Respond to 2 people, Maria and Amber, 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.
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The medical interview process is the most important avenue in building a relationship with the patient regardless of race, culture, and age. Foundation for building a positive relationship with the patient based on communication built on courtesy, comfort, connection, and confirmation (Ball et al, 2015). By encouraging open communication, we may obtain more complete information, enhance the possibility of a more accurate diagnosis, and promote appropriate counseling, thus potentially improve adherence to treatment plans that benefit long term health.
Our 76 years old patient who is currently living in an urban setting and having disabilities. The interview takes place in a quiet and private environment such as the examination room. With the patient being disabled, I want to make sure he is fully accommodated as much as possible. Before I begin with my interview, I knock on the door as a courtesy, wash my hands, and since the interview begins with a meeting between strangers, clear introductions, and as well set of tone are important. The basic interview would start with the introduction, establishes names, roles, purpose (including an interest in the patient’s response to illness), the time limits of the interview, and ask him what he is preferred to be called. I will provide privacy by closing the door, pulled the curtain, and make sure that the television is turned off to eliminate the noise (Ball et al,2015). Next is I will assess the patient comfort level, make sure he is not in any distress. If family members or other visitors are in the patient’s room, I will also introduce myself to all those present and explain the purpose of the interview. I will also ask the patient if they can stay, I will also inform the family that the patient must be given a chance to speak without unreasonable interruptions. If the family does not comply, this problem must be addressed promptly. I will make sure I am in front of the patient and sitting at eye level if possible and remove any barrier between me and the patients such as bedside tables or desk and make certain that his information is confidential. After introductions completed and patient comfort assessed I will initiate further questioning by using an open-ended question to allow my patient freely and continuously regarding the reason what brought him, his past medical history, family history, social history and other concern he has. I will use nondirectional questions to encourage the patient to report any and all problems he is experiencing, I will use questions that are worded, avoid using technical terms and diagnostic level so that the patient has no difficulty understanding what is being asked. I will let the patient talk spontaneously rather than restricting and directing the flow of information with multiple questions because frequently interrupt patients on the interview will prevent them from expressing their major concerns. I will respond to the patient in a non-judgmental manner and use empathetic response, validation, and reassurance during the interview to be able to obtain necessary detail without staggering the patient yet aid to form a picture on what the patient is trying to say to determine the best care plan.
As people age, they become more susceptible to many risk factors. These factors could potentiate from one factor to the other. For example, the fact that my patient who is above 65 years old tend to be frail and have poor functional reserve even a significant slight illness or an adjustment in medication can predispose to a sudden disastrous functional decline which precipitates them to fall and becoming immobile or rapidly confused thus lead to poor adherence to treatment and automatically set them up to malnutrition thus induce them to failure to thrive (Fjell et al, 2018). Therefore, the risk assessment tool that I can employ is the Comprehensive Geriatric Assessment (CGA). It is an important way to implement the comprehensive management of aging populations. It integrates physical health, functional status, social adaptability, mental health, and environmental conditions and evaluates the elderly overall health objectively. Additionally, it also formulates and makes treatment plans that protect the health and functional status of the elderly to maximize their quality of life. This includes an extensive review of prescription and over the counter drugs, herbal products as well as immunization (Jiang & Li, 2016). The targeted question I would ask includes.
Do you live alone or your leaving with someone?
What medication are you currently taking and what do you use to organize them?
Do you drink alcohol or using any recreational drugs?
Are you having trouble remembering stuff?
Have you fallen in the past 3 months?
Do you have trouble with your vision?
Have you lost weight in the past 6 months?
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
Fjell, A., Cronfalk, B. S., Carstens, N., Rongve, A., Kvinge, L., Seiger, Å., Skaug, K., & Bostrom, A. M. (2018). Risk assessment during preventive home visits among older people. Journal of multidisciplinary healthcare, 11, 609–620. https://doi.org/10.2147/JMDH.S176646
Jiang, S., & Li, P. (2016). Current Development in Elderly Comprehensive Assessment and Research Methods. BioMed research international, 2016, 3528248. https://doi.org/10.1155/2016/3528248
Week 1 Health History Discussion
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Week 1 Discussion: Building a Health History
A health history is a conversation between the patient and health provider. It is
used to build and establish a relationship with the patient as well as reveal the issues and problems that need attention. The health perspective is a full report based on the patient’s perspective not the health care provider’s. It is imperative to give full attention during the time of interview to collect all data possible for best diagnosis and treatment. The patient I choose to do a health history on in this discussion is the 76 year old male with disabilities in an urban setting.
Interview and Communication Techniques
Before entering in the room to interview my patient I would do an overview of the patient’s health information that was already obtained. “A change in knowledge, experience, cognitive abilities, and personality may occur with aging”(Ball et al., 2015). Therefore it is important anticipate any effects this may have on the interview. After entering the room, introducing myself as a student at Walden University and full name is the first thing I would say. The older patient may have sensory losses due to his age such as hearing or seeing. I would speak clearly and slowly facing the patient due to the older age and disabilities. It is important not to shout at the patient because this can magnify the problem by deforming consonants and vowels. Adapting to the patient’s disabilities is ideal. I would use the caregiver or family member and health record as resources to find out the disabilities of the patient so the interview can be conducted in the best manner possible. If using a electronic device it is important to not neglect the patient. It builds trust and makes the interview more personable when facing the patient and listening as well as possible (Ball et al., 2015).
Risk Assessment Tool
The OLDCARTS assessment tool is used to ensure a comprehensive presentation by making sure all characteristics of the problem are identified. It can be used for the 76 year old male to get a baseline of what is going on with him. The aim of the OLDCARTS assessment is listed below (Ball et al., 2015).
1. Onset of the problem
2. Location of the problem
3. Duration of the problem
4. Character of the problem
5. Aggravating/associated factors of the problem
6. Relieving factors of the problem
7. Temporal factors of the problem
8. Severity of symptom
The next assessment tool that would be good to use for the 76 year old black male with disabilities would be the geriatric assessment. The geriatric assessment tool was created to evaluate an older person’s functional ability, physical health, psychological health and socioenvironmental circumstances. It differs from a regular comprehensive assessment by focusing on functional capacity and quality of life (Elsawy 2011).
The last assessment tool that could benefit in the proper health history performed on the older patient with disabilities is the Fulmer SPICES assessment tool for older adults. Problems seen in older adult include, sleep disorders, issues with eating or feeding, incontinence, confusion, problems with falling and poor skin integrity (Meridith & Terry 2002). SPICES stands for:
S is for Sleep disorders
P is for Problems with eating or feeding
I is for Incontinence
C is for confusion
E is for evidence of falls
S is for the skin breakdown
Heath History Questions
1. What brings you in today?
2. How long has this been going on?
3. What time of day does this effect you the most?
4. What are your living situation and your daily routine?
5. How does your disabilities effect what brought you in today?
Ball, J.W., Dains, J.E., Flynn J.A., Solomon, B.S., & Stewart, R.W. (2015). Seidel’s
guide to physical examination (8th ed.) St.Louis, MO: Elsevier Mosby.
Elsawy, B., Higgins, K.E.(2011). The geriatric assessment. American Family
Physician. Vol.83 pp.48‐56.
Meredith, W., & Terry, F. (2002). Fulmer SPICES: An Overall Assessment Tool of
Older Adults. Dermatology Nursing, 2, 124.
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