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NURS 6512 Middle Tennessee State WK1 Building a Health History Summary
NURS 6512 Middle Tennessee State WK1 Building a Health History Summary
Post a synopsis of the interview along with an explanation of the communication strategies you’d employ with your assigned patient. Why would you employ these strategies? Describe the risk assessment tool you chose and explain why the patient you chose would be a good fit. Give at least five specific queries that you would put to the patient. NURS 6512 Middle Tennessee State WK1 Building a Health History Summary
This is my patient: 76-year-old black male with disabilities living in an urban setting
This it the risk assessment instrument- POMR (Problem-Oriented Medical Record)
1. Comprehensive health history
2. Complete physical examination
3. Problem list
4. Assessment and plan
5. Baseline and problem-directed laboratory and radiologic imaging studies
6. Progress notes
APA format- 3 sources cited. Interview style, relevant questions pertaining to the patient.
Week 1: Building a Comprehensive Health History
Nurses are considered to be the Americans’ most trusted professionals, according to a 2011 Gallup poll. The ability to reassure patients is one of the most prized nursing abilities. Patients are frequently reluctant to disclose personal health information when they enter a medical facility. Patients’ reluctance to share this information can be reduced by compassionate nurses, who will also encourage them to do so.
The initial health history interview can be a great chance for patients and nurses to get to know one another. In order to build trusting relationships with patients and efficiently facilitate the diagnostic process, nurses can use a variety of communication strategies and interviewing techniques. A variety of patient-specific factors may affect the questions advanced practice nurses ask, how they ask those questions, and how thoroughly they assess the patient’s health when conducting interviews.
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.
NURS 6512 Middle Tennessee State WK1 Building a Health History Summary 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
NURS 6512 Middle Tennessee State WK1 Building a Health History Summary Learning Resources
Required Readings (click to expand/reduce)
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.
- Chapter 1, “The History and Interviewing Process”
This chapter explains the process of developing relationships with patients in order to build an effective health history. The authors offer suggestions for adapting the creation of a health history according to age, gender, and disability.
- Chapter 5, “Recording Information”
This chapter provides rationale and methods for maintaining clear and accurate records. The authors also explore the legal aspects of patient records.
Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.
- Chapter 2, “The Comprehensive History and Physical Exam” (pp. 19–29)
NURS 6512 Middle Tennessee State WK1 Building a Health History Summary