NURS 6512 Discussion Building a Health History Essay
Walden University NURS 6512 Discussion Building a Health History Essay-Step-By-Step Guide
This guide will demonstrate how to complete the Walden University NURS 6512 Discussion Building a Health History Essay assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.
How to Research and Prepare for NURS 6512 Discussion Building a Health History Essay
Whether one passes or fails an academic assignment such as the Walden University NURS 6512 Discussion Building a Health History Essay depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.
After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.
How to Write the Introduction for NURS 6512 Discussion Building a Health History Essay
The introduction for the Walden University NURS 6512 Discussion Building a Health History Essay is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.
How to Write the Body for NURS 6512 Discussion Building a Health History Essay
After the introduction, move into the main part of the NURS 6512 Discussion Building a Health History Essay assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.
Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.
How to Write the Conclusion for NURS 6512 Discussion Building a Health History Essay
After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.
How to Format the References List for NURS 6512 Discussion Building a Health History Essay
The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.
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Sample Answer for NURS 6512 Discussion Building a Health History Essay
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.
There are so many sources that entail the life of Florence Nightingale. This version makes me envision Florence as a very inspiring accolade. Florence Nightingale refused to be married when she was 17 years old as she chose to answer her calling despite her parents being against enrolling as a nursing student at the Lutheran Hospital in Germany. Nightingale faced a cholera outbreak in an unsanitary environment when she returned from school to London and worked at Middlesex hospital. She worked hard to improve the environment’s sanitation, significantly decreasing the number of deaths. All the hard work eventually affected Nightingale’s health. The Crimean War happened between the British and Russian Empires, and many soldiers were admitted into military hospitals. There were not enough female nurses stationed at Crimea hospitals. England then was angry due to the neglect of the soldiers who had fallen ill and injured and lacked medical care due to insufficient caregivers leading to dreadful unsanitary, and inhumane conditions. Nightingale then was called to her calling despite barely recovering from her illness. She assembled a team of nurses and sailed them to Crimea. Nightingale and her nurses warned of the conditions they were about to face but were still unprepared for what they witnessed upon their arrival.
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.
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
Sample Answer 2 for NURS 6512 Discussion Building a Health History Essay
The main question post for this discussion entails building a health history regarding a pre-school-aged white female living in a rural community. I would use a patient-centered care approach with techniques that included courtesy, comfort, connection, and confirmation during the interview to develop a rapport with the parent(s) and the patient (Ball et al., 2019). The discussion will focus on communication techniques, social determinants of health considerations, risk assessment tools, and targeted questions to improve the patient and the family’s wellbeing.
Communication and Interview Techniques
I would review the pre-visit questionnaire and identify who was attending the patient before entering the exam room. Of note, if the person accompanying the child were not the parent, then I would check with my mentor the policies and procedures for my primary care setting. I would also review the patient’s History of Present Illness, Past Medical History, Surgeries, Allergies (medications, food, and environment), Current, Present, and Past Medications, and Family Health History.
The patient should be close to or held by the parent in a pediatric centered room that elicits reassurance for the pediatric patient. The room temperature should be comfortable. The furniture would be placed so that there were no barriers between the patient, parent(s), and myself (Ball et al., 2019). Decreasing physical barriers during the interview can facilitate a comfortable and engaging experience for the patient and parent(s).
I would knock before entering the room and introduce myself as a registered nurse and a student family nurse practitioner, working closely with an experienced mentor.
I would address the parent by their last name and ask how they would prefer I address their child (i.e., nickname). I would then say hello to the patient in a kind tone of voice and tell her that I am happy to meet her. My questions would be open-ended and non-leading, and I would courteously wait for them to answer the questions (Malloy & Stolzenberg, 2019).
Considerations of Social Determinants of Health
My patient is a pre-school-aged white female living in a rural community. One of my concerns would be access to health care providers. Nielson et al. (2019) report that 20% of Americans live in rural settings, but only 10% of primary care providers (PCP)provide medical service to these areas. Nielson et al. also report that the shortage of PCPs is expected to reach 25,000 by 2025 in rural communities. Another consideration would be access to urgent care or acute care facilities within a reasonable geographical area. Is the child exposed to lead paint if the houses are old? Does the child have access to clean water? Is there a grocery near them with access to fresh fruits and vegetables? Is there a good school district for the patient? Are there parks and sidewalks and safe places for the child to play? How old are the parents? What is the educational background of the parents? The age and educational background of the parents would be significant in terms of assessing health literacy. The parents’ religious or spiritual beliefs are also important considerations.
Questions Posed to Assess Health Risks
My first question would be addressed to the parents, and I would ask what brought you in today? The following questions would revolve around the chief concern of the parents, and I would paraphrase their concern(s) and ask them if I understand their concerns. Once I established their chief concern(s), I would ask them what is their most important concern today? What do you think is going on with your child (if there is a concern)? How do you feel your child is doing? Tell me about your child? What kind of activities does she do during the day?
Potential Health Risks Based on Patient’s Age, Gender, and Ethnicity
The patient is considered vulnerable because she is of pre-school age and is dependent on caregivers. She does not have an adult’s cognitive or physical abilities and needs her primary caregivers’ protection. The patient may not be able to verbalize if someone is abusing or neglecting them. The patient is also female and may be more vulnerable to sexual abuse (Melmer & Gutovitz, 2020). Health care providers have an ethical responsibility to protect their patients. The patient is white and should be screened for common genetic anomalies that affect white populations, such as Cystic Fibrosis.
Risk Assessment Tool
The Safe Environment for Every Kid (SEEK) risk assessment tool would be mailed to the parents after the first interview. I would respectfully address any concerns raised once I reviewed the completed questionnaire (American Academy of Pediatrics, 2021). Using a risk assessment tool will help to assess the strengths and weaknesses of the parents or caregivers. Early identification of risks to the pediatric patient can be mitigated by providing the parents with educational resources the parents could use when necessary.
Targeted Risk Assessment Questions
The targeted questions that I would ask the parents would involve risk assessments: Is your child current with their vaccinations? Does your child have a car seat, and are you comfortable with how it works? What type of childproofing do you use for your home? When was the last time your child saw a dentist? How is potty training going? How would you describe your child’s sleeping pattern? How would you describe your child’s eating habits? How often does your child attend daycare or pre-school? How often do you read to your child? How much time does your child spend watching television or on computer devices? Does she have any difficulties pronouncing words? Does anyone besides the parents take care of your daughter? I would assess if the pre-school child is meeting developmental milestones based on her age. Lastly, I would summarize the chief concern with the parent(s) and ask if there are any other questions or concerns for me before they leave. The parents would be given a written patient/parent educational handout after the visit (American Academy of Pediatrics, n.d.).
Conclusion
Building a health history with a pediatric patient involves cooperation with the family and building a strong rapport based on respect and dignity. One of the most important aspects of becoming a successful family nurse practitioner is listening to the patient (and parents) and learning. Open-ended questions that are not leading allow a greater depth of building the patient’s history. Summarizing the visit with the patient and the parent is a helpful tool that improves communication. Risk assessment tools help to prioritize a plan of care for the patient (and their family).
References
American Academy of Pediatrics. (n.d.). Bright futures tool kit, 2nd edition new.
https://brightfutures.aap.org/materials-and-tools/tool-and-resource-kit/Pages/default.aspx
American Academy of Pediatrics. (2021). Screening tools.
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.). Elsevier Mosby.
Malloy, L.C., & Stolzenberg, S.N. (2019, March). Editorial perspective: Questioning kids:
applying the lessons from the developmentally sensitive investigative interviewing to the research context. Journal Child Psychology Psychiatry, 60(30), 325-327. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7017956/
Melmer, M.N., & Gutovitz, S. (2020, November 20). Child sexual abuse and neglect. In:
StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470563/
Nielson, M., D’Agostino, D., & Gregory, P. (2017). Addressing rural health challenges head
- Missouri Medicine, 114(5), 363-366.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140198/
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.
Photo Credit: Sam Edwards / Caiaimage / Getty Images
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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
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What’s Coming Up in Module 2?
Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images
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
Sample Answer 3 for NURS 6512 Discussion Building a Health History Essay
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 Essay
Effective quality care begins with obtaining a detailed medical history for the patient. This, therefore, requires developing a therapeutic relationship with the patient to foster trust, which allows the patient to divulge information to build an accurate health history.
Brief summary of interview
The patient in the scenario is an 80-year-old white male with angina who lives on a farm 80 miles away from a healthcare center. The patient present with a complaint of worsening chest pain and a feeling of heavy weight on his chest. He reports a squeezing pain and tightness in the chest that worsen when he does activities around his farm but goes away with rest. Past medical history includes type 2 diabetes, hyperlipidemia, and hypertension. He reports he takes Metformin, Atorvastatin, and lisinopril medication in the morning and evening. He is allergic to penicillin. The patient reports both parents are deceased, but his mother was hypertensive and died from a stroke at 70 years old, while his father had diabetes. The patient reports he smokes 1/2 pack of cigarettes daily, chew tobacco and drinks 1-2 beers with dinner.
Communication technique
Every patient is different, and as such special consideration and care should be taken to identify and address factors that can affect the ability to gather information from the patient. The patient in the scenario is an elderly male, and with older patients, careful attention should be given to the communication techniques used. According to Ball et al. (2019), Communication can be more difficult with the older patient due to the changes in cognitive abilities and sensory deficits. Therefore, in the interview with this patient, communication techniques include speaking clearly and slowly. This allows the patient to gain a better understanding of what is being asked and be able to provide answers. Additionally, identifying if the patient has a hearing deficit and which ear is the stronger side allows for better positioning to ensure the patient can still see the provider’s face and have easier hearing. Sitting close to the patient and providing a quiet area for the interview can enhance the communication process. Older adults may have difficulties with memories or get confused easily, therefore, it is important to use short open-ended questions that are uncomplicated and free from medical jargon when assessing the patient. It also helps the gain collateral information from a relative or caregiver of the patient once permission is obtained, as this can gain greater accuracy and yield more information.
Risk assessment instrument
One risk assessment instrument applicable for this patient is obtaining a personal and social history. Personal and social history helps to obtain information on the patient’s lifestyle habits. This includes nutrition and diet patterns, smoking, and alcohol use, along with self-care habits such as exercise. This assessment instrument must be included as these lifestyle factors are major contributors to the patient’s angina condition. According to Ruan et al. (2018), risk factors such as smoking, alcohol drinking, fruit/vegetable intake (diet), and physical activity (exercise) influence the risk of angina across different ethnic groups. Furthermore, the information is crucial to treating the patient’s condition as he reports smoking and alcohol use. Therefore, providers must establish a baseline of these lifestyle factors to suggest and plan for modifications that can improve the patient’s condition. Significant priority should be placed on optimizing lifestyle factors in addition to preventive medications to reduce complications associated with angina (De Lemos, 2021.) As patient’s get older it is important to have good access to health care resources as their health is at greater risk to deteriorate. The personal and social history consist of the assessment of the patient’s access to care. The patient in the scenario lives far away from the health center. It is important then to assess the patient’s ability to access transportation for care, his regular pattern in seeking care and identify and address any worry the patient might have in regards to his access to care to manage his existing conditions and his present complaint of angina.
Target questions to be addressed to the patient includes:
1)What is the reason for your visit? When did these symptoms start, and is there anything that makes it worse or better?
Do you have any existing medical conditions? Does anyone else in your family has/had these conditions?
Do you smoke/chew tobacco? If yes, what do you smoke, and how much per day?
Do you drink alcohol? How much per day?
How physically active are you on an average day?
What type of diet do you follow at home and outline your average meal for the day.
How often do you seek medical attention and follow up with your doctor?
Explain any alternative therapy or home herbs used to manage presenting symptoms?
References
Ball, J. W., Danis, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s Guide to Physical Examination: An Interprofessional Approach. St. Louis, MO: Elsevier, Inc.
De Lemos, J. A. (2021). Diagnosis and management of stable angina. JAMA, 325(17), 1765. https://doi.org/10.1001/jama.2021.1527Links to an external site.
Ruan, Y., Guo, Y., Zheng, Y., Huang, Z., Sun, S., Kowal, P., Shi, Y., & Wu, F. (2018). Cardiovascular disease (CVD) and associated risk factors among older adults in six low-and middle-income countries: results from SAGE Wave 1. BMC Public Health, 18(1). https://doi.org/10.1186/s12889-018-5653-9Links to an external site.
Sample Answer 5 for NURS 6512 Discussion Building a Health History Essay
Accurate patient history is essential for APRNs to develop appropriate care plans and comprehensively understand their previous health concerns (Ding et al., 2020). The provided case study presents a 33-year-old Caucasian individual who identifies as male despite being assigned female at birth. Three years ago, the individual transitioned from female to male while residing in Florida. Now, he has returned to his home in Texas and is openly sharing his complete transition with his family and social circle. He is currently without employment and lacks access to further hormonal replacement for suppression. The individual has a documented history of depression, is living with HIV, and engages in the use of cannabis. The paper demonstrates my role as the APRN in communicating effectively and building the patient’s health history described above.
Socioeconomic, Spiritual, Lifestyle, and other Cultural Factors
The various factors related to a patient’s socioeconomic status, spirituality, lifestyle, and culture can significantly affect their access to healthcare, financial burdens, and decision-making processes. B.C. is currently without employment and lacks access to further hormonal replacement for suppression. Unemployment can impact individuals’ access to healthcare and ability to afford necessary medications or treatments. Transitioning may also incur financial expenses (Sbragia & Vottero, 2020). In addition to his medical history, he has a diagnosis of depression, is living with HIV, and uses cannabis. The patient’s spiritual beliefs can impact their coping mechanisms, support systems, and decision-making regarding healthcare. Individuals who are HIV positive and engage in cannabis consumption may experience effects on their overall well-being, necessitating the need for proper care and assistance. Transitioning from female to male, particularly in conservative regions such as Texas, can pose difficulties concerning acceptance, discrimination, and the availability of transgender-affirming healthcare (Friley & Venetis, 2021).
Sensitive Issues
As an APRN, it is crucial to recognize the significance of respectful interactions with B.C. This includes honoring his gender identity, acknowledging his journey, maintaining a non-judgmental attitude towards his HIV status and cannabis use, respecting his privacy and confidentiality, and fostering a safe environment that encourages open communication. It is clear that B.C. is currently facing personal, economic, and emotional challenges, and it is crucial to address these concerns professionally. It is crucial to offer comprehensive counseling and educate patients about appropriate treatment for HIV while ensuring a stigma-free environment (Boyd et al., 2022). Addressing the sensitive issue of hormonal replacement therapy requires respectful consideration, ensuring that the patient’s dosage is appropriate. B.C. should be informed about the health risks associated with smoking marijuana and encouraged to quit. In order to prevent any potential victimization based on B.C. appearing as a male, it is essential to approach the situation professionally and ensure that he feels treated with the same level of respect as everyone else.
Communication Techniques
In order to establish effective communication with B.C., it is crucial to utilize affirming language and pronouns that correspond to the patient’s gender identity. Additionally, active listening, empathy, and allowing the patient to lead the conversation are essential. Employing open-ended questions and delivering apparent explanations further contribute to successful communication. It is crucial to employ communication techniques prioritizing respect for identity, cultural sensitivity, a non-judgmental attitude, and empathy (Kronk et al., 2021). It is essential to prioritize the patient’s autonomy by allowing them to guide the conversation, share information at their preferred speed, and employ open-ended questions to delve into their needs and objectives. As a nurse practitioner, it is crucial to communicate with patients clearly and compassionately, avoiding using complex medical terminology.
Health History Interview
As an APRN, I will proficiently do a health history interview with B.C. using active listening, open-ended inquiries, reassurance, and cooperation. Active listening entails attentively observing the patient’s reactions, asking more inquiries, and motivating them to divulge further details about their encounters. Open-ended questions promote confidentiality and foster patient engagement in decision-making processes. Here are some specific questions I would ask the patient (Mikulak et al., 2021):
- Could you please provide a detailed account of your transition process and highlight any obstacles you encountered during this period? This inquiry recognizes the patient’s progression and offers an understanding of their encounters and requirements.
- How are you coping with your HIV diagnosis, and are you now doing treatment? This inquiry evaluates the patient’s ability to effectively manage their HIV condition and adhere to the prescribed treatment regimen while also identifying any obstacles that may hinder their access to healthcare.
- Could you elaborate on your use of cannabis and how often you engage in its use? Have you encountered any adverse consequences? This inquiry delves into the patient’s patterns of drug use and the possible health hazards linked to cannabis.
- Do you have significant spiritual or cultural beliefs crucial to your health and well-being? This question acknowledges the impact of spirituality and culture on the patient’s healthcare choices and strategies for dealing with difficulties.
- What is the specific effect of transitioning on your mental health, specifically about depression? This inquiry pertains to the patient’s psychological well-being and the possible need for assistance or intervention.
Risk Assessment
The Patient Health Questionnaire-9 (PHQ-9) is a risk assessment tool that applies to B.C. since it may evaluate symptoms of depression, track changes in mood over time, and inform treatment choices, thereby making it a significant resource for this patient’s care. The patient has a documented history of depression, is now jobless, openly communicating their complete gender change to both family and society, has tested positive for HIV, and engages in cannabis use, all of which are recognized risk factors for depression. The PHQ-9 is a very accurate and consistent instrument for diagnosing Major Depressive Disorder, with a sensitivity rate of 88% and a specificity rate of 88% (Costantini et al., 2021).
Conclusion
APRNs rely on precise patient history to formulate treatment plans and get insight into previous medical issues. Age, gender, ethnicity, and living environment influence a patient’s health. Proficient communication and interviewing strategies are crucial for acquiring information. The male patient in the given case study is transitioning from female to male. Several aspects, such as socioeconomic status, spirituality, lifestyle, and cultural background, influence this change. These factors affect the patient’s ability to access healthcare, the financial expenses involved, and the decision-making process. Effective communication requires respectful interactions, the use of affirming words, active listening, empathy, and the use of open-ended inquiries.
References
Boyd, I., Hackett, T., & Bewley, S. (2022). Care of Transgender Patients: A General practice Quality Improvement approach. Healthcare, 10(1), 121. https://doi.org/10.3390/healthcare10010121
Costantini, L., Pasquarella, C., Odone, A., Colucci, M. E., Costanza, A., Serafini, G., Aguglia, A., Murri, M. B., Brakoulias, V., Amore, M., Ghaemi, S. N., & Amerio, A. (2021). Screening for depression in primary care with Patient Health Questionnaire-9 (PHQ-9): A systematic review. Journal of Affective Disorders, 279, 473–483. https://doi.org/10.1016/j.jad.2020.09.131
Ding, J. M., Ehrenfeld, J. M., Edmiston, E. K., Eckstrand, K., & Beach, L. B. (2020). A model for improving health care quality for transgender and gender nonconforming patients. Joint Commission Journal on Quality and Patient Safety, 46(1), 37–43. https://doi.org/10.1016/j.jcjq.2019.09.005
Friley, L. B., & Venetis, M. K. (2021). Decision-making criteria when contemplating disclosure of transgender identity to medical providers. Health Communication, 37(8), 1031–1040. https://doi.org/10.1080/10410236.2021.1885774
Kronk, C. A., Everhart, A. R., Ashley, F., Thompson, H. M., Schall, T. E., Goetz, T. G., Hiatt, L., Derrick, Z., Queen, R., Ram, A., Guthman, E. M., Danforth, O. M., Lett, E., Potter, E., Sun, D., Marshall, Z., & Karnoski, R. (2021). Transgender data collection in the electronic health record: Current concepts and issues. Journal of the American Medical Informatics Association, 29(2), 271–284. https://doi.org/10.1093/jamia/ocab136
Mikulak, M., Ryan, S., Ma, R., Martin, S., Stewart, J., Davidson, S., & Stepney, M. (2021). Health professionals’ identified barriers to trans health care: a qualitative interview study. British Journal of General Practice, 71(713), e941–e947. https://doi.org/10.3399/bjgp.2021.0179
Sbragia, J. D., & Vottero, B. (2020). Experiences of transgender men in seeking gynecological and reproductive health care: a qualitative systematic review. JBI Evidence Synthesis, 18(9), 1870–1931. https://doi.org/10.11124/jbisrir-d-19-00347
Rubric Detail
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Content
Name: NURS_6512_Week_1_Discussion_Rubric
| 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. |
|
| Main 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. |
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| Total Points: 100 | |||||