How are your living arrangements and do you feel it is safe to navigate?
2 days ago Tamara Pottillo
Week 1
COLLAPSE
An important step in obtaining a comprehensive patient health history is to establishing a rapport with your patient. There are numerous communication and interview techniques for building a health history. However, first indentifying with your patient will be the most important factor. Communication cues are non verbal as well as verbal. Seeking connection during the introduction phase and your overall presentation is most important. According to Ball et al. (2019) consider intellectual and emotional constraints related to how you ask questions and offer information. Patients also communicate nonverbally, and understanding this is advantageous to both you and the patient (Henry et al, 2012). Non verbal communication is one important technique that is often overlooked; be mindful of the patient’s body language, facial expression, and eye contact there are several ques that can guide some of your questions. Active listening and adaptive questioning are important tools to assist with gathering as much information about the patient. Communication may be at times different for each patient, as some patients have language barriers, speech impediments, and trust issues. However, it is always important to meet the patient at there level to gain the most information.
Targeting questions related to the social determinants are based upon the social determinant history of the patient. According to Laforge et al. (2018) states that the Centers for Medicare & Medicaid Services has recognized the 5 social determinants of health domains that can be addressed through community services; which are housing
instability, food insecurity, transportation difficulties, utility assistance needs, and interpersonal safety. The social determinants are particularly important because they are identified as barriers to overall health and wellness. Focused questions in regards to the five social determinants using open ended question will elude a specific answer from your patient and identify a barrier if there is one. Other potential health risks include age, gender, ethnicity and environmental setting should always be included during each phase of the health history including plan and reevaluation. Quite simply, functional assessment is an attempt to understand a patient’s ability to achieve the basic activities of daily living. This assessment should be made for all older adults and for any person limited by disease or disability, acute or chronic. The usefulness of health screening and assessment tools to collect relevant information on particular individuals, and/or a specific target population is typically expressed in terms of validity, reliability and utility of application (Gordon et al., 2019).
76-year-old black male with disabilities living in an urban setting
I would first introduce my patient by Mr. X with a firm handshake, direct eye contact and a smile. I will then proceed to ask what brings you in to the office today. Patient will state his CC and I will review his PMH, SH, ROS, PE, and SD. Using adaptive questioning and active listening communication techniques. The risk assessment instrument that I would utilize for my patient is the functional assessment tool so that I can have a comprehensive assessment of my patient’s functioning at home.
Five Targeted Questions to determine Health Risks
Do you have a PCP?
When was your last visit to a Health Professional?
How do you get to your move about during your day to day activities?
How do you get to your medical appointments and obtain your medications?
How are your living arrangements and do you feel it is safe to navigate?
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.
Gordon, S. J., Grimmer, K., Bradley, A., Direen, T., Baker, N., Marin, T., Kelly, M. T., Gardner, S., Steffens, M., Burgess, T., Hume, C., & Oliffe, J. L. (2019). Health assessments and screening tools for adults experiencing homelessness: a systematic review. BMC Public Health, 19(1), 994. https://doi-org.ezp.waldenulibrary.org/10.1186/s12889-019-7234-y
LaForge, K., Gold, R., Cottrell, E., Bunce, A. E., Proser, M., Hollombe, C., Dambrun, K., Cohen, D. J., & Clark, K. D. (2018). How 6 Organizations Developed Tools and Processes for Social Determinants of Health Screening in Primary Care: An Overview. The Journal of ambulatory care management, 41(1), 2–14. https://doi.org/10.1097/JAC.0000000000000221
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