I have a 26-year-old Lebanese female living in graduate-student housing as a patient in my first case study. Lebanese people arise from the Arab region and are influenced by Phoenicians, Assyrians, Romans, Ottoman Turks, Greeks, Persians, Arabs, and the French. Typically, Lebanese women tend to have more freedom and rights compared to women living somewhere else in the world with Arab background. Having less restrictions will make it easier to examine the patient and ask them more detailed questions about their history.
The communication technique I would use to interview this patient will be the same as another patient with the same gender as myself. I would first build some type of a rapport with them, by asking if there is anything, I can do to help them feel more comfortable and to provide them with some more privacy. For example, when I am doing my examination if there are any body parts that I am not currently examining I would cover the rest of the body up with a sheet. I have been in a situation where I am practically naked myself in front of my examiner who is just palpating my breast. So, having discretion for the other person my help them feel less anxious and less violated.
With the patient being in grad school and dorming, she would be exposed to many parties and possible substances. When attending these social gatherings, she might use substances like alcohol or drugs to destress. If she is under the influence, she may fall victim to being raped or harassed. This can lead to her having PTSD or depression from the occurrence. Depression and PTSD can make her feel suicidal leading to self-harming behavior. I believe mental health in this age group is at an alarming high with all the life factors that they must deal with. For example, stressors include graduate school, relationship issues, possible work, family and on type of that any type of trauma that she might have to deal with. Asking these targeted questions is something that I will ask.
A key component of health risk assessments is the detailed collection of family health history information. (Wu & Orlando, 2015). Sometimes the patient might not know their family health history due to being orphaned, adopted, or just not being privy to the information because they never asked. For example, mental health usually runs in the family, especially schizophrenia. Schizophrenia is usually inherited from one of the parents and the child is most likely going to have it if both parents have it. Schizophrenia usually does not have any onset until the late teens or early 20s, unless it is drug induced. Having a thorough screening of the patient is important but also asking about any familial disease is important as well.
Key questions I would ask this patient would be more directed to her age group. Questions include sexual orientation and possible exposure to STDs, drug alcohol or cigarette use, diet, BMI, stress, work school, mental health, pregnancies, and if she is currently on any medication especially birth control. An unhealthy diet, sedentary lifestyle, smoking, and excessive alcohol consumption are the most important behavioral risk factors and are responsible for approximately 80 % of cases of CHD and cerebrovascular disease. (Thiago, V. J., Lima Sousa, A. L., Thais Inacio, R. P., Weimar Kunz, S. B., Chinem, B., Jardim, L., . . . Paulo Cesar Brandao, V. J. 2015).
The risk assessment instrument that I would use for this individual would be the CAGE questionnaire. The CAGE acronym helps practitioners quickly recall the main concepts of the four questions (Cutting down, Annoyance by criticism, Guilty feeling, Eye-openers). (Ball, Dains, Flynn, Solomon & Stewart, 2019). These questions are aimed towards anyone with a current or history with alcohol. The extended version asks the patient if they have every felt guilty of drinking, waken up and started drinking, heard others criticize them about drinking or believe that they should cut down on drinking. If they answer one or more to the questions than they nurse can ask them if they would like to seek help regarding their drinking issues.
Questions that I would like to ask this individual would include age related health history like I mentioned above. Are you currently sexually active and have been exposed to or think you might have any STDs? Are you currently abusing any substance including alcohol or drugs? Do you ever feel depress or have any thoughts of hurting yourself? Have you ever experienced any trauma such as being abused physically, sexually, or mentally? Do you or your family have any predisposing medical or psychiatric health issues? Being thorough with the patient when the APRN does her history and physical will help the practitioner determine any past or current issues that needs to be addressed.
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.
Thiago, V. J., Lima Sousa, A. L., Thais Inacio, R. P., Weimar Kunz, S. B., Chinem, B., Jardim, L., . . . Paulo Cesar Brandao, V. J. (2015). The natural history of cardiovascular risk factors in health professionals: 20-year follow-up. BMC Public Health, 15 Retrieved from https://ezp.waldenulibrary.org/login?qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocview%2F1779676185%3Faccou
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
Response
We have the same patient and I enjoyed reading about your interaction with her. Also, I can relate to some of the points you mentioned. This response will focus on the description of communication and interview techniques and risk assessment tools used in assessing a 26- year old Lebanese female who lives in a graduate-student housing.
As you alluded, when you plan to communicate and interview the patient by making her feel comfortable at the beginning of your conversation, it will help to earn her trust and, building a rapport will be easier. Having a rapport with her will help in getting as much information as possible needed to help in formulating a diagnosis and treatment. After introducing myself to the patient, being from Lebanon, thus a foreigner, I would ask if she needs an interpreter since English is not her first language. I will ask open-ended questions about her life while ensuring that I give her undivided attention with little or no interruption. Kourkouta and Papathanasiou (2015), stated that the use of verbal and non-verbal cues, listening, and asking questions with concern means to build a trustful and harmonious relationship in a modern multicultural society. In recognizing the individual’s values and adapting to provide patient-centered communication, competent cultural competency in a care provider can lead to a trusting relationship between the provider and patient (Ball, J. W. et al., 2019).
We share the same opinion about the patient being a young adult, 26 years in graduate school, living in a student house may expose her to going out with her friends and possibly drinking and abusing illicit drugs. Graduate school can be very stressful so socializing with her friends by drinking and smoking can be a form of relaxation, however; if she is under the influence of alcohol and drugs, she can become a victim of sexual assault or abuse. The assault or abuse can cause her to have post-traumatic stress disorder, depression to the point of even thinking of committing suicide. I had a 24-year-old Puerto Rican female patient in dentistry school who was suicidal. She reported being stressed because she had to work, go to graduate school, and could not afford to fail. She started getting anxious, depressed to the point of drinking, and abusing illegal substances. It was pathetic because this patient was almost done with her program. Luckily for her, the school gave her more time to prepare for her final exams.
Back to our Lebanese patient, the fact that she seeks help was a great step to helping her since most people from her cultural background choose not to go to the hospital because they do not believe in mental health. While interviewing her, an essential component of the health risk assessment will be to obtain detailed information about her family health history. A thorough health assessment of the patient is important however obtaining a history of her family background is essential and beneficial in treating her. According to Wu and Orlando (2015), conducting a health risk assessment while using health and family history as a critical component provides an opportunity to discover areas to promote health. Also asking the patient about target questions relating to social determinants is of utmost importance. Thus, asking target questions about safety and abuse of alcohol will be of great use. Just like you, I used the CAGE questionnaire tool as my risk assessment instrument.
The CAGE questionnaire of alcohol use, asks questions about Cutting down, Annoyance by criticism, Guilty feeling, and Eye-openers. Using an assessment tool for the screen in an interview facilitates the process of finding out that a patient has an existing problem, which will require a thorough follow-up via assessment, leading to a better treatment outcome (Ball, J. W. et al., 2019). The only difference is that your target questions were focused more on safety, violence, drug use, and abuse while my questions were more geared towards drinking and the possibility of getting help to stop. Thank you again for your post. I learned some new because I did not realize that Lebanese women tend to have more freedom and rights compared to women with an Arab background.
Reference
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.
Kourkouta, L., Papathanasiou, I. V. (2015). Communication in nursing practice. Mater Sociomedica, 26, 65-67. http://dx.doi.org/10.5455/msm.2014.26.65-67
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
Response 2
Thanks for providing such a depth to this discussion. I agree with you that risk-taking behaviors, such as alcohol, substance abuse, and reckless sexual activities are common among college students, including graduate students. These risky behaviors can lead to detrimental outcomes, which include fatal accidents as a result of drunk driving, and sexually transmitted diseases, just a name a couple. As risky behaviors may be due to stress, having excellent coping skills can help mitigate the behaviors, which, as a result, may reduce the negative consequences. Protective factors such as familiar support and religiosity have been found to help minimize engagement in risk-taking behaviors in college students (Mohammadpoorasl, Ghahramanloo, & Allahverdipou, 2013).
Asking questions such as “how do you cope with stress,” “what is you spiritual or religious preference,” or “how might your healthcare team provide emotional support” may help elicit the patient’s coping skills. Also, questions such as “has anyone hurt or threatened to hurt you” may be critical to identifying whether the patient may have been a victim of sexual abuse. However, like many unreported cases of sexual assaults, the provider should be aware that the patient may not be forthcoming about the sensitive issue of sexual abuse. According to the National Institute of Justice (2010), the majority of cases of rape and sexual assaults are unreported. This emphasizes the need to build a robust clinician-patient relationship through effective communication, at the beginning of the history-taking or patient interview.
References
Mohammadpoorasl, A., Ghahramanloo, A. A., & Allahverdipour, H. (2013). Risk-taking behaviors and subgrouping of college students: A latent class analysis. American Journal of Men’s Health, 7(6), 475–481. https://doi-org.ezp.waldenulibrary.org/10.1177/1557988313483540
National Institute of Justice. (October 25, 2010). Reporting of sexual violence incidents. https://nij.ojp.gov/topics/articles/reporting-sexual-violence-incidents
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.
When a 4-year-old biracial boy presents for a visit with his grandmother, the nurse faces two challenges. The first challenge is collecting patient history, and the second challenge is providing information and communication in a manner that the patient can understand. According to Marginean et al. (2017), every healthcare provider working with pediatric patients must possess extensive communication skills, as well as cultural competence and sensitivity to establish the atmosphere of trust and rapport in therapeutic relationships with the client.
Here, considering the patient’s cultural and socioeconomic background is important. As mentioned in the scenario, the 4-year-old boy lives with his grandmother in a high-density public housing complex. While collecting patient history, the nurse is to ask general, simple questions about the boy’s health; his grandmother should be present and encouraged to participate. Equally important is evaluating the boy’s developmental characteristics, as social determinants of health can have profound implications for pediatric health status. The boy’s grandmother can provide valuable information to complete the patient’s family history profile (Centers for Disease Control and Prevention, 2019). Questions should be simple, such as “how do you feel”, “what do you usually eat”, or “do you have any questions about your health”.
The scenario suggests that the patient comes from a minority, low socioeconomic background. Some of the health risks associated with his status include obesity and diabetes, malnutrition, behavioral health problems, and violence (Noonan et al., 2016). Given the patient’s age, not many health risk assessment tools are available for clinical practice. However, the HEEADSSS could provide a context for a better understanding of the health issues facing the child (Ball et al., 2017). The following targeted questions could be useful when collecting patient history and interviewing the 4-year-old boy and his grandmother in a clinical setting.
Do you go to a preschool facility? Are you successful?
What do you usually eat? What does your grandmother cook for you?
Can you describe your day?
Do you feel nervous? Do you experience pain?
Do you have any conflicts with your peers?
References
Ball, J.W., Dains, J.E., Flynn, J.A., Solomon, B.S., & Stewart, R.W. (2014). Seidel’s guide to
physical examination. Elsevier Health Sciences.
Centers for Disease Control and Prevention. (2019). Family health history and your child.
https://www.cdc.gov/genomics/famhistory/famhist_child.htm
Marginean, C.O., Melit, L.E., Chincesan, M., Muresan, S., Georgescu, A.M., Suciu, N., Pop,
A., & Azamfirei, L. (2017). Communication skills in pediatrics – the relationship between pediatrician and child. Medicine, 96(43), e8399. https://doi.org/10.1097/MD.0000000000008399
Noonan, A.S., Velasco-Mondragon, H.E., & Wagner, F.A. (2016). Improving the health of
African Americans in the USA: An overdue opportunity for social justice. Public Health Reviews, 37(12). https://doi.org/10.1186/s40985-016-0025-4
response
Thanks for your informative post. I do agree that collecting a patient ‘s history from a 4-year-old is challenging. It takes an all-rounded effective communicator who is verse with cultural competency and sensitivity in order to create a trusting relationship. It is important to involve the patient with age-appropriate questions and role-playing scenarios to obtain undisclosed issues (Ball, Daines, Flynn, Solomon, & Stewart, 2019). Obtain as much information from the grandmother about why the biological parents are not in the child’s life.
Your targeted questions can strengthen the amount and quality of information gathered. Asking the patient to describe his day, feelings, and eating habits. Observe the relationship dynamic between grandparent and the patient, if they are caring and nurturing, or strained and abusive. The socio-economic circumstances of the patient can determine his access to healthcare, diet, exposure to violence, and abuse (Leo et al., 2018).
Reference
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An Interpersonal approach (9th ed.). St. Lousis, MO: Elsevier Mosby.
Lee, J. O., Jones, T. M., Kosterman, R., Cambron, C., Rhew, I. C., Herrenkohl, T. I., & Hill, K. G. (2018). Childhood neighborhood context and adult substance use problems: The role of socio-economic status at the age of 30 years. Public Health, 165, 58–66. https://doi-org.ezp.waldenulibrary.org/10.1016/j.puhe.2018.09.011
response 2
I agree that communication is key when trying to extract information from a patient, especially if the patient is only four years old. The grandmother will be able to provide some information, but it will not be as correct as information from the boys biological parents. Especially questions surrounding the maternal parents gestational progress and any complications that occurred prenatal through postnatal.
Other community links that can influence the health of children include schools, sports programs, and learning resources. (MedicineNet, n.d.). This patient does live in a high density public housing complex making his socioeconomic status lower then average. This child may or may not have a well balanced meal or be able to go to a school with extracurricular activities. The grandmother may not be working, so their income is limited. He may or may not be going to all of his well child check up, when he is sick he might just get the proper care he deserves. Growing up with limitations may make this child’s health be predetermined by other illness like childhood obesity, diabetes, high blood pressure and more.
Because of their limitation in resources, this child may not have a healthy well planned meal. But, there are ways that can be done to have the child eat healthy. You may even be able to sneak in vegetables, a little cheese, or other healthy additions to create a balanced meal. (Groom, 2019). Usually fruits and vegetables are cheaper to buy than fast food or snacks, incorporating in some grains and milk product will complete a healthy meal. Have the child snack right, avoid high processed food like chips or soda will lower the child’s chance of having heart disease as an adult.
Preferences
Groom, J. (2019). Surprising ways to get children to eat healthy. Retrieved on June 4, 2020 from https://healthprep.com/articles/family-pregnancy/surprising-ways-to-get-children-to-eat-healthy-and-enjoy-it/7/?msclkid=f251021401a61778745e5ccddf8fc44d
MedicineNet. (n.d.). Why is a child’s health important? Retrieved on June 4, 2020 from https://www.medicinenet.com/childrens_health/article.htm
