Module 1: Comprehensive Health History

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What’s Happening in This Module?

This course is composed of four (4) separate modules. Each module consists of an overarching topic in which each week within the module includes specific subtopics for learning. As you work through each module, you will have an opportunity to draw upon the knowledge you gain in various Digital Clinical Experiences (DCE) and lab assignment components that will be due throughout each of the modules.

Module 1: Comprehensive Health History is a 1-week module, Week 1 of the course, in which you will examine how social determinants of health such as age, gender, ethnicity, and environmental situations impact the health and risk assessment of the patients you serve. You will also consider how social determinants of health influence your interview and communication techniques as you work in partnership with a patient to gather data to build an accurate health history.

Go to the Week’s Content

Week 1: Building a Comprehensive Health History

According to a 2011 Gallup poll, nurses are ranked as the most trusted professionals in the United States. One of the most admired nursing skills is the ability to put patients at ease. When patients enter into a healthcare setting, they are often apprehensive about sharing personal health information. Caring nurses can alleviate the hesitance of patients and encourage them to be forthcoming with this information.

The initial health history interview can be an excellent opportunity to develop supportive relationships between patients and nurses. Nurses may employ a variety of communication skills and interview techniques to foster strong bonds with patients and to effectively facilitate the diagnostic process. In conducting interviews, advanced practice nurses must also take into account a range of patient-specific factors that may impact the questions they ask, how they ask those questions, and their complete assessment of the patient’s health.

This week, you will consider how social determinants of health such as age, gender, ethnicity, and environmental situation impact the health and risk assessment of the patients you serve. You will also consider how social determinants of health influence your interview and communication techniques as you work in partnership with a patient to gather data to build an accurate health history.

Learning Objectives

Students will:

• Analyze communication techniques used to obtain patients’ health histories based upon social determinants of health
• Analyze health-related risk
• Apply concepts, theories, and principles related to patient interviewing, diagnostic reasoning, and recording patient information

Learning Resources

Required Readings (click to expand/reduce)

Required Media (click to expand/reduce)

Discussion: Building a Health History

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

What’s Coming Up in Module 2?

Registration for Shadow Health

Throughout this course, you will participate in digital clinical experiences using the online simulation tool Shadow Health. The Shadow Health digital clinical experience provides a dynamic, immersive experience designed to improve nursing skills and clinical reasoning through the examination of digital standardized patients. Using Shadow Health you will participate in health histories, focused exams, and a comprehensive assessment.

There will be four Shadow Health assessment components that you will need to complete in Module’s 2 and 3:

• Health History Assessment (Week 3 & 4)
• Focused Exam: Cough (Week 5) for a pediatric patient presenting with cough
• Focused Exam: Chest Pain (Week 7) for an adult patient presenting with chest pain
• Comprehensive (Head-to-Toe) Physical Assessment (Week 9)

Before you can participate in these simulations, you will need to register for a Shadow Health account. To do this:

• Go to the Walden Bookstore and purchase access to Shadow Health and the required texts.
• Once Shadow Health has been purchased, an access code will be emailed to you from the bookstore.
• Review this video explaining how to register in Shadow Health: https://vimeo.com/275921826/c12d50ee6e
• Use the Shadow Health link located in the navigation menu on the left in the Blackboard course.
• Follow the prompts to register in Shadow Health. You will need the access code provided from the bookstore to register. Once registered, Shadow Health should always be accessed via the link in Blackboard.
• Use only Google Chrome when accessing Shadow Health and make sure all other programs are turned off on your computer. Other browsers do not work well and will not allow the Shadow Health speech to text function to work.
•  Once registered, complete the Shadow Health Orientation in the Shadow Health website/program and review the videos designed to assist with navigating and completing assignments.
• Read the Shadow Health Nursing Documentation Tutorial located in the Week 1 Learning Resources.

Note: As nurses you typically use the word assessment to mean completing the physical exam. However, in the SOAP Note format, assessment means diagnosis so start getting in the habit of calling the physical exam exactly that.

Week 2 Case Studies

Next Module

To go to the next module:

Module 2

Module 2: Functional Assessments and Assessment Tools

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What’s Happening in This Module?

Module 2: Functional Assessments and Assessment Tools is a 2-week module, Weeks 2 and 3. In this module, you consider the impact of functional assessments, diversity, and sensitivity in conducting health assessments. You also explore various assessment tools and diagnostic tests that are used to gather information about patients’ conditions and examine the validity and reliability of these tests and tools. Finally, you examine assessment techniques, health risks and concerns, and recommendations for care related to patient growth, weight, and nutrition.

What do I have to do?	When do I have to do it?
Review your Learning Resources.	Days 1–7, Weeks 2 and 3
Discussion: Diversity and Health Assessments	Post by Day 3 of Week 2, and respond to your colleagues by Day 6 of Week 2.
Case Study Assignment: Assessment Tools and Diagnostic Tests in Adults and Children	Submit your Case Study Assignment by Day 6 of Week 3.
DCE: Health History Assessment	You are encouraged to work on your DCE every week. However, this Assessment is not due until Day 7 of Week 4.

Go to the Module’s Content

Week 2: Functional Assessments and Cultural and Diversity Awareness in Health Assessment

Diversity is not about how we differ. Diversity is about embracing one another’s uniqueness.

—Ola Joseph

Countless assessments can be conducted on patients, but they may not be useful. In order to ensure that health assessments result in the necessary care, health assessments should take into account the impact of factors such as cultures and developmental circumstances.

Learning Objectives

Students will:

• Analyze diversity considerations in health assessments
• Apply concepts, theories, and principles related to examination techniques, functional assessments, and cultural and diversity awareness in health assessment

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Learning Resources

Required Readings (click to expand/reduce)

Required Media (click to expand/reduce)

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Discussion: Diversity and Health Assessments

May 2012, Alice Randall wrote an article for The New York Times on the cultural factors that encouraged black women to maintain a weight above what is considered healthy. Randall explained—from her observations and her personal experience as a black woman—that many African-American communities and cultures consider women who are overweight to be more beautiful and desirable than women at a healthier weight. As she put it, “Many black women are fat because we want to be” (Randall, 2012).

Photo Credit: Getty Images

Randall’s statements sparked a great deal of controversy and debate; however, they emphasize an underlying reality in the healthcare field: different populations, cultures, and groups have diverse beliefs and practices that impact their health. Nurses and healthcare professionals should be aware of this reality and adapt their health assessment techniques and recommendations to accommodate diversity.

In this Discussion, you will consider different socioeconomic, spiritual, lifestyle, and other cultural factors that should be taken into considerations when building a health history for patients with diverse backgrounds. Your Instructor will assign a case study to you for this Discussion.

To prepare:

• Reflect on your experiences as a nurse and on the information provided in this week’s Learning Resources on diversity issues in health assessments.
• By Day 1 of this week, you will be assigned a case study by your Instructor. Note: Please see the “Course Announcements” section of the classroom for your case study assignment.
• Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient assigned to you.
• Consider how you would build a health history for the patient. What questions would you ask, and how would you frame them to be sensitive to the patient’s background, lifestyle, and culture? Develop five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.
• Think about the challenges associated with communicating with patients from a variety of specific populations. What strategies can you as a nurse employ to be sensitive to different cultural factors while gathering the pertinent information?

By Day 3 of Week 2

Post an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.

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 2

Respond on or before Day 6 on 2 different days to at least two of your colleagues who were assigned a different patient than you. Critique your colleague’s targeted questions, and explain how the patient might interpret these questions. Explain whether any of the questions would apply to your patient, and why.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 2 Discussion Rubric

Post by Day 3 of Week 2 and Respond by Day 6 of Week 2

To Participate in this Discussion:

Week 2 Discussion

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What’s Coming Up in Week 3?

Photo Credit: Getty Images/iStockphoto

Next week, you examine assessment techniques, health risks and concerns, and recommendations for care related to patient growth, weight, and nutrition. You will also begin your first DCE: Health History Assessment which will be due in Week 4. Plan your time accordingly.

Overview of Digital Clinical Experiences (DCE) and Lab Components

Throughout this course, you are required to not only complete your standard course assignments and discussions, but you will also complete DCE and Lab Components that are either structured as optional or required assignment submissions. Please take the time to review your DCEand Lab Components for this course that are required submissions. See the table below and the attached table for specific DCE and Lab Components for the course.

Note: Each Shadow Health Assessment may be attempted and reopened as many times as necessary prior to the due date to achieve a total score of 80% or better, but you must take all attempts by the Day 7 deadline. You must pass BOTH the Health History and Comprehensive (head-to-toe) Physical Exam of at least a total score of 80% in order to pass the course.

Week	Digital Clinical Experiences	Lab Components
Module 1:  Comprehensive Health History
Week 1: Building a Comprehensive Health History
Module 2: Functional Assessments and Assessment Tools
Week 2: Functional Assessments and Cultural and Diversity Awareness in Health Assessment
Week 3: Assessment Tools, Diagnostics, Growth, Measurement, and Nutrition in Adults and Children	DCE: Health History Assessment (assigned in Week 3, due in Week 4)	Case Study Assignment: Assessment Tools and Diagnostic Tests in Adults and Children
Module 3: Approach to System Focused Advanced Health Assessments
Week 4: Assessment of the Skin, Hair, and Nails	DCE: Health History Assessment	Lab Assignment: Differential Diagnosis for Skin Conditions (SOAP Note for differential diagnosis)
Week 5: Assessment of Head, Neck, Eyes, Ears, Nose, and Throat	DCE: Focused Exam: Cough	Case Study Assignment: Assessing the Head, Eyes, Ears, Nose, and Throat (Episodic SOAP Note)
Week 6: Assessment of the Abdomen and Gastrointestinal System		Lab Assignment: Assessing the Abdomen (Analyze SOAP Note)
Week 7: Assessment of the Heart, Lungs, and Peripheral Vascular System	DCE: Focused Exam: Chest Pain
Week 8: Assessment of the Musculoskeletal System		Discussion: Assessing Musculoskeletal Pain (Episodic SOAP Note)
Week 9: Assessment of Cognition and the Neurologic System	DCE: Comprehensive (head-to-toe) Physical Assessment	Case Study Assignment: Assessing Neurological Symptoms (Episodic SOAP Note)
Week 10: Special Examinations—Breast, Genital, Prostate, and Rectal		Lab Assignment: Assessing the Genitalia and Rectum (analyze SOAP Note)
Module 4: Ethics in Assessment
Week 11: The Ethics Behind Assessment		Lab Assignment: Ethical Concerns

Next Week

To go to the next week:

Week 3

 

Week 3: Assessment Tools, Diagnostics, Growth, Measurement, and Nutrition in Adults and Children

Many experts predict that genetic testing for disease susceptibility is well on its way to becoming a routine part of clinical care. Yet many of the genetic tests currently being developed are, in the words of the World Health Organization (WHO), of “questionable prognostic value.”

—Leslie Pray, PhD

Obesity remains one of the most common chronic diseases in the United States. As a leading cause of United States mortality, morbidity, disability, healthcare utilization and healthcare costs, the high prevalence of obesity continues to strain the United States healthcare system (Obesity Society, 2016).  More than one-third (39.8%) of U.S. adults have obesity (CDC, 2018). The estimated annual medical cost of obesity in the U.S. was $147 billion in 2008 U.S. dollars; the medical costs for people who are obese were $1,429 higher than those of normal weight (CDC, 2018).

According to the Centers for Disease Control and Prevention (CDC), the rate of childhood obesity has tripled in the past 30 years, with an estimated 13.7 million children and adolescents considered obese (CDC, 2018). When seeking insights about a patient’s overall health and nutritional state, body measurements can provide a valuable perspective. This is particularly important with pediatric patients. Measurements such as height and weight can provide clues to potential health problems and help predict how children will respond to illness. Nurses need to be proficient at using assessment tools, such as the Body Mass Index (BMI) and growth charts, in order to assess nutrition-related health risks and pediatric development while being sensitive to other factors that may affect these measures. Body Mass Index is also used as a predictor for measurement of adult weight and health.

Assessments are constantly being conducted on patients, but they may not provide useful information. In order to ensure that health assessments provide relevant data, nurses should familiarize themselves with test-specific factors that may affect the validity, reliabil

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