NURS 6512 Shadow Health: Advanced Health Assessment and Diagnostic Reasoning

Nurs 6521 Week 1 Discussion board
As APRN, developing effective communication skills are fundamental in unraveling patients’ clinical problems during an initial encounter and patient assessment, leading to accurate diagnosis and treatment, overall patient satisfaction, and better clinical outcome (Diamond- Fox, 2021). Most patients often find themselves vulnerable at the point of consultation; thus, establishing a positive relationship will lead to a partnership where the patient develops trust and can verbalize their concerns freely and seek solutions (Ball et al., 2019).  The case scenario in this discussion board will summarize the interview and communication technique used when consulting a 55-year-old Asian female living in a high-density public housing complex.

Interview summary and a description of the communication techniques

The interview process with the mentioned patient will begin with creating a convenient environment to enable the conversational flow.  It implies creating a patient-centered communication environment that enhances trust and evaluation of healthcare quality, leading to patient-centered care (Hong &Oh, 2020).  According to the Institute of Medicine (2001), patient-centered care can is defined as "respecting and responding to patients' wants, needs, and preferences, so that they can make choices in their care that best fit their circumstances".  It includes concepts of caring, sharing, communication, listening, and building therapeutic relationships (Haley et al., 2017).  Based on the scenario, the interview will be centered around the patient's condition and needs, establishing a relationship that enhances dialogue while respecting the patient's cultural and ethnic values. Our mentioned patient is a 55-year-old Asian female living in a high-density public complex. It may suggest that the patient is at risk of abuse, has a poor socioeconomic background. Creating a friendly environment that favors communication built on courtesy, comfort, connectedness, and confirmation will facilitate obtaining accurate health and social history (Ball et al., 2019).

The patient-centered care(PCC) approach to healthcare has been shown to improve patient's clinical outcomes significantly. For example, patient's whose providers have used the patient-centered-care approach have reported better adherence to treatment and better control of chronic conditions like diabetes, blood pressure, cholesterol (Haley et al., 2017).  Using empathy which is a characteristic of PCC, during the patient interview can lead to effective communication and improve therapeutic relationships between the provider and the patient (Haley et al., 2017).  This technique will help create a closer relationship with the patient leading to a more accurate data collection and assessment. Effective communication will lead to better patient outcomes and satisfaction.

Risk assessment instrument selected and justification.

Several health risk assessment tools are available and can be applied based on assessing the individual patient condition and critical health parameters, including history, presence, and severity of risky behavior, pattern, risk factors, intention, and planning (Ayhan & Üstün, 2021). The risk assessment instrument I will apply for the above patient will be the Risk Assessment and Management (RAM) tool.  It consists of three main sections: risk history, risk assessment, and risk management (Ayhan & Üstün, 2021).   The RAM tool has been shown to permit strategic and structured data collection, facilitated personnel risk communication, and enabled effective documentation. It is also an effective tool to assess community psychiatric patients (Ayhan & Üstün, 2021).

Targeted questions to ask the patient.

After creating rapport and establishing a friendly environment for communication, patient-centered questions can now be asked mostly in an open-ended manner to gather enough information as possible about the patient’s condition. Some of these questions may include:

  • What brings you in here today?
  • Describe your current health situation?
  • Tell me how your present health situation has influenced your day-to-day life?
  • Tell me about any health issues you have had in the past?
  •  What are the disease conditions which are common in your family?
  • Tell me about the medications you currently take.
  • Tell me about your current leaving situation.

Establishing a personal connection with each patient through effective communication is key to obtaining detailed information about the patient's condition. It will lead to a more focused assessment, effective diagnosis, and treatment.

 

References

Ayhan, F., & Üstün, B. (2021). Examination of risk assessment tools developed to evaluate risks in mental health areas: A systematic review. Nursing Forum56(2), 330–340. https://doi-org.ezp.waldenulibrary.org/10.1111/nuf.12557

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

Diamond-Fox, S. (2021). Undertaking consultations and clinical assessments at advanced level. British Journal of Nursing30(4), 238–243. https://doi-org.ezp.waldenulibrary.org/10.12968/bjon.2021.30.4.238

Haley, B., Heo, S., Wright, P., Barone, C., Rettigantid, M. R., & Anders, M. (2017). Effects of using an advancing care excellence for seniors simulation scenario on nursing student empathy: A randomized controlled trial. Clinical Simulation in Nursing13(10), 511–519. https://doi-org.ezp.waldenulibrary.org/10.1016/j.ecns.2017.06.003

Hong, H.,  Oh, H. (2020). The effects of patient-centered communication: Exploring the mediating role of trust in healthcare providers. Health Communication, 35(4), 502-511, DOI: 10.1080/10410236.2019.1570427

Institute of Medicine. (2001). Crossing the quality chasm: a new health system for the 21st century, Washington, DC, 2001, National Academies Press.

 

Week 1: Building a Comprehensive Health History

According to a 2011 Gallup poll, nurses are ranked as the most trusted professionals in the United States. One of the most admired nursing skills is the ability to put patients at ease. When patients enter into a healthcare setting, they are often apprehensive about sharing personal health information. Caring nurses can alleviate the hesitance of patients and encourage them to be forthcoming with this information.

The initial health history interview can be an excellent opportunity to develop supportive relationships between patients and nurses. Nurses may employ a variety of communication skills and interview techniques to foster strong bonds with patients and to effectively facilitate the diagnostic process. In conducting interviews, advanced practice nurses must also take into account a range of patient-specific factors that may impact the questions they ask, how they ask those questions, and their complete assessment of the patient’s health.

This week, you will consider how social determinants of health such as age, gender, ethnicity, and environmental situation impact the health and risk assessment of the patients you serve. You will also consider how social determinants of health influence your interview and communication techniques as you work in partnership with a patient to gather data to build an accurate health history.

Learning Objectives

Students will:

  • Analyze communication techniques used to obtain patients’ health histories based upon social determinants of health
  • Analyze health-related risk
  • Apply concepts, theories, and principles related to patient interviewing, diagnostic reasoning, and recording patient information

Learning Resources

Required Readings (click to expand/reduce)
Required Media (click to expand/reduce)

Assignment: Course Acknowledgement

This mandatory assignment is an acknowledgement that you fully understand the course guidelines.

By Day 3 of Week 1

Submit your Assignment.

Submission and Grading Information

Submit Your Assignment by Day 3 of Week 1.

To complete this assignment, follow the link below and answer the questions provided.

Week 1 Assignment


Discussion: Building a Health History

Effective communication is vital to constructing an accurate and detailed patient history. A patient’s health or illness is influenced by many factors, including age, gender, ethnicity, and environmental setting. As an advanced practice nurse, you must be aware of these factors and tailor your communication techniques accordingly. Doing so will not only help you establish rapport with your patients, but it will also enable you to more effectively gather the information needed to assess your patients’ health risks.

For this Discussion, you will take on the role of a clinician who is building a health history for a particular new patient assigned by your Instructor.

Photo Credit: Sam Edwards / Caiaimage / Getty Images

To prepare:

With the information presented in Chapter 1 of Ball et al. in mind, consider the following:

  • By Day 1 of this week, you will be assigned a new patient profile by your Instructor for this Discussion. Note: Please see the “Course Announcements” section of the classroom for your new patient profile assignment.
  • How would your communication and interview techniques for building a health history differ with each patient?
  • How might you target your questions for building a health history based on the patient’s social determinants of health?
  • What risk assessment instruments would be appropriate to use with each patient, or what questions would you ask each patient to assess his or her health risks?
  • Identify any potential health-related risks based upon the patient’s age, gender, ethnicity, or environmental setting that should be taken into consideration.
  • Select one of the risk assessment instruments presented in Chapter 1 or Chapter 5 of the Seidel's Guide to Physical Examination text, or another tool with which you are familiar, related to your selected patient.
  • Develop at least five targeted questions you would ask your selected patient to assess his or her health risks and begin building a health history.
By Day 3 of Week 1

Post a summary of the interview and a description of the communication techniques you would use with your assigned patient. Explain why you would use these techniques. Identify the risk assessment instrument you selected, and justify why it would be applicable to the selected patient. Provide at least five targeted questions you would ask the patient.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the "Post to Discussion Question" link, and then select "Create Thread" to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Read a selection of your colleagues’ responses.

By Day 6 of Week 1

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.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 1 Discussion Rubric

Post by Day 3 of Week 1 and Respond by Day 6 of Week 1

To Participate in this Discussion:

Week 1 Discussion


What's Coming Up in Module 2?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

In Module 2, you explore the impact of functional assessments, diversity, and sensitivity in conducting health assessments. You also examine various assessment tools and diagnostic tests used to gather information about patients’ conditions and examine their validity, reliability, and impact in conducting health assessments.

Next week, you will specifically examine functional assessments as they relate to diversity and sensitivity

Registration for Shadow Health

Throughout this course, you will participate in digital clinical experiences using the online simulation tool Shadow Health. The Shadow Health digital clinical experience provides a dynamic, immersive experience designed to improve nursing skills and clinical reasoning through the examination of digital standardized patients. Using Shadow Health you will participate in health histories, focused exams, and a comprehensive assessment.

There will be four Shadow Health assessment components that you will need to complete in Module’s 2 and 3:

  • Health History Assessment (Week 3 & 4)
  • Focused Exam: Cough (Week 5) for a pediatric patient presenting with cough
  • Focused Exam: Chest Pain (Week 7) for an adult patient presenting with chest pain
  • Comprehensive (Head-to-Toe) Physical Assessment (Week 9)

Before you can participate in these simulations, you will need to register for a Shadow Health account. To do this:

  • Go to the Walden Bookstore and purchase access to Shadow Health and the required texts.
  • Once Shadow Health has been purchased, an access code will be emailed to you from the bookstore.
  • Review this video explaining how to register in Shadow Health: https://vimeo.com/275921826/c12d50ee6e
  • Use the Shadow Health link located in the navigation menu on the left in the Blackboard course.
  • Follow the prompts to register in Shadow Health. You will need the access code provided from the bookstore to register. Once registered, Shadow Health should always be accessed via the link in Blackboard.
  • Use only Google Chrome when accessing Shadow Health and make sure all other programs are turned off on your computer. Other browsers do not work well and will not allow the Shadow Health speech to text function to work.
  •  Once registered, complete the Shadow Health Orientation in the Shadow Health website/program and review the videos designed to assist with navigating and completing assignments.
  • Read the Shadow Health Nursing Documentation Tutorial located in the Week 1 Learning Resources.

Note: As nurses you typically use the word assessment to mean completing the physical exam. However, in the SOAP Note format, assessment means diagnosis so start getting in the habit of calling the physical exam exactly that.

Week 2 Case Studies

In Week 2, your Instructor will assign you a case study related to your Discussion by Day 1 of the week. Please make sure to review the “Course Announcements” area of the course to verify your assigned case study. Please plan ahead to ensure you have time to review your case study and your Learning Resources so that you can complete your Discussions and Assignments on time.

Photo Credit: Getty Images/iStockphoto

Practicum - Upcoming Deadline

In the Nurse Practitioner programs of study (FNP, AGACNP, AGPCNP, and PMHNP) you are required to take several practicum courses. If you plan on taking a practicum course within the next two terms, you will need to submit your application via Meditrek .

For information on the practicum application process and deadlines, please visit the Field Experience: College of Nursing: Application Process – Graduate web page.

Please take the time to review the Appropriate Preceptors and Field Sites for your courses.

Please take the time to review the practicum manuals, FAQs, Webinars and any required forms on the Field Experience: College of Nursing: Student Resources and Manuals web page.

 

 

Week 2: Functional Assessments and Cultural and Diversity Awareness in Health Assessment

 

Diversity is not about how we differ. Diversity is about embracing one another's uniqueness.

—Ola Joseph

 

Countless assessments can be conducted on patients, but they may not be useful. In order to ensure that health assessments result in the necessary care, health assessments should take into account the impact of factors such as cultures and developmental circumstances.

Learning Objectives

Students will:

  • Analyze diversity considerations in health assessments
  • Apply concepts, theories, and principles related to examination techniques, functional assessments, and cultural and diversity awareness in health assessment

Learning Resources

Required Readings (click to expand/reduce)
Required Media (click to expand/reduce)

Discussion: Diversity and Health Assessments

May 2012, Alice Randall wrote an article for The New York Times on the cultural factors that encouraged black women to maintain a weight above what is considered healthy. Randall explained—from her observations and her personal experience as a black woman—that many African-American communities and cultures consider women who are overweight to be more beautiful and desirable than women at a healthier weight. As she put it, “Many black women are fat because we want to be” (Randall, 2012).

Photo Credit: Getty Images

Randall’s statements sparked a great deal of controversy and debate; however, they emphasize an underlying reality in the healthcare field: different populations, cultures, and groups have diverse beliefs and practices that impact their health. Nurses and healthcare professionals should be aware of this reality and adapt their health assessment techniques and recommendations to accommodate diversity.

In this Discussion, you will consider different socioeconomic, spiritual, lifestyle, and other cultural factors that should be taken into considerations when building a health history for patients with diverse backgrounds. Your Instructor will assign a case study to you for this Discussion.

To prepare:

  • Reflect on your experiences as a nurse and on the information provided in this week’s Learning Resources on diversity issues in health assessments.
  • By Day 1 of this week, you will be assigned a case study by your Instructor. Note: Please see the “Course Announcements” section of the classroom for your case study assignment.
  • Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient assigned to you.
  • Consider how you would build a health history for the patient. What questions would you ask, and how would you frame them to be sensitive to the patient’s background, lifestyle, and culture? Develop five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.
  • Think about the challenges associated with communicating with patients from a variety of specific populations. What strategies can you as a nurse employ to be sensitive to different cultural factors while gathering the pertinent information?
By Day 3 of Week 2

Post an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the "Post to Discussion Question" link, and then select "Create Thread" to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Read a selection of your colleagues’ responses.

By Day 6 of Week 2

Respond on or before Day 6 on 2 different days to at least two of your colleagues who were assigned a different patient than you. Critique your colleague’s targeted questions, and explain how the patient might interpret these questions. Explain whether any of the questions would apply to your patient, and why.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 2 Discussion Rubric

Post by Day 3 of Week 2 and Respond by Day 6 of Week 2

To Participate in this Discussion:

Week 2 Discussion


What's Coming Up in Week 3?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

Next week, you examine assessment techniques, health risks and concerns, and recommendations for care related to patient growth, weight, and nutrition. You will also begin your first DCE: Health History Assessment which will be due in Week 4. Plan your time accordingly.

Overview of Digital Clinical Experiences (DCE) and Lab Components

Throughout this course, you are required to not only complete your standard course assignments and discussions, but you will also complete DCE and Lab Components that are either structured as optional or required assignment submissions. Please take the time to review your DCEand Lab Components for this course that are required submissions. See the table below and the attached table for specific DCE and Lab Components for the course.

Note: Each Shadow Health Assessment may be attempted and reopened as many times as necessary prior to the due date to achieve a total score of 80% or better, but you must take all attempts by the Day 7 deadline. You must pass BOTH the Health History and Comprehensive (head-to-toe) Physical Exam of at least a total score of 80% in order to pass the course.

 

Week Digital Clinical Experiences Lab Components
Module 1:  Comprehensive Health History
Week 1: Building a Comprehensive Health History
Module 2: Functional Assessments and Assessment Tools
Week 2: Functional Assessments and Cultural and Diversity Awareness in Health Assessment
Week 3: Assessment Tools, Diagnostics, Growth, Measurement, and Nutrition in Adults and Children DCE: Health History Assessment (assigned in Week 3, due in Week 4) Case Study Assignment: Assessment Tools and Diagnostic Tests in Adults and Children
Module 3: Approach to System Focused Advanced Health Assessments
Week 4: Assessment of the Skin, Hair, and Nails DCE: Health History Assessment Lab Assignment: Differential Diagnosis for Skin Conditions (SOAP Note for differential diagnosis)
Week 5: Assessment of Head, Neck, Eyes, Ears, Nose, and Throat DCE: Focused Exam: Cough Case Study Assignment: Assessing the Head, Eyes, Ears, Nose, and Throat (Episodic SOAP Note)
Week 6: Assessment of the Abdomen and Gastrointestinal System Lab Assignment: Assessing the Abdomen (Analyze SOAP Note)
Week 7: Assessment of the Heart, Lungs, and Peripheral Vascular System DCE: Focused Exam: Chest Pain
Week 8: Assessment of the Musculoskeletal System Discussion: Assessing Musculoskeletal Pain (Episodic SOAP Note)
Week 9: Assessment of Cognition and the Neurologic System DCE: Comprehensive (head-to-toe) Physical Assessment Case Study Assignment: Assessing Neurological Symptoms (Episodic SOAP Note)
Week 10: Special Examinations—Breast, Genital, Prostate, and Rectal Lab Assignment: Assessing the Genitalia and Rectum (analyze SOAP Note)
Module 4: Ethics in Assessment
Week 11: The Ethics Behind Assessment Lab Assignment: Ethical Concerns

 

Next Week