Response to colleague discussion

WK 1 Main post

Case C 38-year-old Native American pregnant female living on a reservation.

Summary of the interview and communication techniques

To start with, I should be aware of my biases and prejudices. I need to understand myself well as a professional. I should resist forming a patient’s sense based on prior knowledge of her race, religion, gender, ethnicity, and sexual orientation or culture as these factors interfere with my understating of the patient. I will use the RESPECT model introduced by Think Cultural Health by the U.S. Department of Health and Human Services Office. This Model is used to be effective in cross-cultural communication, whether verbal, nonverbal or written. It is used to remain open and maintain a sense of respect for our patients (Ball, 2019).

I would use the principle of patient-centered care. The Institute of Medicine defines the principle as respecting and responding to patients’ wants, needs and preferences so that they can make choices in their care (Ball, 2019). I am aware that the patient is a native American, and I should be culture-sensitive. Effective communication is needed to make the interaction clear and understood by the parties and allow the patient to articulate the care plan. I need to invoke patient participation by asking questions and giving responses not just on the physical nature of the health problem alone but also on social and emotional issues. This can be done by asking open-ended questions, active listening, gentle guidance, polite redirection, and avoiding extreme reactions (Ball, 2019).

I would provide courtesy, comfort, connection, and confirmation in my interaction with the patient. I would also assure the patient that I care, and mending worry or pain is my prime concern. I will set everyone as comfortable as possible. I will position myself where there are no barriers like bulky desks or tables, or computer screens. I will sit comfortably and maintain eye contact and a conversational tone of voice.

Assessment consideration

A pregnant patient is influenced by many factors, including previous experiences with childbearing and childrearing, relationship with the patient’s parent and other individuals significant to her life, desire for children, and present life circumstances. My initial interview will include past history, health practices assessment, potential risk factors identification, and assessment of the patient’s knowledge, expectations, and perceptions as they affect her pregnancy.

I would start by asking for basic information like her age and ethnicity, marital status. I will then ask regarding her LMP, previous usual/normal menstrual period, and occupation. I will take into account her description of her current pregnancy and identify previous medical care. This part of the interview also needs to ask for specific problems like bleeding, spotting, nausea, vomiting, fatigue or edema, illnesses, injuries, surgeries, or accidents, or other injuries during conception. The next part of the interview will be regarding her obstetric history, which will include the number of pregnancies, living children, multiple births, miscarriages, abortions, duration of pregnancy, each type of delivery, and complications during any pregnancy or postpartum period or with neonate and use of oral or other contraceptives. We will then discuss her gynecologic history, which will include her most recent pap smear and HPV test together with the history of abnormalities, treatment, or gynecologic surgery. It is also essential to ask regarding sexual history, including the age of first intercourse and whether it was consensual, number of sex partners, safe-sex methods, and partner orientation. Information regarding contraceptive use and reasons for discontinuing, history of infertility should also be explored. I will give full attention to any history of sexual assault. Then we will move on to discuss the past medical history, which will include risk factors for HIV, hepatitis, herpes, TB, and exposure to environmental and occupational hazards. Family history is also part of the interview, where I will obtain a family history of genetic conditions, multiple births, gestational diabetes, eclampsia, and congenital anomalies. Personal and social history will be accounted as well by asking regarding other children, or pets, her feeling towards the pregnancy. A review of systems should also be done. I will give special attention to the reproductive system and cardiovascular systems. Assessment on the endocrine system for signs of diabetes and thyroid dysfunction should also be focused on. I will assess her for urinary tract infection and respiratory function because it may cause a late pregnancy problem or with tocolytic therapy for preterm labor. I will also evaluate dental care as a treatment for periodontitis that can prevent preterm birth or low birth weight. Risk assessment should also be included by identifying factors that threaten the wellbeing of the fetus and the patient. I will ask for concluding questions to give her further opportunities. I will ask her, “is there anything else that you want me to know.”

Risk assessment instrument

American Indian women are especially at risk for health disparities related to a lack of early and ongoing prenatal health care. The reasons behind the lack of prenatal health care are complex and varying. The forces influencing a woman’s attitude toward prenatal care can be social, psychological, behavioral, environmental, biological, or sociodemographic. Besides physical barriers to seeking care (i.e., time, cost, lack of transportation), barriers to prenatal care can also include internal thoughts and emotions unique to the individual, such as mental health issues, problems with substance abuse, or a history of domestic violence (Hanson, 2012).

Interviews with American Indian women in the Northern Plains uncovered several communication barriers within prenatal health care. Some of these communication barriers included providers who seemed too busy to ask or respond to patient-related questions, feeling that the physician did not care about the patient or their reasons for seeking care, and an overall lack of trust of providers, especially White physicians and “modern ways of medicine” (Hanson, 2012).

With this patient, I will conduct a risk assessment on a healthy dietary pattern during pregnancy that promotes fetal growth and development and has been associated with lower risks of pregnancy complications. In contrast, unhealthy dietary habits, undernutrition, and overnutrition have been associated with adverse pregnancy outcomes. Thus, it is essential to evaluate and monitor maternal nutrition both before and during pregnancy, and when appropriate, make changes to improve maternal nutrition (Department of Nutrition, n.d.).

I choose to assess the patient’s nutritional status using the nutrition in pregnancy: Assessment and counseling by Department of Nutrition, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA. I choose this risk assessment tool because adequate nutrition during the periconceptional and prenatal periods is vital for healthy pregnancy outcomes. By enhancing maternal nutritional status, health care providers can help pregnant women lower their risk of certain pregnancy complications (Department of Nutrition, n.d.). Many pregnant individuals in the United States have suboptimal diet quality, which began preconception, and most do not meet dietary recommendations. This is especially true among groups at elevated risk for adverse pregnancy outcomes. National Health and Nutrition Examination Survey (NHANES) data indicate that, on average, pregnant or lactating people consume half the recommended number of total vegetables and dairy products (Carmichael, 2019).

Targeted Questions

My targeted questions will be the following:

  1. Are you frequently bothered by nausea, vomiting, heartburn, or constipation?
  2. Do you skip meals at least three times a week?
  3. Do you try to limit the amount or kind of food you eat to control your weight?
  4. Are you on a special diet now?
  5. Do you avoid any foods for health or any other reasons?

Reference:

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.

Carmichael SL, Ma C, Feldkamp ML, Shaw GM. 2019. National Birth Defects Prevention Study. Comparing Usual Dietary Intakes Among Subgroups of Mothers in the Year Before Pregnancy. Public Health Rep. 2019;134(2):155. Epub 2018 Dec 28. 

Department of Nutrition. n.d. The Right Food for All. DOI: https://sph.unc.edu/nutr/unc-nutrition/

Hanson J. D. (2012). Understanding prenatal health care for American Indian women in a Northern Plains tribe. Journal of transcultural nursing : official journal of the Transcultural Nursing Society23(1), 29–37. https://doi.org/10.1177/1043659611423826

Think Cultural Health. n.d. RESPECT MODEL. DOI: https://thinkculturalhealth.hhs.gov/assets/pdfs/resource-library/respect-model.pdf

 

 

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WK 1 Main post

Case C 38-year-old Native American pregnant female living on a reservation.

Summary of the interview and communication techniques

To start with, I should be aware of my biases and prejudices. I need to understand myself well as a professional. I should resist forming a patient’s sense based on prior knowledge of her race, religion, gender, ethnicity, and sexual orientation or culture as these factors interfere with my understating of the patient. I will use the RESPECT model introduced by Think Cultural Health by the U.S. Department of Health and Human Services Office. This Model is used to be effective in cross-cultural communication, whether verbal, nonverbal or written. It is used to remain open and maintain a sense of respect for our patients (Ball, 2019).

I would use the principle of patient-centered care. The Institute of Medicine defines the principle as respecting and responding to patients’ wants, needs and preferences so that they can make choices in their care (Ball, 2019). I am aware that the patient is a native American, and I should be culture-sensitive. Effective communication is needed to make the interaction clear and understood by the parties and allow the patient to articulate the care plan. I need to invoke patient participation by asking questions and giving responses not just on the physical nature of the health problem alone but also on social and emotional issues. This can be done by asking open-ended questions, active listening, gentle guidance, polite redirection, and avoiding extreme reactions (Ball, 2019).

I would provide courtesy, comfort, connection, and confirmation in my interaction with the patient. I would also assure the patient that I care, and mending worry or pain is my prime concern. I will set everyone as comfortable as possible. I will position myself where there are no barriers like bulky desks or tables, or computer screens. I will sit comfortably and maintain eye contact and a conversational tone of voice.

Assessment consideration

A pregnant patient is influenced by many factors, including previous experiences with childbearing and childrearing, relationship with the patient’s parent and other individuals significant to her life, desire for children, and present life circumstances. My initial interview will include past history, health practices assessment, potential risk factors identification, and assessment of the patient’s knowledge, expectations, and perceptions as they affect her pregnancy.

I would start by asking for basic information like her age and ethnicity, marital status. I will then ask regarding her LMP, previous usual/normal menstrual period, and occupation. I will take into account her description of her current pregnancy and identify previous medical care. This part of the interview also needs to ask for specific problems like bleeding, spotting, nausea, vomiting, fatigue or edema, illnesses, injuries, surgeries, or accidents, or other injuries during conception. The next part of the interview will be regarding her obstetric history, which will include the number of pregnancies, living children, multiple births, miscarriages, abortions, duration of pregnancy, each type of delivery, and complications during any pregnancy or postpartum period or with neonate and use of oral or other contraceptives. We will then discuss her gynecologic history, which will include her most recent pap smear and HPV test together with the history of abnormalities, treatment, or gynecologic surgery. It is also essential to ask regarding sexual history, including the age of first intercourse and whether it was consensual, number of sex partners, safe-sex methods, and partner orientation. Information regarding contraceptive use and reasons for discontinuing, history of infertility should also be explored. I will give full attention to any history of sexual assault. Then we will move on to discuss the past medical history, which will include risk factors for HIV, hepatitis, herpes, TB, and exposure to environmental and occupational hazards. Family history is also part of the interview, where I will obtain a family history of genetic conditions, multiple births, gestational diabetes, eclampsia, and congenital anomalies. Personal and social history will be accounted as well by asking regarding other children, or pets, her feeling towards the pregnancy. A review of systems should also be done. I will give special attention to the reproductive system and cardiovascular systems. Assessment on the endocrine system for signs of diabetes and thyroid dysfunction should also be focused on. I will assess her for urinary tract infection and respiratory function because it may cause a late pregnancy problem or with tocolytic therapy for preterm labor. I will also evaluate dental care as a treatment for periodontitis that can prevent preterm birth or low birth weight. Risk assessment should also be included by identifying factors that threaten the wellbeing of the fetus and the patient. I will ask for concluding questions to give her further opportunities. I will ask her, “is there anything else that you want me to know.”

Risk assessment instrument

American Indian women are especially at risk for health disparities related to a lack of early and ongoing prenatal health care. The reasons behind the lack of prenatal health care are complex and varying. The forces influencing a woman’s attitude toward prenatal care can be social, psychological, behavioral, environmental, biological, or sociodemographic. Besides physical barriers to seeking care (i.e., time, cost, lack of transportation), barriers to prenatal care can also include internal thoughts and emotions unique to the individual, such as mental health issues, problems with substance abuse, or a history of domestic violence (Hanson, 2012).

Interviews with American Indian women in the Northern Plains uncovered several communication barriers within prenatal health care. Some of these communication barriers included providers who seemed too busy to ask or respond to patient-related questions, feeling that the physician did not care about the patient or their reasons for seeking care, and an overall lack of trust of providers, especially White physicians and “modern ways of medicine” (Hanson, 2012).

With this patient, I will conduct a risk assessment on a healthy dietary pattern during pregnancy that promotes fetal growth and development and has been associated with lower risks of pregnancy complications. In contrast, unhealthy dietary habits, undernutrition, and overnutrition have been associated with adverse pregnancy outcomes. Thus, it is essential to evaluate and monitor maternal nutrition both before and during pregnancy, and when appropriate, make changes to improve maternal nutrition (Department of Nutrition, n.d.).

I choose to assess the patient’s nutritional status using the nutrition in pregnancy: Assessment and counseling by Department of Nutrition, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA. I choose this risk assessment tool because adequate nutrition during the periconceptional and prenatal periods is vital for healthy pregnancy outcomes. By enhancing maternal nutritional status, health care providers can help pregnant women lower their risk of certain pregnancy complications (Department of Nutrition, n.d.). Many pregnant individuals in the United States have suboptimal diet quality, which began preconception, and most do not meet dietary recommendations. This is especially true among groups at elevated risk for adverse pregnancy outcomes. National Health and Nutrition Examination Survey (NHANES) data indicate that, on average, pregnant or lactating people consume half the recommended number of total vegetables and dairy products (Carmichael, 2019).

Targeted Questions

My targeted questions will be the following:

  1. Are you frequently bothered by nausea, vomiting, heartburn, or constipation?
  2. Do you skip meals at least three times a week?
  3. Do you try to limit the amount or kind of food you eat to control your weight?
  4. Are you on a special diet now?
  5. Do you avoid any foods for health or any other reasons?

Reference:

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.

Carmichael SL, Ma C, Feldkamp ML, Shaw GM. 2019. National Birth Defects Prevention Study. Comparing Usual Dietary Intakes Among Subgroups of Mothers in the Year Before Pregnancy. Public Health Rep. 2019;134(2):155. Epub 2018 Dec 28. 

Department of Nutrition. n.d. The Right Food for All. DOI: https://sph.unc.edu/nutr/unc-nutrition/

Hanson J. D. (2012). Understanding prenatal health care for American Indian women in a Northern Plains tribe. Journal of transcultural nursing : official journal of the Transcultural Nursing Society23(1), 29–37. https://doi.org/10.1177/1043659611423826

Think Cultural Health. n.d. RESPECT MODEL. DOI: https://thinkculturalhealth.hhs.gov/assets/pdfs/resource-library/respect-model.pdf

 

 

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response to colleague discussion

The health history interview is key in building the advanced practice clinician’s knowledge base by providing awareness of an individual health, habits, and risks. With that said, the stability of this key foundational information is only as solid as one’s ability to gather the information from the patient and their willingness to share. This weeks’ module has discussed strategies in communication tools/assessment tools that aid in efficient and thorough information gathering and rapport building.

This weeks’ scenario has me interviewing a 14-year-old biracial male living with his grandmother in a high-density public housing complex.The other scenarios include:

38-year-old Native American pregnant female living on a reservation Adolescent Hispanic/Latino boy living in a middle-class suburb

Pre-school-aged white female living in a rural community

 

How would your communication and interview techniques for building a health history differ with each patient?

38-year-old Native American pregnant female living on a reservation

 I would ensure a translator was available if needed. I would have a female colleague in the room as well if deemed favorable by the patient. I would ensure furniture arranged on equal planes and adequate spaced. I would ensure my body language was open and I would be active listening. I would que questions in open ended format and promote a sense of trust and compassion. “The topic of reproductive rights is particularly sensitive because of recent forced sterilization practices and should be remembered and respected by physicians when discussing family planning with AI/AN women”.(Cordova-Marks et al., 2020)

 

Pre-school-aged white female living in a rural community

This interview will be conducted with caretaker in the exam room. This interview would be geared toward gathering information of developmental progress as well as ensuring needs of care and safety are met by the caretaker. My questions toward the patient would be at their age level and using props if needed. This interview includes the caretaker as well, building rapport not only with the patient but the caretaker also.

Adolescent Hispanic/Latino boy living in a middle-class suburb

I would ensure a translator was available if needed. I would allow him to decide if he would like to interview independently of any caretaker. This would allow him a since of independence and trust. I would utilize open ended questions and relate to him on a personal level. I want to convey a since of understanding and non-bias answer to his questions/concerns.

(My Assigned Scenario)14-year-old biracial male living with his grandmother in a high-density public housing complex

I would allow him to decide if he would like to interview independently of any caretaker. I would arrange furniture ensuring all are the same level and adequately spaced. I would utilize open ended questions and begin by extracting interests. My attempts would be to gain trust and provide a sense of understanding through active listening and questioning. I would relate to the patient and discuss topics in his/her level of understanding and jargon. 

How might you target your questions for building a health history based on the patient’s social determinants of health? (14-year-old biracial male living with his grandmother in a high-density public housing complex)

 

I would first assess the current health of the patient upon initial meeting. This would gauge the direction of my questioning regarding social determinants of health. I would strive to build a trusting relationship prior to engaging in such. I would also prefer to converse privately. “It is important to make clear to both parent and patient that seeing the young person alone is routine and will allow them to start taking responsibility for their own health, increasing independence and encouraging them to freely speak about their worries and health concerns” (Doukrou & Segal, 2018). A screening tool available specifically for social determinants is the social needs screening tool by the American Academy of Family Physicians. “Screening and coordinating services to meet social needs is an opportunity to reduce physician and staff burnout related to the inertia of improving health in communities where social and policy barriers prevent us from doing so”(O’Gurek & Henke, 2018).

 

Select one of the risk assessment instruments presented in Chapter 1 or Chapter 5 of the Seidel’s Guide to Physical Examination text, or another tool with which you are familiar, related to your selected patient.

Develop at least five targeted questions you would ask your selected patient to assess his or her health risks and begin building a health history

 

I decided to utilize the HEEADSSS risk assessment instrument to screen the assigned scenario of a 14-year-old biracial male living with his grandmother in a high-density public housing complex. The acronym HEEADDSSS is for: home, education/employment, eating, activities, drugs, sexuality, suicidal ideation, and safety. I strongly feel this screening tool would be useful for this scenario as it is broad, covering many factors. My concern would be pressured social influences with the potential of little adult supervision and opportunities to partake in risky behaviors. With that said, I would further my interview utilizing a CRAFFT tool focusing on alcohol and drug abuse.

The five targeted questions I identified as pertinent would be based from the CRAFFT tool which include:

 

C—Have you ever ridden in a Car driven by someone that was high or had been using drugs or alcohol?

 

R—Do you ever use alcohol or drugs to Relax, feel better about yourself?

 

A—Do you ever use drugs or alcohol when you are Alone?

 

F—Do you Forget things you did while using drugs or alcohol?

 

F—Do your Family and Friends ever tell you that you should cut down your drinking or drug usage?

 

T—Have you ever gotten into Trouble while using drugs or alcohol?

 

Two or more yes answers suggest high risk of a serious substance-use problem or a substance-use disorder.

(Doukrou & Segal, 2018)

 

In review, there are many useful screening tools for health screening of adolescents. This population is particularly vulnerable mentally and socially, requiring foresight and understanding to numerous variables. The interviewer must gain trust and foster an environment of safety, promoting a climate that fosters accurate information gathering. This population must understand the role of confidentiality and the need to notify persons if an unsafe situation is unveiled. “Empowering young people to take responsibility for their health will allow them to use the appropriate health services and lead healthier lives”(Doukrou & Segal, 2018). Adolescents health assessment would follow review of systems and SAMPLE (symptom, allergies, medication, past medical history, last po intake, events leading up to) as that of adult clients. However, we must ensure mental and socioeconomic risks are being evaluated and supported as needed.

 

Reference

 

Cordova-Marks, F., Fennimore, N., Bruegl, A., & Erdrich, J. (2020). What Should Physicians Consider About American Indian/Alaska Native Women’s Reproductive Freedom? AMA Journal of Ethics, 22(10), 845–850. https://doi.org/10.1001/amajethics.2020.845

Doukrou, M., & Segal, T. Y. (2018). Fifteen-minute consultation: Communicating with young people—how to use HEEADSSS, a psychosocial interview for adolescents. Archives of Disease in Childhood – Education and Practice, 103(1), 15–19. https://doi.org/10.1136/archdischild-2016-311553

O’Gurek, D. T., & Henke, C. (2018). A Practical Approach to Screening for Social Determinants of Health. Family Practice Management, 25(3), 7–12. https://www.aafp.org/fpm/2018/0500/p7.html

 

 

 

 

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When you pay us, you are paying for a near perfect paper and the time convenience. 

Upon completion, we will send the paper to via email and in the format you prefer (word, pdf or ppt). 

Yes, we have an unlimited revision policy. If you need a comma removed, we will do that for you in less than 6 hours. 

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Yes, through email and messages, we will keep you updated on the progress of your paper. 

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And then follow the progressive flow. 

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