NURS 6512 Discussions and Assignments: Advanced Health Assessment and Diagnostic Reasoning

NURS 6512 Discussions and Assignments: Advanced Health Assessment and Diagnostic Reasoning

By Day 3 of Week 1:

Sharing Interview Summary and Communication Techniques:
In this discussion, you will post a summary of your interview and describe the communication techniques you would employ with your assigned patient. Additionally, you will explain why you chose these techniques, identify the risk assessment instrument you selected, and justify its applicability to the selected patient. Finally, you will provide at least five targeted questions you would ask the patient.

Building a Health History

The primary aim of creating a health history is to gather information from the patient or their family, facilitating collaboration between the patient and the healthcare team for effective healthcare delivery (Ball, Dains, Solomon, & Stewart, 2015). For the adolescent Hispanic boy living in a middle-class suburb, the interview process begins by creating a comfortable environment to encourage the patient’s openness in answering questions. It starts with a proper self-introduction and an explanation of the interview’s purpose. The interview will then proceed to cover a health history checklist, including gathering biographical data such as age, the reason for seeking care, past health history, family health history, functional assessment, and cultural assessment. The interview questions will be structured using both open-ended and close-ended formats.

Moreover, effective communication techniques are crucial in this process. To begin with, medical jargon will be avoided as the adolescent Hispanic boy is unlikely to understand complex medical terms. The use of such terminology could lead to confusion. Active listening will also be employed, ensuring not only hearing what is said but also comprehending and interpreting the patient’s words (Choudhary & Gupta, 2015). Empathy will play a significant role, making the patient more comfortable in providing information without withholding relevant details. Building rapport is another essential communication technique to ensure that no information is concealed during the interview.

Developing the health history includes conducting a comprehensive risk assessment. In this case, the most appropriate risk assessment strategy involves identifying mental healthcare risks through a thorough evaluation of family health history. Mental health issues in adolescents are a major public health concern, with a significant number of young people experiencing mental health problems (López et al., 2017). Since the patient is an adolescent, he is at a higher risk of having or developing mental health disorders. This risk assessment technique will help identify the potential risk and develop a proper healthcare plan for risk mitigation.

Here are the questions that will be asked during the assessment of healthcare risks:

1. What is the reason for seeking care today?
2. What past healthcare issues have you been diagnosed with and treated for?
3. Have you previously been diagnosed or treated for emotional or psychiatric problems?
4. Does your family have any history of mental health disorders?
5. Does your family have a history of significant illnesses like heart disease, cancer, diabetes, or hypertension?
6. Do you engage in any leisure activities?

References:

Ball, J. W., Dains, J. E., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s Guide to Physical Examination. Elsevier Health Sciences.

Choudhary, A., & Gupta, V. (2015). Teaching communication skills to medical students: Introducing the fine art of medical practice. International Journal of Applied and Basic Medical Research, 5(Suppl 1), S41.

López, C. M., Andrews III, A. R., Chisolm, A. M., De Arellano, M. A., Saunders, B., & Kilpatrick, D. (2017). Racial/ethnic differences in trauma exposure and mental health disorders in adolescents. Cultural diversity and ethnic minority psychology, 23(3),.NURS 6512 Discussions and Assignments: Advanced Health Assessment and Diagnostic Reasoning.

Day 6 of Week 1: Responding to Colleagues with Different Patients

You’ve raised some valuable points about including functional and cultural assessments when collecting your patient’s health history. I agree with your method of maintaining structured yet open-ended interview questions, enabling the patient to share their thoughts without any influence. Effective communication skills are vital, especially when dealing with younger patients and adolescents. Developing these skills early is crucial as they form a core competency for healthcare practitioners, benefiting both students and future practitioners (Choudhary & Gupta, 2015). However, it’s important to note that clinical communication with pediatric and adolescent populations presents unique challenges due to the complexity and limited research in this field (Frost et al., 2015).

I also support your approach of avoiding medical jargon, practicing active listening, and expressing empathy. To improve the questionnaire, I suggest including more specific questions about the patient’s mental health status. For instance, you could inquire about the stability of the home environment, any experiences of physical or verbal abuse, incidents of bullying at school, history of substance use, and whether the patient or their friends engage in activities like drinking or using cannabis in various forms. In states like California, where cannabis is legalized, its use has become widespread even among middle school and high school students. As healthcare providers, it’s crucial to ask questions in a non-judgmental manner, assuring the patient of our genuine concern for their overall well-being. This is where patient-specific communication skills come into play (NURS 6512 Discussions and Assignments: Advanced Health Assessment and Diagnostic Reasoning).

Incorporating questions about signs or symptoms of anxiety and depression could also be beneficial. You may inquire about the patient’s sleep patterns, eating habits, racing thoughts, thoughts of suicide, or any history of self-harming behaviors. Self-harm is a significant aspect of the mental health assessment, as it is a leading cause for admission to adolescent inpatient psychiatric facilities and a major risk factor for suicidal ideation and attempts (Boylan et al., 2019). Furthermore, I recommend using the Well-Being Index (WBI) as a risk assessment tool to evaluate the overall health of the adolescent. The WBI assesses four symptom areas: depression, anxiety, rule-breaking, and substance use, along with perceptions of school climate, to promote their overall well-being (Luthar et al., 2020).

I believe that by asking such questions, adolescent patients may gradually become more comfortable sharing details they might otherwise withhold from their families due to fear of judgment or consequences.

References:

– Boylan, K., Chahal, J., Courtney, D. B., Sharp, C., & Bennett, K. (2019). An evaluation of clinical practice guidelines for self-harm in adolescents: The role of borderline personality pathology. Personality Disorders: Theory, Research, and Treatment, 10(6), 500-510. https://doi.org/10.1037/per0000349

– Choudhary, A., & Gupta, V. (2015). Teaching communications skills to medical students: Introducing the fine art of medical practice. International Journal of Applied and Basic Medical Research, 5(4), 41. https://doi.org/10.4103/2229-516x.162273

– Frost, K., Metcalf, E., Brooks, R., Kinnersley, P., Greenwood, S., & Powell, C. (2015). Teaching pediatric communication skills to medical students. Advances in Medical Education and Practice, 35. https://doi.org/10.2147/amep.s68413

– Luthar, S. S., Ebbert, A. M., & Kumar, N. L. (2020). The well-being index (WBI) for schools: A brief measure of adolescents’ mental health. Psychological Assessment, 32(10), 903-914. https://doi.org/10.1037/pas0000913

response 2

Thank you for such a detailed post. Your approach in communication techniques with this teenager is professional and definitely empathic and establishing trust is very important. Adolescence is a critical developmental period associated with increased vulnerability for depressive symptoms and gender differences in depression generally emergence during adolescence (Lorenzo-Blanco et al., 2012). Although the reasons and details of the visit are not indicated, it would be important to inquire about thoughts of wanting to hurt himself or anyone else.  (Caplan, 2019) reports that the rate of self-reported mental illness for Latinos are similar to or slightly less than those of the population as a whole, which is a very large population NURS 6512 Discussions and Assignments: Advanced Health Assessment and Diagnostic Reasoning. I found it interesting that as of 2019, the Hispanic population in the United States is over 60.47 million (2021).

I worked on an inpatient acute child/adolescent behavioral unit for over 3yrs and I have found that being compassionate, yet open and asking teenagers directly, what their thoughts and feelings are about self-harm, suicide, etc has not only opened the space for trust, but for truth-building. I have witnessed how the approach of the health providers can both, be helpful and therapeutic, as well as observing how a teen will shut-down due to a lack of trust. Again, I enjoyed reading your post and your selection of questions were great.

References

Caplan, S. (2019). Intersection of cultural and religious beliefs about mental health: Latinos in the faith-based setting. Hispanic Health Care International, 17(1), 4–10. https://doi.org/10.1177/1540415319828265

Hispanic population by state 2021. (2021). worldpopulationreview.com. https://worldpopulationreview.com/state-rankings/hispanic-population-by-state

Lorenzo-Blanco, E. I., Unger, J. B., Baezconde-Garbanati, L., Ritt-Olson, A., & Soto, D. (2012). Acculturation, enculturation, and symptoms of depression in hispanic youth: The roles of gender, hispanic cultural values, and family functioning. Journal of Youth and Adolescence, 41(10), 1350–1365. https://doi.org/10.1007/s10964-012-9774-7