Discussion: Building a Health History
40-year-old black recent immigrant from Africa without health insurance
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.
Immigrating from one continent to another is a difficult task. A lot of people migrate for various reasons. People immigrate because of political, social, and economic reasons. As people move along, they encounter new problems and opportunities. It is essential for a person who has immigrated to another country to assimilate with the culture and the ways of doing things in their new environment. There are a lot of differences between countries in Africa and the United States when it comes to healthcare. A good example is that most African countries do not use health insurance systems; they all use pay as you go billing system. This means their entire healthcare bills are paid out of pocket.
 
To have a 40-year-old black man from Africa come for consultation without health insurance is difficult. I will like to ask the patient the following questions.

1. I will start by introducing myself to the patient.’
2. When was the last time he visited a doctor? The rationale is to know if we can get his medical history from his primary healthcare doctor
3. What is your family’s medical history? The rationale is to know what the patient is at risk for.
4. What is your medical history? This will enable the nurse practitioner to know what kind of sickness the patient has had in the past
5. The next conversation will be centered on how reliable is the patient’s mode of transportation. The rationale for this question is to see if the patient will be able to go for his medical appointment without any difficulties
6. I will also ask the patient what medication they are currently taking
7. I will also ask about their insurance situation and what method they will like to use for payment. The idea behind this question is to know if the patient will be able to pay his healthcare bill. Also, it is an opportunity to inform the patient about social services that can help the patients get health insurance. The patient will also be informed to contact social work for additional information.

 
SAMPLE
 
To fully understand my patient, I will use a host of communication techniques to get information from the patient. Communication involves the transmission of verbal and non-verbal messages, and It consists of a sender, a receiver, and a channel of communication (Munodawafa & Davison, 2008). Making observations will be one of the techniques of communication that I will use. This method will enable me to assess the patient physical condition. Some of the things a nurse practitioner will be observing are the patient’s physical condition, make sure they do not have any wounds or deformity. Another technique of communication that I will use is interpersonal communication. It involves one on one communication with the individuals (Kashyap, 2019). The reason why I will use interpersonal communication techniques and observational communication techniques is that I will be able to observe the patient and assess them physically. There is a lot that one can determine just by observing a patient. One can conclude if they are malnourished, have any deformity, or have any significant body condition that has an impact on their health. Also, interpersonal communication skills will be used. This will enable me to ask questions and have a conversation with that patient.
A health risk assessment or HRA, sometimes called a health appraisal or health assessment is a screening tool that helps individuals identify and understand their health risks and monitor health status over time (2019). A health risk assessment assists in the evaluation of the risks that an individual has of developing a chronic illness (Wu & Orlando, 2015). I am going to use the prevention health risk assessment tool for this patient. The rationale for using this tool is for screening that patient for various illnesses. Also, what the patient can do to prevent diseases, another health risk assessment tool that I will use is emotional, mental health, and health condition assessment tool. The rationale is to be able to screen for problems like disability, stress, anxiety, and other healthcare issues. I will like to ask the patient the following questions. What is the patient’s past medical history? What is the patient’s family medical history if it includes any psychiatric condition? Also I will like to enquire what region in Africa he is coming from. The rationale behind this question is to know if the is any medical risk associated with where the patient is coming from. I will also ask about the patient’s what brings him to check up. Finally, I will ask him about his method of healthcare payment because he does not have health insurance.
Reference
Kashyap, S. (2019, November 28). Here’s How Effective Communication is in the Hands of 73% of Professionals. Retrieved February 25, 2020, from https://www.proofhub.com/articles/effective-communication
Munodawafa, & Davison. (2008, June 1). Communication: concepts, practice and challenges †. Retrieved February 25, 2020, from https://academic.oup.com/her/article/23/3/369/639974
What Is a Health Risk Assessment? (2019, February 5). Retrieved February 26, 2020, from https://www.pdhi.com/ncqa/what-is-a-health-risk-assessment/
Wu, R. R., & Orlando, L. A. (2015). Implementation of health risk assessments with family health history: barriers and benefits. Postgraduate Medical Journal, 91(1079), 508–513. doi: 10.1136/postgradmedj-2014-133195
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.
Main Post
Communication/Interviewing
This is a 40 -year old black man recently migrated from Africa. He is currently uninsured. To begin communicating with this individual, I would make sure he was able to speak English and that we under stand each other. If language is a barrier, I would get an interpreter on the interpretation Line. Communication techniques doesn’t always have to be spoken word, it can be pointing to an area of the body or using pictures. Communicating across language barriers is a challenge for clinicians and health systems. Federal law requires linguistic services for patients with LEP. Title VI of the US Civil Rights Act states that people cannot be discriminated against as a result of their national origin, race, or color, which has been extrapolated to include primary language by the US Office for Civil Rights and Department of Health and Human Services (Karliner, 2018). If the patient can speak some English the target would be to make sure our words mean the same thing and that’s where pointing to items and using hand gestures could come in handy. I would keep the questions fairly short with simple as possible terminology.
Risk Assessment
Being that this patient is newly immigrated to the U.S., I would want to give this patient resources that are free due to not having insurance but certainly would not deny treatment to the patient. I would focus on screening for any diseases that need immunizations, for one. Components of the health assessment for immigrants and refugees include addressing patient health concerns, screening for diseases associated with the country of origin and migration history, initiating age-appropriate immunizations, and routine health care maintenance (Walker, Barnett, & Stauffer, 2019). The question would be “have you had any illness, sicknesses, or hospitalizations that required any type of medications? Any immunizations? Any infections in your body or out breaks on your skin?” I would also ask about the living conditions and the nutritional conditions.
Other Potential Health Risks
Because of the ethnicity, the age and gender, I would certainly screen for any cardiac issue, hypertension, diabetes, and cancer. The acquisition of risk factors for chronic diseases such as coronary artery disease, hypertension, diabetes and cancer is poorly understood among African immigrants. More information must be gathered in the broad categories of chronic disease, health attitudes and health access to better promote the health of African immigrants (Venters & Gany, 2011).
Screening tool
Because of the area from which this patient came from. I would start by screening for infectious disease. I would focus on food and water exposure for things like Giardia or E. Coli, turn to the lungs and check for tuberculosis and so on. These screenings would require blood, urine, and fecal samples and a chest X-ray as most foreign folks get the Bacille Calmette-Guérin immunization and can cause a false positive when given the skin test.
5 Target Questions
I had mentioned some questions earlier but other questions would be
1. Have you had any coughing with bloody sputum,
2. Can you tell me about where you used to live in Africa?
3. Are you married? Are you sexually active with more than one partner?
4. Have you had any infections or illnesses?
5. Any diarrhea, nausea, or vomiting?
References
Karliner, L. S. (2018, April 2018). When Patients and Providers Speak Different Languages.
AHRQ
. Retrieved from https://psnet.ahrq.gov/webmm/case/440/when-patients-and-providers-speak-different-languagesVenters, H., & Gany, F. (2011, April 13, 2011). African immigrant health.
US National Library of Medicine
, 333-344. https://doi.org/doi: 10.1007/s10903-009-9243-xWalker, P. F., Barnett, E., & Stauffer, W. (2019). Medical screening of adult immigrants and refugees. Retrieved from https://www.uptodate.com/contents/medical-screening-of-adult-immigrants-and-refugees
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340 replies week 5
APA,References, Free plagiarism
Discussion Prompt
COLLAPSE
Top of Form
You are a school nurse. A student comes into your office and is hesitant to share his thoughts with you. What could you say or do to develop a therapeutic alliance?
Bottom of Form
 
Reply 1Ayrin:
It’s a challenge when it comes to opening up to someone and say out your thoughts and emotions. It is usually as a result of trauma, fear of judgment, discomfort in the therapeutic environment and cultural or religious norms. It is normally the duty of the therapist or the nurse performing the therapy to eliminate any viable condition that may bring discomfort to the patient and cause him/her not to open up and be reluctant in seeking help.
As a nurse, to ensure that the student will feel safe and supported (Pihlaja et al., 2018). One way is by making the student feel more welcomed by ensuring the surrounding environment is calm and provides a sense of protection and most importantly, provides privacy. Build up a bond with the student.  After creating a strong bond with the patient, ensure keeping a strong bond by not judging the client and retain yourself from exposing your own emotions as this will make the student get insecure about himself/herself.
Get to know what the student is hoping to achieve at the end of the therapy. This will provide you with a goal and a plan on how to handle your patient. Questions to the patient should vary and make the communication feel less of an interrogation and more of an interview with an interested person. Lastly, focus on the client’s needs and ensure that the client feels accepted and not rejected as this will hinder the patient from opening up and maybe even lead to creating a bigger problem for the patient. It’s also important to refer the student to another therapist if you find out you won’t be able to help out with the problem (Leonard et al., 2018).
 
 
Reply 2 Brittany:
This discussion is right up my ally because I have been a pediatric nurse for five years and a school nurse for two years. I encounter this very situation often,especially when working in schools with higher poverty rates, a higher amountof students who have more emotional and intellectual needs and students who have experienced trauma or a destructive homelife. It is never an easy situation to address but my ultimate goal is to help that student to the absolute best of my ability. I start by ensuring them that they are in a safe place and letting them know I am trustworthy and responsible for their care. I try to relate to them and make them feel like they are being herd and their thoughts and feelins are valued. I am also honest with them,for example if a student indicates the intent for self harm I calmly listen, allow them to express their feelings, ensure them that I am here for them and they are safe and with that I also inform them for their safety we have to report these thoughts.to better assist their wellbeing. I build my theraputic alliance with all my students simply by trust, empathy, honesty and ensuring their safety. When working as a school nurse this can be challenging becasue their are many factors you have to consider in order to build a good relationship, developmental stages being a huge consideration when attempting to care for children at different ages and with different needs. Pediatrics is my specialty, I have always practiced with innocence, nuturing, compassion and kindness and I believe these personal traits are why I do best working in pediatrics. I also believe children are the most vulnerable popualtion of our society and they need good advocates who can stand up and fight for them when they dont have the capabilty to do it for them selves. As I have two children of my own, one with developmental and emotional needs I can also perspanlly relate from a parenting standpoint which I feel  also helps me to have the ability to work and relate to children successfully.
It is stated by the family institute of behavioral health “Dr. Edward Bordin, defined a good therapeutic relationship as consisting of three essential qualities: an emotional bond of trust, caring, and respect; agreement on the goals of therapy; and collaboration on the “work” or tasks of the treatment.” What this means to me is as providers it is our responsibility to treat our patients with a holistic approach in order to build a solid patient-provider relationship and achieve the best possible outcomes for our patients. Providers need to see the patient as a whole, not just the physical aspects that appear in front of them in the moment. All components of a patient’s well being have to be considered and respected when it comes to providing good quality care. This includes taking into consideration the patients physical,emotional,social, psychological and cultural needs. Good providers must also listen to their patients and demonstrate empathy in their care. If these needs are not met and the patient senses disconnect or unimportance with the provider, the patient-provider relationship will fail which could lead to gaps in care, poor communication, non compliance and even medical errors.
 

Reflection Assignment 4: Meeting Essential VIII
This week, reflect on your perception of change theory, management roles and nursing leadership, communication conflict, and the nurse management role in patient care as it has evolved over the course of your RN-BSN program at WCU. Identify specific leadership models you support, and compare and contrast communication techniques for patient-centered care effectiveness. How does your academic work support evidence of meeting the following?
Essential VIII: Professionalism and Professional Values

• Outcome #3: Promote the image of nursing by modeling the values and articulating the knowledge, skills, and attitudes of the nursing profession.

Review your past academic work, evaluate your effectiveness at meeting this program essential, and ponder the impact that this proficiency will have on your future.
Identify how you met the essential by referring to the assignment(s) specifically in your response. Additionally, reflect on and make connections between your academic experience and real-world applications.
Recommended: Refer to the work you completed for NURS 510 Policy, Organization, and Financing of Health Care and LDR 432 Principles of Leadership for Healthcare Organizations, as well as other courses, to gather academic examples and evidence of having met this essential.
Your reflection should be 1-1/2 pages APA formatted. Reference and cite any sources you use.