NURS 6512 Week 3 Essay Assignment
Advanced Health Assessment and Diagnostic Reasoning
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.NURS 6512 Week 3 Essay Assignment
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.NURS 6512 Week 3 Essay Assignment
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 Sidelines 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.
In order to critically reflect upon problem solving skills in health assessment, the motivations and processes entailed in Egan’s skilled helper approach and clinical reasoning will be identified. This will be followed by an evaluation of their contrasting motivations and comparisons of their initial inquiry positions. It will be identified how these positions inform the collection of patient history data. Subsequent to this, appropriate applications of the approaches will be discussed followed by a dissemination of the influence of both upon humanistic nursing processes. It will be identified that both the skilled helper and clinical reasoning approaches encourage reflective practice, which in turn informs health assessment processes.
Egan’s (1997) skilled helper approach is implemented across counseling and health care professions in order to facilitate the patient’s identification of problems. Furthermore, the approach is designed to enable the patient to identify and implement self-identified coping strategies in order to deal with the identified problem. There are two primary motivations behind skilled-helper approach implementation. These are to enable the patient to live effectively and to maximize opportunities, and to enable patient’s ability to manage their own health (Manning, 2000).NURS 6512 Week 3 Essay Assignment
The approach is broadly composed of three interactive stages (Egan, 1997). Firstly, the patient is led through the generation of history data, until enough has been collected so that both the nurse and patient are able to fully conceptualize the current problem. The client and nurse identify major cognitive and behavioral features that may have led to the current scenario. The second stage entails the detailing of the client’s preferred scenario; the nurse assists the patient in identification of an ideal future position, and develops patient courage and confidence in order to pursue the ideal scenario. Lastly, the nurse and patient brainstorm specific actions that would realistically lead to the desired solution. The result is a formulation of specific goals and strategies that the patient will work to achieve.
Clinical reasoning; or problem based learning (Barrows & Pick ell, 1991) employs two knowledge types in order to identify and diagnose patient problems. The authors propose that effective clinical reasoning uses both content and process knowledge in order to achieve diagnosis and health assessment. Content knowledge refers to what knowledge the nurse practitioner has achieved through training and practice. The second form, process knowledge, relates to how the content knowledge is used in health assessment. The approach employs the scientific inductive method in order to achieve a health assessment and diagnosis.
The nurse interacts with the patient over a series of steps to achieve the health assessment. Similarly to Egan (1997), the nurse develops an initial concept through a primary discussion with the patient regarding their problem concept (Barrows & Pick ell, 1991). The problem concept and primary perceptions are used to generate multiple hypotheses of possible diagnoses for the patient’s condition. A focused patient history is conducted in order to discount hypotheses. Critical deductive skills and physical examination are also employed to falsify or support inferred hypotheses. New hypotheses are generated with the assimilation of further information or when the current line of inquiry becomes unproductive. Inquiries should occur in conjunction with an understanding of the psychophysiology mechanism that is operative in the patient’s condition. Inquiry continues until a single remaining hypothesis is supported.NURS 6512 Week 3 Essay Assignment
The skilled helper and clinical reasoning approaches differ in their motivations. Egan’s (1997) skilled helper model aims to enable the patient to identify problems within their current situation while clinical reasoning (Barrows & Pick ell, 1991) aims to use the patient concept to motivate a line of inquiry which will result in the clinician making a diagnosis. While the skilled helper model relies upon facilitation of patient concepts, clinical reasoning approaches incorporate physical examination (Seidel, Dains & Benedict, 1994). Despite this, both approaches begin with a similar concept. Formulations of the skilled helper and clinical reasoning approaches both begin with a generation of patient history data. Acquisition of the contextual data relating to the impact of the patient’s background upon the current problem concept, in conjunction with personal and family history (Epstein, Perkins, Cook son, Watt, & Rakhit, 2008) allows for the formulation of further inquiries in both health assessment approaches.
As Egan’s (1997) skilled helper model facilitates the client’s management of their own problem concepts, it is arguably a more fruitful strategy within community based mental health nursing (Hannigan, 1997). When the patient presents with minor ailments requiring diagnosis and short term treatment, clinical reasoning is potentially a more effective approach to employ (Jones, 2006). However, both approaches share in the benefit of facilitating a patient-centered approach to health assessment and treatment management. For example, a rating study of student nurses’ interviewing skills found that the utilization of both approaches facilitated humanistic inquiry strategies (Arthur, 1999). This benefits nurse-patient communication processes, ensuring a positive experience of health assessment and care provision for the patient (McCabe, 2004).NURS 6512 Week 3 Essay Assignment
Both approaches benefit from the opportunity to engage the nurse in reflective practice. By structuring the health assessment process, the approaches enable nurse practitioners to evaluate successive stages. This provides a structure to reflect upon the successes and limitations of their health assessment behaviors (Schon, 1991). For example, the interactive nature of both processes can be utilized by nurses to adjust health assessment practice in line with self-evaluation strategies. Furthermore, Egan’s (1997) skilled helper approach benefits reflective practice by equipping nurses to utilize the approach upon their own health assessment processes (Kuiper & Pesut, 2004). Concurrently, clinical reasoning skills facilitate skills of critical judgement and limitation identification (Higgs & Jones, 2000).
Egan’s skilled helper approach aims to facilitate patients’ self-management of problem concepts, while clinical reasoning uses the patient’s problem concept in order to inform inductive inquiries. These inquiries result in a diagnosis presented by the clinician. Both approaches begin inquiries with the patient’s formulation of the problem concept which motivates further inquiry. Egan’s skilled helper approach is more appropriate within the context of mental health nursing, while clinical reasoning is useful in the diagnosis and treatment of minor ailments. Both approaches facilitate communication styles that support humanistic nursing processes. Furthermore, both approaches enable reflective nursing practice, informing the health assessment process.NURS 6512 Week 3 Essay Assignment