Examine your colleague’s targeted questions and explain how the patient might interpret them.

Examine your colleague’s targeted questions and explain how the patient might interpret them. Discuss whether any of the questions apply to your patient and why.



Diversity in Health Assessment

To build trust and rapport with our patients, it is vital that we attempt to understand our patient’s individual cultures while exploring and respecting their beliefs. Recognizing that each patient is a unique person and that no one set of cultural standards fits all people or groups will help us adapt to the needs of our patients, which may differ greatly from our own. Ball et al. (2019) say that each group is defined by a set of traits that they all have in common, but that these traits change over time as a result of both internal and external factors (p. 22). Taking these cultural facts into consideration will help the advanced practice nurse to obtain an accurate health assessment.

Patient-Specific Factors

This case study involves a 16-year-old caucasian female whose grandparent is her caregiver due to her mother’s incarceration. The grandmother says that she is acting strangely, spending time alone, and not doing the things she used to enjoy. The grandmother is concerned about drug use, given the patient’s mother’s history of drug abuse. The patient is not on any current medications, with medical history positive for obesity.

The patient has demonstrated some concerning symptoms that might be related to psychological distress. The behavior of isolation and loss of interest in usual activities suggests we should focus on psychological assessment. Adolescence is a time that can be very challenging psychologically, and the patient may be reluctant to open up, especially in front of her grandmother. While the grandmother’s assessment of drug use is a valid concern, the adolescent may be experiencing something else.

Specific Strategies

The Expanded Four Habits Model (Lundeby et al., 2015) is a consultation model that healthcare providers can use to help patients who are experiencing emotional distress. The model consists of “four habits”:

  • Invest in the beginning: This habit involves building rapport with the patient, establishing a comfortable and safe environment, and setting the agenda for the consultation.
  • Elicit the patient’s perspective: This habit involves actively listening to their concerns, emotions, and experiences and seeking to understand their perspective.
  • Demonstrate empathy: This habit involves acknowledging the patient’s emotions and showing that you understand how they are feeling. This can help the patient feel validated and understood.
  • Invest in the end: This habit involves summarizing the discussion, addressing any remaining concerns, and discussing the next steps or referrals if necessary.

By using this model, healthcare providers can create a supportive and collaborative environment for patients in emotional distress and help them feel heard and understood. Additionally, the model can be taught to new providers to help them develop the skills needed to effectively communicate with and support patients in emotional distress.

Interview and Targeted Questions

  1. Can you tell me a little about yourself and what brings you in today?
  2. Have you been feeling any physical or emotional distress lately? If so, can you describe what you’ve been experiencing?
  3. How have these symptoms affected your daily life, such as school, relationships, or activities?
  4. Can you tell me about any recent changes or stressors in your life that may be contributing to these symptoms?
  5. How do you usually cope with difficult emotions or situations? Have you tried any strategies that have worked well for you in the past?
  6. Have you talked to anyone else about how you’re feeling, such as friends, family, or a healthcare provider? If so, can you tell me a little about those conversations?
  7. How do you feel about seeking help for your emotional distress? Are there any concerns or barriers that you’re worried about?
  8. Would you be interested in learning more about coping strategies or therapies to help manage your symptoms and improve your well-being?
  9. Can you think of any goals or changes you would like to work towards in your life related to your emotional health or other areas?
  10. Is there anything else you would like me to know about your situation or how you’re feeling?

Communicating with Different Patient Populations

As advanced healthcare providers, our ultimate goal must be to meet each patient on their own terms and where their needs lie. One of the biggest hurdles we face as providers is to understand and acknowledge our own cultural background and what biases we may hold. Being able to adapt to an unbiased viewpoint without unintentional stereotypes will help us to ask the proper questions of our patients.


Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Dang, B.N., Westbrook, R.A., & Njue, S.M. (2017).Building trust and rapport early in the new doctor-patient relationship: a longitudinal qualitative study. Retrieved February 27, 2023. from.https://doi.org/10.1186/s12909-017-0868-5Links to an external site.

Lundeby, T., Gulbrandsen, P., & Finset, A. (2015). The Expanded Four Habits Model—A teachable consultation model for encounters with patients in emotional distress. Patient Education and Counseling, 98(5), 598-603. https://doi.org/10.1016/j.pec.2015.01.015

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