Building a Health History NURS 6512 week 1 Discussion Post

Patient Overview – 38-year-old Native American pregnant female living on a reservation

Interview Summary

My interview would begin with the basics:  introducing myself to the patient and any accompanying individuals. Afterwards, I would address the patient specifically and verify the manner in which they prefer to be referred, be it formally or informally.  I would also want to insure that the visit was not rushed so I would be sure to schedule an extended amount of time, given that it is the patient’s first time meeting with me.

As an APRN, I need to be aware of the factors that can effect both how I conduct myself during a visit and what the patient expects from me, their provider. Factors such as age, gender, race, ethnic group, cultural attitudes, regional differences, and socioeconomic status influence the way patients seek medical care and the way clinicians provide care. (Ball, et. al, 2010).  I believe that a knowledge of the patient and their background prior to their visit is an important piece of the puzzle. The patient’s cultural background and diversity will play a role in ensuring that I remain sensitive to her specific needs. Health beliefs and practices vary widely between cultures and ethnicities and can affect how the patient defines their current medical situation, how faith and spirituality plays a role in their care, and what level of support and input specific family members have.

In this case, the patient is a pregnant Native American woman. First, as the clinician, I would need to be aware of the specific cultural dynamics at play. For example, in the Native American culture, women play a large role in their communities because many communities are considered matrilineal. In these types of nation’s women are the decision makers and the matriarch should be included in all decisions. (Cerario, 2001).  Explanation of any procedures would be explained in detail and include all possible side effects, outcomes, and complications in an effort to build trust and show transparency.

Additionally, I would ensure that I was aware of the specific practices regarding pregnancy in this population. Childbearing is viewed as part of the life cycle and therefore rhythmic. The pregnant woman’s focus at this time will be on the pregnancy and not on other issues or events that follow the pregnancy, such as child rearing or contraception. (Cerario, 2001).   The beliefs and values surrounding pregnancy, labor, delivery, postpartum, and newborn care vary from tribe to tribe and from individual to individual, and as the primary healthcare provider, it is my duty to be aware of some of the commonly practiced traditions of Native American families. (2001).

In addition to the above practices, completing a health risk assessment also plays a large part in ensuring the appropriateness of patient care. In its simplest terms, a health risk assessment (HRA) is the evaluation of an individual’s risk of developing certain conditions based on specific factors and the role preventative medicine plays in such assessments. (Wu, 2015). As an APRN, (and an individual diagnosed with a chronic/and most likely fatal disease), the importance of preventative medicine as opposed to reactive medicine is of great importance to me.

When developing my targeted questions, I attempted to combine the patient’s cultural background and the concepts surrounding the benefit of an HRA.

 

Targeted Questions:

  1. What Native American tribe do you belong to?
  2. Have any family members had pregnancy complications and if so, what were they?
  3. Is this your first pregnancy?
  4. What is your personal vision for your birth-plan?
  5. What support do you require/need from your medical staff?

 

For me, at the end of the day, the treatment of the patient comes down to a holistic approach and being inattentive to  any portion only serves as a detriment to the patient I am treating.

 

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.

Cerario, S. (2001). Care of the native American woman: Strategies for Practice, Education and Research. Scholarship for the Care of Women, Childbearing Families, and Newborns. (30), 13-19. DOI:https://doi.org/10.1111/j.1552-6909.2001.tb01517.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.

 

Response

Thank you for your fantastic and thorough post! You have made many fantastic points. I agree that being culturally aware is important in your scenario. It appears that you have gathered some extremely useful research regarding treating Native American patients.

Effective communication increases diagnostic accuracy, patient and family understanding of treatment, and improves patient outcomes (Damm, Leiss, Habeler, & Ehrich, 2015). In this scenario, your communication tactics will be extremely important. It is important to be open and sensitive in this scenario. Many Native American individuals and Indigenous patients feel stereotyped, ignored, and not respected by non-indigenous health care providers (Roessel, n.d.). Letting this particular patient know that they are respected and in control of their care will go a long way.

                                                                                                      References

Damm, L., Leiss, U., Habeler, U., & Ehrich, J. (2015). Improving care through better communication: Continuing the debate. EUROPEAN PAEDIATRIC ASSOCIATION167(2), 501-502. Retrieved from https://www.jpeds.com/article/S0022-3476(15)00547-8/pdf

Shannon, M., Best, D., Binns, H., Kim, J., Mazur, L., Weil, W., … Spire, P. (2005). Lead exposure in children: Prevention, detection, and management. AMERICAN ACADEMY OF PEDIATRICS116(4), 1036-1046. http://dx.doi.org/10.1542/peds.2005-1947

 

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.

 

 

38-year-old Native American pregnant

Summary of Interview and Description of Communication Techniques

Appropriate communication skills are crucial to complete adequate patient’s health assessment. Communication skills form the foundation for a more positive patient-provider relationship, leading to higher patient satisfaction and better patient compliance (Berman & Chutka, 2016). Berman and Chutka (2016) noted that patients commonly complain that providers do not listen to them. According to Berman and Chutka (2016), communication skills are not restricted to talking but also listening and nonverbal communication. The American College of Obstetricians and Gynecologists (ACOG) (2016) underlined four crucial components of caring, practical communication skills to support quality patient-centered interviewing: comfort, acceptance, responsiveness, and empathy.

Summary of Interview

The interview conducted with the patient, a 38-year-old Native American pregnant female living on a reservation, would require cultural competence from the provider. According to the Native American Aid (2015) compared living conditions on the reservations to that of Third World, dominated by unemployment, overcrowded households, and significant health disparities. Hence safety of the mom and the baby is of utmost concern. The provider must assess and interview the patient in a language and literacy level suitable for the latter. The provider must ensure the availability of professional interpreter services as needed. The interview process would focus on prenatal care by assessing the patient’s readiness, understanding, and needs. Assessing patient medical history, family health history, and environmental and behavioral risk factors would provide more insights into the patient’s health risks and needs (Sullivan, 2019). Furthermore, educating the patient on available resources such as Medicaid and WIC services could help alleviate some challenges linked to health coverage, food insecurity, and inadequate dietary intake, which might represent barriers for a healthy pregnancy.

Communication Techniques with Rationale

An effective introduction does much to lessen patient anxiety (Berman & Chutka, 2016). According to Berman and Chutka (2016), an interviewer must establish and maintain consistent eye contact with the patient by having the provider’s eyes and the patient’s eyes at approximately the same level. Berman and Chutka (2016) explained that nonverbal communication through facial expressions, nodding of the head, posture, body position, or movements of the extremities can give information regarding how interested and empathetic the provider is toward the patient by conveying a sense of warmth, caring, reassurance, and support. Hashim (2017) indicated that eliciting the patient’s agenda with open-ended questions, especially early on, not interrupting the patient, and engaging in focused active listening could facilitate effective patient-centered interviewing.

As illustrated by Hashim (2017), open-ended questions would help the provider understand the patient’s perspective of her pregnancy while offering opportunities to express empathy for the patient’s concerns. Allowing enough time for the patient to answer one question before asking the next question is important (Hashim, 2017). Hashim (2017) called for awareness of unspoken issues to enable providers to read between the lines and gently probing when necessary. Berman and Chutka (2016) indicated that providers should be mindful not to overwhelm the patient with medical information but rather provide small chunks of data using repeated cycles of the “ask-tell-ask” approach. Finally, the provider must favor an appropriate closure of the interview to ensure the patient has no lingering issues through welcoming body language, which can help solicit additional patient concerns (Hashim, 2017).

Selected Risk Assessment Instrument with Rationale

The HEEADSSS screening tool is a practical risk assessment tool for this patient. The HEEADSSS interview focuses on assessing the home environment, education and employment, eating, peer-related activities, drugs, sexuality, suicide/depression, and safety from injury and violence (Klein, Goldenring, & Adelman, 2015). Park-Lee, Lipari, Bose, & Hughes (2018) found significant use of drugs, alcohol, and cigarettes on reservations on Native American reservations as compared to the national average. Hence, the HEEADSSS screening tool is helpful since it can help the provider identify health threats to the pregnant patient and her baby.

Five Targeted Questions

1. Is this your first pregnancy?

2. How are you feeling about being pregnant?

3. When was your last menstrual cycle?

4. When was the last time you drank alcohol and used illicit drugs?

5. Do you have any health problems or medical conditions?

References

American College of Obstetricians and Gynecologists. (2016). Effective patient–physician communication. Retrieved June 2, 2020, from https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2014/02/effective-patient-physician-communication#:~:text=Physicians%20may%20consider%20five%20steps,%2C%20and%204)%20empathy%2011

Berman, A. C., & Chutka, D. S. (2016). Assessing effective physician-patient communication skills: “Are you listening to me, doc?” Retrieved from https://www-ncbi-nlm-nih-gov.ezp.waldenulibrary.org/pmc/articles/PMC4951737/

Hashim, M. J. (2017). Patient-centered communication: Basic skills. Retrieved from https://www.aafp.org/afp/2017/0101/p29.pdf

Klein, D. A., Goldenring, J. M., & Adelman, W. P. (2015). HEEADSSS 3.0 The psychosocial interview for adolescents updated for a new century fueled by media. Retrieved from https://mmcp.health.maryland.gov/epsdt/healthykids/AppendixSection4/Section-4-Addendum.pdf

Native American Aid. (2015). Living conditions. Retrieved June 2, 2020, from http://www.nativepartnership.org/site/PageServer?pagename=naa_livingconditions

Park-Lee, E., Lipari, R. N., Bose, J., & Hughes, A. (2018). Substance use and mental health issues among U.S.-born American Indians or Alaska natives residing on and off tribal lands. Retrieved from https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/DRAIANTribalAreas2018/DRAIANTribalAreas2018.pdf

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

 

sample response

You did a great job discussing communication techniques and targeted questions to ask your patient. I would also add that in order for your patient to trust you and open up, it is important to build rapport. According to Ball, Dains, Flynn, Solomon and Stewart, a great technique to achieve this is by seeking connection such as being a kind listener and using open-ended questions (2019). It is important that the patient understands that all information provided will be confidential. By gaining the patient’s trust, you will be able to have open conversations which you can discuss sensitive topics.

The National Congress of American Indians (n.d.), discussed ways to improve techniques within the Native American culture such as being humble, listening and learning, and simplifying the medical jargon to common language. Knowing the cultural preferences is important when dealing with every patient. Being disrespectful according to the patients culture could hinder the interview and care delivered. It is important for everyone to determine what make the patients feel comfortable and keep all factors in mind when discussing in depth questions about the patients 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: Elseiver Mosby.

National Congress of American Indians. (n.d.). Effective Tools for Communications and Leadership in Indian Country. Retrieved June 05, 2020, from http://www.ncai.org/news/tribal-communicators-resources/NCAI_ConferenceBooklet_FINAL_SinglePage.pdf

sample response 2

Great post! Your post showed that appropriate communication skills are vital to adequate health assessment of a patient because it allows a positive patient-provider relation that results in high patient satisfaction and better patient compliance. The post also shows that interviewing a pregnant female living on a reservation requires cultural competence from the provider since such living conditions are dominated by overcrowded households, unemployment, and substantial health disparities (Berman & Chutka, 2016). It is also evident from your post that it is vital to use health risk assessment through the collection of the patient’s medical history, family health history, environmental, and behavioral risk factors (Sullivan, 2019).

Moreover, additional interview and communication technique that health care provider may apply is a qualitative interview (Hanson, 2012). Lastly, it is correct to say that the HEEADSSS screening is a good risk assessment tool for this scenario because it can help in finding health threats for the patient and her unborn baby (Klein, Goldenring, & Adelman, 2015).

Thanks,

Gladys

 

 

References

Berman, A. C., & Chutka, D. S. (2016). Assessing effective physician-patient communication skills: “Are you listening to me, doc?” Retrieved from https://www-ncbi-nlm-nih-gov.ezp.waldenulibrary.org/pmc/articles/PMC4951737/

Hanson, J. (2012). Understanding prenatal health care for American Indian women in a Northern Plains tribe. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4098117/

Klein, D. A., Goldenring, J. M., & Adelman, W. P. (2015). HEEADSSS 3.0 The psychosocial interview for adolescents updated for a new century fueled by media. Retrieved from https://mmcp.health.maryland.gov/epsdt/healthykids/AppendixSection4/Section-4-Addendum.pdf

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

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