NURS 6512: Advanced Health Assessment and Diagnostic Reasoning
By Day 3 of Week 1
Table of Contents
Share a brief recap of your talk and describe how you’d talk with your patient. Explain why you’d choose these methods. Pick a risk assessment tool and explain why it’s right for the patient. Also, list at least five questions you’d ask them.
Recap: Patient A.G is a 38-year-old woman, pregnant, living on an Indian reservation, here for a prenatal visit, 28 weeks into her third pregnancy. She’s stable with normal vital signs, clear heart sounds, lungs, and mood. Her review of systems was normal, and she has no known drug allergies.
My communication style would involve open-ended conversation and the “teach back” technique. Since there might be a language barrier, asking the patient to summarize what they’ve learned helps to clear up any misunderstandings and reinforce accurate information. Open-ended questions encourage the patient to share more about how they’re feeling and their experiences, which allows for deeper evaluation and personalized care planning.
For risk assessment, I’d use the PRAMS tool, which focuses on maternal behaviors before, during, and after pregnancy to reduce infant health issues. This fits well because Native American women often face disparities in prenatal care. The questions cover various aspects like feelings about the pregnancy, prenatal care, substance use, and more.
Here are some questions I’d ask:
1. Who will take care of the baby primarily?
2. Do you have access to prenatal care?
3. Are you using or planning to use tobacco or alcohol during pregnancy?
4. Have you experienced any pain?
5. Do you use traditional medicines?
These questions are crucial considering the higher risks Native American women face due to delayed care, substance use, and cultural factors affecting pain perception.
References
CDC. (2021, May 3). CDC – PRAMS Questionnaires – Pregnancy risk ASSESSMENT monitoring system – reproductive health. Centers for Disease Control and Prevention. https://www.cdc.gov/prams/questionnaire.htm.
Cesario, S. K. (2001, January 1). Care of the Native American Woman: Strategies for Practice, Education, and Research. JOGNN. https://www.jognn.org/article/S0884-2175(15)33875-2/fulltext.
Hanson, J. D. (2014, January). Understanding prenatal health care for American Indian women in a Northern Plains Tribe. Journal of transcultural nursing:official journal of the Transcultural Nursing Society. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4098117/.
Shepard, K. (2018, July 17). Nursing communication Skills: NurseZone. Nursing Communication Skills | NurseZone. https://www.americanmobile.com/nursezone/career-development/5-nursing-communication-techniques-that-work/.
By Day 6 of Week 1
Respond to at least two peers on separate days, each with different patients than yours, using one or more of these methods:
Share other effective communication methods.
Suggest additional health risks to consider.
Support points with personal experience or further research.
Thank you for sharing your thoughts. It’s concerning that trust issues can hinder healthcare, especially for marginalized groups like Native Americans. It’s crucial for us to recognize and address these barriers. Additionally, using the PRAMS tool seems apt for understanding maternal behaviors and reducing infant health risks. Considering cultural practices like traditional medicine is also vital for holistic care. In my experience, patients often don’t realize the importance of disclosing all treatments they’re undergoing, including alternative therapies.
NURS 6512: Advanced Health Assessment and Diagnostic Reasoning
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.
Summary: Patient A.G is a 38-year-old female, who is pregnant and lives in an Indian reservation. Patient came in for prenatal visit. Pt is 28 weeks of her third pregnancy. Vital signs stable, patient AAOX3, and mood is stable. Patient is not in acute distress, has normal heart sounds, lungs WNL and no respiratory distress noted. Full review of systems performed and was otherwise unremarkable. Patient has NKDAs.
The Communication style I would use is open ended dialogue and teach back method. There could be a communication barrier. Therefore, by asking the patient to summarize what they have learned, it creates the opportunity to correct any misinformation and reinforces the correct information. Asking open-ended questions is a communication technique that forces the patient to explain in more detail how they may be feeling and what they are experiencing, which allows for follow up questions for further evaluation and to create a more personalized plan of care (Shepard, 2018).
I would use the PRAMS risk assessment tool. PRAMS stands for Pregnancy Risk Assessment Monitoring System. It was created by influencing maternal behaviors before, during and after the pregnancy to reduce infant morbidity and mortality. Questions include: Attitudes and feelings about the most recent pregnancy, Preconception care, Content of prenatal care, Medicaid and WIC participation, Breastfeeding, Cigarette smoking and alcohol use, Health insurance coverage, Physical abuse, Infant health care, and Contraceptive use (CDC, 2021). Native American women are high risk for health disparities due to lack of early prenatal care and ongoing prenatal care. A study found that a cause of the health disparity was due to a barrier in communication. The native American women interviewed expressed how they felt the physicians seemed to busy to ask questions to and to respond to questions, feeling that the physician didn’t care about them nor their medical needs, and overall lack of trust of the physician and their practice of modern medicine (Hanson, 2014).
Targeted Questions
- Who will be the primary caregiver of the baby?
- Do you have access to prenatal care?
- Are you or will you be using tobacco or alcohol during the pregnancy?
- Are you in pain or have been experiencing any pain?
- Do you utilize traditional medicines and healing?
I chose these questions because Native American women are high risk for poor birth outcomes due delayed prenatal care, adolescent age, and use of tobacco and alcohol during pregnancy. Furthermore, due to the traditional family organization and the role of the woman in the culture, the mother may not be the primary caretaker of the child. It is important to educated the family member who will be the caretaker and not to judge the family dynamic. Native Americans are viewed as stoic during painful procedures or labor, and should not be mistaken for lack of pain (Cesario, 2001).
References
CDC. (2021, May 3). CDC – PRAMS Questionnaires – Pregnancy risk ASSESSMENT monitoring system – reproductive health. Centers for Disease Control and Prevention. https://www.cdc.gov/prams/questionnaire.htm.
Cesario, S. K. (2001, January 1). Care of the Native American Woman: Strategies for Practice, Education, and Research. JOGNN. https://www.jognn.org/article/S0884-2175(15)33875-2/fulltext.
Hanson, J. D. (2014, January). Understanding prenatal health care for American Indian women in a Northern Plains Tribe. Journal of transcultural nursing:official journal of the Transcultural Nursing Society. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4098117/.
Shepard, K. (2018, July 17). Nursing communication Skills: NurseZone. Nursing Communication Skills | NurseZone. https://www.americanmobile.com/nursezone/career-development/5-nursing-communication-techniques-that-work/.
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:
responses
Thank you for your input this week on building a health history. The nurse practitioner should keep a line of communication open with the patient based on comfort, politeness, and affirmation (Ball et al., 2019). The patient-centered approach is a communication technique that helps a physician build a relationship with a patient during an evaluation, allowing a vulnerable patient to establish trust in the doctor (Ball et al., 2019). The patient-centered approach is my preference since it fosters the patient’s trust and confidence in the practitioner. As a result, putting the patient at ease makes it easier for her to convey the reason for her consultation.
American Native women in the United States faced acknowledged barriers to prenatal care, including a lack of access to care, differing communication styles, and uneven treatment continuation (Johnson, 2020). Furthermore, because the gap is well-known, the nurse practitioner must assess the disparities described (lack of access to care, distinct communication styles, and inconsistent continuation of care). Another concern I would discuss with the mother and counsel her on is the pregnant woman’s age and the dangers she confronts. Although problems can emerge during pregnancy, it is a well-established trend that complications grow with age (Johnson, 2020).
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.
Bohn DK. (2020). Lifetime and current abuse, pregnancy risks, and outcomes among Native American women. Journal of Health Care for the Poor & Underserved, 13(2), 184–198. https://doi-org.ezp.waldenulibrary.org/10.1353/hpu.2010.0624
Johnson, M. B. (2020). Prenatal Care for American Indian Women. MCN: The American Journal of Maternal Child Nursing, 45(4), 221–227. https://doi-org.ezp.waldenulibrary.org/10.1097/NMC.0000000000000633
response 2
Thank you for your insightful post. It is sad to learn that certain populations have a lack of trust in their health care providers due to bias and lack of empathy. I appreciate that you stated this, as it is an uncomfortable truth which we, as future providers must remain aware of. Particularly in the case of Native Americans, more research is required to investigate cultural influences for prenatal care. It is unfortunate that Native Americans and women of other minority groups continue to be underrepresented in clinical studies, despite Federal statutes requiring the inclusion of women and minorities in research (Heck, 2020).
I like the idea of using the PRAMS risk assessment tool to reduce infant morbidity and mortality. It also helps assess the mother’s level of well-being and quality of current prenatal care. Asking the question of using traditional medicines and healing is an excellent point to keep in mind when dealing with not only the First Nation population but all patients of diverse backgrounds. Many times patients don’t realize that perhaps their cultural practice might counter the effect of Western medicine. Cultural practices and spiritual beliefs, family support or lack thereof, all influence the patient’s medical care (Ball et. al, 2019). Therefore, the provider must be well informed of all types of treatments the patient is receiving, even if non-allopathic. I can share a personal note here. When I was growing up, homeopathic medicine was always considered in high regard and encouraged to take simultaneously with allopathic medicines without informing the physician. Looking back now, I’m not so sure how I feel about this practice; I’m sure to share with my PCP any supplements I may be taking.
As nurse practitioners and nurses, given our holistic approach and person-centered philosophy of care, we’re in a distinct position to provide the necessary insight to maternal mortality review committees to obtain optimum patient care (Bradford, 2021). Given the severity of possible outcomes in your patient’s scenario, you did well in gathering the necessary data to compile this patient’s profile to make an accurate assessment. Kudos!
Nadia
References
Ball, J. W., Dains, J. E., Stewart, R. W., Professor of Medicine John A Flynn Med, & MPH, B. S. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). Elsevier Mosby.
Bradford, H. (2021). The essential role of nurse practitioners and midwives on maternal mortality review committees. Nursing for Women’s Health, 25(2), 107-111. https://doi.org/10.1016/j.nwh.2021.01.005
Heck, J. (2020). A phenomenological study of postpartum depression in women who are Native Americans or Alaska Natives. Journal of Obstetric, Gynecologic & Neonatal Nursing, 49(6), S1-S2. https://doi.org/10.1016/j.jogn.2020.09.004
Week 1: Building a Comprehensive Health History
According to a 2011 Gallup poll, nurses are ranked as the most trusted professionals in the United States. One of the most admired nursing skills is the ability to put patients at ease. When patients enter into a healthcare setting, they are often apprehensive about sharing personal health information. Caring nurses can alleviate the hesitance of patients and encourage them to be forthcoming with this information.
The initial health history interview can be an excellent opportunity to develop supportive relationships between patients and nurses. Nurses may employ a variety of communication skills and interview techniques to foster strong bonds with patients and to effectively facilitate the diagnostic process. In conducting interviews, advanced practice nurses must also take into account a range of patient-specific factors that may impact the questions they ask, how they ask those questions, and their complete assessment of the patient’s health.
This week, you will consider how social determinants of health such as age, gender, ethnicity, and environmental situation impact the health and risk assessment of the patients you serve. You will also consider how social determinants of health influence your interview and communication techniques as you work in partnership with a patient to gather data to build an accurate health history.
Learning Objectives
Students will:
- Analyze communication techniques used to obtain patients’ health histories based upon social determinants of health
- Analyze health-related risk
- Apply concepts, theories, and principles related to patient interviewing, diagnostic reasoning, and recording patient information
Learning Resources
Assignment: Course Acknowledgement
This mandatory assignment is an acknowledgement that you fully understand the course guidelines.
By Day 3 of Week 1
Submit your Assignment.
Submission and Grading Information
Submit Your Assignment by Day 3 of Week 1.
To complete this assignment, follow the link below and answer the questions provided.
Week 1 Assignment
Discussion: Building a Health History
Effective communication is vital to constructing an accurate and detailed patient history. A patient’s health or illness is influenced by many factors, including age, gender, ethnicity, and environmental setting. As an advanced practice nurse, you must be aware of these factors and tailor your communication techniques accordingly. Doing so will not only help you establish rapport with your patients, but it will also enable you to more effectively gather the information needed to assess your patients’ health risks.
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.
Photo Credit: Sam Edwards / Caiaimage / Getty Images
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.
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.
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.
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 1 Discussion Rubric
Post by Day 3 of Week 1 and Respond by Day 6 of Week 1
To Participate in this Discussion:
Week 1 Discussion
What’s Coming Up in Module 2?
Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images
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.
hoto Credit: Getty Images/iStockphoto
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.
