Communication is the foundation for creating a positive and effective patient-provider relationship. Building rapport with an individual allows for a better understanding of how to tailor one’s communication for effective results Discussion: Building a Health History. Observing and obtaining information on an individual’s education, developmental status, socioeconomic background, perceptions, and needs aid in delivering quality assessment, planning, education, intervention compliance, and overall outcomes. The following will discuss communication techniques, risk assessment instruments, and targeted questions for the case-study patient: Adolescent Hispanic/Latino boy living in a middle-class suburb.
Communication techniques should always be tailored to the individual, this provides a better understanding and positive results. When providing care to an adolescent, it is imperative to analyze the child’s language, to distinguish their reactions and perceptions, and provide consent and empowerment (Peña & Rojas, 2013). The patient in this case study is an adolescent Hispanic/Latino boy living in a middle-class suburb. Adolescents, described by The World Health Organization, is a person “between 10 to 17 years of age” (Organization, n.d., para. 5). This population is in a stage of critical developmental, emotional, and physical growth, which may differ individually Discussion: Building a Health History. The sensitivity of some health-related topics may be a barrier in assessing an adolescent; some youth may not feel comfortable discussing them with a guardian in the room. Confidentiality should take precedence, with an understanding of the importance of reporting safety concerns (Barry Solomon, Jane Ball, John Flynn, Joyce Dains, Rosalyn Stewart, 2017).
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In a study on nurse-patient communications, the identified four themes for effective communication; approach, manner, interaction techniques, and both verbal and non-verbal communication skills (O’Hagan et al., 2013). The approach and manner should be patient-focused, empathetic, and sensitive; not task-oriented or busy (O’Hagan et al., 2013) Discussion: Building a Health History. The interaction should include simple non-bias explanations with summarization for clarification (O’Hagan et al., 2013). The verbal and non-verbal communication should be tailored to the individual; patient appropriate language, space management, eye contact, sitting down with the patient and allowing the patient to speak (O’Hagan et al., 2013). These techniques may vary for different individuals based on their communication needs. Discussion: Building a Health History.
In a study evaluating a program focused on communication improvement in an emergency department in Singapore, there was over an 80% decrease in negative feedback from patients after the “I Hear You” program was implemented (Khoo et al., 2020). The stages to this program are I (Introduce, identity, information gathering), Hear (Patient’s perspective/patient’s language), and You (Agreement/closure) (Khoo et al., 2020). This technique helps builds an empowered provider-patient relationship by acknowledgment, respect, and participation.
In this patient interview, I would approach the patient first with an introduction and handshake, then the guardian if available. This gives the adolescent patient a sense of individuality and priority. Once history, medications, and concerns are collected; if the patient is comfortable, with their consent I would request the guardian to exit the room for the assessment. Discussion: Building a Health History.
Risk Assessment Instrument
Discussion: Building a Health History This vulnerable age population, between child and adult, is curious by nature and risky behaviors due to peer pressure, self-esteem, identity, school performance, parent relationships, and susceptibility to media are often adopted (Barry Solomon, Jane Ball, John Flynn, Joyce Dains, Rosalyn Stewart, 2017). Risk assessment screening tools that may be used for an adolescent patient are available to screen for mental health, sexual/physical abuse, substance use, sexuality, and safety (Barry Solomon, Jane Ball, John Flynn, Joyce Dains, Rosalyn Stewart, 2017). PACES (Parents/peers, Accidents/Alcohol/drugs, Cigarettes, Emotional issues, and School/Sexuality), HEEADSSS (Home environment, Education/employment, Eating, Activities/affect, Drugs, Sexuality, Suicide/depression, and Safety from injury/violence) and CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble) are three tools used to evaluate adolescences (Barry Solomon, Jane Ball, John Flynn, Joyce Dains, Rosalyn Stewart, 2017).
For the patient: adolescent Hispanic/Latino boy living in a middle-class suburb; I would first determine the individual’s communication preferences such as preferred language, education level, developmental status, and individual’s perception and comfortability Discussion: Building a Health History. Being from a Hispanic/Latino background, I would build questions around his diet and daily activities; due to the high rate of heart disease and diabetes in this population. I would also focus on his peer circle and activities, due to the developmental stage of adolescence.
Leading targeted questions for this patient would be:
- Tell me how things are at home.
- What kind of foods do you like to eat?
- How has school been this year?
- What do you like to do for fun?
- Describe your friends.
- What do you and your friends like to do?
- Do you ever use drugs or alcohol?
- Are you sexually active?
Barry Solomon, Jane Ball, John Flynn, Joyce Dains, Rosalyn Stewart. (2017). Seidel’s guide to physical examination (9th ed.). Elsevier Health Sciences (US).
Khoo, S., Aswin, W., Shen, G., Haq, H., Junaidah, B., Yiew, J., Abiramy, M., & Sashikumar, G. (2020). Improving provider-patient communication skills among doctors and nurses in the children’s emergency department. The Asia Pacific Scholar, 5(3), 28–41. https://doi.org/10.29060/taps.2020-5-3/oa2160
O’Hagan, S., Manias, E., Elder, C., Pill, J., Woodward-Kron, R., McNamara, T., Webb, G., & McColl, G. (2013). What counts as effective communication in nursing? evidence from nurse educators’ and clinicians’ feedback on nurse interactions with simulated patients. Journal of Advanced Nursing, 70(6), 1344–1355. https://doi.org/10.1111/jan.12296
Organization, W. H. (n.d.). Adolescence: A period needing special attention – recognizing-adolescence. Retrieved September 1, 2020, from https://apps.who.int/adolescent/second-decade/section2/page1/recognizing-adolescence.html
Peña, A., & Rojas, J. G. (2013). Ethical aspects of children’s perceptions of information-giving in care. Nursing Ethics, 21(2), 245–256. https://doi.org/10.1177/0969733013484483
The patient presented in your discussion post is in a vulnerable age group and is a high risk for unsafe behaviors such as drug use, smoking, and alcohol abuse due to peer pressure or simply wanting to fit in, therefore, the advanced practice nurse needs to utilize effective communication techniques to when conducting a health risk assessment for patients in this age group. In this case, the advanced practice nurse will initially need to establish a connection with the patient and gain his trust. Establishing a positive patient relationship depends on the communication built on courtesy, comfort, connection, and confirmation (Ball, Dains, Flynn, Solomon, & Stewart, 2019). Once the patient-provider relationship is formed, patient confidentiality should be explained to the patient before conducting the health history and physical assessment. As part of obtaining the patient’s health history, health risk assessments must be conducted for health promotion and disease prevention (Wu and Orlando, 2015). Moreover, it should also be explained that patient safety is of the utmost importance (Ball et al., 2019). The target questions listed in your discussion post were appropriate for this patient and will provide insight into the patient’s health history and current lifestyle to determine an appropriate plan of care. Discussion: Building a Health History
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.
Wu, R. R., & Orlando, L. A. (2015). Implementation of health risk assessments with family health history: Barriers and benefits. Postgraduate Medical Journal, 91(1079), 508. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.1136/postgradmedj-2014-133195