NRNP 6552 Taking or Building a Health History Asking Difficult Questions Paper Example
NRNP 6552 Taking or Building a Health History: Asking Difficult Questions Assignment
NRNP 6552 Taking or Building a Health History Asking Difficult Questions Assignment Brief
Course: NRNP 6552 – Advanced Nurse Practice in Reproductive Health Care
Assignment Title: NRNP 6552 Taking or Building a Health History: Asking Difficult Questions Assignment
Assignment Overview
The assignment explores the delicate process of building a patient’s health history, emphasizing the importance of approaching difficult questions with sensitivity and respect. This assignment tasks students with developing a script for interviewing a volunteer acting as a patient, focusing on creating an environment conducive to open and productive dialogue.
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Understanding Assignment Objectives
This assignment aims to assess students’ ability to craft a comprehensive script for obtaining a patient’s health history while navigating sensitive topics. Students will demonstrate their understanding of effective communication strategies, cultural competence, and patient-centered care.
The Student’s Role
As a student in NRNP 6552, your role is to develop a script that reflects your understanding of the complexities involved in taking a patient’s health history. You will need to consider various factors such as cultural backgrounds, special populations, and the impact of difficult questions on both the nurse practitioner and the patient.
Competencies Measured
This assignment evaluates students’ proficiency in the following areas:
- Communication: Crafting a script that fosters open dialogue and encourages patient disclosure.
- Cultural Competence: Demonstrating sensitivity to diverse backgrounds and addressing the unique needs of special populations.
- Critical Thinking: Analyzing the challenges associated with asking difficult questions and proposing strategies for improvement.
- Professionalism: Maintaining ethical standards and respecting patient autonomy throughout the health history interview process.
You Can Also Check Other Related Assessments for the NRNP 6552 – Advanced Nurse Practice in Reproductive Health Care Course:
NRNP 6552 Different Roles of the Nurse Practitioner Discussion Assignment Example
NRNP 6552 Building a Health History Discussion Post Assignment Example
NRNP 6552 Taking or Building a Health History Asking Difficult Questions Paper Example
Script for Building a Health History
Introduction
“Good [morning/afternoon], [Patient’s Name]. My name is [Your Name], and I am a nurse practitioner. Today, I’d like to ask you some questions to better understand your health history and any current concerns you might have. Our conversation will be confidential, and I’m here to provide the best care and support. If at any point you feel uncomfortable or have questions, please let me know. Let’s start with some basic information about you.”
Personal and Demographic Information
“Let’s start with some basic information. Can you please tell me your full name, age, gender identity, and race or ethnicity?”
Chief Complaint (CC)
“What brings you in today? Please describe any specific concerns or symptoms you’re experiencing.”
History of Present Illness (HPI)
“Can you tell me more about [symptom/concern]? When did it start, and how has it progressed? Are there any particular times when it gets better or worse?”
Using the LOCATES Mnemonic
- Location: “Where exactly do you feel the [symptom]?”
- Onset: “When did you first notice it?”
- Character: “Can you describe what it feels like? Is it sharp, dull, throbbing, etc.?”
- Associated Signs and Symptoms: “Are there other symptoms that accompany it?”
- Timing: “Is there a specific time of day when it happens? How often does it occur?”
- Exacerbating/Relieving Factors: “Is there anything that makes it better or worse?”
- Severity: “On a scale from 1 to 10, how would you rate your discomfort?”
Current Medications
“Can you tell me about any medications you are currently taking, including dosages and how often you take them? This includes any over-the-counter or herbal supplements.”
Allergies
“Do you have any allergies to medications, foods, or environmental factors? If so, what kind of reactions do you have?”
Past Medical History (PMHx)
“Have you had any major illnesses, surgeries, or hospitalizations in the past? Are you up to date on your vaccinations, including your last tetanus shot?”
Social and Substance History (SocHx)
“Tell me a little about your living situation. Do you live alone or with others? What is your occupation, and do you have any major hobbies? Do you use tobacco or alcohol? If so, how much and how often?”
Family History (FamHx)
“Can you tell me about any significant health issues in your immediate family, such as your parents, siblings, or children? Are there any genetic conditions or chronic illnesses that run in your family?”
Surgical History
“Have you had any surgeries in the past? If so, can you provide details?”
Mental Health History
“Have you ever been diagnosed with any mental health conditions, such as anxiety or depression? Are there any current concerns you would like to discuss?”
Violence History
“Do you have any concerns about your safety at home, in your community, or in any other aspect of your life? Have you ever experienced violence or abuse?”
Reproductive Health History
“Can you tell me about your menstrual history, including the date of your last menstrual period? Have you had any gynecologic conditions or surgeries in the past? Do you have regular Pap smears? How many sexual partners have you had, and do you use any form of contraception? Are you currently pregnant or nursing? Have you ever had a sexually transmitted infection? Are there any sexual health concerns you would like to us address?”
Review of Systems (ROS)
“Do you have any other symptoms or health concerns that we haven’t discussed?” “I’d like to go over each system in your body to make sure we haven’t missed anything.”
- General: “Have you experienced any weight changes, fever, or fatigue?”
- HEENT: “Do you have any issues with your eyes, ears, nose, or throat?”
- Skin: “Have you noticed any rashes or changes in your skin?”
- Cardiovascular: “Do you have any chest pain or palpitations?”
- Respiratory: “Do you have any shortness of breath or cough?”
- Gastrointestinal: “Have you experienced any nausea, vomiting, or abdominal pain?”
- Genitourinary: “Any issues with urination or changes in your menstrual cycle?”
- Neurological: “Any headaches, dizziness, or numbness?”
- Musculoskeletal: “Do you have any muscle or joint pain?”
- Hematologic: “Any unusual bleeding or bruising?”
- Lymphatics: “Have you noticed any swollen lymph nodes?”
- Psychiatric: “Any changes in mood or anxiety levels?”
- Endocrinologic: “Do you have any symptoms like excessive sweating or changes in thirst?”
- Reproductive: “Any concerns about your sexual health or recent pregnancies?”
- Allergies: “Any history of asthma, hives, or eczema?”
Reflection
Summary of Experiences
Developing this script involved careful consideration of sensitive topics and the use of empathetic language to ensure patient comfort. Implementing the script with a volunteer highlighted the importance of building rapport and maintaining a non-judgmental attitude.
Challenges and Insights
Asking about sexual history and lifestyle choices were particularly challenging due to the potential for discomfort or embarrassment. However, approaching these topics with sensitivity and reassurance helped facilitate open communication. I learned that creating a safe and respectful environment is crucial for obtaining accurate and comprehensive health histories.
Future Improvements
In future assessments, I would focus on refining my questioning techniques to be more conversational and less clinical. Additionally, I would incorporate more specific questions tailored to diverse populations to ensure inclusivity and address unique health needs.
Considerations for Special Populations
- LGBTQ+ Individuals: Use inclusive language, inquire about gender identity and preferred pronouns, discuss specific health risks, and provide a non-judgmental environment.
- Adolescents: Address confidentiality concerns, ensure privacy, and use age-appropriate language.
- Elderly Patients: Consider cognitive function, presence of multiple comorbidities, and potential barriers to communication.
Health Maintenance Guidelines
For initial and follow-up assessments, it is essential to include:
Initial Assessment
- Vaccinations: Gardasil (HPV prevention vaccine), Shingles vaccine (for individuals over 50), influenza, Tdap, and MMR if not previously administered.
- Screenings: Pap test (starting at age 21), HPV test (co-testing from age 30), mammograms every 1-2 years (starting at age 40-50 depending on risk factors), bone density test (postmenopausal women or those with risk factors for osteoporosis).
- Lifestyle Counseling: Diet, exercise, smoking cessation, alcohol use, and safe sex practices.
Follow-Up Assessments
- Regular Screenings: Continued Pap and HPV testing as per guidelines, mammograms every 1-2 years.
- Annual Check-ups: General health assessment, review of medications, and management of chronic conditions.
- Additional Tests: Colonoscopy (starting at age 50 or earlier if at risk), diabetes screening, and cholesterol monitoring.
These guidelines help in the early detection and prevention of common health issues, improving patient outcomes and overall health.
References
Adler-Milstein, J., & Nong, P. (2019). HIPAA Privacy Rule compliance in patient care and research. Journal of the American Medical Association, 321(7), 710-711.
Bouayad, L., Ialynytchev, A., & Padmanabhan, B. (2017). Patient satisfaction with telehealth services in home care settings: A systematic review. Telemedicine and e-Health, 23(8), 561-567.
Schuiling, K. D., & Likis, F. E. (2022). Women’s gynecologic health. Jones & Bartlett Learning.
Tessier, L. H., Adam, P., & Atkinson, S. (2019). The influence of patient-centered care on healthcare outcomes. Journal of Nursing Care Quality, 34(3), 243-249.
Detailed Assessment Instructions for the NRNP 6552 Taking or Building a Health History Asking Difficult Questions Paper Assignment
NRNP 6552 Taking / Building a Health History: Asking Difficult Questions
Module 1 Assignment: Taking a Health History: Building a Health History: Asking Difficult Questions
Description
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 this week’s Learning Resources and consider the difficult questions you might have to ask when you take a patient’s 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 health history. (Note: You will also find the Health History Form in Chapter 7)
- Describe the components of a complete gynecologic health history. 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.)?
- What questions would you consider in your patient’s assessment? For example
- What is your patient’s living situation?
- Do they have stairs?
- Do they live by themselves?
- Do they have a working refrigerator?
- 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.
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.
http://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6551/02/mm/conversation/index.html
Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting.
Rubric Detail
Select Grid View or List View to change the rubric’s layout.
Name: NRNP_6552_Module1_Assignment_Rubric
Grid View List View
Describe the components of a comprehensive gynecologic 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.)?
What questions would you consider in your patient’s assessment?
For example
- What is your patient’s living situation?
- Do they have stairs?
- Do they live by themselves?
- Do they have a working refrigerator?
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 react and provide a summary of your experiences in developing your script during your health history.
Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, “ow logically, and demonstrate continuity of ideas. Sentences are carefully focused— neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria.
Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation
Written Expression and Formatting – The paper follows the correct APA format for the title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.
Excellent
27 (27%) – 30 (30%)
The response provides clear, complete, and appropriate descriptions of a comprehensive gynecologic history. Health maintenance guidelines are clear and complete. Social factors affecting health are appropriately incorporated.
22.5 (22.5%) – 25 (25%)
The script contains a complete set of questions, including di”cult questions, necessary to build a health history. Questions are phrased in a manner that supports the patient’s comfort.
27 (27%) – 30 (30%)
The response provides an accurate, clear, and complete summary of experiences in developing the script during the health history
5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for #ow, continuity, and clarity.
A clear and comprehensive purpose statement, introduction, and conclusion is provided which delineates all required criteria.
5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors.
5 (5%) – 5 (5%)
Uses the correct APA format with no errors.
Good
24 (24%) – 26 (26%)
The response provides clear, complete, and most of the components of a comprehensive gynecologic history. Most health maintenance guidelines are included and appropriate. Social factors affecting health are mostly included.
20 (20%) – 22 (22%)
The script contains a mostly complete set of questions, including di”cult questions, necessary to build a health history. Most questions are phrased in a manner that supports the patient’s comfort.
24 (24%) – 26 (26%)
The response provides an accurate summary of experiences in developing the script during the health history
4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for #ow, continuity, and clarity 80% of the time.
Purpose, introduction, and conclusion of the assignment is stated, yet is brief and not descriptive.
4 (4%) – 4 (4%)
Contains a few (1 or 2) grammar, spelling, and punctuation errors.
4 (4%) – 4 (4%)
Contains a few (1 or 2) APA format errors.
Fair
21 (21%) – 23 (23%)
The response provides components of the gynecologic history but they are incomplete, vague or inaccurate. Health maintenance guidelines are somewhat complete or inappropriate applied. Social factors are included but some are missing.
17.5 (17.5%) – 19.5 (19.5%)
The script contains some relevant questions, including a few difficult questions. The information collected provides a cursory health history.
Questions are not phrased in a supportive tone.
21 (21%) – 23 (23%)
The response provides a vague, inaccurate, or incomplete summary of the experiences in developing the script during the health history
3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for #ow, continuity, and clarity 60%–79% of the time.
Purpose, introduction, and conclusion of the assignment is vague or o! topic.
3.5 (3.5%) – 3.5 (3.5%)
Contains several (3 or 4) grammar, spelling, and punctuation errors.
3.5 (3.5%) – 3.5 (3.5%)
Contains several (3 or 4) APA format errors.
Poor
0 (0%) – 20 (20%)
The response provides unclear, incomplete, or inappropriate components of the gynecologic health history. Health maintenance guidelines are missing, incorrect, or inappropriately applied. Social factors are missing or incorrect.
0 (0%) – 17 (17%)
The script contains few or no relevant questions, including few or no di”cult questions. The information collected is not sufficient to provide an adequate health history.
Questions are not phrased in a supportive tone.
0 (0%) – 20 (20%)
The response provides a vague, inaccurate, or incomplete summary of the experiences in developing the script during the health history, or the summary is missing.
0 (0%) – 3 (3%)
Paragraphs and sentences follow writing standards for #ow, continuity, and clarity < 60% of the time.
No purpose statement, introduction, or conclusion was provided.
0 (0%) – 3 (3%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
0 (0%) – 3 (3%)
Contains many (≥ 5) APA format errors.
Name: NRNP_6552_Module1_Assignment_Rubric
CAGE Questionnaire
- Have you ever felt you should Cut down on your drinking?
- Have people Annoyed you by criticizing your drinking?
- Have you ever felt bad or Guilty about your drinking?
- Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (Eye opener)?
Scoring:
Item responses on the CAGE are scored 0 or 1, with a higher score an indication of alcohol problems. A total score of 2 or greater is considered clinically significant.
………………………………..
Developed by Dr. John Ewing, founding Director of the Bowles Center for Alcohol Studies, University of North Carolina at Cahpel Hill, CAGE is an internationally used assessment instrument for identifying alcoholics. It is particularly popular with primary caregivers. CAGE has been translated into several languages.
The CAGE questions can be used in the clinical setting using informal phrasing. It has been demonstrated that they are most effective when used as part of a general health history and should NOT be preceded by questions about how much or how frequently the patient drinks (see “Alcoholism: The Keys to the CAGE” by DL Steinweg and H Worth; American Journal of Medicine 94: 520-523, May 1993.
The exact wording that can be used in research studies can be found in: JA Ewing “Detecting Alcoholism: The CAGE Questionaire” JAMA 252: 1905-1907, 1984. Researchers and clinicians who are publishing studies using the CAGE Questionaire should cite the above reference. No other permission is necessary unless it is used in any profit-making endeavor in which case this Center would require to negotiate a payment.
………………………………..
Source: Dr. John Ewing, founding Director of the Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill
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