advanced health assessment week 2- peer review

Instructions:

Please respond to at least 2 of your peer’s posts.  To ensure that your responses are substantive, use at least two of these prompts:

  • Do you agree with your peers’ assessment?
  • Take an opposing view to a peer and present a logical argument supporting an alternate opinion.
  • Share your thoughts on how you support their opinion and explain why.
  • Present new references that support your opinions.

Responses need to address all components of the question, demonstrate critical thinking and analysis, and include peer reviewed journal evidence to support the student’s position.

Please be sure to validate your opinions and ideas with in-text citations and corresponding references in APA format.

 

1- Shanda Keaton-Ditcharo

Consider performing a health history on someone that may not be able to provide you with answers, such as an infant, child, an elderly person, a developmentally disabled individual, or patients who speak a language you do not know.

What strategies would you employ to obtain a complete health history?

Historically, when I have been faced with trying to obtain a health history for a patient that is unable to effectively communicate, I have used strategies such as an interpreter, old charts, contacting family or friends, and assessing the patient for medical alert tags and old scars to divert these barriers. Whenever a patient is unresponsive, I have obtained information from the patient’s smartphone. There is a feature on most smartphones that allows the owner of the phone to enter demographic information, medical history, and emergency contacts. The information is available from the lock screen, so even without a passcode, it can easily be accessed if the patient has input the information. This has been very helpful in several traumatic situations I have encountered in the emergency department. Communication with elderly patients can be a challenge at times due to the patient being confused or a lack of knowledge of their condition. Caregivers and old charts can be very effective in closing this informational gap(Obtaining an Older Patient’s Medical History, 2017).

Provide a rationale for why you think these strategies would be effective.

Because of the increase in patients with limited English proficiency, the need for interpreters has drastically increased in the last several years (Ju, 2021). Interpreters have provided effective communication for patients with limited English proficiency and patients that are deaf or heard of hearing.  Medical alert tags and old scars have proven to be effective in obtaining at least part of the patient’s history (“Plain Language Emergency Alerts,” 2017). For example, some patients that have diabetes, seizures, and certain allergies wear bracelets or pendants that will alert the team this patient has this condition or provide important allergy information. Old scars such as a midline incision on the chest may indicate a history of a Coronary Artery Bypass Graph (CABG) which would indicate cardiac issues. Without disclosing the findings of your assessment or the treatment plan it is possible to obtain information from a friend or family member. Patients often share their medical information which can be very helpful when unable to obtain information. Lastly, reviewing the patient’s old chart is effective because it provides valuable information about the patient’s past medical history. It will provide a previous diagnosis, a medication list, allergies, demographic information, past diagnostic testing, and much more.

 

2- Katie Austin

Strategies for obtaining an accurate health history include utilizing family as a potential source of information, empathy, support, and alternative forms of communication (Kripke, 2018)). For example, patients can answer questions with increased honesty and descriptive information when they feel that the provider understands the value of their experience. Providing a supportive environment and acknowledging the importance of each patient’s experience will facilitate this open communication. Other times, a patient may not be able to communicate their needs or history, as in the care of the very young or the elderly. These instances may be addressed through the inclusion of family members or close support individuals. This allows for a more accurate response and illustration of the patient’s health over time, as some patients may only be able to elaborate on current health concerns (Nichol et al., 2021). This must be used only as necessary because gathering information for the patient directly is essential. Only a patient can speak on their perspectives, experiences, and symptoms (Kripke, 2018).  

Alternative forms of communication are essential when obtaining a health history for patients that may be developmentally unable to express health history and those that may not speak the same language. Utilization of sign language, body language, letter boards, objects, pictures, gestures, and behavior can be an essential strategy for obtaining information. Providers must be aware of the limitations of each patient, as some gestures are unintentional, and some behaviors can be misrepresented. Tailoring the approach to each patient is essential, including both expressive and receptive communication. This allows an individual to participate in health care education, choices, and planning (Kripke, 2018). Interpretation services are essential for addressing patients that speak a different language, as these can open clear lines of communication. Many approaches are available such as in person, phone based, video based and online translation services. These come at an increased cost to providers but have been shown to directly impact the patient experience, quality of care, and long-term health promotion (Shamsi et al., 2020).  

Utilization of these strategies can prevent medical errors, missed diagnosis, guide care progression, and promote long term health (Nichol et al., 2021). 

 

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