According to Sullivan (2019), “The comprehensive history and physical examination is the vehicle used to document not only the patient’s medical history but also the physical examination findings, diagnosis or medical problems, diagnostic studies to be performed, and initial plan of care implemented to address any problems identified” (p. 19). When healthcare providers fail to take a detailed history or recognize essential findings, it leads to inadequate care of the patient. Dains, Baumann, and Scheibel (2016) found that all patients that arrive at the clinic does not have acute symptoms and the healthcare provider does health screenings on asymptomatic adults and children and develop evidence-based guidelines for prevention and screening interventions. Evidenced-based screenings services help improve the overall quality of care for the individual. When a healthcare provider asks the correct questions and uses clinical reasoning to help for applying the best evidence to clinical practice, they become more efficient. Ball, Dains, Flynn, Solomon, and Stewart (2015) mentioned that the relationship with the patient and family begins with good behaviors. The relationship is well-established from a therapeutic effect of really listening to what the child’s parents say, exploring hidden concerns and explaining information without being bias.
Healthcare providers must not predict individual character from the basis of common cultural behavior or stereotype because it is not appropriate however the appropriate thing to do is understand and take the common cultural behavior into account. Questions that explore the patient’s culture should be addressed to the parents or caregivers to gain insight about the individual to help avoid stereotyping and lead to a true individualization of care. Because the family of the 5-year-old boy is opposed to the child receiving any vaccines, Canadian Paediatric Society (2018) mentioned that vaccine hesitancy is a growing health concern around the globe and is labeled as a barrier to immunization program success. Healthcare providers play an essential role in fostering vaccine acceptance among vaccine-hesitant parents that outright refuse certain or all recommended vaccines. Healthcare providers must form a decision-making partnership in the best interest of the children. As an advanced practice nurse, I would respond to scenario 1 by forming a decision-making partnership in the best interest of the child. It is my responsibility to protect the child and the public by educating the parents on the importance of vaccinations. As stated by the Canadian Paediatric Society (2018), healthcare providers can influence the parent’s decision to have their children vaccinated or be vaccinated themselves. Information obtained from a physician has fewer concerns than information relied on by friends, family or the internet. Educating children’s parents on the benefits of vaccination along with the risks of vaccine-preventable disease is critical to helping parents in decision making. Providers should show knowledge as well as care and compassion. Using a presumptive approach like “He needs to be immunized today” will likely result in vaccine acceptance than a participatory approach such as “What do you want to do about his vaccines?” With the presumptive approach, parental concerns must be addressed in a non-judgmental, non-confrontational manner. Parents will accept vaccines when their concerns are valued and addressed appropriately even though some parents never change their minds. Once a healthcare provider has gained the parent’s trust in the immunization program, parents will change their minds and support vaccine acceptance for their children.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
Canadian Paediatric Society. (2018). Working with vaccine-hesitant parents: An update. Retrieved from https://www.cps.ca/en/documents/position/working-with-vaccine-hesitant-parents
Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.
Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.