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NRNP 6552 Module 1 Assignment: Taking a Health History: Building a Health History: Asking Difficult Questions

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NRNP 6552 Module 1 Assignment: Taking a Health History: Building a Health History: Asking Difficult Questions

Taking a Health History: Building a Health History: Asking Difficult Questions

A comprehensive gynecologic health history is a foundational component of safe, patient-centered care in advanced practice nursing. Wilson-Liverman et al. (2025) note that such a history enables clinicians to systematically identify current health concerns, recognize underlying risk factors, and anticipate potential complications that may affect reproductive and overall health outcomes. It also strengthens continuity of care across the lifespan. Using a structured yet conversational approach supports trust and encourages disclosure of sensitive information, particularly in areas that may be culturally sensitive or emotionally difficult to discuss. This assignment presents a scripted approach to obtaining a complete health history, incorporating gynecologic, medical, psychosocial, and preventive domains, drawing on the framework outlined by Schuiling and Likis (2020). It also integrates considerations for special populations, social determinants of health, and health maintenance guidelines to ensure holistic assessment and evidence-based decision-making.

Opening Script and Chief Concern

Hello, my name is – and I am the nurse practitioner, and I will be asking you questions about your health today. I want to take a few minutes to get to know you and understand your concerns in a respectful and supportive way. Everything you share is confidential and will only be used to guide your care. What brings you in today, and can you describe your main concern in your own words? When did it begin, and how has it affected your daily life, work, or relationships? Have you noticed anything that makes it better or worse? I will ask detailed follow-up questions to understand your symptoms and overall health better, so I can provide safe, evidence-based, and appropriate care.

History of Present Illness and Medical History

To better understand your concern, I will begin by exploring the history of your present illness using a structured approach. Have you experienced anything similar in the past? What treatments, if any, have you tried so far, and how effective were they? I will also review your overall medical history, including any chronic conditions such as hypertension, diabetes, or mental health disorders. In addition, I will ask about previous surgeries and hospitalizations, as well as any current medications, supplements, or herbal products you may be taking.

Gynecologic and Sexual History

I will now ask specific questions about your gynecologic and sexual health to understand your reproductive well-being better. When did your last menstrual period begin, and are your menstrual cycles typically regular or irregular? Do you experience any pelvic pain, unusually heavy bleeding, spotting between periods, or significant cramping? Are you currently sexually active, and if so, what genders of partners do you have? What forms of contraception, if any, are you currently using, and are you satisfied with your chosen method? Have you ever been diagnosed with a sexually transmitted infection in the past? Have you noticed any pain during sexual intercourse or changes in sexual desire or satisfaction? Additionally, have you ever been pregnant, and what were the outcomes, including any live births, miscarriages, abortions, or complications you would like to share?

Mental Health, Substance Use, and Safety

I want to ask a few questions about your emotional well-being, substance use, and personal safety to ensure comprehensive care. How would you describe your mood over the past several weeks? Have you been experiencing symptoms of anxiety, persistent sadness, loss of interest, or difficulty coping with daily stressors? Have you ever had thoughts of self-harm or felt unsafe with yourself? Do you currently use alcohol, tobacco, vaping products, cannabis, or any other substances? If so, how frequently and in what amounts? Have you noticed any changes in your use over time? I would also like to ask whether you feel safe in your home environment, relationships, and community, and whether anyone has ever threatened, harmed, or made you feel unsafe or controlled in any way?

Social History and Determinants of Health

I would like to understand your social circumstances, as they play an important role in your overall health and access to care. Can you describe your current living situation, including who you live with and whether your housing is stable and safe? Are you currently employed, in school, or involved in caregiving responsibilities? Do you have reliable access to transportation, nutritious food, and healthcare services? Have you experienced financial stress, food insecurity, or difficulty affording medications or medical visits? Have you ever experienced discrimination, violence, or other social stressors that have affected your health? What is your highest level of education completed, and do you feel your income is sufficient to meet your basic needs regularly currently?

Special Populations Considerations

When conducting a gynecologic health history, it is important to adapt communication and assessment strategies for special populations to ensure equitable, respectful, and effective care. For adolescents, I would prioritize privacy, confidentiality, and developmentally appropriate language while encouraging autonomy and trust. For older adults, I would assess menopausal status, cognitive function, bone health, and age-related changes in reproductive and sexual health. For LGBTQ+ individuals, I would use inclusive, nonjudgmental language regarding identity, anatomy, and sexual partners. For individuals with disabilities, I would ensure accessible communication methods and physical accommodations. For postpartum patients, I would assess physical recovery, emotional well-being, breastfeeding status, contraception needs, and risk for postpartum depression while providing supportive, individualized counseling with ongoing holistic patient-centered care delivery.

Health Maintenance and Preventive Care

I would conduct a thorough review of health maintenance and preventive care tailored to the patient’s age, risk factors, and clinical guidelines. It includes reviewing immunization status for HPV, influenza, COVID-19, and other recommended vaccines. I would assess the need for routine screening tests, including Pap smears, mammograms, sexually transmitted infection testing, and bone density scans where appropriate. Cardiovascular risk screening, including assessments of blood pressure, cholesterol, and diabetes, would also be incorporated. Counseling on contraception, reproductive planning, nutrition, physical activity, and lifestyle modification would be provided. I would also use evidence-based clinical decision tools and screening guidelines to ensure timely preventive interventions and to promote long-term health outcomes across the lifespan, in a structured and individualized manner, for optimal care.

Patient-Centered Care Improves Gynecologic Outcomes Practice

Patient-centered care is essential in gynecologic practice because it prioritizes the patient’s values, preferences, and lived experiences while fostering trust and engagement. Clinicians encourage open communication by creating a supportive environment, which leads to more accurate histories and improved diagnostic accuracy. According to Huynh et al. (2023), this approach enhances adherence to treatment plans and preventive care recommendations. It also reduces disparities in reproductive health outcomes by ensuring culturally sensitive and individualized care delivery. In addition, patient-centered communication strengthens shared decision-making, empowering individuals to participate actively in their health management. Ultimately, integrating patient-centered principles into gynecologic assessments improves clinical outcomes, enhances patient satisfaction, and promotes long-term health and well-being across diverse populations within the healthcare system through a holistic, evidence-based, and compassionate nursing practice delivery approach model.

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Reflection

SDOH Overview and Script Development Experience

Developing my health history script required careful consideration of language, flow, and patient comfort. I relied on Schuiling and Likis (2020) for the structured framework, particularly the OLD CARTS mnemonic and the gynecologic health history domains. Transforming these into conversational questions demanded intentional phrasing to avoid sounding mechanical. I began with confidentiality and rapport-building, which establish trust before introducing sensitive topics. The script then logically moved from general health to intimate areas, such as sexual health and safety. This structure mirrors recommendations from the NPWH Well Woman Visit app, which organizes preventive guidelines by age and risk, ensuring comprehensive, patient-centered care.

Implementing the script highlighted challenges in asking questions about intimate partner violence, sexual trauma, and gender identity. These topics carry potential for patient distress, and clinicians must balance thoroughness with sensitivity. Combining a thorough, scripted history with thoughtful preventive questions ensures equitable, patient‑centered care that addresses the whole person. I found that using normalizing statements such as “I ask these questions to everyone” reduces stigma and increases disclosure. Similarly, contraceptive counseling guided by iContraception applies WHO criteria without judgment. The challenge lies in adapting scripted language to each patient’s emotional state, ensuring that difficult questions are asked respectfully and empathetically.

The most insightful aspect of developing the script was recognizing the importance of inclusive language. Asking patients about pronouns, sexual orientation, and gender identity affirms their identity and builds trust. I realized that assumptions can alienate patients, while inclusivity fosters openness. Another insight was the role of social determinants of health. Questions about housing, food access, and employment revealed how external factors shape health outcomes. Integrating these into the script ensures a holistic approach. I also learned that preventive care guidelines must be tailored to age and population. This step reinforced the need for individualized care within standardized frameworks, balancing evidence‑based practice with patient‑centered communication.

If I were to revise my script, I would focus on pacing and patient comfort. Allowing more time for sensitive topics ensures patients feel heard and respected. I would also incorporate culturally sensitive phrasing, recognizing that health beliefs vary across communities. For example, discussing contraception may require acknowledging religious or cultural perspectives. Improving transitions between topics, such as moving from general health to sexual health, would maintain flow and reduce discomfort. Additionally, I would ensure privacy during sensitive discussions, especially with adolescents. These adjustments would enhance patient trust and improve the quality of information gathered, making the health history more effective and compassionate.

Social determinants of health emerged as critical in shaping patient experiences. Safe housing, transportation, and neighborhood conditions influence access to care. Racism, discrimination, and violence affect mental and physical health outcomes. Education, job opportunities, and income stability determine whether patients can afford medications or attend appointments. Access to nutritious food and opportunities for physical activity impacts chronic disease prevention. Environmental factors such as polluted air and water disproportionately affect marginalized communities. Language and literacy skills determine whether patients can navigate healthcare systems and understand instructions. Providers can identify disparities by systematically addressing these domains in the health history and tailor interventions to promote equity and holistic well‑being.

As a nurse practitioner, I could implement community resources to address SDOH by partnering with local organizations. I would create a resource guide listing food banks, transportation vouchers, legal aid for housing discrimination, and shelters of domestic violence victims. Establishing referral pathways to social workers embedded within the clinic would assist patients with benefits enrollment. I would advocate for universal SDOH screening during well-woman visits, using validated tools such as the AHRQ ePSS. Educational materials in plain language and interpreter services would support patients with low literacy or limited English proficiency. According to Schuiling and Likis (2020), combining a thorough, scripted history with evidence-based screening tools ensures equitable, patient-centered care that addresses the whole person.

 

 

References

Huynh, K., Brito, J. P., Bylund, C. L., Prokop, L. J., & Ospina, N. S. (2023). Understanding diagnostic conversations in clinical practice: A systematic review. Patient Education and Counseling, 116, 107949. https://doi.org/10.1016/j.pec.2023.107949

Schuiling, K. D., & Likis, F. E. (2020). Gynecologic History and Physical Examination. In Gynecologic Health Care: With an Introduction to Prenatal and Postpartum Care (4th ed.). Jones & Bartlett Learning.

Wilson-Liverman, A., Stec, M., Cocco, A. S., & Smith, M. (2025). Rise of advanced practice professionals in women’s health. Obstetrics and Gynecology Clinics, 52(4), 757-771. https://doi.org/10.1016/j.ogc.2025.07.011

 

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TAKING A HEALTH HISTORY: BUILDING A HEALTH HISTORY: ASKING DIFFICULT QUESTIONS

Much of an archeologist’s work is done under the mantra “proceed with caution.” Archeologists must dutifully secure permissions to access sites. They also must exercise extreme caution when excavating or analyzing in a lab to avoid potential damage to historical artifacts.

Likewise, nurse practitioners must proceed with caution when building a patient’s health history. Important questions can be difficult for both nurse and patient. Care must be taken to approach such questions with dignity, tact, and respect to create an environment conducive to productive conversations.

More importantly in today’s society, the possible Social Determinants of Health for each of our patient’s also needs to be taken into consideration

For this Assignment, you will develop a make-believe script to be used when you first encounter a patient for a well woman appointment.

RESOURCES

 

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

 

LEARNING RESOURCES

Required Readings

  • Schuiling, K. D., & Likis, F. E. (2022). Gynecologic health care (4th ed.). Jones and Bartlett Learning.
    • Chapter 6, “Gynecologic Anatomy and Physiology” (pp. 87–98)
    • Chapter 7, “Gynecologic History and Physical Examination”?(pp. 99–124)?(Previously read in Week 1)
    • Chapter 9, “Periodic Screening and Health Maintenance” (pp. 149–164)
    • Chapter 12, “Sexuality and Sexual Health” (pp. 211–228)
    • Chapter 13, “Contraception” (pp. 236–266)
    • Chapter 14, “Menopause” (pp. 267–291)
    • Chapter 15, “Intimate Partner Violence” (pp. 295–307)
    • Chapter 16, “Sexual Assault” (pp. 313–329)

SCREENING GUIDELINES

ADULT GERONTOLOGY RESOURCES

RESOURCES FOR LGBTQ+

APPS FOR COMMON SCREENINGS

The following common screening apps will require a download or install into your personal device for you to access. Note: Should you have any technical issues, you will need to contact the rightsholder of the app itself and not Walden Student Support for any assistance.

Note: This download is available for Android devices only.

Note: This download is available for iOS devices only.

Note: This webpage will provide you with downloads for both iOS and Android Devices.

CLINICAL GUIDELINE RESOURCES

Required Media

  • Taking a Health History
    Dr. Marianne Shaughnessy discusses one of the most critical components of the nurse/patient relationship—the health interview with the patient. She further discusses how to conduct a health history interview with demonstration (16 mins).
  • Women’s Issues and Tough ConversationsLinks to an external site.
    In this interactive media program, Dr. Rebecca Lee and Cindy Nypaver describe their experiences related to women’s issues and tough conversations (5 mins).

Optional Resources

Note: In Weeks 1-10, these resources are optional for your review. In Week 11, you will be required to review each of the PowerPoint slides from the text Gynecologic Health Care (4th ed.).

To prepare:

  • 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)
    • Safe housing, transportation, and neighborhoods
    • Racism, discrimination, and violence
    • Education, job opportunities, and income
    • Access to nutritious foods and physical activity opportunities
    • Polluted air and water
    • Language and literacy skills
    • SDOH also contribute to wide health disparities and inequities.
    • 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.

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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:
    • A brief summary of your experiences in developing and implementing your script during your health history.
    • Explanations of what you might find difficult when asking these questions. What you found insightful and what would you say or do differently.
    • As a NP, what could you implement in your community to provide resources/assistance of the Social Determinants of Health.

ReminderLinks to an external site.: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting.

BY DAY 7 OF WEEK 2

Submit your Module 1 Assignment by Day 7 of Week 2.

SUBMISSION INFORMATION

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.

  1. To submit your completed assignment, save your Assignment as M1Assgn_LastName_Firstinitial
  2. Then, click on Start Assignment near the top of the page.
  3. Next, click on Upload File and select Submit Assignment for review.

Rubric

NRNP_6552_Module1_Assignment_Rubric

NRNP_6552_Module1_Assignment_Rubric
Criteria Ratings Pts
This criterion is linked to a Learning OutcomeDescribe the components of a comprehensive gynecologic complete health history. Include considerations for special populations such as LGBTQ+ individuals,,. What health maintenance guidelines should be included during the initial and follow up assessments. (i.e., bone density test, Gardasil vaccine, shingles, etc.)?..What questions would you consider in your patient’s assessment?
30 to >26.7 ptsExcellent

The response provides clear, complete, and appropriate descriptions of a comprehensive gynecologic complete health history. Health maintenance guidelines are clear and complete.

 26.7 to >23.7 ptsGood

The response provides clear, complete, and most of the components of a comprehensive gynecologic complete health history. Most health maintenance guidelines are included and appropriate.

 23.7 to >20.7 ptsFair

The response provides components of the gynecologic health history but they are incomplete, vague or inaccurate. Health maintenance guidelines are somewhat complete or inappropriate applied.

 20.7 to >0 ptsPoor

The response provides unclear, incomplete, or inappropriate components of the gynecologic health history. Health maintenance guidelines are missing, incorrect, or inappropriate applied.
30 pts
This criterion is linked to a Learning OutcomeBuilding a Health History: Asking Difficult Questions… Create your own script for building a health history. Consider the type of language you would use to help your patient be more comfortable). Ensure you include the difficult questions required to complete a thorough health history.
25 to >22.3 ptsExcellent

The script contains a complete set of questions, including difficult questions, necessary to build a health history. Questions are phrased in a manner that supports the patients comfort.

 22.3 to >19.75 ptsGood

The script contains a mostly complete set of questions, including difficult questions, necessary to build a health history. Most questions are phrased in a manner that supports the patients comfort.

 19.75 to >17.25 ptsFair

The script containing some relevant questions, including a few difficult questions. Information collected provides a cursory health history. Questions are not phrased in a supportive tone.

 17.25 to >0 ptsPoor

The script contains few or no relevant questions, including few or no difficult questions. Information collected is not sufficient to provide an adequate health history. Questions are not phrased in a supportive tone.
25 pts
This criterion is linked to a Learning OutcomeIn addition to your script for building a health history for this assignment, include a separate section called “Reflection”… Briefly reflect and provide a summary of your experiences in developing your script during your health history.
30 to >26.7 ptsExcellent

The response provides an accurate, clear, and complete summary of experiences in developing the script during the health history

 26.7 to >23.7 ptsGood

The response provides an accurate summary of experiences in developing the script during the health history

 23.7 to >20.7 ptsFair

The response provides a vague, inaccurate, or incomplete summary of the experiences in developing the script during the health history

 20.7 to >0 ptsPoor

The response provides a vague, inaccurate, or incomplete summary of the experiences in developing the script during the health history, or the summary is missing.
30 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – Paragraph Development and Organization:Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria.
5 to >4.45 ptsExcellent

Paragraphs and sentences follow writing standards for flow, continuity, and clarity… A clear and comprehensive purpose statement, introduction, and conclusion is provided which delineates all required criteria.

 4.45 to >3.95 ptsGood

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time… Purpose, introduction, and conclusion of the assignment is stated, yet is brief and not descriptive.

 3.95 to >3.45 ptsFair

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time… Purpose, introduction, and conclusion of the assignment is vague or off topic.

 3.45 to >0 ptsPoor

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time… No purpose statement, introduction, or conclusion was provided.
5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English writing standards:Correct grammar, mechanics, and proper punctuation
5 to >4.45 ptsExcellent

Uses correct grammar, spelling, and punctuation with no errors.

 4.45 to >3.95 ptsGood

Contains a few (1 or 2) grammar, spelling, and punctuation errors.

 3.95 to >3.45 ptsFair

Contains several (3 or 4) grammar, spelling, and punctuation errors.

 3.45 to >0 ptsPoor

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.
5 to >4.45 ptsExcellent

Uses correct APA format with no errors.

 4.45 to >3.95 ptsGood

Contains a few (1 or 2) APA format errors.

 3.95 to >3.45 ptsFair

Contains several (3 or 4) APA format errors.

 3.45 to >0 ptsPoor

Contains many (≥ 5) APA format errors.
5 pts
Total Points: 100

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