Risk Assessment for Patient Health History

Building a health history with a new patient requires more than active listening and the development of trust and rapport. The intake interview and initial health assessment should be thorough, taking into account the area(s) in which the patient has lived, their workplace environment or work history, their family background and family health history, socioeconomic variables, and any other relevant environmental factors that may impact personal health. Of course, demographic variables like age, ethnicity, and gender will all be taken into account when building a health history with a new patient. Communication techniques and interviewing style, risk assessment instruments, and the specific questions to be asked would also vary considerably depending on the patient. Consider the following example of a pre-school aged white female living in a rural community:
A pre-school aged white female needs to be interviewed with a parent or legal guardian present for practical, legal, and ethical purposes (Goetzel, Staley, Ogden, et al, 2011). In fact, the majority of the interview questions would be directed at the adult because the pre-school aged patient will be unable to respond to some of the more in-depth inquiries due to a lack of health literacy (“Health Risk Assessments,” n.d.). The interview process can be used as a springboard for building health literacy in the young patient, but the parent or guardian remains responsible for answering the questions related to health risks, environmental variables, family or cultural background, and any other relevant variable. In some ways, having the parent or guardian present helps the nurse build a more comprehensive patient health history than with a patient who is of the age of majority because the family member can fill in some of the pertinent details or add information the patient might leave out. Five targeted questions I would present to the patient and the present parent or guardian are as follows:
1. (Directed to the parent/guardian): Do you or the biological parents have a history of any disease or medical condition, such as heart disease, diabetes, or cancer?
2. (Directed at the patient): How are you feeling? Do you ever feel any pain or discomfort? If so, when? When directing questions at the young patient, it is important to pay attention to the reaction and assess their level of health literacy or understanding or engagement.
3. (Directed to the parent/guardian): You live in a rural area. What medical or healthcare services are available to you? How close are the nearest doctor, hospital, and pharmacist? Are you aware of any telemedicine services? Do you have broadband Internet access?
4. (Directed at the parent/guardian): Are all members of your family insured? How would you rate your level of financial security?
5. Tell me about your family background and structure. Are there any mental health issues or issues with substance abuse? (If directed at the patient: Do you have any siblings? How do you get along? Do you get along with everyone in your family?).
The interview would actively include the patient, with observations of the patient’s body language during the conversation. If there is indication the patient may be uncomfortable or expresses fear in responding to any question, the nurse may want to speak alone with the child. The risk assessment methods suggested by Goetzel, Staley, Ogden, et al, (2011) and by the Stratis Health Risk Assessment (n.d.) framework demonstrate the importance of ascertaining patient socio-emotional and real-time thinking skills, as well as overall physical and cognitive ability. It is important to take into account the geographic situation of the patient, for living in a rural region may preclude the patient from having access to the same services or products that someone living closer to an urban center might have. The nurse is responsible for informing the patient and the family member(s) present of options for telemedicine and preventive services, and can provide information to the parent or guardian. The interview would also include an assessment of the parent or guardian’s own health literacy, to assess how well the health-related information is being translated into practice with the child patient.




References

Goetzel, R.Z., Staley, P., Ogden, L, et al. (2011). A framework for patient-centered health risk assessments. CDC. https://www.cdc.gov/policy/hst/HRA/FrameworkForHRA.pdf
“Health Risk Assessments,” (n.d.). Stratis Health. https://www.stratishealth.org/documents/HITToolkitcoordination/4-Health-Risk-Assessments.pdf