Health History of a Patient

Health History of a Patient

Follow these guidelines when completing this assignment.
1. Complete a health assessment/history on an individual of your choice who is 18 years of age or older and NOT a family member or close friend.
a. The purpose of this restriction is to avoid any tendency to anticipate answers or to influence how the questions
are answered. Your goal in choosing an interviewee is to simulate the interaction between you and an individual
for whom you would provide care.
b. Inform the individual that information obtained will be kept confidential and do not use identifying information
within the assignment.
c. There are three parts to this assignment.
2. Include the following sections when completing the assignment
A. Health History Assessment
1) Demographics
2) Perception of Health
3) Past Medical History
4) Family Medical History
5) Review of Systems
6) Developmental Considerations- use Erikson’s Stages of Psychosocial Development- which stage is your
participant at and give examples of if they have met or not met the milestones for that stage.
7) Cultural Considerations- definition, cultural traditions, cultural viewpoints on healing/healers, traditional and
complementary medicine, these are examples but please add more
8) Psychosocial Considerations- support systems-family, religious, occupational, community these are examples
but please add more
9) Resources to Improve Health- give examples of resources available to improve the health of the participant such as community, nutritional recommendations, healthcare, spiritual, etc.
B. Reflection
Reflection is used to intentionally examine our thought processes, actions, and behaviors in order to evaluate outcomes. Provide a written reflection that describes your experience with conducting this Health History.
1) Reflect on your interaction with the interviewee holistically.
a) Describes the interaction in its entirety: include the environment, your approach to the individual, time of day, and other features relevant to therapeutic communication and to the interview process.
2) How did your interaction compare to what you have learned?
3) What barriers to communication did you experience?
a) How did you overcome them?
b) What will you do to overcome them in the future?
4) What went well with this assignment?
5) Were there unanticipated challenges during this assignment?
6) Was there information you wished you had available but did not?
7) How will you alter your approach next time?
3. Style and Organization
Your writing should reflect your synthesis of ideas based on prior knowledge, newly acquired information, and appropriate writing skills. Scoring of your work in written communication is based on proper use of grammar, spelling, APA, and how clearly you express your thoughts and reasoning in your writing.
1) Grammar and mechanics are free of errors.
2) Verbalizes thoughts and reasoning clearly
3) Uses appropriate resources and ideas to support topic with APA where applicable.