Discussion: Building a Health History

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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.

 

Communication Techniques

Building a history during the interview process is a crucial component of patient assessment for delivering high-quality care. The first encounter with the patient sets the tone for a successful partnership. The health care provider should create a patient-centered atmosphere. The Institute of Medicine (IOM) defines patient-centered care as “respecting and responding to patient’s wants, needs, and preferences so that they can make choices in their care that best fit their circumstances” (Jawad Hashim, 2017). The provider should be open, flexible, and eager to deal with all the patient’s questions, concerns, explanations.  The clinicians responsibility is to create a calm, quiet environment with their patients to establish a trusting relationship (Ball, et al., 2019). When communicating with individuals of different cultures we must assure there is cultural competence as  I would have to do when communicating with my patient who is an older Asian American woman.  I can provide my patient the opportunity to fully understand my interview and address any question by keeping calm, using open ended, maintaining eye contact and avoiding medical jargon  (Ball, et al., 2019). 

The Interview

 Asian women are affected by breast cancer 50- 60 % more than other cultures(Zhao & Conard, 2016). The percentage  Mammography screenings are affected by  health disparities, modesty, religious belief, and cultural norms of Asian American women. Asian American face many challenges in obtaining healthcare and completing screening (Weng & Wolf, 2016).When interviewing this patient I must ensure that I address any familiar history or patient history of breast cancer. Understanding this aspect of inequality of healthcare services for Asian American women should impact my cultural competence in opening a dialogue that is critical. It is my responsibility to inquire about any past  or familial history of breast cancer. 

Risk Assessment 

With her age and cultural  background the patient is at increased risk for breast cancer and osteoporosis.  As her provider it is imperative that I order diagnostic tests and screening exams. ,  1. Chem Panel to evaluate hormone levels, electrolytes- phosphorus, calcium, and calcitonin

n.2. Bone density exam 3. Mammogram . To ascertain any mammogram results from their past for comparison.After all the tests have been completed I will have the patient make a follow up appointment to discuss the results and develop a treatment plan if one is needed.

 5 Targeted Questions 

1. What has brought you into the clinic today? 

2. Do you have any chronic medical conditions?

 3. Do you have medications that you are taking at this time? 

4. Have you ever had a bone scan in the past? 

5. When was your last mammogram?  

6. What are your main concerns today?

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.

Jawad Hashim, M. (2017). Patient-Centered Communication: Basic Skills. American Family Physician, 95(1), 29–34. https://www.aafp.org/afp/2017/0101/p29.html

Weng, S. S., & Wolfe III, W. T. (2016). Asian american health inequities: An exploration of cultural and language incongruity and discrimination in accessing and utilizing the healthcare system. International Public Health Journal, 8(2), 155–167. com.ezp.waldenulibrary.org/login.aspx?direct=true&db=rzh&AN=118800385&site=edslive&scope=site 

 

Zhao, M., & Conard, P. L. (2016). Content validity of a screening instrument for breast cancer early detection among asian american women: the cultural health and screening mammography belief scale. Journal of Nursing Measurement, 24(3), 356–364. https://doi-org.ezp.waldenulibrary.org/10.1891/1061-3749.24.3.356

By Day 6 of Week 1

Respond to at least two of your colleagues on 2 different days who selected a different patient than you, using one or more of the following approaches:

  • Share additional interview and communication techniques that could be effective with your colleague’s selected patient.
  • Suggest additional health-related risks that might be considered.
  • Validate an idea with your own experience and additional research.

 

sample response 1

You brought up some great ideas that I did not think of before in the risk assessments such as testing for hormone levels and checking for osteoporosis. Additionally, I did not know that Asian American women were 50% more likely to develop breast cancer than other cultures. That just seems so high so I had to do some of my own research into this as it was just so crazy to think of the numbers so high for this population. Gomez et al. (2010) suggests that part of this reason could be that US Asian women are thought to be healthier than other populations so they tend to see the doctor less than other populations for prescreenings and preventative measures. As providers we need to find ways to encourage all populations, regardless of their perceived health status to have breast cancer screenings as it is also the number one type of cancer for women (Gomez et al., 2010).

Also, when you were talking about cultural sensitivity, I can completely appreciate and humbly say I do not know if I know enough about other cultures to be the best physician with cultural sensitivity. It is something I will absolutely have to learn about so I can help all cultures and be the best provider possible no matter what culture I am working with. Tucker et al. (2011) point out that when patients feel their cultures are valued and respected, they are more likely to respect their provider and adhere to the health advice given to them. I can definitely see the importance of needing to be culturally aware and sensitive in my care when I am a provider. I am sure it will take time and experience to become better and better. You gave great advice to give a full workup and panel to do a very good comprehensive exam. I would also talk to her about her risks being an Asian American and her risks and encourage her to tell family members and friends about their risks and the importance of having preventative healthcare. It is very important to be proactive for our patients and also to encourage them to become knowledgeable and advocates for their health. When the patients are involved in their healthcare and feel the provider is part of it as well, then success can be at its greatest.

References

Gomez, S. L., Quach, T., Horn-Ross, P. L., Pham, J. T., Cockburn, M., Chang, E. T., Keegan, T. H., Glaser, S. L., & Clarke, C. A. (2010). Hidden breast cancer disparities in Asian women: disaggregating incidence rates by ethnicity and migrant status. American Journal of Public Health, 100(Suppl 1), S125–S131. https://doi.org/10.2105/AJPH.2009.163931

Tucker, C. M., Marsiske, M., Rice, K. G., Nielson, J. J., & Herman, K. (2011). Patient-centered culturally sensitive health care: model testing and refinement. Health psychology: official journal of the Division of Health Psychology, American Psychological Association, 30(3), 342–350. https://doi.org/10.1037/a0022967

 

sample response 2

Thanks for the great points. A good health history is very important to diagnosis a patient. Providers should understand patient beliefs and culture. In order for the provider to have effective commination the provider need to be self-aware (Jones, 2006).  The provider must be a skilled listener and observer with a polished sense of timing and a kind of repose that is at once alert and reassuring. Your nonverbal behavior complements your listening. Your face need not be a mask. You can be expressive and nod in agreement, but it is better to avoid the extremes of reaction (Ball et al. 2019).

I would also recommend Patient-centered culturally sensitive health care has the following specific characteristics: (a) it emphasizes displaying patient-desired, modifiable provider and staff behaviors and attitudes, implementing health care center policies, and displaying physical health care center environment characteristics and policies that culturally diverse patients identify as indicators of respect for their culture and that enable these patients to feel comfortable with, trusting of, and respected by their health care providers and office staff; (b) it conceptualizes the patient-provider relationship as a partnership that emerges from patient centeredness; and (c) it is patient empowerment oriented (Tucker et al., 2011). This care is unique in that it is based on views of culturally diverse patients rather than the views of health care professionals. Empowering patients to share their views concerning culturally sensitive health care is a manifestation of patient-centeredness. Health care providers and staff can be responsive to such views of patients through engaging in behaviors and attitudes and fostering clinic characteristics and policies identified as important by culturally diverse patients.

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References

Jones, D. S. (2006). The persistence of american indian health disparities. American Journal of Public Health, 96(12), 2122–2134. Retrieved September 2, 2021, from https://doi.org/10.2105/ajph.2004.054262

Tucker, C. M., Marsiske, M., Rice, K. G., Nielson, J., & Herman, K. (2011). Patient-centered culturally sensitive health care: Model testing and refinement. Health Psychology, 30(3), 342–350. https://doi.org/10.1037/a0022967

Tucker CM, Marsiske M, Rice KG, Nielson JJ, Herman K. Patient-centered culturally sensitive health care: model testing and refinement. Health Psychol. 2011;30(3):342-350. doi:10.1037/a0022967

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.). Mosby.