Topic 1: History Taking and Physical Exams
Topic 1: History Taking and Physical Exams
NUR 643 Topic 1: History Taking and Physical Exams
Topic 1: History Taking and Physical Exams
Health Assessment Topic Reflection 1
Complete a 250‐word reflection of what you learned during this topic. Include the following in your reflection:
Think about an experience you’ve encountered when viewing or completing the particular assessment.
Discuss difficulties that could potentially arise or specific questions related to completing this type of assessment.
Include illustrative examples of potential strategies used to overcome the difficulties encountered when completing (the particular) assessment.
Describe how the Christian worldview and compassion for all plays a role in this type of assessment.
APA style is not required, but solid academic writing is expected.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
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Topic 1 DQ 1: NUR 643 Topic 1: History Taking and Physical Exams
You are working with a nursing student who is introducing herself to a Native American patient to establish rapport. The nursing student is trying to make eye contact and puts her hand on the shoulder of the patient to get his attention. What situation could arise with this approach? How would you handle this situation? Defend rationale with references.
Topic 1 DQ 1
Cultural Competency, Awareness, Sensitivity, and Humility
Establishing rapport and a therapeutic nurse-patient relationship is an essential step to cultivating a culture of care (Treas, Wilkinson, Barnett, & Smith, 2018). According to Treas et al. (2018), approaching patient care from a holistic perspective includes active engagement in culturally competent care, which includes: cultural awareness, cultural sensitivity, and cultural competence. The American Nurses Association (ANA) as cited by Treas et al. (2018) has developed cultural competencies for the registered nurse that outline expectations for the nurse to operate in a culturally congruent manner. Some of the culturally congruent competencies include; demonstration of respect, empathy, equity, lifelong learning of culture, creating an inventory of values and beliefs, applying knowledge, considering the impact of discrimination, utilizing culturally sensitive skills, communicate with appropriate language and behaviors, identify cultural-meaning of interactions, respect patient decisions, advocate for policy to protect culturally diverse groups, and educates colleagues (ANA as cited by Treas et al., 2018).
When faced with the scenario of working with a nursing student who introduces herself to a Native American patient by making eye contact and physical touch, some potential situations that could arise regarding specific cultural expression and cues (Office of Rural Health, 2012). According to the Office of Rural Health (2012), communication norms for Native American individuals may differ from Western cultural norms. Eye contact varies in many cultures, and for many Native American cultures, direct eye contact could potentially be considered rude and disrespectful (Office of Rural Health, 2012). Personal space is also a concern with culturally diverse populations such as Native Americans as a wide variation in comfort levels with interpersonal proximity, touch, and non-verbal communication (Office of Rural Health, 2012). From the patient’s perspective, the patient may feel offended, intimidated, or afraid of the direct eye contact and touch. The student nurse may misinterpret the patient’s lack of eye contact or withdrawal from touch and document their findings as depression or assume the patient is in pain or upset (Office of Rural Health, 2012). Some barriers to culturally competent care include; bias, ethnocentrism, and cultural stereotypes (Treas et al., 2018).
Some ways to instill cultural competence in nursing students is to kindly and respectfully educate them regarding concepts of cultural humility. Bickley and Szilagyi (2017) proclaim that there are three dimensions to cultural humility that include; self-awareness or learning about our own bias, respectful communication or striving to eliminate assumptions about what we believe to be normal which also involves a pursuit of learning directly from patients, and collaborative partnerships or building patient relationships on respect and mutually acceptable plans. The Office of Rural Health (2012), offers some tips for interacting with Native Americans in the health care setting in a culturally humble manner and suggest that healthcare providers become familiar with communication styles, ask patients about their tribe and family history, personal practices, and expectations, build rapport, understand potential system transference, and listen.
References
Bickley, S., & Szilagyi, P. (2017). Bate’s guide to physical examination and history taking (12 ed.). Philadelphia, PA: Wolters Kluwer.
Office of Rural Health. (2012). Cultural awareness to help while serving native veterans. Retrieved from https://www.ruralhealth.va.gov/docs/webinars/richardson-cultural-sensitivity-062712.pdf
Treas, L. M., Wilkinson, J. M., Barnett, K. L., & Smith, M. H. (2018). Basic nursing: Thinking, doing and caring (2 ed.). Philadelphia, PA: F.A. Davis Company.
Topic 1 DQ 2: NUR 643 Topic 1: History Taking and Physical Exams
While completing a health assessment, you notice that there are indications that the patient may have been cutting herself. You inquire about the marks and she indicates that she scratched her wrist when she tried to break her fall. How do you handle this information? How can you incorporate your Christian worldview to help in providing quality care? What are the key elements to accurately obtaining the needed information for effective treatment?
Re: Topic 1 DQ 2
According to Jones, Cohen, Worley & Worthington ( 2015), some adolescents use sharp or rough objects to inflict injuries on their arms, legs, or other parts of their bodies. Individuals may cut, scratch, burn, abrade, or prick the skin repeatedly, often leaving scars. They may then attempt to hide the resulting injuries with clothing Self-cutting often is grouped with those for other forms of non-suicidal self-injury (NSSI), including burning, hair-pulling, self-hitting, and self-poisoning. According to Jones, Cohen, Worley & Worthington (2015), these self-harm behaviors have been reported in more than 10% of ninth graders7 and college students,8 and in up to 4% of adults. It is very important for a healthcare provider to check for all of their body parts, especially on hands, legs, as a routine health assessment.
According to kids health (2015) Cutting is is an attempt to interrupt strong emotions and pressures that seem impossible to tolerate. It can be related to broader emotional issues that need attention. Most of the time, cutting is not a suicide attempt. Cutting is usually associated with some kind of mental condition such as anxiety/depression, borderline personality disorder, and bipolar disorder. Detail self and family history is needed to find out what is going on with her.
We are healthcare professionals. To provide quality care, any patient should be treated holistically. To treat a patient holistically and provide spirit-guided care, nurses must attend to their own spiritual self-care. For Christians, spiritual self-care involves personal time with God in Bible study, prayer, worship, fellowship with other believers, and Sabbath rest. nurse to truly be the hands and feet of Christ to holistically intervene to restore and maintain the patient’s whole being, not simply his/her physical being. Providing Spirit-guided care encompasses the acts of Christ as a foundation for our professional practice. For nurses with a foundation in Christianity, we strive to live a Christ-like life, treating others as Christ would (John 13:34-35). We strive to think and act like Christ because the Holy Spirit of God lives within us ( Murphy & Walker, 2013)
Reference:
Hodge D. R., Horvath V. E. (2011). Spiritual needs in health care settings: A qualitative meta-synthesis of clients’ perspectives. Social Work, 56(4), 306-316.
Jones, J.G., Cohen, A.L, Worley, K.B., Worthington, T. (2015) Accidental scratch or a sign of self-cutting? J Fam Pract. 2015 May;64(5):277-281
Kids health (2015) Helping teens who cut Retrieved from https://kidshealth.org/en/parents/help-cutting.html
Murphy, L. S., Walker, M.S. (2013) Spirit guided care; Christian nursing for the whole personRetrieved from https://www.nursingcenter.com/cearticle?an=00005217-201309000-00009&Journal_ID=642167&Issue_ID=1562623
ADDITIONAL INSTRUCTIONS FOR THE CLASS
Discussion Questions (DQ)
Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.
Weekly Participation
Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.
APA Format and Writing Quality
Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.
Use of Direct Quotes
I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.
LopesWrite Policy
For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.
Late Policy
The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.
Communication
Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.
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