NURS 6512 Discussion: Building a Health History

Sample Answer 2 for NURS 6512 Discussion: Building a Health History

85-year-old white female living alone with no family in declining health

Introduction

My assignment is based on working with an 85-year-old white female living alone with no family in declining health. While working on this task, I assume the patient is my mother, and I interrogate him with empathy, knowing that she is an elderly person who is likely to be more isolated and lonelier than individuals living with their loved ones. Here, I need to create an interviewing strategy to employ in assessing this patient’s medical condition, taking into account his advanced age that his health is declining.

Communication is a difficult endeavor that requires empathy and courtesy, especially when dealing with senior individuals. It’s critical to observe, listen, and gather information when pertinent information is offered when speaking with these kinds of patients. To preserve a constant pace with the patient, the medical practitioner not only should go slowly and be very patient (Ball et al., 2019). Furthermore, by observing, the healthcare professional can connect to and be brought into the environment of the elderly. It is critical to comprehend the participant’s reality and the circumstances that may impact their responses. It’s critical for health care professionals to establish a good connection with patients in the interview session to create a favorable interaction.

The nurse tells the patient to introduce themselves to create familiarity and as the patient settles in the interview. Showing sincerity is vital while getting to know the social circle’s nature and the living condition of the patient. The questions could be personal, but they are meant to know the situation of the healthcare provider.

Target Health Question

The impact of social determinants on patient health is an important issue to consider when assessing a patient’s health.  Food availability, social support, social position, and low-income levels, are all closely linked to premature death and higher incidents of sickness, based on empirical evidence. Inquiring into social determinants of health and how they affect the patient’s health can be a touchy subject (Ryan, 2019). As a result, I’d organize my queries in a way that respects the older patient while also demonstrating empathy and sincerity for their plight. Moreover, because such individuals may have difficulties communicating their conditions and ideas, I would be using effective listening skills.

Risk Assessment

The arranging of the patient’s health record through the Subjective Objective Assessment (SOAP) and Plan Problem Oriented Medical Record (POMR) would be appropriate tools for the assessment of this patient. The POMR tool is an effective instrument as it provides for a thorough recording and assessment of medical information about a patient (Pdhi.com, 2022). Furthermore, it enables the collection of data from all care team members in order to ascertain the diagnosis and develop an empirical medication regimen. POMRs often include the patient’s condition, complaints, test findings, and a care plan that enables the medical practitioner to address each issue individually, write patient records, and a review of discharge with instructions for follow-up (Feldman et al., 2021).

Health-Related Risk

Since the patient is elderly and has a declining health status, there are certain risks that are mainly linked to social health determinants. Old age put the patient at risk of falling (Abdi et al., 2019). As such, the health care provider should investigate if she has already incurred any injuries from falling.

Five Target Questions

On the first encounter, it is vital to first build a connection and therapeutic relationship with the patient to make them comfortable to open up. This way, there would be mutual understanding, which is essential in knowing the needs of the patients. Some of the questions, I would ask include;

1. Do you experience any pains?
2. What do you think could be the reasons for your symptoms?
3. Are you under any medication?
4. What do you think of your quality of life?
5. Have any medications triggered any allergies in you?

References

Abdi, S., Spann, A., Borilovic, J., de Witte, L., & Hawley, M. (2019). Understanding the care and support needs of older people: a scoping review and categorisation using the WHO international classification of functioning, disability and health framework (ICF). BMC Geriatrics, 19(1). https://doi.org/10.1186/s12877-019-1189-9

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

Feldman, R., Chiu, M., Lawson, A., & Sadavoy, J. (2021). Evaluating Caregiver Risk: The Dementia Caregiver Interview Guide. Psych, 3(4), 552-561. https://doi.org/10.3390/psych3040036

Pdhi.com. (2022). What is a Health Risk Assessment? | ConXus Platform. Pdhi.com. Retrieved 2 June 2022, from https://www.pdhi.com/ncqa/what-is-a-health-risk-assessment/.

Ryan, L. (2019). Clinical Applications of a Smart Physical Examination System for the Health Management in Elderly. Case Medical Research. https://doi.org/10.31525/ct1-nct03858660

Sample Answer 3 for NURS 6512 Discussion: Building a Health History

I really liked the way you presented your discussion post; it was very organized and thought out. However, as a PMHNP student, I was inclined to read through a few articles and I came across the following Risk assessment tools that would assess the psychological issues associated with one’s LGBTQIA status.

The Gender Minority Stress and Resilience Scale (GMRS) is used to measure the difficulties associated with identifying as a gender minority and protective factors for psychological well-being.The 58 items were adapted from other measures and compiled into the GMRS to measure nine different constructs, including Gender-related Discrimination, Gender-related Rejection, Gender-related Victimization, non-affirmation of Gender Identity, Internalized Transphobia, Negative Expectations for Future Events, and Nondisclosure (Shulman et al., 2017).

Strength of Transgender Identity Scale (STIS)This assesses how strongly an individual identifies as transgender and how important transitioning is to them. Although largely related to identifying transgender people, it contains items that may be relevant to understanding someone’s gender identity and how that might change in therapeutic interventions. The STIS has six questions and no factors were identified in the original validation study. Example items include “I identify as trans,” “It is important to me that people I am close to know I transitioned,” and “The fact that I transitioned is important to who I am.”

Transgender Adaptation and Integration Measure (TG AIM) measure the stresses associated with being transgender and the individual’s efforts to cope with stress. The TG AIM has 15 items, and three factors were identified in the initial validation study that is scored as subscales: Coping and Gender Reorientation Efforts, Psycho social Impact of Gender Status, and Gender-related Fears. A fourth factor, Gender Locus of Control, was also identified but was not recommended for use due to poor internal consistency. Example items of the three recommended factors include “I fear discrimination,” “I take/have taken hormones,” and “Being transgender causes me relationship problems.”

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.

Shulman, G. P., Holt, N. R., Hope, D. A., Mocarski, R., Eyer, J., & Woodruff, N. (2017). A review of contemporary assessment tools for use with transgender and gender nonconforming adults. Psychology of Sexual Orientation and Gender Diversity, 4(3), 304–313. https://doi.org/10.1037/sgd0000233Links to an external site.

Effective nursing health assessment interview techniques. (n.d.). Walden University. https://www.waldenu.edu/online-bachelors-programs/bachelor-of-science-in-nursing/resource/effective-nursing-health-assessment-interview-techniquesLinks to an external site.

Sample Answer 4 for NURS 6512 Discussion: Building a Health History

Your post was thorough and responsive to the needs of the patient. The patient’s history of type 2 diabetes causes a decrease in insulin secretion that leads to less glucose in the cells, tissues, and organs for energy (McCance & Huether, 2019). With the genetic component of diabetes, this patient is at higher risk for complications associated with diabetes since he also stated a family history(Rosenthal & Burcham, 2019). Based on the medications the patient is taking, it is evident he is exhibiting comorbidities such as hypertension and dyslipidemia (Bernabe-Ortiz et al., 2022). As patients age, medication cost can be a factor in medication compliance, so addressing the patient’s ability to afford medications (Obuobi et al., 2021). It is also important to address how the patient receives his medications as most pharmacies will deliver medications versus a personal pick-up (Obuobi et al., 2021). Medication cost that contributes to compliance is also a factor that you addressed in your interview (Mishra et al., 2018). Since the patient lives in a rural area, it would be beneficial to inquire if the patient is open to home health services to monitor signs and symptoms, as well as check the patient’s A1C to determine the control of his diabetes (Bhalodkar et al., 2020). As you stated, this is a factor in the patient experiencing angina and hypertension. I agree with assessing his transportation access to a primary care provider to help maintain his healthcare as many elderly people have difficulty obtaining transportation, which is why establishing home health would be a good resource (Bhalodkar et al., 2020). A primary care provider is necessary to order this service. The patient’s disease processes are intertwined so lifestyle, diet, exercise, and smoking play a factor in his angina, T2DM, hypertension, and hyperlipidemia (Obuobi et al., 2021). Establishing trust through a thorough assessment builds a foundation of trust that leads to empowering the patient and family to own the healthcare management.

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 (9^th ed.). St. Louis, MO: Elsevier Mosby.

Bernabe-Ortiz, A., Borjas-Cavero, D. B., Páucar-Alfaro, J. D., & Carrillo-Larco, R. M. (2022).

Multimorbidity Patterns among People with Type 2 Diabetes Mellitus: Findings from Lima, Peru. International Journal of Environmental Research and Public Health, 19(15). https://doi.org/10.3390/ijerph19159333Links to an external site.

Bhalodkar, A., Sonmez, H., Lesser, M., Leung, T., Ziskovich, K., Inlall, D., Murray-Bachmann, R., Krymskaya, M., & Poretsky, L. (2020). the effects of a comprehensive multidisciplinary outpatient diabetes program on hospital readmission rates in patients with diabetes: a randomized controlled prospective study. Endocrine Practice, 26(11), 1331–1336. https://doi-org./10.4158/EP-2020-0261

McCance, K.L. & Huether, S.E. (2019). Pathophysiology: The biologic basis for disease in

adults and children (8^th ed.). St. Louis, MO: Mosby/Elseier

Mishra, Vinaytosh, Samuel, Cherian &Sharma, S.K. (2018). Supply chain partnership assessment of a diabetes clinic. International Journal of Health Care Quality Assurance, 31(6), 646–658. https://doi-org./10.1108/IJHCQA-06-2017-0113

Obuobi, S., Chua, R. F. M., Besser, S. A., & Tabit, C. E. (2021). Social determinants of health and hospital readmissions: can the HOSPITAL risk score be improved by the inclusion of social factors? BMC Health Services Research, 21(1), 5. https://doi-org./10.1186/s12913-020-05989-7Links to an external site.

Rosenthal, L.D., & Burchum, J.R. (2018). Lehne’s pharmacotherapeutics for advanced practice

 nurses and physician assistants (2^nd ed.) St. Louis, MO: Elsevier

Sample Answer 5 for NURS 6512 Discussion: Building a Health History

The patient in this scenario is a 14-year-old biracial male. The first step in interacting with the patient is to build a trustworthy rapport with the patient and determine his fluency in communication and speaking the English language, as any language barriers can hinder the effectiveness of the communication, it is important to ensure the client understands the language of communication (Brooks et al., 2019). Effective communication is required needed in any patient-healthcare provider interaction. The language assessment is important in making communication easier.

Communication Techniques

Furthermore, the use of verbal techniques will be ensured in the communication process (Wang et al., 2018). However, caution will be taken not to offend the client in the conversation. The meaning and interpretation of the non-verbal techniques tend to vary from one cultural group to another (Sullivan, 2019). Therefore, considering that the client is from another cultural group and young, understanding their values would be necessary to reduce the conflicts in the communication process. I will also be empathetic to the client (Ball et al., 2019).

Subsequently, active listening is also important when interacting with the patient. Listening actively help the healthcare provider to capture important information about the patients and their possible health needs (LeBlond et al., 2014). On the other hand, some clients may be too talkative and so the healthcare provider must be able to control and ensure that the relevant information is obtained from the interaction. Controlling the conversation also helps in managing the time used in the interaction. The HEEADSSS risk assessment tool will be used when interviewing the patient because it will help in understanding the client’s home environment and education experiences among other areas of interest.

        Target Interview Questions

1. Whom do you live with at home?
2. What is your relationship with the parents and siblings?
3. What is it that makes you happy about your family?
4. Who is your best friend?
5. What do you like doing during your free time?

Conclusion

Finally, communication is important in the interaction between the patient and the healthcare providers. Both verbal and non-verbal communication matters in the interaction. Cultural values vary from one patient to another and this could be a major hindrance to effective interaction between the patient and the healthcare providers. Therefore, the nurses must demonstrate cross-cultural competencies and interact with their clients accordingly without judging them or looking down upon their cultural values.

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.

Brooks, L. A., Manias, E., & Bloomer, M. J. (2019). Culturally sensitive communication in healthcare: A concept analysis. Collegian, 26(3), 383-391. https://doi.org/10.1016/j.colegn.2018.09.007

LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw- Hill Medical.

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

Wang, Y., Wan, Q., Lin, F., Zhou, W., & Shang, S. (2018). Interventions to improve communication between nurses and physicians in the intensive care unit: An integrative literature review. International Journal of Nursing Sciences, 5(1), 81-88. https://doi.org/10.1016/j.ijnss.2017.09.007