Building a Health History Discussion

Communication Techniques

Communication techniques between patient and provider can result in multiple ways. Depending on how the interaction goes, the provider can either have access to too much or too little information. Providers encounter patients of varying ages, social statuses, cultural backgrounds, and many more in all situations. These situations can either provide the patients some form of edge or withdrawal in society.

The Interviewing Process and Factors

The many factors that affect patients during an interviewing process include education, language, culture, financial background, and others. Additionally, providers need to create a comfortable and trusting environment with patients. Providers need to ensure that patients are satisfied with the setting of the interview. Another factor is ensuring patients earn the provider’s trust and feel connected to provide certain information because all patients are unique.

Adolescence is one of the many difficult stages in life, ranging from puberty to pre-adulthood (Spirito et al., 2018). There are certain expectations for each age group by the individuals in the age group and society. Adolescents face several societal pressures with education, personal relationships, and psychological when they experiment with opposite sex, drugs, alcohol, and other responsibilities that comes with the initiation into adulthood such as driving.

Cultural and financial statuses connect to education and specific risk assessments. Adolescents often perceive certain social norms and rewards with substance use and choose role models depending on physical manifestations (Spirito et al., 2018). For a Hispanic/ Latino adolescent boy, one of the risk assessments will focus on alcohol or drugs. There is little information about some of the reasons why adolescents resort to drug use, but according to research, parental attachment, psychosocial and cultural issues account for some of the reasons (Gattamorta et al., 2017). Many parents in poorer communities often work odd hours, which accounts for a lack of supervision over their children with associated problems such as drug use, absenteeism, poor grades, and other emotional stressors (Lee & Clancy, 2020). Additionally, more impoverished communities may have crowded homes, making it uncomfortable for adolescents to live.

Risk Assessment Tool

Using the CRAFFT risk assessment tool for adolescents enables assessment of drug and alcohol use with sensitivity to drugs used and specific to race and ethnicity (Lee et al., 2021). The CRAFFT tool uses abbreviations for car, relax, alone, forget, family and friends, and trouble. CRAFFT helps ask questions about driving or riding a car with someone under the influence, using drugs to relax, using drugs while aloneforgetting things under the influence, family, and friends criticizing substance use, and getting into trouble while under the influence. According to a survey, many middle and high school students reported the use of alcohol, cigarettes, and other substances, according to a 2016 report (Lee & Clancy, 2020).

Questions to Ask

  1. How are you, and what brings you here?
  2. Who do you live with or who takes care of you?
  3. How are you doing at home with your family/household members?
  4. How are you doing at school, do you have any friends? Are they nice to you?
  5. Is anyone bullying you at school/home or in your community?
  6. Do you drive or ride the bus to/from school?
  7. Have you ever tried any substances like cigarettes, alcohol, marijuana, or have you ever taken any drug to help you relax?

 

 

References

Gattamorta, K. A., Varela, A., McCabe, B. E., Mena, M. P., & Santisteban, D. A. (2017). Psychiatric Symptoms, Parental Attachment, and Reasons for Use as Correlates of Heavy Substance Use Among Treatment-Seeking Hispanic Adolescents. Substance Use & Misuse52(3), 392–400. https://doi-org.ezp.waldenulibrary.org/10.1080/10826084.2016.1229338

Lee, C. A., Smith, D. C., Lanker, A., & Clary, K. L. (2021). Sensitivity and specificity of the CRAFFT to identify heavy cannabis use: Evidence from a large statewide adolescent sample. Addictive Behaviors122. https://doi-org.ezp.waldenulibrary.org/10.1016/j.addbeh.2021.107006

Lee, K., & Clancy, B. (2020). Impact of Poverty on Adolescent Drug Use: Moderation Effects of Family Support and Self-Esteem. Journal of Social Work Practice in the Addictions20(4), 272–291.

Spirito, A., Hernandez, L., Cancilliere, M. K., Graves, H. R., Rodriguez, A. M., Operario, D., Jones, R., & Barnett, N. P. (2018). Parent and Adolescent Motivational Enhancement Intervention for Substance-Using, Truant Adolescents: A Pilot Randomized Trial. Journal of Clinical Child & Adolescent Psychology47, S467–S479.

 

response

I appreciate the thorough work and study that went into this intricate piece. I agree with you that it’s vital for a doctor to communicate with patients at their level to comprehend better and retain more information. Patient outcomes, patient satisfaction, retention of information, and treatment adherence are all influenced by the patient-provider connection and how well the two communicate, according to Al-Amin et al. (2016). The authors assert that data demonstrate that efficient communication providers had shorter stays and less complicated conditions. Poor communication between patients and healthcare providers identified the primary cause of a lack of patient contentment and bad outcomes. The patient’s living situation and their relationship with their parents (guardians) help determine how to treat them (Mayo Clinic, 2019). Thanks for the great insight.

 

 

References

Al-Amin, M., Makarem, S. C., & Canose, J. (2016). The Effects of Hospital-Level Factors on Patients’ Ratings of Physician Communication. Journal of Healthcare Management61(1), 28–43. https://doi-org.ezp.waldenulibrary.org/10.1097/00115514-201601000-00007

Mayo Clinic. (2019). Lead poisoning. Retrieving from https://www.mayoclinic.org/diseases-conditions/lead-poisoning/diagnosis-treatment/drc-20354723

 

 

Week 1: Building a Comprehensive Health History

According to a 2011 Gallup poll, nurses are ranked as the most trusted professionals in the United States. One of the most admired nursing skills is the ability to put patients at ease. When patients enter into a healthcare setting, they are often apprehensive about sharing personal health information. Caring nurses can alleviate the hesitance of patients and encourage them to be forthcoming with this information.

The initial health history interview can be an excellent opportunity to develop supportive relationships between patients and nurses. Nurses may employ a variety of communication skills and interview techniques to foster strong bonds with patients and to effectively facilitate the diagnostic process. In conducting interviews, advanced practice nurses must also take into account a range of patient-specific factors that may impact the questions they ask, how they ask those questions, and their complete assessment of the patient’s health.

This week, you will consider how social determinants of health such as age, gender, ethnicity, and environmental situation impact the health and risk assessment of the patients you serve. You will also consider how social determinants of health influence your interview and communication techniques as you work in partnership with a patient to gather data to build an accurate health history.

Learning Objectives

Students will:

  • Analyze communication techniques used to obtain patients’ health histories based upon social determinants of health
  • Analyze health-related risk
  • Apply concepts, theories, and principles related to patient interviewing, diagnostic reasoning, and recording patient information

Learning Resources

Required Readings (click to expand/reduce)
Required Media (click to expand/reduce)

Assignment: Course Acknowledgement

This mandatory assignment is an acknowledgement that you fully understand the course guidelines.

By Day 3 of Week 1

Submit your Assignment.

Submission and Grading Information

Submit Your Assignment by Day 3 of Week 1.

To complete this assignment, follow the link below and answer the questions provided.

Week 1 Assignment


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.

Building a Health History

Case Study B: 14-year-old biracial male living with his grandmother in a high-density public housing complex

When establishing an initial relationship with a new patient, it is wise to build a history based on an involved joint effort that genuinely reflects the unique perspectives of the individual being interviewed (Ball et al., 2019).   The key to establishing a positive patient relationship lies in the 4 C’s of effective communication: courtesy, comfort, connection, and confirmation (Ball et al., 2019). Throughout this discussion, I will address some effective communication and interview techniques used specialized for the patient in the case study and recommend an appropriate assessment tool and develop five questions targeted for this specific patient.

Effective Communication and Interview Techniques

The basis for effective communication begins with trust.  Establishing a trusting relationship occurs through being courteous, providing emotional and physical comfort, an honest connection, and confirming that the patients’ concerns are understood.  Again, these are the 4 C’s of effective communication.  It is also important to remember that every patient is unique, and the initial interview should be tailored to the individual.

The patient in the case study is a 14-year-old male, which creates some unique challenges to identify during the initial interview.  Obtaining consistent, continuous, and corroborative information and adolescent and family often poses a significant challenge (Srinath et al., 2019).   Adolescence is defined as the second decade of a child’s life and includes the physical, hormonal, and psychosocial changes that come with puberty.  Adolescents are particularly vulnerable during this period due to bodily changes, peer pressure, and self-identity establishment (Smith & McGuinness, 2017).  Children in this stage are also prone to risk-taking behaviors, including experimenting with smoking, drugs, alcohol, and sexual activity, which can have life-changing consequences.

Confidentiality is the most critical concept when addressing an adolescent.  It is crucial to introduce yourself and state your title to the patient when initiating the interview.  Especially when there may be a parent or family member present, adolescents may be reluctant to speak, which is where trust and confidentiality factor in.  In this case, a 14-year-old may or may not be comfortable discussing personal details in front of his grandmother.  In which case, she may be asked to step out and the interview conducted in private.  Situations need to be evaluated case by case.

The initial interview should be conducted in a welcoming environment with minimal distractions between the patient and the provider conducting the interview.  Discussions about the patients’ day-to-day experiences and open-ended conversations about home, school, activities, and friends prove beneficial (Ball et al., 2019).  Forcing the conversation with an adolescent can lead to confrontation, which adolescents do not handle well, thus jeopardizing any trust established.

Risk Assessment Tool

The screening tool I would use to determine and evaluate the risks for this patient is the HEEADSSS examination.  Given that our patient is of middle adolescence and a male, he is at a substantially increased risk of risk-taking behaviors.  Furthermore, his current living situation presents an additional threat to the patient’s well-being.  The HEEADSSS examination addresses the home environment, education, eating, activities, drugs/alcohol, sexuality, suicidality, and safety and is a valuable tool for assessing the physical, emotional, and social well-being of adolescents (Smith & McGuiness, 2017).

Targeted Questions

  1.  Can you tell me about your living situation and how things are going at home?
  2. How is it going at school? Is there any subject that you are doing great in/ or struggling with?
  3. Are you in a relationship? And if so, how is it going? Are you sexually active?
  4. What kind of activities do you like to do with your friends?
  5. Have you experimented with smoking? Drugs? Or Alcohol?
  6. Have you witnessed or been a victim of violence?

 

References

Ball, J. W., Jane W. Ball, D., Dains, J. E., Flynn, J. A., Flynn, J. A., Solomon, B. S., Solomon, B. S., Stewart, R. W., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). Elsevier.

Sharma, E., Srinath, S., Jacob, P., & Gautam, A. (2019). Clinical practice guidelines for assessment of children and adolescents. Indian Journal of Psychiatry61(8), 158. https://doi.org/10.4103/psychiatry.indianjpsychiatry_580_18

Smith, G. L., & McGuinness, T. M. (2017). Adolescent psychosocial assessment: The HEEADSSS. Journal of Psychosocial Nursing and Mental Health Services55(5), 24-27. https://doi.org/10.3928/02793695-20170420-03

 

response

I enjoyed reading your post! I like the idea of keeping in mind the 4 C’s of communication when interacting with patients. It is an easy way to remember to focus on these simple but fundamental aspects of communication. It reminds me of what we use at my hospital. We are a high-reliability organization and implement a culture of safety. The three tenets we use to define how we provide care are “Take care of me, don’t harm me, be nice to me.” These are the basic principles all patients need, and while they are very simple, they are the basis for providing safe and high-quality care (Agency for Healthcare Research and Quality, 2019).

I also like your idea of beginning an interview with an adolescent patient by asking about their day-to-day activities. That is a great way to get resistant or shy patients to open up and express their feelings (Ball et al., 2019). I have worked with adolescents for about 13 years, and I find that keeping up with their vocabulary and pop culture goes a long way when trying to get the patient to relate to you. This age group needs to have someone they can trust to talk to about issues such as sexuality, gender identity, or substance abuse, and showing the patient that you care about what is going on in their lives is a big step towards building this trust and confidence.

 

 

References

 

Agency for Healthcare Research and Quality. (2019). High reliability. Retrieved from https://psnet.ahrq.gov/primer/high-reliability

 

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.