Fatmata Diaby 26-year-old Lebanese female

COLLAPSE

History Taking and Risk Assessment

Developing an appropriate rapport is necessary when evaluating patient’s health needs as well as their risk assessment for the development of various debilitating conditions. An effective patient-practitioner rapport has been linked to improved patient health-care outcomes. A health care professional should have the intellectual capacity to internalize their patient’s feelings and emotional concerns aiming at maintaining the appropriate respect for their individual patients. In the case scenario provided, the patient is a 26-year-old Lebanese female living in a graduate-student housing requiring a health risk assessment. The initial step that should be taken by the health care professional is to introduce themselves to the patient to eliminate any possible ambiguity about their current care giver. The next step is to commence a rapport while making sure to maintain sociocultural sensitivity for extraction of precise and optimal details that will promote the formulation of an appropriate treatment plan for the patient. Use of open-ended questions is integral when obtaining a thorough history as it avoids omission and clinician-based bias (Tanwani, 2016). Empathy is exercised during practice as it allows the patient to feel understood and facilitates promotion of an effective patient-clinician rapport. Listening is a communication skill commonly overlooked but has a crucial role when attempting to narrow in on a diagnosis following an elaborate history of presenting illness.

Health Risk Assessment Instrument of Choice

The patient is a 26-year-old student living in the graduate-student housing. She is currently of child bearing age and is prone to contracting sexually transmitted diseases. This evokes the need for a Sexually transmitted disease (STD) risk assessment which involves diseases such as Human immunodeficiency virus infections among other STDs. Obtaining a sexual history from patients can at times seem challenging but should be carried out thoroughly with empathy and a non-judgmental attitude. Patient-practitioner confidentiality should also be assured for comfort and ease of assessment (Barrow, Ahmed, Bolan & Workowski, 2020). Women of child bearing age that are engaged in sexual intercourse should be frequently screened for STDs via history taking and physical examination. Moreover, culture and socioeconomic status play a major role in STD acquisition predisposition as various individuals have different practices as well as beliefs.

Targeted Questions

Specific sexual history questions should be asked in reference to the patient’s health assessment. The frequency and modes of sexual pleasure should be documented alongside the number of sexual partners involved with the patient. Multiple sexual partners are highly associated with a higher risk of STD acquisition. In addition, multiple sexual practices can greatly increase the risk of developing a sexually transmitted disease. History of previous STDs is expected to be inquired as patients with a positive history of disease are at a higher risk of recurrence owing to their sexual practices. Physiologic alterations in the patient’s genitalia such as abnormal bleeding, pain and foul discharge should be inquired about as they are common signs and symptoms associated with STDs (Barrow et al., 2020). Methods of contraception that are undertaken, if any, by the patient should be documented for assessment of patient education and self-care involvement. Other social parameters are also included in the STD risk assessment tool such as whether or not the patient has exchanged money for sexual intercourse. Drug use including cigarette smoking, chronic alcohol use and other forms of intravenous drug use are greatly linked to STD acquisition hence require probing as part of the assessment tool in routine care (Jenkins et al., 2019).

References

Barrow, R. Y., Ahmed, F., Bolan, G. A., & Workowski, K. A. (2020). Recommendations for providing quality sexually transmitted diseases clinical services, 2020. MMWR. Recommendations and Reports, 68(5), 1-20. doi:10.15585/mmwr.rr6805a1

Jenkins, W. D., Vohra, S., Grundy, S., & Choat, L. (2019). Incentivized screening to reduce sexually transmitted infection risk and prevalence. Sexually Transmitted Diseases, 46(10), 654-656. doi:10.1097/olq.0000000000001049

Tanwani, R. (2016). Communication skills in clinical practice. The Skills of History Taking (for Medical Students and Practitioners), 196-196. doi:10.5005/jp/books/12827_18

Adebukola Aladesanmi RE: Discussion – Week 1COLLAPSE

Health assessment is an important exercise that assists clinicians to identify people at risk of certain health problems such as chronic diseases, abuse, alcoholism, and other unfavorable health outcomes. Techniques used in health assessment to gather a comprehensive health history of an individual differ from population to population depending on factors such as age. In this health assessment, my case scenario is a 26-year-old female from Lebanon.

I would start an interview by creating a conducive environment that is friendly and welcoming for the client. For example, I would warmly welcome them to the office and ask them to feel comfortable. To promote comfort, I would sit on the same level as the client as opposed to being separated by a desk. Given that the client is a young adult, having a desk between might be intimidating while on the other hand, sitting together with her will make the patient less anxious. This enhances trust and the ability to build rapport (Kim & White, 2018). The second technique I will apply is using a person-centered or culturally appropriate approach, for instance, asking the client which language she is comfortable with. Given that the patient is Lebanese, she may not fully understand English and might require an interpreter. Similarly, I would assure them of the privacy and confidentiality of any information they share.

Building rapport is important for establishing a therapeutic relationship with the client. I would apply communication techniques such as interpersonal relations, empathy, respect, and active listening when interviewing the patient. These techniques will help in building trust as the patient knows that the therapist is not only listening, but also understands their experiences and feelings through empathy. I will also employ open-ended questions especially at the beginning of the interview to allow the patient to provide as much information as possible, which can be used to evaluate any possible health concerns.

The client is a young female adult and at this age, she is exposed to various health issues such as potential abuse from her partner, gender discrimination, racial discrimination, as well as peer pressure. Moreover, the client leaves in graduate housing indicating a background of low socioeconomic status. Low-socioeconomic status is associated with poor health outcomes because of lack of adequate income to provide necessities, proper/healthy diet, clean environment, and safe neighborhood. As such, the client is exposed to several risk factors including an unhealthy lifestyle, the possibility of developing chronic diseases, smoking, effects of crime, and abuse (Nagasu & Yamamoto, 2020). Additionally, given that the client belongs to a minority group, they may not be having a job or working menial jobs and extra shifts to make ends meet, or working and studying, which poses the risk of psychological health issues due to distress and burnout (Kulsoom & Afsar, 2015).

For risk assessment, I would use the CRAFFT questionnaire, which assesses potential involvement in alcohol and substance abuse. The assessment tool has 6 targeted questions each examining a component of the CRAFT (Car, Relax, Alone, Forget, Family/Friends, and Trouble). The rationale for examining alcohol abuse is because the client lives in a residential place for students. In this case, there is a high probability of peer pressure and involvement in alcohol and substance abuse because of the environment where most people engage in such habits. I would also use the YouthCHAT screening tool to assess any mental health issues and risky behavior manifesting in the patient (Goodyear-Smith, et al., 2017). Given the age and cultural background, the client is exposed to several issues that might cause anxiety, depression, or any other mental health issue. For example, lack of employment, difficulties adjusting to the environment, experience from the home country, and balancing education and work among others.

Targeted Questions

What language are you comfortable with?

What challenges have you encountered with accessing health services?

Do you have any other family members in this country?

What is your understanding of abuse, have you experienced it?

Are you involved in any routine physical activity? What is your daily diet like?

References

Goodyear-Smith, F., Martel, R., Darragh, M., Warren, J., Thabrew, H., & Clark, T. (2017). Screening for risky behavior and mental health in young                     people: the YouthCHAT program.  Public Health Rev, 38, 20. https://doi.org/10.1186/s40985-017-0068-1.

Kim, B.,  & White, K. (2018).  How can health professionals enhance interpersonal communication with adolescents and young adults to improve health care outcome?: a systemic literature review.  International Journal of Adolescence and Youth, 23(2), 198-218. Doi:10.1080/02673843.2017.1330696.

Kulsoom, B., & Afsar, N. (2015).  Stress, anxiety, and depression among medical students in a multiethnic setting.  Neuropsychiatr Dis Treat, 11, 1713-22. Doi: 10.2147/NDT.S83577.

Nagasu, M., & Yamamoto, I. (2020). Impact of socioeconomic-and lifestyle-related risk factors on poor mental health conditions:  A Nationwide

               longitudinal 5-wave panel study in Japan.  PlosOne.  https://doi.org/10.1371/journal.pone.0240240.

respond to each discussion with 3 sources