NURS 6512 week 1 Building a Healthy History
Building an accurate health history is more than just asking patients questions during their appointment. It is the entryway to building a compelling clinician–patient relationship that will empower patients to feel calm, supported, and engaged. It involves many different steps and techniques to collect patient health information, so patients can receive the accurate care that they need. NURS 6512 week 1 Building a Healthy History
The Patient
The patient I chose to interview is the 76-year-old Black/African-American male with disabilities living in an urban setting. According to Elsawy & Higgins (2011), the geriatric assessment is a multidimensional, multidisciplinary assessment designed to evaluate an older person’s functional ability, physical health, cognition and mental health, and socioenvironmental circumstances. Geriatric patients regularly present with complex medical issues that have been recently overseen by various health care practitioners, a considerable list of medications, and physical constraints. Additionally, numerous patients go to their appointments joined by others, including relatives and home chaperons. Bearing this in mind, to increase productivity at the patient’s first encounter, I would ask the patient and/or their families to complete a pre-visit questionnaire. The answers provided can facilitate the initial visit by concentrating the dialog on the patient’s concerns, while enabling me to obtain an intensive history including medications and review of systems.
Although the patient most likely will have someone present with them, making him the focus of my attention during the appointment will enable a healthy patient-practitioner relationship. Active listening, empathy, validation, reassurance, adaptive questioning, and partnering and summarization all build for effective health assessment interview techniques. Using the pre-visit questionnaire will enable me to implement any environmental adjustments for the patient since I do not know what disabilities the patient has. According to Helzner (2005), presbycusis affects more than half of adults by age 75 years so I will make a conscious effort to make accommodations such as using my stethoscope as an amplifier by placing the earpieces into the patient’s ears and speaking through the diaphragm if needed. Also, using slow, clear speech and low-pitched voice allows for hearing impaired patients to lip read if needed. Other accommodations include proper lighting in the examination room and sitting closed enough to the patient to help the him see my facial expressions and gestures, which is imperative to making the patient feel comfortable. If this patient is aphasic, having a pen and paper available will assist with effective communication. NURS 6512 week 1 Building a Healthy History
Unless told to do otherwise, I will address my patient by his title and last name to show respect. All questions will be directed to the patient and I will make sure everyone present understands the patient should answer all the questions unless he is unable or gives them permission. This will empower the patient and validate that his voice matters. Listening attentively and allowing for the patient to finish rather than correcting or speaking for him and using open ended questions will allow for more information such as feelings and understanding of the subject to emerge. If the patient comes alone, eliciting formal and informal social support information is important to forming practical treatment plans. Gathering educational background, literacy, and cultural preferences also offers a bridge to understanding the goals of the patients and his significant other’s.
In a descriptive‐correlational study, the purpose was to analyze relationships between cultural mistrust, medical mistrust, and racial identity and to predict patient satisfaction among African American adults who are cared for by primary‐care nurse practitioners using Cox’s Interaction Model of Client Health Behaviors. The conclusion was, “participants simultaneously held moderate cultural mistrust of European American providers and mistrust of the health care system, and high levels of trust and satisfaction with their nurse practitioners. One racial identity schema (conformity) and trust of nurse‐practitioner (NP) providers explained 41% of variance in satisfaction” (Benkert, Hollie, Nordstrom, Wickson, & Bins-Emerick 2009). There is also a link between the Tuskegee Syphilis Study and its effect on the trust of many African Americans of the health system especially those living in urban areas. With this in mind, I will do my best to gain his trust, be aware of any nonverbal communication, and address all of his questions and apprehensions.NURS 6512 week 1 Building a Healthy History
Because elderly patients usually have several concerns, the initial visit will focus on the one or two most active issues that affect his activities of daily living (ADL) and instrumental activities of daily living (IADL). ADLs include eating, dressing, and bathing while IADLs include doing housework, managing finances, and preparing meals. I would utilize the Katz ADL Scale and the Lawton IADL scale. Deficits can indication the patient’s necessity for a more thorough evaluation and the need for further assistance.
Questions
- Can you go shopping for groceries without help, with some help, or completely unable to do any shopping?
- In the past 12 months, have you fallen or been afraid you would fall because of a walking problem?
- Over the past 2 weeks, have you been bothered by little interest or pleasure in doing things?
- Do you have problems with your memory?
- Have you unintentionally lost any weight within the past 6 months?
- Who do you live with?NURS 6512 week 1 Building a Healthy History