NURS 6512 Discussion Week 1 Main Post

Being able to obtain a comprehensive health history for a patient is important in developing a treatment plan for them. The purpose of this discussion post is to discuss interview techniques I would use for an 85-year-old white female living alone with declining health. I will talk about the risk assessment instrument I would use and why. Lastly, I will list five targeted questions I would ask to assess her health to start building a health history.

The use of nursing theories is critical to patient care because of the different purposes that they serve. Nursing theories assist in informing every interaction between nurses and patients. Through defining the features of the nurse-patient interaction, these theories shape how nurses develop relationships with patients (Wei et al., 2019). The purpose of most nursing theories is to help nurses identify care needs among patients, articulate what they can do for patients and why they do it, and determine the kind of information to collect to develop care plans. Through theories, nurses can comprehend and evaluate health situations, explain and anticipate certain responses from patients and map out objectives and anticipated outcomes (Bahabadi et al., 2020). These theories also help nurses determine the interventions to deliver, best practices, and selection of productive areas for research. The implication is that nursing theories are fundamental to quality care provision as they help nurses to possess background propositions to offer the best care.

The first meeting with any patient is so important to build a good relationship and partnership from the start (Ball et al., 2019). With this patient being 85 and living alone there will be a lot to consider when interviewing her. I will need to establish is she is mentally with it, if she has hearing problems, and how much she understands about her health. Older adults often assume certain problems are just normal parts of aging and not anything to be considered (Ball et al., 2019). Often, older adults can also experience agism (Garrison-Diehn et al., 2022). Even in health care settings older adults experience feelings of incompetence and being a burden (Garrison-Diehn et al., 2022). It will be important to make sure she feels comfortable speaking to me knowing there is no bias or judgement.

The risk assessment I would do for this patient is the functional assessment. This is an older lady who lives alone. It will be essential to figure out how well she is able to function on her own. One of the biggest risks for older patients is falling. Falling is associated with adverse outcomes that can lead to a patient not being able to live at home anymore along with increased mortality (Snehal et al., 2020). The functional assessment would give information regarding how well she can move around the house, is she is able to keep a clean environment, how meals are prepared, how she goes to the bathroom, and keeps good hygiene (Ball et al, 2019). All these issues are going to contribute to her overall health. It is important to gather this information to determine what assistance, if any, she will need.

After introducing myself and establishing how the patient would like to be addressed, I would start by simply asking “What brings you in today?” This is a way to find out what her chief complaint is for coming in. My second question would be “When did this start?” This brings the patient back to the beginning and prompts them to tell the whole story regarding why they came in. My third question would be “What medications do you take on a regular basis and what are they for?” In my experience patients may or may not even know what they are taking, let alone why they are taking them. It can also lead to her discussing if she is compliant with her medications. To follow that, my fourth question would be “What medical problems do you have?” Before going through a formal review of systems, this can give a clue to what she considers to be important in her history. My last question would be “How well do you feel you are able to take care of yourself at home?” This is an open-ended question to gain some insight on the functional assessment. If the patient’s initial chief complaint is not urgent it is okay to give the patient some time while understanding the time constraints of you as the provider (Ball et al., 2019).

Establishing a relationship with patients and getting a thorough health history can be a daunting task for providers. It is key to tailor interviewing skills to meet patient specific needs. Modifying interview skills to the individual will eliminate communication barriers between the provider and patient (Bass et al., 2019). Creating a strong relationship with the patient will allow the nurse practitioner to obtain the most comprehensive health history and provide the best possible care to clients.

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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.

Garrison-Diehn, C., Rummel, C., Au, Y. H., & Scherer, K. (2022). Attitudes toward older adults and aging: A foundational geropsychology knowledge competency. Clinical Psychology: Science and Practice, 29(1), 4–15. https://doi.org/10.1037/cps0000043

Snehal, K., Rashmi, G., & Aarti, N. (2020). Risk factors for fear of falling in older adults in India. Journal of Public Health, 28(2), 123-129. doi:https://doi.org/10.1007/s10389-019-01061-9

Summary of the interview and a description of the communication techniques you would use with your assigned patient. Five targeted questions you would ask the patient.
To provide a summary of the interview and communication techniques I would use with a preschooler age child from a rural community would be getting down to the level of the child, briefly evaluating the family dynamics and the overall support within the home. Likely the child will be accompanied by an adult or caregiver.
Five target questions I would ask are:
1. If there are several concerns that bring you hear today; what problem concerns you most?
2. Can you tell me what happen?
3. Why do you think it happened?
4. Do you feel safe in your home?
5. Is there anything else that you want me to know?
Explain why you would use these techniques
Many children love it when you get down on the floor to play with them. They often have anxieties and fears that must be eased (Ball et al., 2019). I would use these techniques to allow the preschool age child to feel comfortable and decrease anxiety. I would also provide the patient with a coloring paper or something to allow her to feel interested in what we were discussing. I could use this as a distraction tool while asking question to her guardian and her. At some point within the interview I would discuss safety hazards related to her age group such as falls, chocking, burns, and poisoning (Ball et al., 2019).
Identify the risk assessment instrument you selected and justify why it would be applicable to the selected patient
Many risk assessments instruments have been developed to improve child welfare workers’ decision making (Vial et al., 2021). For this patient I would complete and organize the health record by SOAP ( subjective ,objective ,Assessment, Plan) (Ball et al., 2019). The screening tool I would use is HEEADSSS (home environment, education, eating, activities, drugs, sexuality, suicide/depression, and safety from injury/violence) (Ball et al., 2019). I would use this tool to both review with the patient as well as parent to get and overall understanding of the concerns for the visit. The collection of family health history information is part of routine healthcare interactions and can inform clinical decision making and preventive services (Lushniak, 2015). This as well would be an area to focus my assessment.

References

Ball, J., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). In Seidel’s guide to
physical examination: an interprofessional approach (9th ed., pp. 58–59). essay, Mosby.
Lushniak, B. D. (2015). Family Health History: Using the past to Improve Future Health. Public
Health Reports, 130(1), 3–5. https://doi.org/10.1177/003335491513000102
Vial, A., van der Put, C., Stams, G. J., Dinkgreve, M., & Assink, M. (2021). Validation and
further development of a risk assessment instrument for child welfare. Child Abuse &
Neglect, 117, 1–11. https://doi.org/10.1016/j.chiabu.2021.105047

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.

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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.
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.
Submission and Grading Information

Grading Criteria

To access your rubric:
Week 1 Discussion Rubric

Post by Day 3 of Week 1 and Respond by Day 6 of Week 1

To Participate in this Discussion:

Week 1 Discussion

________________________________________
What’s Coming Up in Module 2?

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In Module 2, you explore the impact of functional assessments, diversity, and sensitivity in conducting health assessments. You also examine various assessment tools and diagnostic tests used to gather information about patients’ conditions and examine their validity, reliability, and impact in conducting health assessments.
Next week, you will specifically examine functional assessments as they relate to diversity and sensitivity
Registration for Shadow Health
Throughout this course, you will participate in digital clinical experiences using the online simulation tool Shadow Health. The Shadow Health digital clinical experience provides a dynamic, immersive experience designed to improve nursing skills and clinical reasoning through the examination of digital standardized patients. Using Shadow Health you will participate in health histories, focused exams, and a comprehensive assessment.
There will be four Shadow Health assessment components that you will need to complete in Module’s 2 and 3:
• Health History Assessment (Week 3 & 4)
• Focused Exam: Cough (Week 5) for a pediatric patient presenting with cough
• Focused Exam: Chest Pain (Week 7) for an adult patient presenting with chest pain
• Comprehensive (Head-to-Toe) Physical Assessment (Week 9)
Before you can participate in these simulations, you will need to register for a Shadow Health account. To do this:
• Go to the Walden Bookstore and purchase access to Shadow Health and the required texts.
• Once Shadow Health has been purchased, an access code will be emailed to you from the bookstore.
• Review this video explaining how to register in Shadow Health: https://vimeo.com/275921826/c12d50ee6e
• Use the Shadow Health link located in the navigation menu on the left in the Blackboard course.
• Follow the prompts to register in Shadow Health. You will need the access code provided from the bookstore to register. Once registered, Shadow Health should always be accessed via the link in Blackboard.
• Use only Google Chrome when accessing Shadow Health and make sure all other programs are turned off on your computer. Other browsers do not work well and will not allow the Shadow Health speech to text function to work.
• Once registered, complete the Shadow Health Orientation in the Shadow Health website/program and review the videos designed to assist with navigating and completing assignments.
• Read the Shadow Health Nursing Documentation Tutorial located in the Week 1 Learning Resources.
Note: As nurses you typically use the word assessment to mean completing the physical exam. However, in the SOAP Note format, assessment means diagnosis so start getting in the habit of calling the physical exam exactly that.

Week 2 Case Studies

In Week 2, your Instructor will assign you a case study related to your Discussion by Day 1 of the week. Please make sure to review the “Course Announcements” area of the course to verify your assigned case study. Please plan ahead to ensure you have time to review your case study and your Learning Resources so that you can complete your Discussions and Assignments on time.

Photo Credit: Getty Images/iStockphoto
Practicum – Upcoming Deadline
In the Nurse Practitioner programs of study (FNP, AGACNP, AGPCNP, and PMHNP) you are required to take several practicum courses. If you plan on taking a practicum course within the next two terms, you will need to submit your application via Meditrek .
For information on the practicum application process and deadlines, please visit the Field Experience: College of Nursing: Application Process – Graduate web page.
Please take the time to review the Appropriate Preceptors and Field Sites for your courses.
Please take the time to review the practicum manuals, FAQs, Webinars and any required forms on the Field Experience: College of Nursing: Student Resources and Manuals web page.
• Field Experience: College of Nursing Quick Answers

• Field Experience: MSN Nurse Practitioner Practicum Manual
• Student Practicum Resources: NP Student Orientation
Next Module

To go to the next module:
Module 2

Rubric Detail

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Content
Name: NURS_6512_Week_1_Discussion_Rubric
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Excellent Good Fair Poor

Main Posting Points Range: 45 (45%) – 50 (50%)
“Answers all parts of the Discussion question(s) with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources. Supported by at least three current, credible sources. Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style. Points Range: 40 (40%) – 44 (44%)
“Responds to the Discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module. At least 75% of post has exceptional depth and breadth. Supported by at least three credible sources. Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style. Points Range: 35 (35%) – 39 (39%)

“Responds to some of the Discussion question(s). One or two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Post is cited with two credible sources. Written somewhat concisely; may contain more than two spelling or grammatical errors. Contains some APA formatting errors. Points Range: 0 (0%) – 34 (34%)
“Does not respond to the Discussion question(s) adequately. Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible sources. Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style.

Post: Timeliness Points Range: 10 (10%) – 10 (10%)
Posts main post by Day 3. Points Range: 0 (0%) – 0 (0%)
N/A Points Range: 0 (0%) – 0 (0%)
N/A Points Range: 0 (0%) – 0 (0%)
Does not post main post by Day 3.
First Response Points Range: 17 (17%) – 18 (18%)

“Response exhibits synthesis, critical thinking, and application to practice settings. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of Learning Objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English. Points Range: 15 (15%) – 16 (16%)
“Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English. Points Range: 13 (13%) – 14 (14%)
“Response is on topic and may have some depth. Responses posted in the Discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited. Points Range: 0 (0%) – 12 (12%)

“Response may not be on topic and lacks depth. Responses posted in the Discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Second Response Points Range: 16 (16%) – 17 (17%)
“Response exhibits synthesis, critical thinking, and application to practice settings. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of Learning Objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English. Points Range: 14 (14%) – 15 (15%)

Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English. Points Range: 12 (12%) – 13 (13%)
“Response is on topic and may have some depth. Responses posted in the Discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited. Points Range: 0 (0%) – 11 (11%)
“Response may not be on topic and lacks depth. Responses posted in the Discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Participation Points Range: 5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days. Points Range: 0 (0%) – 0 (0%)
N/A Points Range: 0 (0%) – 0 (0%)
N/A Points Range: 0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on three different days.
Total Points: 100
Name: NURS_6512_Week_1_Discussion_Rubric