Building a Health History 

Thorough and accurate pediatric history is a challenging and very important to children’s wellbeing that allows nurses and patients to establish a nurse-patient therapeutic relationship. History building is also essential in the interpretation of physical examination (Ball et al., 2019). Completing a comprehensive health history and physical examination is a tool used to document patient medical history, physical examination findings, and diagnosis (Sullivan, 2019). Using good communication skills to obtain this information is very important as communication creat a positive patient relationship. In other to develop this positive patient relationship, the nurse practitioner needs to build on courtesy, connection with the patient/guardian, ensure comfort and provide an opportunity for confirmation of what has been discussed to ensure understanding (Ball et al., 2019). Performing an assessment and history taking in children can bring upon anxiety, so practitioners should try to ease the anxiety by making sure the child is in the room with the parent, especially preschoolers (Ball et al., 2019).

Interview and Communication Techniques 

Children in rural areas face risk factors that are particular to their demographic features. Children living in rural areas are more at risk for health and developmental conditions. Performing an assessment and history taking in children can bring upon anxiety, so practitioners should try to ease the anxiety by making sure the child is in the room with the parent, especially preschoolers (Ball et al., 2019). Gaining confident and building practitioner-patient–caregivers relationship that is based on trust is very important as it facilitates with data collection (Mărginean et al., 2017). The practitioner should be empathetic as this will improve communication, be an active listener and observer to pick up any cues that patients might not share like grimacing, use open-ended questions. The use of questionnaire is encouraged too where the parent fills it out and by freely writing down patient concerns without having to answer the questions in person (Ball et al., 2019). 

 Risk Assessment Tool

According to Chung et al. (2016), 20 percent of US children live in poverty in rural, urban, and suburban, so it is critical to know the social determinant of the health of children to assess them better and provide safe and appropriate care needed (Chung et al., 2016). This social determinant includes family financial support, child maltreatment, and child education. Chung et al. (2016), also continues to explain that children who live in poverty are exposed to adverse childhood experiences like toxic stress, developmental delay, and health conditions like asthma and heart diseases. Rural people are usually poor and experience healthcare disparities. According to the center for disease control and prevention (2016), younger children are more likely to experience fatal abuse and neglect than older kids. Risk factors for victimization include child age and special needs that may be as a result of increased caregiver burden from developmental and intellectual disabilities, mental health issues, and chronic physical illnesses (Center for Disease Control and Prevention, 2016).

Targeted Questions

Does your child have any allergies?

Does your child have a good appetite to eat?

Does your family has enough food?

What is the child living situation, has there being any change in the child living situation within the past one month?

What are your family concerns or needs?

Does your child take vaccinations?

Is there anything I can do for you? 

                                                                                      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.

Center for Disease Control and Prevention (2016). Preventing Child Abuse and Neglect: A Technical Package for Policy, Norm, and Programmatic Activities. Retrieved from https://www.cdc.gov/violenceprevention/pdf/can-prevention-technical-package.pdf

Chung, E. K., Siegel, B. S., Garg, A., Conroy, K., Gross, R. S., Long, D. A., Lewis, G., Osman, C. J., Jo Messito, M., Wade, R., Jr, Shonna Yin, H., Cox, J., & Fierman, A. H. (2016). Screening for Social Determinants of Health Among Children and Families Living in Poverty: A Guide for Clinicians. Current problems in pediatric and adolescent health care, 46(5), 135–153. doi:10.1016/j.cppeds.2016.02.004

Mărginean, C. O., Meliţ, L. E., Chinceşan, M., Mureşan, S., Georgescu, A. M., Suciu, N., Pop, A., & Azamfirei, L. (2017). Communication skills in pediatrics – the relationship between pediatrician and child. Medicine, 96(43), e8399. doi.10.1097/MD.0000000000008399

Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.

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