NURS 6512 Discussion: Building a Health History and Example Solution ProvidedEffective communication

NURS 6512 Discussion: Building a Health History and Example Solution Provided

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: Getty Images/Caiaimage

To prepare for NURS 6512 Discussion: Building a Health History:

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. Patient Profile to Use: 40-year-old black recent immigrant from Africa without health insurance
• 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.

Also read:

Diversity and Health Assessments NURS 6512

NURS6512 Week 7: Assessment of the Heart, Lungs, and Peripheral Vascular System

NURS 6512 Week 5 Focused Exam Cough Danny Rivera

Resource List

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.

• Chapter 1, “The History and Interviewing Process”

This chapter explains the process of developing relationships with patients in order to build an effective health history. The authors offer suggestions for adapting the creation of a health history according to age, gender, and disability.

• Chapter 5, “Recording Information”

This chapter provides rationale and methods for maintaining clear and accurate records. The authors also explore the legal aspects of patient records.

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

• Chapter 2, “The Comprehensive History and Physical Exam” (pp. 19–29)

Deckx, L., van den Akker, M., Daniels, L., De Jonge, E. T., Bulens, P., Tjan-Heijnen, V. C. G., … Buntinx, F. (2015). Geriatric screening tools are of limited value to predict decline in functional status and quality of life: Results of a cohort study. BMC Family Practice, 16, 1–12.  https://doi-org.ezp.waldenulibrary.org/10.1186/s12875-015-0241- x 

Wu, R. R., & Orlando, L. A. (2015). Implementation of health risk assessments with family health history: Barriers and benefits. Postgraduate Medical Journal, (1079), 508–513. 

Jardim, T. V., Sousa, A. L. L., Povoa, T. I. R., Barroso, W. K. S., Chinem, B., Jardim, L., … Jardim, P. C. B. V. (2015). The natural history of cardiovascular risk factors in health professionals: 20-year follow-up. BMC Public Health, 15(1111), 1–7. https://doi-org.ezp.waldenulibrary.org/10.1186/s12889-015-2477-8 

NURS 6512 Discussion: Building a Health History Example 1 – Healthcare Challenges for a Homeless African American

The patient, a 46-year-old African American male residing in a homeless shelter, presents with a complex background that profoundly impacts his health management. Socioeconomically, his homelessness highlights a severe lack of stability, greatly complicating his access to consistent healthcare and necessary medications, such as Norvasc for hypertension. The instability and stress associated with his living situation may hinder regular follow-up care, thereby exacerbating his chronic conditions (Bensken et al., 2021). This socioeconomic backdrop is crucial in understanding the barriers he faces toward achieving optimal health outcomes, necessitating targeted interventions that address these specific challenges.

Furthermore, the patient’s decision to quit drinking could reflect a significant spiritual or personal shift, possibly driven by cultural or religious beliefs that emphasize transformation and redemption as components of recovery. However, he continues to smoke cigarettes, a lifestyle choice that likely serves as a coping mechanism to manage stress. This behavior could also be influenced by cultural norms surrounding masculinity and stress management prevalent in his community (Bensken et al., 2021). As an African American, he faces additional challenges like healthcare disparities and potential stigmatization in medical settings, which can influence his healthcare engagement and treatment adherence. Recognizing these intertwined cultural, lifestyle, and socioeconomic factors is essential for providing culturally competent care that effectively addresses his comprehensive health needs.

Addressing Healthcare Barriers in Marginalized Populations

When interacting with a 46-year-old African American male patient currently residing in a homeless shelter, it is imperative to be cognizant of several sensitive issues that directly impact his health and well-being. Firstly, his homelessness introduces significant challenges, including erratic access to healthcare services, medication, and stable living conditions. This precarious living situation can lead to heightened stress and exacerbate health conditions like hypertension, which he is currently facing. 

Understanding and acknowledging the logistical and emotional hurdles he encounters daily is crucial in providing realistic and empathetic medical guidance (Bantham et al., 2021). Considering these socioeconomic barriers allows healthcare providers to tailor their recommendations to the patient’s specific circumstances, thereby enhancing the effectiveness of the treatment plan and adherence to it.

Additionally, the patient’s history of alcohol dependency and recent cessation is a critical aspect of his health profile. This background requires a compassionate approach that supports his current efforts to abstain from alcohol without passing judgment. Also, being sensitive to his continued use of cigarettes to manage stress involves recognizing this as a coping mechanism rather than merely a harmful habit. Engaging in open conversations about his smoking and exploring alternative stress-relief techniques could foster a more trusting patient-provider relationship (Bantham et al., 2021). Furthermore, as an African American, he may have experienced biases in healthcare settings, which could affect his engagement and trust in medical advice. Addressing these potential experiences respectfully and ensuring that communication is clear, respectful, and culturally competent are fundamental to providing care that not only treats but also empowers the patient.

Effective Communication Strategies for Sensitive Patient Care

Effective communication with a patient facing multiple health and social challenges requires tailored techniques to ensure sensitivity and improve treatment outcomes. Employing patient-centered communication is paramount. This approach involves active listening, asking open-ended questions to encourage the patient to share his experiences and feelings, and responding in a way that validates these expressions (Kwame & Petrucka, 2021). Such interactions are crucial for building trust and rapport, especially given his current unstable living conditions and previous healthcare experiences. Focusing on the patient’s perspectives and needs enhances their sense of respect and understanding, which in turn increases their engagement and compliance with medical recommendations.

Additionally, motivational interviewing is a critical technique in this context. This method focuses on empathetic engagement, highlighting discrepancies between the patient’s health goals and behaviors and reinforcing his autonomy in making health-related decisions. This approach is particularly effective for discussing sensitive issues such as smoking and its cessation, as it encourages the patient to consider the benefits of change without feeling judged.

Furthermore, simplifying medical information by avoiding jargon and ensuring that explanations are clear and relatable is essential for his understanding and active participation in his health care plan (Kwame & Petrucka, 2021). Acknowledging and incorporating cultural sensitivities into all interactions, understanding his background, and respecting his coping mechanisms, like smoking, can lead to more personalized and effective healthcare strategies. These communication strategies facilitate a better healthcare experience and empower the patient to take more significant control over his health, reflecting a respectful acknowledgment of his circumstances and cultural identity.

Targeted Health History Interview for Comprehensive Risk Assessment

1. Can you describe your current daily diet and fluid intake?

This question aims to understand his nutritional status, which is crucial for managing hypertension and overall health. Nutritional deficiencies or imbalances can significantly impact chronic health conditions.

2. Have you experienced any symptoms like chest pain, dizziness, or unusual fatigue recently?

These symptoms are relevant to his known hypertension and potential cardiac issues. Clarifying these symptoms can help evaluate his condition’s severity and any immediate risks.

3. What medications are you currently taking, and how often do you take them?

Given his previous prescription for Norvasc and his current lack of access, this question checks for medication adherence and understanding, which are critical for the effective management of hypertension.

4. Can you tell me about your smoking habits, including how much and how often you smoke?

Smoking is a significant risk factor for many health issues, including cardiovascular disease. Understanding his smoking habits will help in discussing potential interventions and support for cessation.

5. What kinds of support do you have from friends, family, or community services?

This question assesses his social support network, which can influence his ability to manage health conditions and access healthcare services. Social support is essential for overall well-being and can impact his recovery and health management.

Framingham Score for Cardiovascular Assessment

For the 46-year-old African American male patient currently residing in a homeless shelter and dealing with hypertension and a history of alcohol dependence, the appropriate risk assessment instrument would be the Framingham Heart Study Risk Score. This tool estimates the 10-year cardiovascular risk based on factors such as age, gender, cholesterol levels, blood pressure, diabetes, and smoking status.

Given his known history of hypertension and smoking, these are critical factors that contribute significantly to cardiovascular risk. The Framingham Risk Score would provide a quantitative measure of his risk of developing cardiovascular diseases over the next decade, which is crucial for early intervention and management (Iadecola & Parikh, 2020). Utilizing this tool would allow healthcare providers to prioritize interventions that could significantly impact his cardiovascular health, such as smoking cessation, blood pressure management, and lifestyle modifications.

Additionally, considering his socioeconomic challenges and lifestyle factors, integrating the Framingham Risk Score with a comprehensive assessment of his social determinants of health is essential. This dual approach ensures that interventions are medically appropriate and contextually relevant to his living conditions and available resources (Iadecola & Parikh, 2020). For instance, the patient’s ability to adhere to a prescribed medication regimen or to make lifestyle changes is likely influenced by his living situation in a homeless shelter.

Therefore, using the Framingham Risk Score provides a foundation for understanding his medical risks, while a broader assessment of his social circumstances helps in tailoring the interventions to be realistic and effective (Iadecola & Parikh, 2020). This approach maximizes the potential for positive health outcomes by addressing his immediate medical needs and the underlying social factors impacting his health.

NURS 6512 Discussion: Building a Health History References

Bantham, A., Ross, S. E. T., Sebastião, E., & Hall, G. (2021). Overcoming barriers to physical activity in underserved populations. Progress in Cardiovascular Diseases, 64, 64-71. https://doi.org/10.1016/j.pcad.2020.11.002

Bensken, W. P., Krieger, N. I., Berg, K. A., Einstadter, D., Dalton, J. E., & Perzynski, A. T. (2021). Health status and chronic disease burden of the homeless population: an analysis of two decades of multi-institutional electronic medical records. Journal of Health Care for the Poor and Underserved, 32(3), 1619. https://doi.org/10.1353%2Fhpu.2021.0153

Iadecola, C., & Parikh, N. S. (2020). Framingham general cardiovascular risk score and cognitive impairment: the power of foresight. Journal of the American College of Cardiology, 75(20), 2535-2537. https://doi.org/10.1016/j.jacc.2020.03.061

Kwame, A., & Petrucka, P. M. (2021). A literature-based study of patient-centered care and communication in nurse-patient interactions: barriers, facilitators, and the way forward. BMC Nursing, 20(1), 158.  https://doi.org/10.1186/s12912-021-00684-2

NURS 6512 Discussion: Building a Health History Example Solution 2

The scenario I was given for this week is an 80-year-old white male with angina who lives on a farm 80 miles from a healthcare center. 

According to the National Institute on Aging (NIA), 25% of seniors aged 65 to 70 have hearing loss, while 50% of those over 75 have debilitating hearing loss. Talking clearly and slowly, looking at the patient directly, and reducing background noise are all ways of dealing with hearing loss (National Institute on Aging, n.d.-b). 

Background noise could distract patients from listening to what you are trying to communicate with the patient. Sit facing the patient, employ active listening techniques, ask open-ended questions that might elicit a more thorough response, inquire about their functional status, and, if possible, request medical records from another provider before the appointment so that you can gather additional information that the patient may not provide to obtain an accurate medical history via interview (National Institute on Aging, n.d.-a).

When there is excellent communication between the practitioner and the patient, health assessment questions can be answered to the best of one’s ability. For the patient to grasp what you are asking or saying, the National Institute on Aging (n.d.-b) advises avoiding medical terms and adopting straightforward language and expressions. 

The cardiovascular risk calculator from the ACC/AHA is the risk assessment tool I selected to employ for this patient. The patient’s angina complaint was why I decided on this tool. To ascertain the likelihood of a stroke, heart attack, or death from cardiovascular illness within the next ten years, persons should have a cardiovascular risk assessment (UpToDate, n.d.). To use this tool efficiently, this patient would require simple laboratory tests to determine his total cholesterol and HDL cholesterol. His medical history for diabetes, the drugs he is on now, his social history for smoking, and his current medications would all need to be evaluated by the healthcare professional (UpToDate, n.d.). 

Age, race, and gender of the patient are all potential health hazards that should be taken into account. According to the Centers for Disease Control and Prevention, approximately 1 in every 4 American male fatalities are attributable to heart disease in 2021, and 7.7% of white males, or 1 in 13, had coronary artery disease. Diabetes history, a poor diet, being overweight, being inactive physically, and drinking too much alcohol are all potential risk factors for heart disease (Centers for Disease Control and Prevention, 2021). When beginning new drug management, this information should be carefully reviewed and may be obtained during the patient interview. 

A few questions I would ask the patient are:  

• What medications are you now taking? Can I see them, please? 
• What do you consume in the morning? Lunch? Dinner?
• Do you have any dietary or medicine allergies? What responses did you get? 
• Do you find it easy to stand up and move around or feel out of breath?
• Do you experience breathing issues while lying on your back? 
• Any issues using the restroom? 
• Are there any aches or weakened muscles?
• How does this pain feel when it is present? Does it extend to your arm, neck, or jaw? 
• Does it hurt or feel like someone is stabbing you? 
• How long does this discomfort linger before it stops? 
• Is there anything you do that affects it positively or negatively?
• Do you consume alcohol, illegal substances, or smoke?
• What procedures have you previously undergone? 
• How do you feel today?
• Do you get enough rest at night?

NURS 6512 Discussion: Building a Health History References 

Ball, J., Dains, J., Flynn, J., Soloman, B., & Stewart, R. (2021). Seidel’s guide to physical examination 9th edition 2018 (9th ed.). Elsevier. https://evolve.elsevier.com/cs/product/9780323545068#:~:text=Seidel’s%20Guide%20to%20Physical%20Examination

Centers for Disease Control and Prevention. (2021, February 3). Men and heart disease. https://www.cdc.gov/heartdisease/men.htm

National Institute on Aging. (n.d.-a). Obtaining an Older Patient’s Medical History. https://www.nia.nih.gov/health/obtaining-older-patients-medical-history

National Institute on Aging. (n.d.-b). Tips for improving communication with older patients. https://www.nia.nih.gov/health/tips-improving-communication-older-patients#: %7E:text=Talk%20slowly%20and%20clearly%20in,or%20pick%20up%20visual %20clues.  

UpToDate. (n.d.). Calculator: Cardiovascular risk assessment in adults (10-year, ACC/AHA 2013) (patient education). https://www.uptodate.com/contents/calculator-cardiovascularrisk-assessment-in-adults-10-year-acc-aha-2013-patient-education 

NURS 6512 Week 2: Functional Assessments and Cultural and Diversity Awareness in Health Assessment

DIVERSITY AND HEALTH ASSESSMENTS

May 2012, Alice Randall wrote an article for The New York Times on the cultural factors that encouraged black women to maintain a weight above what is considered healthy. Randall explained—from her observations and her personal experience as a black woman—that many African-American communities and cultures consider women who are overweight to be more beautiful and desirable than women at a healthier weight. As she put it, “Many black women are fat because we want to be” (Randall, 2012).

Randall’s statements sparked a great deal of controversy and debate; however, they emphasize an underlying reality in the healthcare field: different populations, cultures, and groups have diverse beliefs and practices that impact their health. Nurses and healthcare professionals should be aware of this reality and adapt their health assessment techniques and recommendations to accommodate diversity.

In this Discussion, you will consider different socioeconomic, spiritual, lifestyle, and other cultural factors that should be taken into considerations when building a health history for patients with diverse backgrounds. Your Instructor will assign a case study to you for this Discussion.

To prepare:

• Reflect on your experiences as a nurse and on the information provided in this week’s Learning Resources on diversity issues in health assessments.
• By Day 1 of this week, you will be assigned a case study by your Instructor. Note: Please see the “Course Announcements” section of the classroom for your case study assignment.
• Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient assigned to you.
• Consider how you would build a health history for the patient. What questions would you ask, and how would you frame them to be sensitive to the patient’s background, lifestyle, and culture? Develop five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.
• Think about the challenges associated with communicating with patients from a variety of specific populations. What strategies can you as a nurse employ to be sensitive to different cultural factors while gathering the pertinent information?

BY DAY 3 OF WEEK 2

Post an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.

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 Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply!   

Required Readings

• Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2023). Seidel’s guide to physical examination: An interprofessional approach (10th ed.). St. Louis, MO: Elsevier Mosby.
  • Chapter 1, “Cultural Competency”
    This chapter highlights the importance of cultural awareness when conducting health assessments. The authors explore the impact of culture on health beliefs and practices.

• Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
  Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.
  • Chapter 2, “Evidenced-Based Clinical Practice Guidelines”
• Centers for Disease Control and Prevention. (2020, October 21). Cultural competence in health and human services
• . Retrieved from https://npin.cdc.gov/pages/cultural-competence
  This website discusses cultural competence as defined by the Centers for Disease Control and Prevention (CDC). Understanding the difference between cultural competence, awareness, and sensitivity can be obtained on this website.
• United States Department of Human & Health Services. Office of Minority Health. (n.d.). A physician’s practical guide to culturally competent care. Retrieved June 10, 2019, from https://cccm.thinkculturalhealth.hhs.gov/
  From the Office of Minority Health, this website offers CME and CEU credit and equips healthcare professionals with awareness, knowledge, and skills to better treat the increasingly diverse U.S. population they serve.
• Coleman, D. E. (2019). Evidence based nursing practice: The challenges of health care and cultural diversity. Journal of Hospital Librarianship, 19(4), 330–338. https://doi.org/10.1080/15323269.2019.1661734
• Young, S., & Guo, K. L. (2016). Cultural diversity training. The Health Care Manager, 35(2), 94–102. https://doi.org/10.1097/hcm.0000000000000100

NURS 6512 Week 3: Assessment of Nutrition in Children

Week 3: Assignment 1 Case Study Assignment: Assessment of Nutrition in Children

When seeking to identify a patient’s health condition, advanced practice nurses can use a diverse selection of diagnostic tests and assessment tools; however, different factors affect the validity and reliability of the results produced by these tests or tools. Nurses must be aware of these factors in order to select the most appropriate test or tool and to accurately interpret the results.

Not only do these diagnostic tests affect adults, body measurements can provide a general picture of whether a child is receiving adequate nutrition or is at risk for health issues. These data, however, are just one aspect to be considered. Lifestyle, family history, and culture—among other factors—are also relevant. That said, gathering and communicating this information can be a delicate process.

For this Assignment, you will  consider examples of children with various weight issues. You will explore how you could effectively gather information and encourage parents and caregivers to be proactive about their children’s health and weight.

To Prepare:

• Review this week’s Learning Resources and consider factors that impact the validity and reliability of various assessment tools and diagnostic tests. You also will review examples of pediatric patients and their families as it relates to BMI.
  • Based on the risks you might identify consider what further information you would need to gain a full understanding of the child’s health. Think about how you could gather this information in a sensitive fashion.
  • Consider how you could encourage parents or caregivers to be proactive toward the child’s health.

THE ASSIGNMENT

Assignment (3–4 pages, not including title and reference pages):

Assignment: Child Health Case:

Include the following:

• An explanation of the health issues and risks that are relevant to the child you were assigned.
• Describe additional information you would need in order to further assess his or her weight-related health.
• Identify and describe any risks and consider what further information you would need to gain a full understanding of the child’s health. Think about how you could gather this information in a sensitive fashion.
• Taking into account the parents’ and caregivers’ potential sensitivities, list at least three specific questions you would ask about the child to gather more information.
• Provide at least two strategies you could employ to encourage the parents or caregivers to be proactive about their child’s health and weight.

Required Readings

• Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2023). Seidel’s guide to physical examination: An interprofessional approach (10th ed.). St. Louis, MO: Elsevier Mosby.
  • Chapter 3, “Examination Techniques and Equipment”
    This chapter explains the physical examination techniques of inspection, palpation, percussion, and auscultation. This chapter also explores special issues and equipment relevant to the physical exam process.
  • Chapter 8, “Growth and Nutrition”
    In this chapter, the authors explain examinations for growth, gestational age, and pubertal development. The authors also differentiate growth among the organ systems.

• Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Student checklist: Health history guide 
• Download Student checklist: Health history guide. In Seidel’s guide to physical examination (9th ed.). St. Louis, MO: Elsevier Mosby.
  Credit Line:  Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearan

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