Each post should have at least 2 refences, in text citations.
Respond to at least two of your colleagues on 2 different days who selected a different patient than you, 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.
Building a Health History
As healthcare workers, the key to successfully treating a patient is building rapport. If a patient finds the healthcare worker to be trustworthy, and a harmonious relationship is developed, the patient is more likely to follow their instructions (Butt, 2021). On the flip side, if a patient does not trust their healthcare professional or has any negative thoughts towards them, they will be more likely to be wary of the information received. This may eventually lead to worsening of the patient’s disease.
Today, an 80-year-old white male diagnosed with angina, who lives on a farm 80 miles away from a healthcare center will be interviewed. At the beginning of this interview, the patient is placed in a room with very minor background noise. Pleasantries are exchanged with light conversation to ascertain patient’s ability to hear clearly. Some elderly patients develop hearing deficiencies, but this is not to be assumed. Elderly patients could become offended if it assumed that they are hard of hearing. This time is also used to assess the patient’s appearance, as this can also give some insight on how the patient cares for himself. The patient is then allowed to explain why he has visited the healthcare center, this allows the patient to verbalize his needs clearly. Active listening is done through this process, while taking notes to ensure nothing is missed. The patient states that he feels healthy, he just has occasional mild chest discomfort during strenuous activity, which is alleviated by nitro tablets previously prescribed. Asking open ended questions, resulted in the patient divulging this information, as the patient can explain in his own words exactly what he is feeling. Paraphrasing is another technique used to ensure the healthcare professional understands what the patient is saying and prevents any misunderstandings. The patient’s vital signs and weight are recorded. Blood samples are taken. The patient is then educated about angina and the importance of taking all medication as prescribed. This is done using simple language that the patient can understand and slowly explained, so that the patient is able to grasp the information (Koo et al., 2016). The patient is then tested on this education and the information is broken down as needed, to ensure patient fully understands what is required of him. The patient is then given the appropriate print size information packet. This includes reminders, information about his illness and follow up care. At the conclusion of the visit, the patient is given adequate time to think of any additional questions he may have or ask for additional information.
The risk assessment instrument I selected for this patient is the HEART score. HEART is an acronym for history, electrocardiogram, age, risk factors and troponin (Brady & de Souza, 2018). This score is classified into 3 groups, low, intermediate and high risk and is used to determine the risk of a patient having a major adverse cardiac event (MACE) (Stepinska et al., 2020). Patients who are low risk may be managed less aggressively than a person who is at a high risk (Brady & de Souza, 2018). The heart pathway would then be used to determine the best treatment route. A score of less than 4 with a negative troponin would result in follow-up. A score of less than 4 with a positive troponin would result in the patient being admitted with a cardiology consult, stress test and cardiac imaging. A score of greater than 4 with a positive or negative troponin would result in admission, with a cardiology consult, stress test and cardiac testing (Brady & de Souza, 2018).
The questions I would ask this patient are as follows:
- What time of day does the pain usually occur and are you active or inactive during the onset of chest pain?
- What makes the pain better or worse?
- What does the pain feel like?
- Does the pain move, or does it remain in one area?
- Do you have any symptoms along with the pain, for example, shortness of breath or nausea?
As an advanced practice nurse, being aware of their cultural background and personal experiences is crucial while interviewing a new patient to create a solid connection and acquire accurate health information (Pergolizzi et al., 2020). My patient in this situation is a 19-year-old black male athlete with muscular pain. To begin the interview, I would introduce myself, create trust and a relaxed atmosphere, and explain the aim of the discussion. I would use open-ended questions such as, “Tell me about your muscular pain?” When did it all begin? What causes it to be better or worse?” to urge the patient to offer specific details (Heiss et al., 2019). I would also utilize active listening and compassionate communication strategies to demonstrate my care and comprehension of the patient’s situation.
I would use a patient-centered approach, considering the patient’s age, gender, and ethnicity, and avoid any assumptions or preconceptions that impede good communication. I would also consider the patient’s athletic history and address any worries regarding their performance or rehabilitation (Mor-Anavy et al., 2021). I would utilize the Pain Catastrophizing Scale (PCS) as a risk assessment tool for this patient to analyze their pain intensity and emotional reaction. The PCS is appropriate in this scenario because it assesses an individual’s negative thoughts and feelings surrounding pain, which might influence their capacity to deal with and recover from injuries (Heiss et al., 2019).
Some specific questions I would ask the patient are:
- How has muscular pain influenced your everyday activities and athletic performance?
- Have you ever felt pain like this before? If so, how did you deal with it?
- How would you characterize the pain’s severity and frequency?
- Is there any swelling or stiffness in the afflicted muscle?
- Are you using any pain medications or supplements?
Response to Chade
Great job, Chade! I was intrigued by your approach to interviewing an elderly patient with angina. I agree that building rapport and trust with patients is crucial in healthcare. In addition to your approach, I suggest incorporating cultural sensitivity when interviewing patients, especially those from diverse backgrounds. Understanding cultural beliefs, values, and practices can help healthcare professionals provide individualized care that respects the patient’s culture and preferences (Boyd et al., 2019). Regarding the health-related risks of an elderly patient with angina, you may also consider falls and polypharmacy. Falls are a common problem in older adults and can lead to severe injuries, hospitalization, and decreased quality of life.(Risk Assessment Discussions and Responses-Essay)
Patients with angina may be on medications that can increase the risk of falls, such as nitrates, beta-blockers, and calcium channel blockers. Polypharmacy, or taking multiple medications, can also increase the risk of adverse drug events and drug interactions in older adults (Gnjidic et al., 2019). Therefore, reviewing the patient’s medication regimen and considering deprescribing or adjusting doses as appropriate is essential. Lastly, I appreciate your use of the HEART score as a risk assessment tool. Another tool that could be considered is the TIMI score, which incorporates age, risk factors, and biomarkers to predict the risk of adverse cardiac events. Both tools can help determine the appropriate management plan for the patient.(Risk Assessment Discussions and Responses-Essay)
Boyd, C., Smith, C. D., Masoudi, F. A., Blaum, C. S., Dodson, J. A., Green, A. R., … & Tinetti, M. E. (2019). Decision making for older adults with multiple chronic conditions: executive summary for the American Geriatrics Society guiding principles on caring for older adults with multimorbidity. Journal of the American Geriatrics Society, 67(4), 665-673.
Gnjidic, D., Hilmer, S. N., Blyth, F. M., Naganathan, V., Waite, L., Seibel, M. J., … & Cumming, R. G. (2019). Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes. Journal of clinical epidemiology.(Risk Assessment Discussions and Responses-Essay)
Response to Beatrice
Your post was very informative and well-structured. Your approach to interview techniques and risk assessment tools for the selected patient is comprehensive. However, I suggest adding a few health-related risks that could be considered for this patient. As an athlete, the patient might be at risk for injuries such as sprains, strains, and fractures. Therefore, it is crucial to assess their risk of sustaining such injuries and educate them on ways to prevent them (Nikolaou et al., 2020). Additionally, athletes are at higher risk for heat exhaustion, dehydration, and overtraining syndrome. As part of the patient-centered approach, it is essential to consider the patient’s athletic history and address any worries regarding their performance or rehabilitation, as you mentioned.(Risk Assessment Discussions and Responses-Essay)
In terms of interview techniques, I suggest incorporating motivational interviewing (MI) to engage the patient in the change process and promote self-efficacy (Rollnick et al., 2019). In an MI session, you can use open-ended questions to elicit the athlete’s concerns and goals related to their injury recovery and return to athletic performance. You would then use reflective listening and affirmations to acknowledge and reinforce the athlete’s self-efficacy and commitment to recovery. You could also explore any ambivalence the athlete may have toward following the prescribed treatment plan and provide information and guidance to address any barriers to adherence. Incorporating motivational interviewing techniques in healthcare can be a powerful tool for engaging patients in the change process and promoting self-efficacy (Rollnick et al., 2019).(Risk Assessment Discussions and Responses-Essay)
Nikolaou, V. S., Tzatzairis, T. K., & Giannoudis, P. V. (2020). Musculoskeletal injuries in athletes: A review. Healthcare, 8(4), 424.
Rollnick, S., Miller, W. R., & Butler, C. C. (2019). Motivational interviewing in health care: Helping patients change behavior. Guilford Press.