NRNP 6552 TAKING A HEALTH HISTORY: BUILDING A HEALTH HISTORY: ASKING DIFFICULT QUESTIONS

NRNP 6552 TAKING A HEALTH HISTORY: BUILDING A HEALTH HISTORY: ASKING DIFFICULT QUESTIONS

NRNP 6552 TAKING A HEALTH HISTORY: BUILDING A HEALTH HISTORY: ASKING DIFFICULT QUESTIONS

Taking a Health History: Building a Health History: Asking Difficult Questions

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A careful and comprehensive history is vital before the examination of any patient.  In addition to a good general history, focusing on the history of the presenting complaint enables the clinic to tailor the examination to elicit the appropriate signs and make an accurate diagnosis. The gynecology history taking and exam should always be conducted with appropriate privacy and sensitivity.  The purpose of this paper is to present a script that will be used in my first encounter with a patient for a well-woman appointment.

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Creating rapport

Hello.  I am Ayeshia, and I will be examining you today.  I believe you are here for your first well-woman appointment.

I will ask you several questions about your medical and sexual history, some of which might be uncomfortable.  Your information will be confidential and not be shared with another person without your consent.

Demographic History

I will start by taking your personal information.

  • What is your name?
  • How old are you?
  • How would you describe your gender?
  • What is your address?

Medical history

I will then proceed to your general medical history.

  • Do you have any chronic illnesses?
  • What medications and supplements, prescribed or over-the-counter, are you taking, and what are their indications?
  • What food, drug, or environmental allergies do you have?
  • When was your last Tetanus and Influenza shot?
  • Which mental health disorders have you been diagnosed with currently or in the past? (Schuiling & Likis, 2022).

Substance Use History

  • I will ask you about your substance use.
  • Do you currently take alcohol, and if yes, how often and what amount?
  • Do you smoke, and if yes, how many packets per day?
  • Have you ever used illicit substances like marijuana, cocaine, or heroin?

Family Health History

  • Do you have family members with chronic illnesses?
  • Has any family member died from a chronic illness?
  • Which gynecologic disorders are present in your family members? (Schuiling & Likis, 2022)

SDOH

  • What is your current education level?
  • What is your occupation?
  • What is your income level?
  • What challenges do you experience accessing healthcare?
  • Do you have private or public-funded health insurance?
  • What is your marital status?
  • How many children do you have?
  • How often do you engage in physical exercises?
  • How would you describe your sleep pattern?
  • How many meals do you have daily, and what are your food preferences?
  • What challenges do you face in accessing healthy foods? (Ziso et al., 2022).
  • Have you encountered domestic abuse?
  • Have you ever been convicted?

Gynecologic Health History

I will now ask you questions about your reproductive and sexual health.  This will include your menstruation, contraceptive use, sexual functioning, reproductive and obstetric history, and cancer screening (Aryal & Atreya, 2022).

Menstrual History

  • At what age did you have your first menses?
  • When was your last menstrual period?
  • How long is your menstrual cycle?
  • Is your menstrual cycle regular or irregular?
  • What is the duration of your menses? (Schuiling & Likis, 2022).
  • Do you experience very painful menses or excessive menstrual bleeding?
  • Do you experience clots or vaginal pooling during menses?
  • How many tampons or pads do you use per day during menses?
  • Do you experience spotting between menses or missed menses?
  • What premenstrual symptom do you experience, that is, 3-7 days before the onset of menses?

Contraceptive Use

  • Which contraceptives do you use?
  • How often do you use the said contraceptive?
  • Have you experienced any associated problems with birth control or STD- prevention methods like reaction to spermicides, diaphragms, or condoms? (Aryal & Atreya, 2022).
  • What problems have you experienced with hormonal contraceptive methods?
  • Have you ever considered using long-term contraceptive methods like implants or IUDs?

Sexual functioning

  • What is your sexual preference?
  • What unusual sexual interests do you have?
  • How many sexual partners do you have?
  • How would you rate your sexual satisfaction?
  • Do you experience pain during intercourse or delayed infrequent or absent orgasms? (Hagey et al., 2020).

Reproductive medical history

  • Have you previously been diagnosed with gynecological infections like yeast infections, salpingitis, endometritis, PID, or cervicitis?
  • Which STIs have you ever been diagnosed with?
  • How were the STIs treated? (Barrow et al., 2020).
  • Do you have a history of uterine fibroids or ovarian cysts?
  • Obstetric History
  • How many pregnancies have you had?
  • What were the dates of those pregnancies?
  • What was the outcome of the pregnancies (a live birth or a miscarriage)?
  • What complications did you experience during pregnancy, labor, delivery, and after delivery?

Reproductive Cancer Screening

  • When was your last self-breast exam?
  • What unusual findings did you find during the breast exam?
  • When was your last mammography?
  • When did you last have a pap smear?
  • What were the results of the Pap smear?

Reflection

Developing the script for building a health history for a well-woman exam was time-consuming.  I learned that taking the patient’s general medical history is crucial since some medical conditions are comorbid with gynecological disorders (Park et al., 2020).  The experience enlightened me that when taking a gynecologic history, the clinician should ask about the problem prompting the visit, sexual activities, past and present menstrual periods, past pregnancies, contraceptive use, and gynecologic symptoms, disorders, and treatments the client has had.

When undertaking the gynecology history, I may encounter difficulties asking clients about their sexual preference, orientation, number of sexual partners, interests, and satisfaction.  It would also be difficult to ask patients about their history of STIs and STDs since most shy away from answering, and others give false information.  I found it insightful that it is essential to ask about sexual identity and gender identity issues to allow clients to talk about these issues (Easpaig et al., 2022).  Assuming a client’s sexual preference and orientation prevents LGBTQ patients from receiving better healthcare.  When asking about sexual orientation and preferences, I would use neutral and inclusive terms like “partner” and ask the questions non-judgmentally.  If the patient appears offended or reluctant to answer, I would briefly explain why I am asking the question.

Access to healthy, nutritious foods is a major challenge for Americans, especially those with low-income levels.  This contributes to the high prevalence of chronic diseases.  Low-income and minority communities often lack suitable places that offer affordable, healthier foods.  As an NP, I would support farm-to-institution programs in my community to connect community members to healthier foods (Ziso et al., 2022).  I would also connect local food hubs to organizations that sell healthy foods in low-income communities.

References

Aryal, S., & Atreya, A. (2022). History taking in gynecology revisited. Acta bio-medica : Atenei Parmensis, 92(6), e2021554. https://doi.org/10.23750/abm.v92i6.11940

Barrow, R. Y., Ahmed, F., Bolan, G. A., & Workowski, K. A. (2020).  Recommendations for Providing Quality Sexually Transmitted Diseases Clinical Services, 2020.  MMWR.  Recommendations and reports: Morbidity and mortality weekly report.  Recommendations and reports, 68(5), 1–20.  https://doi.org/10.15585/mmwr.rr6805a1

Easpaig, B. N. G., Reynish, T. D., Hoang, H., Bridgman, H., Corvinus-Jones, S. L., & Auckland, S. (2022).  A systematic review of the health and health care of rural sexual and gender minorities in the UK, USA, Canada, Australia, and New Zealand.  Rural and Remote Health, 22(3), 1–16.  https://doi.org/10.22605/RRH6999

Hagey, J. M., Toole, J., Branford, K., Reynolds, T., Livingston, E., & Dotters-Katz, S. K. (2020).  Understanding Sexual Complaints and History Taking: A Standardized Patient Case on Dyspareunia for Obstetrics and Gynecology Clerkship Students.  MedEdPORTAL: the journal of Teaching and learning resources, p. 16, 11001.  https://doi.org/10.15766/mep_2374-8265.11001

Park, K., Wu, P., & Gulati, M. (2020).  Obstetrics and Gynecological History: A Missed Opportunity for Cardiovascular Risk Assessment.  JACC.  Case reports 2(1), 161–163.  https://doi.org/10.1016/j.jaccas.2019.11.035

Schuiling, K. D., & Likis, F. E. (2022). Gynecologic health care (4th ed.). Jones and Bartlett Learning.

Ziso, D., Chun, O. K., & Puglisi, M. J. (2022). Increasing Access to Healthy Foods through Improving Food Environment: A Review of Mixed Methods Intervention Studies with Residents of Low-Income Communities.  Nutrients, 14(11), 2278.  https://doi.org/10.3390/nu14112278

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TAKING A HEALTH HISTORY: BUILDING A HEALTH HISTORY: ASKING DIFFICULT QUESTIONS

Much of an archeologist’s work is done under the mantra “proceed with caution.” Archeologists must dutifully secure permissions to access sites. They also must exercise extreme caution when excavating or analyzing in a lab to avoid potential damage to historical artifacts.

Likewise, nurse practitioners must proceed with caution when building a patient’s health history. Important questions can be difficult for both nurse and patient. Care must be taken to approach such questions with dignity, tact, and respect to create an environment conducive to productive conversations.

More importantly in today’s society, the possible Social Determinants of Health for each of our patient’s also needs to be taken into consideration

For this Assignment, you will develop a make-believe script to be used when you first encounter a patient for a well woman appointment.

RESOURCES

Be sure to review the Learning Resources before completing this activity.

Click the weekly resources link to access the resources.

WEEKLY RESOURCES

LEARNING RESOURCES

Required Readings

Schuiling, K. D., & Likis, F. E. (2022). Gynecologic health care (4th ed.). Jones and Bartlett Learning.

Chapter 6, “Gynecologic Anatomy and Physiology” (pp. 87–98)

Chapter 7, “Gynecologic History and Physical Examination” (pp. 99–124) (Previously read in Week 1)

Chapter 9, “Periodic Screening and Health Maintenance” (pp. 149–164)

Chapter 12, “Sexuality and Sexual Health” (pp. 211–228)

Chapter 13, “Contraception” (pp. 236–266)

Chapter 14, “Menopause” (pp. 267–291)

Chapter 15, “Intimate Partner Violence” (pp. 295–307)

Chapter 16, “Sexual Assault” (pp. 313–329)

SCREENING GUIDELINES

American Academy of Family Physicians. (2021, August). Adult preventive health care schedule: recommendations from the USPSTF.Links to an external site. American Family Physician. https://www.aafp.org/dam/AAFP/documents/journals/afp/USPSTFHealthCareSchedule2021.pdf

American College of Obstetricians and Gynecologists (ACOG). (n.d.). Well-Woman Health CareLinks to an external site.. https://www.acog.org/topics/well-woman-health-care?utm_source=redirect&utm_medium=web&utm_campaign=otn

Agency for Healthcare Research and Quality (2014). Guide to Clinical Preventive Services, 2014.Links to an external site. https://www.ahrq.gov/prevention/guidelines/guide/index.html

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. (n.d.). A guide to taking a sexual history.Links to an external site. https://www.cdc.gov/std/treatment/SexualHistory.p

ADULT GERONTOLOGY RESOURCES

Shifren, J. L., & Gass, M. L. S. (2014). The North American Menopause Society Recommendations for Clinical Care of Midlife Women.Links to an external site. The Journal of The North American Menopause Society, 21(10), pp. 1-25. http://www.menopause.org/docs/default-source/2014/nams-recomm-for-clinical-care.pdf

RESOURCES FOR LGBTQ+

Aisner, A. J., Zappas, M., & Marks, A. (2020). Primary Care for Lesbian, Gay, Bisexual, Transgender, and Queer/Questioning (LGBTQ) PatientsLinks to an external site.. The Journal for Nurse Practitioners, 16(4), 281–285. https://go.openathens.net/redirector/waldenu.edu?url=https://doi.org/10.1016/j.nurpra.2019.12.011

Office of Disease Prevention and Health Promotion (ODPHP). (2020, April 18). Lesbian, gay, bisexual, and transgender health.Links to an external site. https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health

Wingo, E., Ingraham, N., & Roberts, S. C. M. (2018). Reproductive Health Care Priorities and Barriers to Effective Care for LGBTQ People Assigned Female at Birth: A Qualitative StudyLinks to an external site.. Women’s Health Issues, 28(4), 350–357. https://go.openathens.net/redirector/waldenu.edu?url=https://doi.org/10.1016/j.whi.2018.03.002

APPS FOR COMMON SCREENINGS

The following common screening apps will require a download or install into your personal device for you to access. Note: Should you have any technical issues, you will need to contact the rightsholder of the app itself and not Walden Student Support for any assistance.

Alvar-Gonzalez, J. (2020). iContraception.Links to an external site. https://play.google.com/store/apps/details?id=com.itiox.icontraception&hl=en_US

Note: This download is available for Android devices only.

ITIOX Technologica S.L. (2020). iContraception.Links to an external site. https://apps.apple.com/us/app/icontraception/id668520861

Note: This download is available for iOS devices only.

Agency for Healthcare Research and Quality (AHRQ). (n.d.). ePSS Electronic Preventive Services Selector.Links to an external site. https://epss.ahrq.gov/PDA/index.jsp

Centers for Disease Control and Prevention (2020). CDC Vaccine Schedules.Links to an external site. https://www.cdc.gov/vaccines/schedules/hcp/schedule-app.html#download

Note: This webpage will provide you with downloads for both iOS and Android Devices.

Nurse Practitioners in Women’s Health. (n.d.). Well Woman Visit Mobile AppLinks to an external site.. https://npwh.org/page/mobile-app

CLINICAL GUIDELINE RESOURCES

American College of Obstetricians and Gynecologists (ACOG).Links to an external site. (2020). https://www.acog.org/

American Cancer Society, Inc. (ACS). (2020). Information and Resources about for Cancer: Breast, Colon, Lung, Prostate, Skin.Links to an external site. https://www.cancer.org/

Centers for Disease Control and Prevention. (CDC).Links to an external site. (n.d.). https://www.cdc.gov/

American Nurses Association (ANA).Links to an external site. (n.d.). https://www.nursingworld.org/

The American Association of Nurse Practitioners (AANP).Links to an external site. (2020). https://www.aanp.org/

HealthyPeople 2030. (2020). Healthy People 2030 Framework.Links to an external site. https://www.healthypeople.gov/2020/About-Healthy-People/Development-Healthy-People-2030/Framework

Required Media

Taking a Health History

Dr. Marianne Shaughnessy discusses one of the most critical components of the nurse/patient relationship—the health interview with the patient. She further discusses how to conduct a health history interview with demonstration (16 mins).

Women’s Issues and Tough ConversationsLinks to an external site.

In this interactive media program, Dr. Rebecca Lee and Cindy Nypaver describe their experiences related to women’s issues and tough conversations (5 mins).

Optional Resources

Note: In Weeks 1-10, these resources are optional for your review. In Week 11, you will be required to review each of the PowerPoint slides from the text Gynecologic Health Care (4th ed.).

Chapter 6, “Gynecologic Anatomy and Physiology” Download “Gynecologic Anatomy and Physiology”

Chapter 7, “Gynecologic History and Physical Examination”Download “Gynecologic History and Physical Examination”

Chapter 9, “Periodic Screening and Health Maintenance” Download “Periodic Screening and Health Maintenance”

Chapter 12, “Sexuality and Sexual Health” Download “Sexuality and Sexual Health”

Chapter 13, “Contraception” Download “Contraception”

Chapter 14, “Menopause”Download “Menopause”

Chapter 15, “Intimate Partner Violence”Download “Intimate Partner Violence”

Chapter 16, “Sexual Assault”Download “Sexual Assault”

To prepare:

Review the screening tools found in the Learning Resources and consider how you might use an app or tool to assist in screening.

Review the media programs related to a vaginal exam, pap test, and breast exam.

Review the health history guide presented in Chapter 7 of the Schuiling & Likis (2022) text and consider how you would create your own script for building a complete health history. (Note: You will also find the Health History Form in Chapter 7)

Provide all the components of a complete gynecologic health history. Include considerations for special populations such as LGBTQ+ individuals.

What health maintenance guidelines should be included for initial and follow up might be needed for follow-up assessments? (i.e., bone density test, Gardasil vaccine, pap smear, Mammorgram, etc.)?

Using the 5 areas of the Social Determinants of Health:

(Examples of SDOH include but not limited to)

Safe housing, transportation, and neighborhoods

Racism, discrimination, and violence

Education, job opportunities, and income

Access to nutritious foods and physical activity opportunities

Polluted air and water

Language and literacy skills

SDOH also contribute to wide health disparities and inequities.

What questions would you consider in your patient’s complete health history?

Develop your own script for building a complete health history and as you create your script, consider the difficult questions you want to include in your script. There is no sample template to provide to you. (Utilize chapter 7 of your Schuiling textbook to provide guidance). You are the one to develop the script. Think of it as you are writing a movie and you need to write the script for the movie. What lines would you provide for the actor to utilize when sitting down with a patient to perform a COMPLETE Medical History which also entails those DIFFICULT GYN questions. You do not need to provide the answers to the questions however, if you find that beneficial, you may do so.

Assignment: (1- to 2-page reflection)

In addition to your script for building a health history for this assignment, include a separate section called “Reflection” that includes the following:

A brief summary of your experiences in developing and implementing your script during your health history.

Explanations of what you might find difficult when asking these questions. What you found insightful and what would you say or do differently.

As a NP, what could you implement in your community to provide resources/assistance of the Social Determinants of Health.

ReminderLinks to an external site.: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting.

BY DAY 7 OF WEEK 2

Submit your Module 1 Assignment by Day 7 of Week 2.

SUBMISSION INFORMATION

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.

To submit your completed assignment, save your Assignment as M1Assgn_LastName_Firstinitial

Then, click on Start Assignment near the top of the page.

Next, click on Upload File and select Submit Assignment for review.

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