AIDET is a useful tool for the majority of patients and situations; but, depending on the patient, alternative interview and communication approaches may be required. For example, if this patient is a teenager, I might inform him and his grandma that I will be speaking with them separately and together. Even though the boy’s grandmother is required for background information, most teenagers are capable of providing an accurate health history and may speak more freely if given the opportunity. Adolescents, on the other hand, may find it difficult to express themselves or may feel guilty, thus they should be given space to do so without being confronted, as they do not respond well to confrontation (Bell, Dains, Flynn, Solomon, & Stewart, 2019). Furthermore, anticipatory advice refers to topics that should be discussed with patients and caregivers at a suitable age (Sullivan, 2019). Patients aged 10 to 14 should pay special attention to safety concerns, nutrition, dental hygiene, peer pressure, puberty, safe sex/contraception/STD prevention, safety rules with adults, communication, screen time, self-control, depression/anxiety, tobacco/alcohol/substance use, educational goals and activities, after-school activities, and supervision.
An accurate and complete patient history requires effective communication. Many factors influence a patient’s health or sickness, including age, gender, ethnicity, and environmental location. You must be aware of these factors as an advanced practice nurse and modify your communication tactics accordingly. This will not only help you create rapport with your patients, but it will also allow you to obtain the information needed to analyze their health risks more efficiently.
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.
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 Seidel’s 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.
Also Check Out: HQS 620 Topic 1 DQ 2
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.
Main Question Post
Being able to obtain a comprehensive health history for a patient is important in developing a treatment plan for them. The purpose of this discussion post is to discuss interview techniques I would use for an 85-year-old white female living alone with declining health. I will talk about the risk assessment instrument I would use and why. Lastly, I will list five targeted questions I would ask to assess her health to start building a health history.
The first meeting with any patient is so important to build a good relationship and partnership from the start (Ball et al., 2019). With this patient being 85 and living alone there will be a lot to consider when interviewing her. I will need to establish is she is mentally with it, if she has hearing problems, and how much she understands about her health. Older adults often assume certain problems are just normal parts of aging and not anything to be considered (Ball et al., 2019). Often, older adults can also experience agism (Garrison-Diehn et al., 2022). Even in health care settings older adults experience feelings of incompetence and being a burden (Garrison-Diehn et al., 2022). It will be important to make sure she feels comfortable speaking to me knowing there is no bias or judgement.
The risk assessment I would do for this patient is the functional assessment. This is an older lady who lives alone. It will be essential to figure out how well she is able to function on her own. One of the biggest risks for older patients is falling. Falling is associated with adverse outcomes that can lead to a patient not being able to live at home anymore along with increased mortality (Snehal et al., 2020). The functional assessment would give information regarding how well she can move around the house, is she is able to keep a clean environment, how meals are prepared, how she goes to the bathroom, and keeps good hygiene (Ball et al, 2019). All these issues are going to contribute to her overall health. It is important to gather this information to determine what assistance, if any, she will need.
After introducing myself and establishing how the patient would like to be addressed, I would start by simply asking “What brings you in today?” This is a way to find out what her chief complaint is for coming in. My second question would be “When did this start?” This brings the patient back to the beginning and prompts them to tell the whole story regarding why they came in. My third question would be “What medications do you take on a regular basis and what are they for?” In my experience patients may or may not even know what they are taking, let alone why they are taking them. It can also lead to her discussing if she is compliant with her medications. To follow that, my fourth question would be “What medical problems do you have?” Before going through a formal review of systems, this can give a clue to what she considers to be important in her history. My last question would be “How well do you feel you are able to take care of yourself at home?” This is an open-ended question to gain some insight on the functional assessment. If the patient’s initial chief complaint is not urgent it is okay to give the patient some time while understanding the time constraints of you as the provider (Ball et al., 2019).
Establishing a relationship with patients and getting a thorough health history can be a daunting task for providers. It is key to tailor interviewing skills to meet patient specific needs. Modifying interview skills to the individual will eliminate communication barriers between the provider and patient (Bass et al., 2019). Creating a strong relationship with the patient will allow the nurse practitioner to obtain the most comprehensive health history and provide the best possible care to clients.
References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Garrison-Diehn, C., Rummel, C., Au, Y. H., & Scherer, K. (2022). Attitudes toward older adults and aging: A foundational geropsychology knowledge competency. Clinical Psychology: Science and Practice, 29(1), 4–15. https://doi.org/10.1037/cps0000043
Snehal, K., Rashmi, G., & Aarti, N. (2020). Risk factors for fear of falling in older adults in India. Journal of Public Health, 28(2), 123-129. doi:https://doi.org/10.1007/s10389-019-01061-9
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
Read a selection of your colleagues’ responses.
By Day 6 of Week 1
Respond to at least two of your colleagues on 2 different days who selected a different patient than you, using one or more of the following approaches:
- Share additional interview and communication techniques that could be effective with your colleague’s selected patient.
- Suggest additional health-related risks that might be considered.
- Validate an idea with your own experience and additional research.
Developing or building an accurate and detailed patient history is a cornerstone of initiating an appropriate plan of care for any patient and is a skill that is essential for the APRN. In this way, we get to know our patient’s, their past concerns and issues, and how past problems impact current functioning. A complete health history is also necessary when collaborating with other healthcare clinicians or when there is a transfer of care. Factors such as age, gender, ethnicity, and living environment all should be considered since they greatly impact a patient’s health status. When interviewing a patient, whether it is a first encounter or follow-up care, communication, interviewing techniques, and other tools are necessary to ensure that the necessary information is gathered and understood to meet the needs of the patient. For the purpose of this discussion, the patient in question is a 14 year old biracial male living with his grandmother in a high-density public housing complex.
Whenever meeting with any patient, I prefer to use a method called AIDET which is as follows: Acknowledge and greet the patient by name, make eye contact, smile, and include any others who are present; Introduce yourself, your position, and background or experience; the Duration that the interview and exams will take; Explain what steps are next and what the patient can expect from the visit; and lastly, Thank the patient and any family or friends for their time and consideration (Studer Group, 2020).. These steps can be completely in a few sentences, take less than five minutes, and can provide reassurance to nervous patients who don’t know what to expect.
As previously stated, adolescents face more social risks than medical risks. As a result, an assessment tool like the HEEADSSS can help obtain an accurate psychosocial history for this age group. Many of the same social determinants are covered by the acronym HEEADSSS, which stands for home, education/employment, eating, activities, drugs, sexuality, suicide/depression, and safety (Sullivan, 2019).
The following are five specific questions I asked my patient to assess his health risks and build his health history: 1) Do you have any acquaintances who have committed suicide? While suicide is an uncomfortable subject, it is a common cause of death in adolescents, particularly males, and should be evaluated (Bell et al., 2019). This is a non-threatening question that may start a conversation and reassures the teen that the subject is safe. 2) Do you engage in sexual activity? Adolescence is a time for trying new things and taking risks. Children are becoming sexually active at an earlier age and should be educated on safe sex, contraception, and disease prevention; 3) Do you feel safe at home? This is an excellent open-ended question that can start a discussion and lead to a variety of safety-related issues. For example, does the boy trust his grandmother? Contrary responses may indicate abuse or neglect. Perhaps he does not feel safe in his living environment as a result of overcrowding in a public housing complex. 4) Could you please tell me what you had for breakfast this morning? This question assesses the patient’s memory recall while also providing information about nutrition and dietary habits. 5) Is there anything we haven’t discussed that you believe I should be aware of? Often, patients, particularly those who are young, expect the clinician to direct the interview and answer questions. They may be more hesitant to initiate their own topics or concerns, and this allows them to have the floor to ask or discuss anything in a safe environment.
Welcome to 6512!
This is your Week 1 Update!!!! I try to do an update at least once a week, to make announcements, share information, and discuss overall class issues and activities. It is my goal to keep you informed in order to decrease your anxiety, and also make this a very enjoyable learning experience!!
This is my 8th year at Walden University. I taught this same course each semester…….so rest assured……my job is to make sure that we are all successful in completing this course!! Your job is to stay informed, and ask questions as they arise!
1. Class Cafe: If you haven’t already introduced yourself….please do so! We want to hear your past work experience, your goals, your family, your pets, and what you intend to do after completing your NP degree!! Post pictures….it is always great to place a face with a name! We will be spending alot of time together the next 11 weeks!!! Also, use this forum to ask your classmates questions. Many times, your classmates are experiencing the same issues as you are……so this helps everybody out if you post your issues and can troubleshoot together!
2. Weekly discussions: Since we do not get to see each other on a weekly basis…..this is the place where you share your knowledge, and challenge your colleagues to think deeper about the topic. Be sure to follow the grading rubric as you develop your Main Discussion and your replies to Colleagues. This is how you will be graded. Pay close attention to the dates and times in which you post…..points are deducted if you are not posting on the required timelines. When posting your main discussion, please post like this Your last Name- Main Post Week 1. This way, myself and your colleagues will be able to follow your discussion thread. I am looking for your posts to have scholarly citations, outside of your required texts, when possible, and also that your in-text and reference lists are all listed in APA format. Here are some resources to assist you with APA formatting, outside of the APA Manual:
3. This Week’s Discussion Board
1. 26-year-old Lebanese female living in graduate-student housing
2. 14-year-old biracial male living with his grandmother in a high-density public housing complex
3. 38-year-old Native American pregnant female living on a reservation
4. 40-year-old black recent immigrant from Africa without health insurance
- 1 Last names starting with A-C
- 2 Last names starting with D-H
- 3 Last names starting with I-O
- 4 Last names starting with P-Z
Please make sure that you answer all of the required info in your post:
- 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 Seidel’s 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.
4. Shadow Health– If you have not yet done so, be sure to set up your account with Shadow Health. Beginning in Week 3 we will be having required assignments in this learning tool.
5. Communication: As I mentioned….I like to do weekly updates to the class. I post this update in the Announcement area each week. I try to keep everyone informed to the best of my ability.
I am teaching multiple sections of this course this semester. In order to streamline communication with me, I ask that you communicate with me in the “Contact Instructor” tab of Blackboard. If your question or issue is of a personal nature that you would prefer not posting in this section, please email or call me. My Walden Email is kimberly.olszewski@mail.waldenu.edu. In the subject line of your email…..please start with your section number….. ie: D-4 Olszewski Discussion Question. This will be able to track the issue in a more expedient manner. I try to check email daily, but if you need to speak with me urgently, please call my cellphone.
For many of you this may be one of your first online courses. Please do not hesitate to ask questions!! For problems with Blackboard or the website, please contact FrontLine frontline.team@laureate.net. I will not be able to help you with any technical questions. For course content questions, please contact me directly.
I know that all of you are now on information overload!! Take a deep breath, and get ready for a fast paced, and information packed 11 weeks!! Please take time to review the syllabus and Academic Integrity policy for this course. I intend to make this course as interactive and enjoyable as possible…..and I really look forward to being part of your educational journey at Walden!!
In Module 2, you explore the impact of functional assessments, diversity, and sensitivity in conducting health assessments. You also examine various assessment tools and diagnostic tests used to gather information about patients’ conditions and examine their validity, reliability, and impact in conducting health assessments.
Next week, you will specifically examine functional assessments as they relate to diversity and sensitivity
Registration for Shadow Health
Throughout this course, you will participate in digital clinical experiences using the online simulation tool Shadow Health. The Shadow Health digital clinical experience provides a dynamic, immersive experience designed to improve nursing skills and clinical reasoning through the examination of digital standardized patients. Using Shadow Health you will participate in health histories, focused exams, and a comprehensive assessment.
There will be four Shadow Health assessment components that you will need to complete in Module’s 2 and 3:
- Health History Assessment (Week 3 & 4)
- Focused Exam: Cough (Week 5) for a pediatric patient presenting with cough
- Focused Exam: Chest Pain (Week 7) for an adult patient presenting with chest pain
- Comprehensive (Head-to-Toe) Physical Assessment (Week 9)
Before you can participate in these simulations, you will need to register for a Shadow Health account. To do this:
- Go to the Walden Bookstore and purchase access to Shadow Health and the required texts.
- Once Shadow Health has been purchased, an access code will be emailed to you from the bookstore.
- Review this video explaining how to register in Shadow Health: https://vimeo.com/275921826/c12d50ee6e
- Use the Shadow Health link located in the navigation menu on the left in the Blackboard course.
- Follow the prompts to register in Shadow Health. You will need the access code provided from the bookstore to register. Once registered, Shadow Health should always be accessed via the link in Blackboard.
- Use only Google Chrome when accessing Shadow Health and make sure all other programs are turned off on your computer. Other browsers do not work well and will not allow the Shadow Health speech to text function to work.
- Once registered, complete the Shadow Health Orientation in the Shadow Health website/program and review the videos designed to assist with navigating and completing assignments.
- Read the Shadow Health Nursing Documentation Tutorial located in the Week 1 Learning Resources.
Note: As nurses you typically use the word assessment to mean completing the physical exam. However, in the SOAP Note format, assessment means diagnosis so start getting in the habit of calling the physical exam exactly that.
Week 2 Case Studies
In Week 2, your Instructor will assign you a case study related to your Discussion by Day 1 of the week. Please make sure to review the “Course Announcements” area of the course to verify your assigned case study. Please plan ahead to ensure you have time to review your case study and your Learning Resources so that you can complete your Discussions and Assignments on time.
Practicum – Upcoming Deadline
In the Nurse Practitioner programs of study (FNP, AGACNP, AGPCNP, and PMHNP) you are required to take several practicum courses. If you plan on taking a practicum course within the next two terms, you will need to submit your application via Meditrek .
For information on the practicum application process and deadlines, please visit the Field Experience: College of Nursing: Application Process – Graduate web page.
Please take the time to review the Appropriate Preceptors and Field Sites for your courses.
Please take the time to review the practicum manuals, FAQs, Webinars and any required forms on the Field Experience: College of Nursing: Student Resources and Manuals web page.
