Building a Health History
Adolescent Hispanic/Latino boy living in a middle-class suburb
The first thing to do when interviewing any adolescent is to make them comfortable and to them trust you. The nurse can ask the parent to step out for the patient to be more comfortable and open since sometimes this population might not want the parent to know or might be embarrassed to answer some questions. If the interpreter is needed, a professional interpreter will be required but, in this case, the patient does not need an interpreter. Ball et al. (2019) states that when interviewing the patient, choose a comfortable setting, maintain eye contact, begin by introducing yourself and explain what your role is, use open-ended questions and avoid confrontational questions (Ball et al., 2019).
Communication Techniques
After the patient is comfortable and ready for the interview, use open-ended questions, so the patient can explain himself more so that you can get more information instead of yes or no answers. Give the patient enough time to answer the question without rushing him, some questions asked can be embarrassing to the patients and they may hesitate to answer them. To be able to have good communication skills and techniques the interviewee must be prepared. Edgemon et al. (2020) states that asking appropriate questions is an indicator that an interviewee has prepared for the interview and by doing this the interviewer can get the targeted answers (Edgemon et al., 2020). Maintaining eye contact and having a good posture can help the patient to trust you and can help the interviewee to notice any uncomfortable behavior or hesitation and give the patient more time. The interviewee should have appropriate nonverbal communication throughout the interview for the patient to cooperate.
Risk Assessment Instrument
The risk assessment of choice is the Structured Interview of Family Assessment Risk (SIFAR). According to Santos & Alberto (2016), SIFAR is designed as a structured professional judgment (SPJ) tool for assessing adolescent offenders’ family risk, it evaluates physical health, mental stability, substance abuse, education, employment, housing/transport, legal problems, violence, ethnic and social dissonance, poverty, social net, and parenting (Santos, & Alberto, 2016). This assessment tool was chosen because it covers all the targeted questions for the adolescent. This assessment instrument is perfect because it covers pretty much all the information needed both in the medical unit and psychiatric unit.
Targeted Questions
Where do you live and who do you live with?
Do you go to school? What grade are you in?
Do you have any medical problems?
Do you sometimes feel sad more than usual?
Do you smoke or use any illegal drugs?
References
Edgemon, A. K., Rapp, J. T., Brogan, K. M., Richling, S. M., Hamrick, S. A., Peters, R. J., & O’Rourke, S. A. (2020). Behavioral skills training to increase interview skills of adolescent males in a juvenile residential treatment facility. Journal of Applied Behavior Analysis, 53(4), 2303–2318. https://doi-org.ezp.waldenulibrary.org/10.1002/jaba.707
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.
Santos, D., & Alberto, I. (2016). Developing a Family Risk Assessment Tool in Adolescent Offenders: An Exploratory Study. Child & Adolescent Social Work Journal, 33(2), 103–113. https://doi-org.ezp.waldenulibrary.org/10.1007/s10560-015-0409-1
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.
Photo Credit: Sam Edwards / Caiaimage / Getty Images
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.
response
I enjoyed reading your post. You did a great job highlighting your communication skills. People with the age range of 10 and 24 years are term as adolescence. At this period of life, these individuals usually place a high value on social stimuli and are more concerned with the need for peer interaction.
However, the difference in culture might play a part in how this adolescent responds to questions asked by a provider. The provider might be very sharp with assessment skills but having a high intelligent quotient is not only what is needed (Emanuel & Gudbranson, 2018). Emotional intelligence is necessary when interviewing an adolescent.
There have been different scientific, human, and animal research studies that show how valuable peer acceptance and peer influence are to adolescents and how social deprivation and isolation affect the brain and behavior of adolescent animals compared with other stages of life. These findings show how physical isolation or distancing can disproportionately affect this age group (Orben et al., 2020).
Since this social interaction is of utmost importance with people of this age group, social deprivation questions become the focal point during the interview.
The use of an interpreter is ideal during the interviewing process; however, cultural competency and sensitivity are crucial to making the boy feel comfortable relating to the interviewer.
Racial Socialization Competency Scale (RaSCS), also known as the Racial Encounter Coping Appraisal and Socialization Theory (RECAST), is ideal in assessing three dimensions (stress, skills, and confidence) of racial socialization competency in these individuals (Anderson et al., 2020. This tool, RaSCS, addresses racial socialization stressors in adolescents but addresses other health-related issues.
Ball et al. (2019) highlights HEEADASSS as a good screening tool for adolescents, including home environment, education, employment, eating, activities, drugs, sexuality, suicide/depression safety from injury and violence. The PACES screening tool addresses parents and peers, accidents, alcoholism/drugs, cigarette smoking, emotional issues, and school and sexuality (Ball et al., 2019). The CRAFFT (an acronym for Cars, Relax, Alone, Forget, Friends, Trouble) tool poses questions about car driving issues, Relaxation styles, what is being used when alone, friends, and troubles adolescents get into (Ball et al., 2019).
Some identified health-related risks among Hispanic adolescent boys include cardiovascular disease (relating to increased cholesterol secondary to ethnic food choices high in saturated fats), alcohol binge drinking, and illegal drugs (Assari et al., 2019). Your questions posed to this young boy are necessary and very important. Do you think some of your questions can be re-worded to avoid yes and no responses, which can block effective communication?
References
Anderson, R. E., Jones, S. C., & Stevenson, H. C. (2020). The initial development and validation of the Racial Socialization Competency Scale: Quality and quantity. Cultural Diversity and Ethnic Minority Psychology, 26(4), 426-436. doi:10.1037/cdp0000316
Assari, S., Farokhnia, M., & Mistry, R. (2019). Education Attainment and Alcohol Binge Drinking: Diminished Returns of Hispanics in Los Angeles. Behavioral Sciences, 9(1), 9. doi:10.3390/bs9010009
Ball, J., 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: Mosby.
Emanuel, E. J., & Gudbranson, E. (2018). Does Medicine Overemphasize IQ? Jama, 319(7), 651. doi:10.1001/jama.2017.20141
Orben, A., Tomova, L., & Blakemore, S. (2020). The effects of social deprivation on adolescent development and mental health. The Lancet Child & Adolescent Health, 4(8), 634-640. DOI:10.1016/s2352-4642(20)30186-3