Discussion: Building a Health History

Communication is the foundation for creating a positive and effective patient-provider relationship. Building rapport with an individual allows for a better understanding of how to tailor one’s communication for effective results Discussion: Building a Health History. Observing and obtaining information on an individual’s education, developmental status, socioeconomic background, perceptions, and needs aid in delivering quality assessment, planning, education, intervention compliance, and overall outcomes. The following will discuss communication techniques, risk assessment instruments, and targeted questions for the case-study patient: Adolescent Hispanic/Latino boy living in a middle-class suburb.

Communication techniques should always be tailored to the individual, this provides a better understanding and positive results. When providing care to an adolescent, it is imperative to analyze the child’s language, to distinguish their reactions and perceptions, and provide consent and empowerment (Peña & Rojas, 2013). The patient in this case study is an adolescent Hispanic/Latino boy living in a middle-class suburb. Adolescents, described by The World Health Organization, is a person “between 10 to 17 years of age” (Organization, n.d., para. 5).  This population is in a stage of critical developmental, emotional, and physical growth, which may differ individually Discussion: Building a Health History. The sensitivity of some health-related topics may be a barrier in assessing an adolescent; some youth may not feel comfortable discussing them with a guardian in the room. Confidentiality should take precedence, with an understanding of the importance of reporting safety concerns (Barry Solomon, Jane Ball, John Flynn, Joyce Dains, Rosalyn Stewart, 2017).

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In a study on nurse-patient communications, the identified four themes for effective communication; approach, manner, interaction techniques, and both verbal and non-verbal communication skills (O’Hagan et al., 2013). The approach and manner should be patient-focused, empathetic, and sensitive; not task-oriented or busy (O’Hagan et al., 2013) Discussion: Building a Health History.  The interaction should include simple non-bias explanations with summarization for clarification (O’Hagan et al., 2013). The verbal and non-verbal communication should be tailored to the individual; patient appropriate language, space management, eye contact, sitting down with the patient and allowing the patient to speak (O’Hagan et al., 2013). These techniques may vary for different individuals based on their communication needs. Discussion: Building a Health History.

In a study evaluating a program focused on communication improvement in an emergency department in Singapore, there was over an 80% decrease in negative feedback from patients after the “I Hear You” program  was implemented (Khoo et al., 2020). The stages to this program are I (Introduce, identity, information gathering),  Hear (Patient’s perspective/patient’s language), and You (Agreement/closure) (Khoo et al., 2020). This technique helps builds an empowered provider-patient relationship by acknowledgment, respect, and participation.

In this patient interview, I would approach the patient first with an introduction and handshake, then the guardian if available. This gives the adolescent patient a sense of individuality and priority. Once history, medications, and concerns are collected; if the patient is comfortable, with their consent I would request the guardian to exit the room for the assessment. Discussion: Building a Health History.

Discussion: Building a Health History This vulnerable age population, between child and adult, is curious by nature and risky behaviors due to peer pressure, self-esteem, identity, school performance, parent relationships, and susceptibility to media are often adopted (Barry Solomon, Jane Ball, John Flynn, Joyce Dains, Rosalyn Stewart, 2017). Risk assessment screening tools that may be used for an adolescent patient are available to screen for mental health, sexual/physical abuse, substance use, sexuality, and safety (Barry Solomon, Jane Ball, John Flynn, Joyce Dains, Rosalyn Stewart, 2017). PACES (Parents/peers, Accidents/Alcohol/drugs, Cigarettes, Emotional issues, and School/Sexuality), HEEADSSS (Home environment, Education/employment, Eating, Activities/affect, Drugs, Sexuality, Suicide/depression, and Safety from injury/violence) and CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble) are three tools used to evaluate adolescences (Barry Solomon, Jane Ball, John Flynn, Joyce Dains, Rosalyn Stewart, 2017).

For the patient: adolescent Hispanic/Latino boy living in a middle-class suburb; I would first determine the individual’s communication preferences such as preferred language, education level, developmental status, and individual’s perception and comfortability Discussion: Building a Health History. Being from a Hispanic/Latino background, I would build questions around his diet and daily activities; due to the high rate of heart disease and diabetes in this population. I would also focus on his peer circle and activities, due to the developmental stage of adolescence.

Leading targeted questions for this patient would be:

• Tell me how things are at home.
• What kind of foods do you like to eat?
• How has school been this year?
• What do you like to do for fun?
• Describe your friends.
• What do you and your friends like to do?
• Do you ever use drugs or alcohol?
• Are you sexually active?

response

The patient presented in your discussion post is in a vulnerable age group and is a high risk for unsafe behaviors such as drug use, smoking, and alcohol abuse due to peer pressure or simply wanting to fit in, therefore, the advanced practice nurse needs to utilize effective communication techniques to when conducting a health risk assessment for patients in this age group. In this case, the advanced practice nurse will initially need to establish a connection with the patient and gain his trust. Establishing a positive patient relationship depends on the communication built on courtesy, comfort, connection, and confirmation (Ball, Dains, Flynn, Solomon, & Stewart, 2019). Once the patient-provider relationship is formed, patient confidentiality should be explained to the patient before conducting the health history and physical assessment.  As part of obtaining the patient’s health history, health risk assessments must be conducted for health promotion and disease prevention (Wu and Orlando, 2015).  Moreover, it should also be explained that patient safety is of the utmost importance (Ball et al., 2019). The target questions listed in your discussion post were appropriate for this patient and will provide insight into the patient’s health history and current lifestyle to determine an appropriate plan of care. Discussion: Building a Health History

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.

Wu, R. R., & Orlando, L. A. (2015). Implementation of health risk assessments with family health history: Barriers and benefits. Postgraduate Medical Journal, 91(1079), 508. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.1136/postgradmedj-2014-133195

For this discussion, I elected the case study “76-year-old black male with disabilities living in an urban setting”. In the interview, I will try to assess the level of disabilities the patient is experiencing, impact of disabilities on activities of daily living, support system, available resources, home environment, and psychological well-being. I will use a variety of communication techniques to interact with the patient. I will use simple language so that patient can easily understand me. I will avoid any complex medical terms. I will try to communicate precisely and clearly. I will use open-ended questions. Open-ended questions are regarded as less threatening and respondents can talk freely (Martyn, Munro, and Fava, 2013). I will try to understand non-verbal signs and direct my questions to gather more information. I will listen and empathize with the patient so that he can feel comfortable answering my questions. Discussion: Building a Health History.

I will use the WellSuite Health Risk Assessment Tool (WHRAT). This tool is fully online and easily accessible. It helps to keep patient information in an organized manner which is very helpful while analyzing the responses (WellSuite, 2020).  It helps to identify and predict risk factors for preventable chronic conditions specific to patient populations – and their readiness to change (Abass, Carlsen, and Rautio, 2016). With this information, I will be able to pinpoint and prioritize the best programs and interventions to help reduce costs downstream. This tool considers patient’s race, ethnicity, level of activity, and home environment. The interactive and intuitive design of WHRAT uses three-dimensional branching logic (WellSuite, 2020). This adjusts content with each successive response. That way, patients will only see the questions that are relevant to them. Evidence-based question set can be completed in less than 15 minutes and produces a wealth of information for the patient, healthcare team, and health plan.

The five targeted questions I will ask patient are listed below:

1. How does your disabilities affect your day to day activities?
2. Tell me more about your disabilities.
3. Tell me about other medical issues you are having.
4. How do you feel about your home environment? Discussion: Building a Health History
5. What can you do to improve your situation?

References

Abass, K., Carlsen, A., & Rautio, A. (2016). New approaches in human health risk assessment. International Journal of Circumpolar Health, 75(1). doi:10.3402/ijch.v75.33845

Martyn, K. K., Munro, M. L., & Fava, N. M. (2013). Patient-centered communication and health assessment. Nursing Research, 62(6), 383-393. doi:10.1097/nnr.0000000000000005

WellSuite® IV HRA for the Workforce. (2020). Improve the health of your employee or patient population. Retrieved from https://www.wellsource.com Discussion: Building a Health History