NURS 6512: Advanced Health Assessment and Diagnostic Reasoning
Scenario: 14-year-old biracial male living with his grandmother in a high-density public housing complex
Scenario: 14-year-old biracial male living with his grandmother in a high-density public housing complex
The history and interviewing process of patients’/clients differ in approach depending on age, gender, disability, and social determinants of health (Ball, Dains, Flynn, Solomon & Stewart, 2019). The primary objective of establishing an effective communication with a client is to capture the clients’ main concerns, expectations, and to obtain a detailed history and physical examination (Ball et al., 2019).
The client being assessed is a 14-year-old, biracial male living with his grandmother in a high-density, public housing complex. The adolescent stage is marked by a tendency to experiment with risky behaviors (Ball et al., 2019. Adolescents undergo significant physical, psychological and social changes (Elden, Lessard & colder, 2016). Providers should be flexible, respectful, and observe confidentiality when attending to adolescents (Ball et al., 2019).
Effective communication can be established first greeting the client and whoever is accompanying the client (Ball et al., 2019). The use of open-ended questions is a way to encourage the adolescent to talk. Questions should be non-threatening in nature to gain the trust and establish a therapeutic connection with the primary provider (Ball et al., 2019). Do not coerce the adolescent to talk, instead give them time or allow them to present their concern in a written fashion before transitioning to a verbal discussion. Providers should avoid interrupting clients at the start of the interview but instead use gentle guidance and polite redirection to maintain a focused discussion (Ball et al., 2019). Ask specific follow-up questions to address the patients’ history and main concern.
Beware of the need and limitations to confidentiality when interviewing adolescents. You may ask the clients’ grandmother or whoever is accompanying the adolescent to step out of the room to provide a safe place for the client to speak freely. Be sure to discuss the limits to confidentiality when it involves the safety of the client or others (Ball et al., 2019).
This 14-year old is biracial, therefore it is important to take note that adolescence is an age where psychological issues and self-awareness become more evident. Biracial adolescents face adjustment difficulties and institutional discrimination relative to white and monoracial minority youth (Clark, Nguyen & Coman, 2015). These factors will influence health outcomes through disparities found within health status and access to care, controlling for insurance, income, and educational status of this adolescent. Parental absence in the life of this 14-year-old client may cause worries or anxiety related to feeling unsafe or unsure of the stability of the home, adjustment disorders, poor school attendance and performance, suicidal ideations, post-traumatic disorders among (Hodgson, Shelton, van de Breer, 2015).
The living conditions of this client makes his susceptible to risky behaviors due to peer pressure such as substance abuse, risky sex behaviors, gang activity, and biracial discrimination (Clark, Nguyen & Coman, 2015). High-density housing complex increases the risk of exposure to communicable diseases due to poor sanitation and low socio-economic status that may limit access to healthcare (Sullivan, 2019).
An appropriate screening tool that may be used when attending to adolescents’ issues is the HEEADSSS (Ball et al., 2019).
HEEADSS:
Home environment
Education
Eating
Activities (peer-related), affect, ambitions, anger
Drugs
Sexuality
Suicide/depression
Safety from injury and violence
The following questions may be appropriate during the history and interviewing process of this 14-year-old (Ball et al., 2019):
“How are things back at home?”, “Tell me more about your living situation?”
“Tell me about your friends?”.
“What do you look forward to each time you go to school?”
“What kind of activities do you engage in during your free time?”
“What are you good at?”
References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Clark, T. T., Nguyen, A. B., & Coman, E. (2015). Smoking Trajectories Among Monoracial and Biracial Black Adolescents and Young Adults. Journal of Drug Issues, 45(1), 22–37. https://doi.org/10.1177/0022042614542511
Elden, R. D., Lessard, J., &Colder, C. R., (2016), Developmental Cascade Model for adolescent
Substance use from infancy to late adolescence, Developmental Psychology, 52(10),
Pp 1619-1633
Hodgson, K. J., Shelton, K. H.,& van de Breer, M. B., (2015), Psychopathology among young
Homeless people: longitudinal mental health outcomes for different subgroups, The
British Journal of Clinical Psychology, 54(3), pp 307-325
Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis
