Posted: June 6th, 2024

Reflection on Developing a Gynecologic Health History Script

Reflection on Developing a Gynecologic Health History Script

In developing a script for taking a thorough gynecologic health history, I found several screening tools and resources helpful for ensuring all important areas are addressed. The CDC’s guide on taking a sexual history provides a helpful overview of key topics to cover, such as sexual practices, history of STIs, and use of protection (CDC, 2021). The ACOG’s well-woman care resources also outline important preventive services and health maintenance topics to include based on age and risk factors, such as cervical cancer screening, mammograms, and immunizations (ACOG, n.d.).

In addition to medical history, it’s crucial to gather information on social determinants of health that may impact gynecologic and overall health. This includes asking about access to healthcare, health literacy, socioeconomic status, experiences of racism and discrimination, and environmental exposures (Office of Disease Prevention and Health Promotion, 2020). For LGBTQ+ patients, providers should use gender-neutral language, avoid assumptions about sexual practices and partners, and screen for experiences of stigma and violence (Potter et al., 2018).

Some of the more difficult and sensitive topics that need to be addressed include sexual trauma, intimate partner violence, sexual dysfunction, and abortion. It’s important to broach these subjects in a trauma-informed manner, express empathy and lack of judgement, and connect patients with support services as needed (Stevens, 2018). As a provider, I need to be aware of my own biases and discomfort with certain topics so that it doesn’t negatively impact patient care.

Implementing this gynecologic health history script with patients provided valuable insights. I found that starting with less sensitive questions, using normalizing language, and expressing empathy helped patients feel more comfortable sharing personal information. However, discussing topics like sexual orientation and gender identity, sexual abuse, and substance use still felt challenging at times. With practice and continued self-reflection, I aim to improve my skills in gathering sensitive health information in a respectful manner.

As a nurse practitioner, I can advocate for community-level interventions to address social determinants of health impacting patients. This includes supporting policies to improve access to healthcare, affordable housing, and education; partnering with community organizations to provide culturally appropriate care; and addressing implicit bias among healthcare staff. By gathering a robust health history and working to advance health equity, I can provide more holistic, effective care to patients from all backgrounds.

References:
American College of Obstetricians and Gynecologists. (n.d.). Well-woman health care. https://www.acog.org/topics/well-woman-health-care

Centers for Disease Control and Prevention. (2021). A guide to taking a sexual history. https://www.cdc.gov/std/treatment/sexualhistory.pdf

Office of Disease Prevention and Health Promotion. (2020). Social determinants of health. Healthy People 2030. https://health.gov/healthypeople/objectives-and-data/social-determinants-health

Potter, J., Fessler, D., Huang, G., Baker, K., & Dearborn, H. (2018). Challenging assumptions about LGBTQ health: A nurse practitioner’s perspective. The Journal for Nurse Practitioners, 14(1), 33-39. https://doi.org/10.1016/j.nurpra.2017.10.019

Stevens, P. E. (2018). Trauma-informed approaches to care: The role of the nurse practitioner. The Journal for Nurse Practitioners, 14(10), 767-772. https://doi.org/10.1016/j.nurpra.2018.08.012

• Review the screening tools found in the Learning Resources and consider how you might use an app or tool to assist in screening.
• Review the media programs related to a vaginal exam, pap test, and breast exam.
• Review the health history guide presented in Chapter 7 of the Schuiling & Likis (2022) text and consider how you would create your own script for building a complete health history. (Note: You will also find the Health History Form in Chapter 7)
• Provide all the components of a complete gynecologic health history. Include considerations for special populations such as LGBTQ+ individuals.
• What health maintenance guidelines should be included for initial and follow up might be needed for follow-up assessments? (i.e., bone density test, Gardasil vaccine, pap smear, Mammorgram, etc.)?
• Using the 5 areas of the Social Determinants of Health:
(Examples of SDOH include but not limited to)
•
o Safe housing, transportation, and neighborhoods
o Racism, discrimination, and violence
o Education, job opportunities, and income
o Access to nutritious foods and physical activity opportunities
o Polluted air and water
o Language and literacy skills
o SDOH also contribute to wide health disparities and inequities.
o What questions would you consider in your patient’s complete health history?
• Develop your own script for building a complete health history and as you create your script, consider the difficult questions you want to include in your script. There is no sample template to provide to you. (Utilize chapter 7 of your Schuiling textbook to provide guidance). You are the one to develop the script. Think of it as you are writing a movie and you need to write the script for the movie. What lines would you provide for the actor to utilize when sitting down with a patient to perform a COMPLETE Medical History which also entails those DIFFICULT GYN questions. You do not need to provide the answers to the questions however, if you find that beneficial, you may do so.
Assignment: (1- to 2-page reflection)
• In addition to your script for building a health history for this assignment, include a separate section called “Reflection” that includes the following:
o A brief summary of your experiences in developing and implementing your script during your health history.
o Explanations of what you might find difficult when asking these questions. What you found insightful and what would you say or do differently.
o As a NP, what could you implement in your community to provide resources/assistance of the Social Determinants of Health.

APA format scholarly references
https://www.aafp.org/dam/AAFP/documents/journals/afp/USPSTFHealthCareSchedule2021.pdf

https://www.acog.org/topics/well-woman-health-care?utm_source=redirect&utm_medium=web&utm_campaign=otn

https://www.cdc.gov/std/treatment/SexualHistory.pdf

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