Building a Health History: Asking Difficult Questions

Building a Health History: Asking Difficult Questions

            Dealing with gynecological issues can be challenging for most people because of the stigma associated with talking about such topics. The stigma linked to gynecological health issues can be debilitating especially among individuals belonging to the LGBTQ+ community or other minority groups. Nurses and other healthcare practitioners are responsible for ensuring that patients feel comfortable talking about their gynecological problems.

Components of a Complete Gynecological Health History

            A gynecological health history should be comprehensive to ensure that all the critical data required is captured. Some of the components of a gynecological health history include inquiring about the chief complaint and history of present illness, the patient’s menstrual history when dealing with women or transgender men, perimenopause/menopause symptoms among older women and transgender men, issues of fertility, and the current method of contraception used. Additional information that should be collected includes sexual history such as the number of sexual partners one has had, homosexuality or heterosexuality, concerns about dyspareunia, and history of sexual assault or abuse. A history of sexually transmitted infections like herpes and non-sexually transmitted infections like candidiasis and endometriosis should also be documented. The patient should be asked about the specific type of infection diagnosed, frequency over the years, and treatment approach used. Other additional information that should be collected includespast gynecological surgical history and obstetric history among women who have had children, their experiences with each pregnancy and any maternal or fetal complications that might have occurred (Goodrich, et al., 2017).

            Some of the health maintenance guidelines that should be included in the initial assessment would be a pap smear for women or transgender women who have not undergone a sex reassignment surgery and HPV vaccine for all male and female patients between 11 and 26 years who may benefit from the vaccine. The guidelines would entail the recommended age and frequency of getting pap smears among the women and the benefits of HPV vaccines among the female and male clients below 26 years. Follow-up assessments would be based on determining the results of the tests conducted and advising the clients on health maintenance approaches that they should implement in their lives based on the results (Bibbins-Domingo, 2017; Mehta, et al., 2018).

            Some of the questions that would be considered for a patient assessment include those related to daily life, past medical conditions, and current health status. The questions would include in the past seven days have you required help from others to perform daily activities such as dressing, walking, bathing, laundry, and housekeeping?, have you had any serious health condition in the past?, and how would you describe your current health status? General health questions would include, have you suffered any form of loss over the past six months (like job loss, death of someone close to you, or separation from a loved one)?, describe your diet over the past five days?, what are your current health priorities?, how often do you exercise?. Gynecological related question would include how many sexual partners do you have?,what is your sexual orientation?, have you engage in any risky sexual behaviors before?, do you have a history of any STDs?, have you gone through any gynecological screening like pap smears before?, and do you have any current gynecological issues now? (Goodrich, et al., 2017).

Script

            The script would be divided into five sections, which would include the subjective data that would entail the chief complaint and history of illness, review of systems, objective data that would be based on physical assessments, and diagnosis and differentials. The questions addressed in the subjective data section would include inquiring about the chief complaints and history of presenting illness by asking the client about the signs and symptoms felt, aggravating and relieving factors, duration, and severity of pain. The review of systems will entail examining each system and focusing on the gynecological/genitourinary system for further assessment. Sensitive questions would entail asking the patient about his or her history of sexual activities/intercourse, past medical and surgical sexual history, involvement in risky sexual behaviors like engaging in sexual intercourse while drug or while under the influence of drugs, and their history of gynecological infections (Bibbins-Domingo, 2017).

Reflection

            During the health history, I did not experience a challenge when developing my script because I based most of the information on the script on standard questions asked during patient examination and assessment procedures. The challenging part in developing and implementing the script entailed the incorporation of considerations for LGBTQ community members, as their gynecological issues may differ slightly from those affecting heterosexual individuals who do not engage in unhealthy sexual behaviors. The challenge in addressing gynecological issues for LGBTQ community members was based on ways of addressing them as either females or male, understanding the genitourinary anatomy and physiology of those who had undergone or were in the process of going through sex reassignment procedures, and determining whether they face additional challenges and complication when compared to those who had not undergone these surgeries.

            Some of the things that I perceive as being difficult when asking these questions to patients include those relating to gynecological infections, their sexual intercourse history and engagement in risky sexual behaviors. These questions might be particularly challenging when dealing with individuals from the LGBTQ community who might not be comfortable with revealing their sexual history or discussing their gynecological health with a nurse. The challenge related to asking these questions was based on the need to ensure that the patient would not feel judged or picked on during the assessment session and would understand the need for such critical assessments. Aside from that, other challenges entailed ensuring that the questions directed to patients would not offend them based on their cultural backgrounds, religion, and beliefs. While these considerations made it difficult to ask the questions, it was necessary to ensure that the patients’ understood the importance of the questions asked. I noticed that patients who understood the objectives of the nurse or healthcare practitioners assessing them were more open to answering the questions that they were asked. In future, I would explain to patients’ the importance of a comprehensive assessment and the data collected to ensure that they remain compliant during the assessment session.

            Gynecological assessment and examination can be challenging for both patients and healthcare practitioners. Ensuring that patients are comfortable and avoiding using remarks that might be perceived as being judgmental can improve the data collection process. Utilizing a pre-written script can ensure that adequate health information is collected and sensitive or difficult questions are addressed in a manner that does not offend the patient.

References

Bibbins-Domingo, K. (2017). Screening for Gynecologic Conditions With Pelvic Examination: US Preventive Services Task Force Recommendation Statement. JAMA Network, 317(9), 947-953. https://jamanetwork.com/journals/jama/fullarticle/2608228.

Goodrich, K. M., Farmer, L. B., Watson, J. C., Luke, M., Davis, R. J., Dispenza, F., . . . Griffith, C. (2017). Standards of Care in Assessment of Lesbian, Gay, Bisexual, Transgender, Gender Expansive, and Queer/Questioning (LGBTGEQ+) Persons. Journal of LGBTQ Issues in Counseling, 11(4), 203-211. https://www.tandfonline.com/doi/full/10.1080/15538605.2017.1380548.

Mehta, P. K., Easter, S. R., Potter, J., Castleberry, N., Schulkin, J., & Robinson, J. N. (2018). Lesbian, Gay, Bisexual, and Transgender Health: Obstetrician-Gynecologists’ Training, Attitudes, Knowledge, and Practice. Journal of Womens Health, 27(12), 1459-1465. https://pubmed.ncbi.nlm.nih.gov/30067148/.