Holly Anne Mayes
11:40amAug 30 at 11:40amManage Discussion EntryMain Post:As a nurse practitioner, adapting your communication and interview techniques to meet each patient’s needs is crucial. When dealing with a 4-year-old African American male living in a rural community, there are several factors to consider when conducting a comprehensive interview and building an accurate health history.Establishing rapport and creating a comfortable environment for the child is essential. This can be achieved by using age-appropriate language, engaging in play or storytelling, and ensuring a friendly and non-threatening demeanor. By doing so, you can build trust and encourage the child to open up about their health concerns.When targeting questions for building a health history, it is essential to consider the patient’s social determinants of health. In this case, living in a rural community may pose unique challenges, such as limited access to healthcare services or exposure to specific environmental factors. To address these issues, you should inquire about the availability of healthcare facilities in the community, transportation barriers, or any specific environmental exposures that may impact the child’s health (Ball et al., 2023).Regarding risk assessment, several instruments can help gather information about the patient’s health risks. One example is the Pediatric Environmental Health Toolkit, which focuses on identifying and addressing environmental factors that may impact a child’s health. Considering the patient’s age, gender, ethnicity, and environmental setting, assessing potential risks such as exposure to toxins, infectious diseases in rural communities, or specific health conditions that may disproportionately affect African American children, such as sickle cell anemia, is essential.To assess the child’s health risks and begin building a health history, here are five targeted questions you could ask:

Can any specific environmental factors in your community or home affect your health?

• Have you experienced any symptoms like coughing, wheezing, or skin rashes that could be related to your environment?

Do you have any family history of chronic illnesses or conditions that may impact your health?

Are any challenges or barriers preventing you from accessing healthcare services?

Have you received all the recommended vaccinations for your age? (Goldman et al., 2021).

By asking these questions, you can gather valuable information about the child’s health risks and tailor their care accordingly. Remember, it is crucial to approach the interview process with cultural sensitivity, respect, and a genuine desire to understand the unique circumstances of each patient.ReferencesBall, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2023). Seidel’s guide to physical examination: An interprofessional approach (10th ed.). St. Louis, MO: Elsevier Mosby.Bosquet Enlow, M., Chung, R. J., Parisi, M. A., Sagiv, S. K., Sheridan, M. A., Stroustrup, A., Wright, R. J., Cox, L. A., Hendershot, T., Beverly, J., Maiese, D. R., & Hamilton, C. M. (2022). Standard measurement protocols for pediatric development research in the phenX toolkit: RTI Press. https://doi.org/10.3768/rtipress.2022.mr.0049.2209Links to an external site.Goldman, R. H., Zajac, L., Geller, R. J., & Miller, M. D. (2021). Developing and implementing core competencies in children’s environmental health for students, trainees and healthcare providers: a narrative review. BMC medical education, 21(1), 503. https://doi.org/10.1186/s12909-021-02921-3Links to an external site. ReplyReply to Comment

Collapse SubdiscussionAngela AlbarracinAngela Albarracin
11:57amAug 30 at 11:57amManage Discussion Entry             Obtaining a thorough patient history is a complex and individualized process that providers must adapt to according to the specific needs of each patient. Being adaptable and knowing how to interview each patient personally is the best method to obtain the most accurate history and create a rapport that is open and honest. For the patient in this case scenario, he is a 50-year-old LBTQIA male graduate student working in the college bookstore. This patient has several determinants of health that need to be assessed using proper interviewing techniques and screening tools. The 5 determinants of health can be divided into groups that are: economic stability, education access and quality, healthcare access and quality, neighborhood and working environment, and social and community context (Ball et. al, 2023). This patient possesses a high educational level that can be useful in his healthcare plan. Although medical jargon should be avoided while in the interview process, a healthcare provider can ask open-ended questions to help assess the level of comprehension that the individual has about his healthcare, and unlike a patient who has not completed formal education, a provider can safely assume that this individual can adequately read and write. This patient also holds a steady job at the college bookstore which gives him access to some economic stability and healthcare coverage. Questions such as: Do you ever have problems filling your prescriptions or finding adequate health care? These are important questions to address with this individual.             Another important social determinant this patient holds is that he is a part of the LGBTQIA community. This patient population has some important considerations and screenings that must be applied particularly regarding sexual health and intimate partner violence. Although STIs and domestic violence are seen in all groups, they are especially high in the LGBTQIA community and must be screened for. Aisner and colleagues report the HIRI-MSM tool to be especially sensitive and useful when identifying high-risk individuals for HIV infections (Aisner, Zappas, Marks, 2020). The HITS (Hurt, Insult, Threaten, or Scream) tool is important for screening individuals for intimate partner violence (Ball et. al, 2023). The approach that the provider takes when interviewing a member of the LGBTQIA community is also important to address. Biases and judgments should be made aware and set aside before any discussion with the patient. Proper pronouns should also be used, and any questions asked should be made in a non-judgmental and open manner such as: Are you sexually active? Or What is your living situation? (Ball et. al, 2023). Other questions that could help assess this patient’s sexual health would include: What form of protection is used during sexual encounters? Have you ever been diagnosed with a sexually transmitted infection?               Suicide is also an important issue to address when interviewing patients, especially those in the LGBTQAI community because homosexual individuals have several times greater risk of suicidal ideation than heterosexual individuals and with 40% of transexual individuals specifically attempting suicide in their lifetime compared to 5% of the general population (Moutier, Pisani & Stahl, 2021). A screening tool that is used for suicide in the emergency department is the Columbia Suicide Severity Rating Scale (CSSR-S), which helps to screen for suicide in high-volume areas and divides individuals depending on the severity of symptoms and the risk they pose to themselves (Syndergaard et. al, 2023). Questions that can be asked to assess mental health include: Have you ever tried to harm yourself or others? Do you feel depressed? Do you wish to go to sleep and never wake up? ReferencesAisner, A. J., Zappas, M., Marks, A. (2020, April 13). Primary Care for Lesbian, Gay, Bisexual, Transgender, and Queer/Questioning (LGBTQ) Patients. The             Journal for Nurse Practitioners, 16(4), 281-285. https://doi.org/10.1016/j.nurpra.2019.12.011Links to an external site..Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2023). Seidel’s guide to physical examination: An interprofessional approach (10th ed.).             St. Louis, MO: Elsevier Mosby.Moutier, C. Y., Pisani, A. R., Stahl, S. M. (2021). Stahl’s handbooks: Suicide Prevention. Cambridge University Press. DOI: 10.1017/9781108564618.Syndergaard, S. Borger, J., Klenzak, S., Grello, A., Adams, A. (2023) Implementation of Columbia Suicide Severity Rating Scale (C-SSRS) as a Universal             Suicide Risk Screening tool in a High Volume Emergency Department, Archives of Suicide Research, 27(2), 769-779, DOI:              10.1080/13811118.2022.2066495