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.
- I will start by introducing myself to the patient.’
- 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
- What is your family’s medical history? The rationale is to know what the patient is at risk for.
- What is your medical history? This will enable the nurse practitioner to know what kind of sickness the patient has had in the past
- 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
- I will also ask the patient what medication they are currently taking
- 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.
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.
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
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.
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.
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).
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?
Karliner, L. S. (2018, April 2018). When Patients and Providers Speak Different Languages.
. 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