Taking a Health History: Building a Health History: Asking Difficult Questions
Much of an archeologist’s work is done under the mantra “proceed with caution.” Archeologists must dutifully secure permissions to access sites. They also must exercise extreme caution when excavating or analyzing in a lab to avoid potential damage to historical artifacts.
Likewise, nurse practitioners must proceed with caution when building a patient’s health history. Important questions can be difficult for both nurse and patient. Care must be taken to approach such questions with dignity, tact, and respect to create an environment conducive to productive conversations.
For this Assignment, you will develop a script to be used to interview a volunteer serving in the role of patient.
To prepare:
· Review the Ewing (2004) questionnaire found in the Week 1 Learning Resources and consider the difficult questions you might have to ask when you take a patient’s complete health history.
· Review the screening tools found in the Learning Resources and consider how you might use an app or tool to assist in screening.
· Review the media programs related to a vaginal exam, pap test, and breast exam.
· Review the health history guide presented in Chapter 7 of the Schuiling & Likis (2022) text and consider how you would create your own script for building a complete health history. (Note: You will also find the Health History Form in Chapter 7)
· Include considerations for special populations such as LGBTQ+ individuals.
· What health maintenance guidelines should be included for initial and follow-up might be needed for follow-up assessments? (i.e., bone density test, Gardasil vaccine, shingles, etc.)?
· Create your own script for building a health history and use the Health History Template for guidance (consider the type of language you would use to help your patient be more comfortable). As you create your script, consider the difficult questions you want to include in your script. There is no sample template to provide to you. You are the one to develop the script. Think of it as you are writing a movie and you need to write the script for the movie. What lines would you provide for the actor to utilize when sitting down with a patient to perform a COMPLETE Medical History which also entails those DIFFICULT GYN questions. You do not need to provide the answers to the questions however, if you find that beneficial, you may do so.
Assignment: (1- to 2-page reflection)
· In addition to your script for building a health history for this assignment, include a separate section called “Reflection” that includes the following:
· A brief summary of your experiences in developing and implementing your script during your health history.
· Explanations of what you might find difficult when asking these questions. What you found insightful and what would you say or do differently.
· Describe the components of a comprehensive gynecologic complete health history. Include considerations for special populations such as LGBTQ+ individuals.
· What health maintenance guidelines should be included during the initial and follow-up assessments. (i.e., bone density test, Gardasil vaccine, shingles, etc.)?
Building a Health History: Asking Difficult Questions
· Create your own script for building a health history. Consider the type of language you would use to help your patient be more comfortable).
· Ensure you include the difficult questions required to complete a thorough health history.
· In addition to your script for building a health history for this assignment, include a separate section called “Reflection”
· Briefly reflect and provide a summary of your experiences in developing your script during your health history.
U.S. Preventive Services Task Force. (2018). Information for health professionals. https://www.uspreventiveservicestaskforce.org/Page/Name/tools-and-resources-for-better-preventive-care/
Ewing, J. (2004). Cage questionnaire. https://www.uspreventiveservicestaskforce.org/Home/GetFileByID/838
American Society for Colposcopy and Cervical Pathology (ASCCP). (2020). New guidelines. New App. www.asccp.org/mobile-app Note: This app will become available in 2020 and may require a fee for purchase. Please be mindful that you are not required to purchase the app for this course. However, it may be an app that will be useful for your professional practice.
Harvard Medical School and Brigham and Women’s Hospital (n.d.). Women’s Health Study. https://whs.bwh.harvard.edu/index.html
Expert Answer and Explanation
Developing a Health History
Script
Healthcare Professional (HP): Hi, I am XX, a nurse professional. I will ask you some questions with the aim of building your health history for effective and better care. For starts, what is your name?
Patient: Answers
HP: How old are you?
Patient: The patient will state their age.
HP: Please, can you briefly tell me why you are here.
Patient: The patient will state the main reason why they have visited the healthcare professional. Podder et al. (2020) note that chief complaint is vital in patient assessment because is summarizes the patient’s purpose of coming to the healthcare facility.
HP: I am sorry for the health problem you are experiencing. To further understand your health issue, I will ask you more questions if do not mind.
Patient: Ok
HP: Are you in any medications currently?
Patient: Answers.
HP: Have you ever suffered major healthcare problems? If yes, please list them.
Patient: Answers.
HP: Thanks for the answer. Can you describe your vaccination history?
Patient: The patient will list immunizations they have taken recently.
HP: Now I am going to ask you about substance abuse. Are you Ok with that?
HP: Patient: Provides an answer.
Patient: Answers.
HP: Do you take cocaine?
Patient: Answers.
HP: What about heroine?
Patient: Answers.
HP: And marijuana?
Patient: Answers.
HP: Do you drink alcohol.
Patient: Answers.
HP: What about in the past?
Patient: Answers.
HP: Do you smoke?
Patient: Answers.
HP: What about in the past?
Patient: Answers.
HP: Any member of the family who drinks alcohol, smokes, or uses drugs?
Patient: Answers.
HP: Now I am going to ask you about your sexual health. The questions are very important as any other question I have asked in this session and do not worry about your privacy because what we say in this meeting is strictly confidential and our ears only. Are comfortable with the questions?
Patient: Answers.
HP: Have you been involved with anyone sexually in the past year, including vaginal, oral, anal, or any other kind of sexual practices?
Patient: Answers.
HP: Have ever been involved sexually with women, men, or both?
Patient: Answers.
HP: Do you use protective, such as condom while having sex?
Patient: Answers.
HP: Do you have sexual desires for women, men, or both?
Patient: Answers.
HP: Are you happy with your sexuality?
Patient: Answers.
HP: Have you ever experienced any sexual violence?
Patient: Answers.
Reflection
I have learned a lot when developing the script, I can use in building the patient’s health history. One of the things I have learned is that there are many questions to select, but because of time, healthcare professionals should choose questions based on the patient’s chief complaint. Another experience I have gained in developing and implementation of the script is that communication is key to success of the script. Ward (2018) notes that patients can open more during patient assessment if effective communication strategies are used. One of the communication strategies I have used in developing the script is empathy (D’Agostino et al., 2017).
The patient will see that I am a concern and caring healthcare professional when I empathize with their situation. Another important experience I have gained from this exercise is that respecting patient’s autonomy is a vital thing. The patient will feel more comfortable when they are the ones making decisions. I might find it difficult to ask the patient about their sexual health history. According to Mannion and Davies (2018), one of the way to connect with patients is understanding their cultural beliefs. Before asking the patient about their sexual practices, I will learn their beliefs about sex for the conversation to be interactive.
References
D’Agostino, T. A., Atkinson, T. M., Latella, L. E., Rogers, M., Morrissey, D., DeRosa, A. P., & Parker, P. A. (2017). Promoting patient participation in healthcare interactions through communication skills training: A systematic review. Patient Education And Counseling, 100(7), 1247–1257. https://doi.org/10.1016/j.pec.2017.02.016
Mannion, R., & Davies, H. (2018). Understanding organisational culture for healthcare quality improvement. Bmj, 363. https://doi.org/10.1136/bmj.k4907
Podder, V., Lew, V., & Ghassemzadeh, S. (2020). SOAP notes. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK482263/
Ward, P. (2018). Trust and communication in a doctor-patient relationship: A literature review. Arch Med, 3(3), 36. https://www.researchgate.net/profile/Masoud-Mohammadnezhad/publication/327575093_Trust_and_Communication_in_a_Doctor-_Patient_Relationship_A_Literature_Review/links/5ca3d2efa6fdcc12ee8ed438/Trust-and-Communication-in-a-Doctor-Patient-Relationship-A-Literature-Review.pdf
Alternative Expert Answer
Developing a Health History
Components of a Comprehensive Gynecologic Health History
Assessing the female reproductive system requires healthcare givers to have high respect and sensitivity as some of the components of the gynecologic assessment are often considered delicate and patients may not respond positively if not addressed well. Well-woman visits are meant to assess the reproductive health of women by assessing components such as palpation, visual inspection of breasts, the external female genitalia, the menstrual cycle patterns and complications, and the use of special medications such as contraception (Stewart, Lee, & Damiano, 2020). Gynecologic health histories also entail the assessment of the current sexual lifestyle of the patient such as the number of sex partners, fertility, concerns about libido, alcohol or tobacco usage, past surgeries, and the history of sexually transmitted infections. For special populations such as LGBTQ+ individuals, this assessment may entail additional detailed assessments such as the presence of negative social characteristics that may lead to adverse emotions such as stress and depression (Stewart, Lee, & Damiano, 2020).
Health Maintenance Guidelines that should be Included for Initial and Follow-up Assessments
Interviewing patients is often coupled with multiple difficulties such as the inability to ask the questions that prompt them to express the problems they face. This is usually the case especially when performing therapy on special populations such as LGBTQ+ individuals or mentally handicapped patients (Deckx et al., 2015). As part of the core health maintenance guidelines, I would perform several assessments on the patients such as bone density test, Gardasil vaccine, shingles, and others that would allow me to better-understand their position. Similarly, I would be sure to adhere to all the rules of preventing the spread of infectious diseases such as keeping social distance between people and wearing masks at all times to prevent Covid-19 spread.
Questions I would consider in the Patient’s Assessment
In the patient assessment, I would be sure to implement the CAGE questionnaire, an instrument used to assess the behavioral wellness of the patients. Developed by Dr. John Ewing in 1993, the questionnaire helps to assess the specific improvements that the patient may have shown over time (Baller et al., 2019). Some of the questions that I would ask in the case of an alcoholic patient are:
- Is there a time when you felt rejected in school or at work because of your sexual orientation?
- Are there family members supporting you in your struggles?
- Would you consider rehabilitation to stop your drinking habit?
- What sexually transmitted disease in your past health history was the most debilitating?
Script for Building Health History
In the health history script, I would include questions such as whether or not the patient has had a history of chronic diseases, or any permanent life-threatening condition (Jardim et al., 2015). I would also include in it an assessment of the patient living situation such as their source of income. Most importantly, I would include a survey of her feelings regarding how other people treat her because of her sexual orientation.
Reflection
The experience of developing the script is phenomenal as it helped me to closely relate about my everyday life as well as that of my patients. Some of the questions that were difficult asking are like the income source of the individual or their sex life. Nevertheless, I would be sure to repeat the same questions in a similar interview in future as they serve to engage the patient and to help in providing the right diagnosis.
References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel\’s guide to physical examination: An inter-professional approach (9th Ed.). St. Louis, MO: Elsevier Mosby.
Deckx, L., van den Akker, M., Daniels, L., De Jonge, E. T., Bulens, P., Tjan-Heijnen, V. C. G., Buntinx, F. (2015). Geriatric screening tools are of limited value to predict a decline in functional status and quality of life: A cohort study. BMC Family Practice, 16, 1–12. https://doi-org.ezp.waldenulibrary.org/10.1186/s12875-015-0241- x
Jardim, T. V., Sousa, A. L. L., Povoa, T. I. R., Barroso, W. K. S., Chinem, B., Jardim, L., … Jardim, P. C. B. V. (2015). The natural history of cardiovascular risk factors in health professionals: 20-year follow-up. BMC Public Health, 15(1111), 1–7. https://doi-org.ezp.waldenulibrary.org/10.1186/s12889-015-2477-8
Stewart, T., Lee, Y. A., & Damiano, E. A. (2020). Do transgender and gender diverse individuals receive adequate gynecologic care? An analysis of a rural academic center. Transgender health, 5(1), 50-58. https://doi.org/10.1089/trgh.2019.0037
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