that patient. Each patient may require different communication techniques and considerations based on their social determinants of health and health risks.
In this week’s discussion, I am presented with an adolescent white male who is without health insurance and seeking medical care for a sexually transmitted infection. The purpose of this discussion is to examine communication techniques specific to my patient and at least five targeted questions to assess the health risks and building of the patient’s health history.
Health History Interview
Since the patient is an adolescent male who presents with STI, my priorities would be identifying high-risk behaviors such as the use of illicit drugs and alcohol, risky sexual behaviors, and suicidal ideations. According to Johnston et al. (2022), data from 184 countries in nine UNICEF regions suggested that there are approximately 17 million adolescent young men who are bisexual and sell sex that need HIV prevention services and social support.
In addition, the America Foundation for Suicide Prevention (2022) stated that 8.9% of youth grades 9-12 reported having at least one suicide attempt within 12 months. Therefore, my targeted questions would include:
Do you smoke or drink? If so, how many times a week?
What is your sexual orientation? (ex. heterosexual, bisexual, etc.)
Do you use any illicit recreational drugs?
How many sexual partners have you had in the last month?
Have you ever had suicidal ideations or attempts?
Communication Techniques
There are many barriers to obtaining an accurate and sufficient health history; in my patient’s case, he is an adolescent teen who may be hesitant to give an honest answer when it comes to sensitive subjects such as alcohol, recreational drug use, or sexual orientation. Many adolescents are exploring to find self-identity during this time, and unfortunately, it often involves high-risk behaviors.
Mental health has been more recognized in the last decade, and suicidal ideation awareness and assessment have been more widely adopted in healthcare settings. Ball et al. (2019) stated that when discussing sensitive issues, there are many essential considerations during the interview, such as providing privacy, being direct and firm by avoiding leading questions, not apologizing for asking a question, not being judgmental or pushy, and using language that is understandable but not patronizing.
First impression is a big factor when introducing yourself to the patient; for this patient, I would try to initially relate to the patient by talking about common hobbies that can relate to adolescents, such as games or sports and build a trusting relationship. I would be firm in saying that you need to tell me the truth about alcohol or drug use but that the information would stay confidential, and I will not purposely expose information that would get the patient in trouble with his guardians or with the law.
One assessment tool that can be used for my patient that would help with obtaining health history is the ‘CRAFFT’ questionnaire. It was developed in 2002 as a screening tool for alcohol and substance abuse in adolescents; two or more (2 to 6) yes answers suggest a serious substance use disorder problem, and the questionnaire also recommends counseling regarding many aspects, such as reviewing the screening results, recommending not to use such drugs, driving risk counseling, eliciting self-motivational statements, and reinforcing self-efficacy (New Jersey Chapter: American Academy of Pediatrics, 2018).
This assessment tool is important because the patient’s social background and high-risk behaviors may be correlated with the patient’s sexual behaviors that led to the patient having an STI.
Conclusion
Obtaining a patient’s health history takes more than just interviewing the patient; it takes a lot of effort in building a trusting relationship and understanding their personal situation and poor social determinants of health such as poverty or no insurance that is constant even after they are discharged from the healthcare setting.
Assessing each patient with individualized plan of care and applying the correct communication techniques that apply to different age groups/gender/ethnicity are key in building a therapeutic relationship with the patient that will yield in better health outcome.
References
American Foundation for Suicide Prevention. (2022). Suicide statistics. Retrieved November 29, 2022 from https://afsp.org/suicide-statistics/
Links to an external site.
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.
Johnston, L., Nguyen, V., Lwamba, C., Sabin, K. (2022). Deriving and interpreting population size estimates for adolescent and young key populations at higher risk of HIV transmission: Men who have sex with men and females who sell sex. PLoS One, 17(9). https://doi.org/10.1371/journal.pone.0269780
Links to an external site.
New Jersey Chapter: American Academy of Pediatrics. (2018). The CRAFFT Questionnaire (version 2.1). https://njaap.org/wp-content/uploads/2018/03/COMBINED-CRAFFT-2.1-Self-Admin_Clinician-Interview_Risk-Assess-Guide.pdf
Links to an external site.
Sarkisian, K., Planalp, E., Carol, V. H., & Goldsmith, H. H. (2022). Leveraging latent profile analysis to synthesize childhood and adolescent risk factors for suicidal ideation. PLoS One, 17(8). https://doi.org/10.1371/journal.pone.0272400
