NRNP 6552 WEEK 2 Taking a Health History: Building a Health History: Asking Difficult Questions
Taking a Health History: Building a Health History: Asking Difficult Questions
A gynecological history entails assessing the female reproductive system. It is often a sensitive subject for some women; thus, the examiner must treat any information provided with sensitivity and respect. The purpose of this paper is to develop a script for building a health history for a well-woman exam and reflect on my experience building the script.
Script for Building a Health History
Hello. I am Nurse XX, and I will take you through today’s well-woman appointment. I will ask you a number of questions about your medical and reproductive health history, some of which might be uncomfortable. However, I assure you that your information will be private and confidential and only be shared with your consent. I hope this will make you more comfortable to express your concerns fully.
Demographic Data
What is your name?
How old are you?
Which gender do you identify with?
Medical History
Do you have any major acute or chronic illnesses?
Do you have a history of surgery or major injury?
Have you ever been hospitalized, and what was the reason?
Which medications (prescriptions or OT) or supplements are you currently taking?
Do you have any drug reactions or environmental or food allergies?
When did you last have your Flu and Tetanus vaccination?
Gynecologic Health History
At what age did you start having your menses?
What difficulties do you experience when on your menses, like heavy bleeding or very painful cramping? (Park et al., 2020).
For how many days do your menses last?
Do you experience symptoms like mood or physical changes days before your menses?
Which reproductive health conditions, including STIs, have you previously been diagnosed with?
How many times have you been pregnant, and what was the outcome of each pregnancy?
What pregnancy-related condition did you experience during pregnancy?
Are you currently sexually active?
How would you define your sexual preference and interests? (Park et al., 2020).
How many sexual partners do you have?
Do you experience difficulties during intercourse that affect your sexual satisfaction? (Hagey et al., 2020).
Which type of contraceptive are you currently using, and which side effects does it have?
Which contraceptives have you used previously, and why did you discontinue using them? (Hagey et al., 2020).
What environmental or socioeconomic factors affect your access to gynecology services?
Reflection
When developing the health history script, I identified that a careful and detailed history is essential before examining a patient presenting for a well-woman exam. I also realized that besides having a good general history, the examiner needs to focus on the history of the presenting complaint to customize the examination to identify the appropriate signs and make an accurate diagnosis. Many women often feel anxious or uneasy about the forthcoming patient interview. Thus, it is vital that the examiner establishes initial rapport with the patient and puts her at ease. During a patient interview, I might feel uneasy asking a patient whether she is sexually active and if there are any difficulties or pain during intercourse. Furthermore, I might be uncomfortable asking a woman about her sexual partners, sexual interests and preferences, and if she gets sexually satisfied. I find that asking a woman about her previous pregnancies can be awkward for the patient, especially if she had an abortion, and often would lie about it if she feels ashamed of it.
I found it insightful for the examiner to be conscious of the different attitudes to various women’s health issues in a religious and culturally diverse population. In addition, I identified a better way of approaching sensitive sexual health questions. This includes initiating the conversation with saying that it is part of my routine to ask all my patients about their sexual health, including sexual functioning and satisfaction (O’Laughlin et al., 2021). SDOH that affects women’s access to gynecology health services can be addressed by maximizing referrals to social services to enhance a patient’s abilities to meet their reproductive health needs (Dagher & Linares, 2022). Furthermore, the NP can advocate for policy changes that promote safe and healthy living environments for women.
Conclusion
The examiner taking a woman through a well-woman exam should take a detailed medical history that includes current acute and chronic illnesses, medications, allergies, and immunization history. The gynecologic history should include menstruation, reproductive medical, obstetric, and contraceptive history. The examiner should assure the patient of confidentiality and create a rapport to ease uneasiness.
References
Dagher, R. K., & Linares, D. E. (2022). A critical review of the complex interplay between social determinants of health and maternal and infant mortality. Children, 9(3), 394. https://doi.org/10.3390/children9030394
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
O’Laughlin, D. J., Strelow, B., Fellows, N., Kelsey, E., Peters, S., Stevens, J., & Tweedy, J. (2021). Addressing Anxiety and Fear during the Female Pelvic Examination. Journal of Primary Care & Community Health, p. 12, 2150132721992195. https://doi.org/10.1177/2150132721992195
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
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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.
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
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- Then, click on Start Assignment near the top of the page.
- Next, click on Upload File and select Submit Assignment for review.
Rubric
NRNP_6552_Module1_Assignment_Rubric
| Criteria | Ratings | Pts | ||||
|---|---|---|---|---|---|---|
| This criterion is linked to a Learning OutcomeSeparate from the actual script, what are the considerations for special populations such as young women, new mothers, older women, women with disabilities, and LGBTQ+ individuals? Provide health maintenance guidelines that should be included during the initial and follow up assessments. (i.e., bone density test, pap smear, Gardasil (HPV) vaccine, shingles, etc.)? |
|
30 pts | ||||
| This criterion is linked to a Learning OutcomeBuilding a Health History: Asking Difficult Questions. Create your own script for building a health history. Consider the type of language you would use to help your patient be more comfortable). Ensure you include the difficult questions required to complete a thorough health history. |
|
25 pts | ||||
| This criterion is linked to a Learning OutcomeIn addition to your script for building a health history for this assignment, include a separate section called “Reflection.” Provide a brief overview of the 5 areas of SDOH for this patient and the questions you would consider. Briefly reflect and provide a summary of your experiences in developing your script during your health history. |
|
30 pts | ||||
| This criterion is linked to a Learning OutcomeWritten Expression and Formatting – Paragraph Development and Organization:Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria. |
|
5 pts | ||||
| This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English writing standards:Correct grammar, mechanics, and proper punctuation |
|
5 pts | ||||
| This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list. |
|
5 pts | ||||
| Total Points: 100 | ||||||