Health History Techniques

Patient: 76-year-old Black/African-American male with disabilities living in an urban setting
The interview process with the patient is crucial for establishing a relationship, finding the problem, and addressing issues.

“Establishing a positive patient relationship depends on communication built on courtesy, comfort, connection, and confirmation” (Ball,

Dains, Flynn, Solomon, & Stewart, 2015, p. 2). This patient is currently living in an urban setting and is disabled. The basic interviews

techniques would be first knocking on the door, introducing myself to the patient and also asking for his preferred name, Mr. S. The

interview would take place in a private setting such as an exam room, and with his disabilities would make sure he is accommodated to the

fullest extent possible as to make him feel comfortable. I would make sure I am in front of Mr. S, sitting at eye level if possible and

explain what I will be doing with obtaining his health history. I would ask him if it is okay to proceed and if he has anyone in the room

with him if it is okay to ask questions in front of them ensuring that his information is private.  Open-ended questions, non-judgmental

responses, and gentle guidance techniques can be used to direct the interview to be able to obtain vital information without over whelming

the patient yet help form the picture that the patient presents to determine the best care plan.
The risk assessment tool that will be used on Mr. S is the Home Safety Self-Assessment Tool (HSSAT), this tool was developed

to evaluate the living conditions of older adults and whether the home was a safe environment to prevent falls and also provide a space

that older adults can stay in their home longer. “Being able to age in place is complicated when homes lack accessible features or when

homeowners have been unable to keep up with home maintenance. Housing problems such as structural problems, fall hazards, or accessibility

problems often negatively impact physical and mental health, increase fall risks and accidents, isolation, nutrition, and quality of life”

(Horowitz, Nochajski, & Schweitzer, 2013, p.218). Although the assessment is often completed by occupational therapist going to assess the

house, a modified version can be used in the interview process. With Mr. S disabilities and age, it is  important to assess his quality of

life and safety. A functional assessment will also be needed in this interview to assess Mr. S. functional ability to care for his self

and to determine what level of care he will need.  “The functional capacity must be assessed in order to plan specific interventions aimed

at eliminating risk factors for disability and, simultaneously, promote health and prevent diseases that influence the functional capacity

of the elderly, particularly those aged over 75 years” (Clemente et al., 2015, p. 66). Often multi-assessment are needed for those who are

older because of their often multi-system diseases, and risk factors. The targeted questions I would ask Mr. S include
1.What are areas that you feel you need help in?
2.Do you live alone?
3.Do you feel safe in your current residence?
4.Have you fallen recently?
5.What medications are you currently taking and what method do you use to organize your medications?
6.Do you have family or friends that are close by or visit?
7.Are their stairs in your home?
8.How does your disability affect your quality of life?
9.Are you able to prepare meals for yourself?
10.Do you need assistance with bathing?
11. What level is your home on? Are their elevators available?
12. Do you drink alcohol or use any recreational drugs?
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination(8th ed.). St.

Louis, MO: Elsevier Mosby.
Clemente Rodrigues, R. M., Ribeiro da Silva, C. F., de Jesus Loureiro, L. M., Tavares da Silva, S. D., da Silva Crespo, S. S., & Sá

Azeredo, Z. A. (2015). The oldest old: multidimensional functional assessment. Revista De Enfermagem Referência, (5), 65-74 10p.

doi:10.12707/RIV14040
Horowitz, B. P., Nochajski, S. M., & Schweitzer, J. A. (2013). Occupational Therapy Community Practice and Home Assessments: Use of the

Home Safety Self-Assessment Tool (HSSAT) to Support Aging in Place. Occupational Therapy In Health Care,27(3), 216-227 12p.

doi:10.3109/07380577.2013.807450

(GARRETT)

Introduction
According to the location and specialty of your practice, you will be exposed to certain demographics of patients.  I live in south

central Georgia.  The rural community I live in has a diverse cultural pool, with a large number of African American residents. For this

reason, I choose the seventy six year old African American male with disabilities living in an urban setting.  I know that I live in a

rural area, but I work at a regional medical facility that serves many surrounding counties of which some are considered rural, urban, and

metropolitan according to census.
Interview and Communication Techniques
In any interview process, a very important task to accomplish is trust between the nurse and the patient.  When dealing with

elderly patients, it is important to make a solid first impression.  The patient should know that they are the center of attention, and

“the health care provider will be open, honest, flexible, and eager to help them, addressing all questions and concerns” (Ball, Dains,

Flynn, Solomon, & Stewart, 2015, p. 1).  When talking with the patient, make certain to set the tone and text accordingly.  Do not talk

above the patients educational capabilities, but do not speak to the patient as if they are incapable either.
A great way to have productive interview is to make it a face to face interview process in a secure, quiet, and well-lit room.  Seating

should be comfortable, eye level, and have nothing separating the patient and nurse.  If it is approved by the patient, a family member or

friend may be present to take notes, or speak up for the patient.  Encourage the patient to wear their glasses if needed, as well as

hearing aids.  Many times the patient may choose not to wear these supportive devices.  These factors can negatively affect the interview

process because the patient will not accurately hear, or see what the nurse has said, shown, or demonstrated for the patient. This occurs

because the patient does not want to appear disabled in any manner, which may be seen as a sign of weakness (Michigan, 2003).
Risk Assessment
The risk assessment tool that I selected for the elderly patient is the functional impairment assessment. The patient in this situation is

elderly with disabilities.  Does the patient live by himself, or does he have anyone living with him.  Safety for the patient is a primary

concern.  Items to be covered in relation to function include activities of daily living, along with instrumental activities of daily

living.  ADL’s consist of bathing, toileting, dressing, transfers, grooming and feeding. IADL’s include driving, shopping, housekeeping,

cooking, finances, and taking medications (Michigan, 2003).
The asking of specific questions are very important in the interview process. In relation to ADL’s, the patient must be asked if they are

able to ambulate without assistance, or do they require assistance?  Has the patient had a fall recently, and if so how often?  If yes is

answered to falls this is a serious health risk item (Ball et al., 2015).  Education and intervention can be applied at this time.

Another question that is valid is can the patient drive to take care of financial obligations, and buy needed items like groceries and

medications?  If not, how do they handle personal affairs, and get their food and medications?  Two more valid questions are, who performs

the house work, and are you able to call for help if needed by telephone, or medical alert systems (Michigan, 2003)?
Conclusion
It is important to remember that the elderly are not always able to perform the basic functional needs to maintain a healthy, happy, and

productive life.  It is important that health care providers be advocates for this population, and make sure these basic needs are being

met.
References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination(8th ed.). St.

Louis, Missouri: Elsevier Mosby.
University of Michigan Medical School. (2003). Geriatric functional assessment.
Retrieved from http://www.med.umich.edu/lrc/coursepages/m1/HGD/GeriatricFunctionalAssess.pdf

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