DISCUSSION: 40-year-old black recent immigrant from Africa without health insurance| NURS 6512
DISCUSSION: 40-year-old black recent immigrant from Africa without health insurance| NURS 6512
Building a Comprehensive Health History
The purpose of this post is to consider a comprehensive health assessment on a 40-year-old black recent immigrant from Africa without health insurance. This post will discuss questions that would be instrumental in building a health history, effective communication and interview techniques, and will identify potential risks based on the gender, ethnicity, and age of this patient.In addition, I will develop five questions that are targeted to assess health risks and build a health history.
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Communication and Interview Techniques
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Effective communication and interview techniques are integral to building professional rapport with patients and to creating an accurate health history to be used in assessment, diagnosis, and treatment. In this clinical scenario, these techniques are potentially more important than average due to the unique cultural and language needs of this recent immigrant from Africa. The practitioner needs to first determine if the patient requires a translator, and this interpreter should be a trained professional as opposed to a family member, ideally (Ball et al., 2019, p. 26). After determining language needs, the provider should attempt to determine some of the cultural beliefs and social determinents that affect health and treatment, such as beliefs around spiritual healing, modesty, gender roles, dietary practices, and culturally-influenced attitudes regarding pain, illness, and health (Ball et al., 2019).
Questions for Building a Health History
A detailed health history is essential for effective diagnosis and treatment. In this scenario these questions should be targeted towards not only the patient’s current health and environmental influences but should also include the patient’s history in Africa and any changes since his recent arrival in the United States. The provider should include questions referencing the medical history of family members, going back at least three generations if possible (Ball et al., 2019). According to Lushniak (2015), “Family health history gives information not only about genes, but also about environmental and behavioral risk factors shared among family members. It therefore can provide a more accurate prediction of disease risk than many genetic tests can alone” (Lushniak, 2015, p. 4). Questions should include immunizations, prior infections, and previous treatment for any infectious diseases. In addition, the provider should inquire about previous psychological history and trauma history, as these tend to be common in immigrants/refugees. “Immigrants are generally prone to psychological health problems due to both pre-migration risk factors such as previous traumatic experiences and post-migration factors such as culture shock and low socioeconomic status”, (Adu-Boahene et al., 2017, p. 48).
Health-Related Risks Specific to Clinical Scenario
In this clinical scenario there are several patient demographics to consider when assessing risk. The patient is male, 40 years of age, and a recent immigrant from Africa. Each of these descriptors presents a different set of risk factors ranging from medical to behavioral and environmental. In addition, this patient does not have insurance, which represents an entirely different set of risk factors. Research indicates “the problem of high healthcare cost was compounded for participants without health insurance”, and frequency of provider visits and trust in the provider were bot significantly reduced in African immigrants lacking insurance (Omenka et al., 2020).
Health Risk Assessment Instruments and Five Targeted Questions
Advanced practice providers have a number of risk assessment tools at their disposal, and according to Wu and Orlando, “Health risk assessments (HRAs) are an important element of the healthy stage” (2015, p. 508). Ideally this risk information is obtained when a patient is healthy and coherent and has established a semblance of trust with their provider. One of the pertinent Health Risk Assessment tools to consider in this clinical scenario is an assessment of cultural needs. I was unable to procure a certified Cultural Assessment, but research provides a proliferative set of questions to aid in a cultural assessment (Ball et al., 2019).
Five targeted questions that should be presented in this health risk assessment (following language assessment and necessity of interpreters) include:
“What does being healthy look like to you? What does being ill look like to you?”
“How long have you lived in the US and where did you live prior to your move? Why did
you come to the United States?”
“What symptoms have you had in the past that concerned you… discomfort, pain, rashes,
feeling like you can’t breathe, or feeling very sad or anxious?”
“What sorts of illnesses are you familiar with, and what illnesses do you know that your
father, mother, sisters, brothers, or aunts and uncles have experienced?”
“Why are you seeking medical help right now, and what can I do to help you?”
Conclusion
It is imperative that advanced practice providers consider all aspects of a person’s health: their cultural expectations and beliefs, their environmental surroundings, their current complaints, their family history, their understanding of health, both ill and well, and their expectations of what health care looks like and how it should serve them best. Advanced practice providers need to carefully consider the unique descriptors of each patient to allow them to develop the most effective assessments to an accurate health history.
References
Adu-Boahene, A. B., Laws, M. B., & Dapaah-Afriyie, K. (2017). Health-Needs Assessment for West African Immigrants in Greater Providence, RI. Rhode Island Medical Journal, 100(1), 47–50. Retrieved November 29, 2020, from
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.). Elsevier Mosby.
Lushniak, B. D. (2015). Family health history: Using the past to improve future health. Public Health Reports, 130(1), 3–5. Retrieved November 29, 2020, from
Omenka, O. I., Watson, D. P., & Hendrie, H. C. (2020). Understanding the healthcare experiences and needs of african immigrants in the united states: A scoping review. BMC Public Health, 20(1). Retrieved November 29, 2020, from
Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). F. A. Davis Company.
Wu, R., & Orlando, L. A. (2015). Implementation of health risk assessments with family health history: Barriers and benefits. Postgraduate Medical Journal, 91(1079), 508–513. Retrieved November 29, 2020, from
PEER RESPONSE
Marsha,
Your post was a well thought out discussion. I would like to add more details regarding the patients lack medical coverage and how it can affect building a health history (primarily ethnicity). According to Adegboyega and Hatcher (2016), the inequities in healthcare cover not only inadequacies in access to care but also differences in the quality of care, as well as the burden of payment. The magnitude of these inequities increases the disease burden, widen social inequities in health status, and generate adverse social effects (Adegboyega & Hatcher, 2016). According Drewniak, Krones, and Wild (2017), not only does the ethnic minority population differ regarding to access to healthcare, face barriers to lower rates of health insurance, lower rates of having a regular doctor, and lower use of care. With that being said, this could cause anxiety, stress and insecurities for the 40-year-old African American immigrant man.
The cultural and ethnical stressors caused by not having insurance include the availability of access to healthcare providers. African immigrants differ by country of origin, reason for migration, languages, health practices and beliefs, education status and cultural background. Retrieving an adequate health history could not be accessibly if the patient is stressed over having no insurance to cover the bill.
References
Adegboyega, A. O., & Hatcher, J. (2016). Unequal Access: African Immigrants and American Health Care. Kentucky Nurse, 64(1), 10–12.
Drewniak, D., Krones, T., & Wild, V. (2017). Do attitudes and behavior of health care professionals exacerbate health care disparities among immigrant and ethnic minority groups? An integrative literature review. International Journal of Nursing Studies, 70, 89–98. https://doi-org.ezp.waldenulibrary.org/10.1016/j.ijnurstu.2017.02.015
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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
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