NURS 6512: Advanced Health Assessment and Diagnostic Reasoning

By Day 3 of Week 1

Post a summary of the interview and describe 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.

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Summary: Patient A.G is a 38-year-old woman who is pregnant and resides in an Indian reservation. She came in for a prenatal visit. She’s currently at 28 weeks of her third pregnancy. Her vital signs are stable, she’s alert and oriented, and her mood is steady. She doesn’t seem to be in any immediate distress, her heart and lungs sound normal, and there are no signs of breathing difficulties. We conducted a thorough review of her health systems, and everything appeared normal. She has no known drug allergies.

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For communicating with this patient, I would employ open-ended dialogue and the teach-back method. There may be a language or cultural barrier, so using the teach-back method, where I ask the patient to explain what they’ve learned, can help correct any misunderstandings and reinforce the correct information. Asking open-ended questions forces the patient to provide more detailed information about their feelings and experiences, allowing for follow-up questions and the creation of a more personalized care plan (Shepard, 2018).

I would use the PRAMS risk assessment tool, which stands for Pregnancy Risk Assessment Monitoring System. This tool was designed to influence maternal behaviors before, during, and after pregnancy to reduce infant morbidity and mortality. It covers various aspects, including attitudes and feelings about the pregnancy, preconception care, the content of prenatal care, participation in programs like Medicaid and WIC, breastfeeding, tobacco and alcohol use, health insurance coverage, physical abuse, infant healthcare, and contraceptive use (CDC, 2021). Native American women often face health disparities due to delayed or insufficient prenatal care. A study found that communication barriers were a significant factor contributing to these disparities. Native American women reported feeling that physicians were too busy to ask or answer questions, didn’t care about their needs, and lacked trust in modern medical practices (Hanson, 2014).

Targeted Questions

1. Who will be the primary caregiver for the baby?
2. Do you have access to prenatal care?
3. Are you currently using or planning to use tobacco or alcohol during your pregnancy?
4. Have you experienced any pain or discomfort?
5. Do you utilize traditional medicines and healing practices?

I selected these questions because Native American women often face a higher risk of adverse birth outcomes due to delayed prenatal care, being at an adolescent age, and using tobacco and alcohol during pregnancy. Additionally, considering the traditional family structures and the role of women in their culture, the mother may not always be the primary caregiver for the child. It’s essential to educate and support the family member who will be taking on this role, without making judgments about their family dynamics. Native Americans are often perceived as stoic during painful situations or labor, so it’s crucial not to mistake their stoicism for a 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:

Response 1:

Thank you for sharing your insights on building a health history. It’s crucial for nurse practitioners to maintain open communication with patients, emphasizing comfort, politeness, and affirmation (Ball et al., 2019). The patient-centered approach is an effective communication technique for establishing a strong patient-doctor relationship during evaluations, which is especially important for vulnerable patients to build trust in their healthcare provider (Ball et al., 2019). I also prefer the patient-centered approach as it fosters trust and confidence in the practitioner, making it easier for the patient to express their concerns.

Native American women in the United States face well-documented barriers to accessing prenatal care, including limited access, distinct communication styles, and inconsistent treatment continuity (Johnson, 2020). It’s essential for nurse practitioners to address these disparities, such as access issues, differences in communication styles, and the importance of ongoing care. Another critical aspect to discuss with the patient is the potential risks associated with her age during pregnancy. It’s a well-established fact that pregnancy complications tend to increase 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.

Johnson, M. B. (2020). Prenatal Care for American Indian Women. MCN: The American Journal of Maternal Child Nursing, 45(4), 221–227.

Response 2:

Thank you for your informative post. It’s disheartening to learn that certain populations face a lack of trust in their healthcare providers due to bias and a lack of empathy. Recognizing this uncomfortable truth is essential as future providers. Particularly for Native Americans, more research is needed to explore cultural influences on prenatal care. It’s unfortunate that Native Americans and other minority groups remain underrepresented in clinical studies, despite federal statutes requiring the inclusion of women and minorities in research (Heck, 2020).

Using the PRAMS risk assessment tool to reduce infant morbidity and mortality is a great idea. It also helps assess the mother’s well-being and the quality of current prenatal care. Asking about the use of traditional medicines and healing practices is a crucial consideration when dealing with patients from diverse backgrounds. Many patients may not realize that their cultural practices could interact with Western medicine. Cultural practices, spiritual beliefs, and family support all impact a patient’s medical care (Ball et al., 2019). As healthcare providers, we must be well-informed about all treatments patients are receiving, even non-allopathic ones.

Your mention of homeopathic medicine and the need for patients to inform their healthcare providers about any supplements they’re taking is valid. Transparency in healthcare is critical for ensuring safe and effective treatment. Your holistic and person-centered approach as a nurse practitioner will contribute to optimal patient care (Bradford, 2021), especially in cases like the one you’ve discussed. Your effort to gather the necessary data for this patient’s profile is commendable. Well done!

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

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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?

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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.

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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.

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• Student Practicum Resources: NP Student Orientation