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:
- Are you frequently bothered by nausea, vomiting, heartburn, or constipation?
- Do you skip meals at least three times a week?
- Do you try to limit the amount or kind of food you eat to control your weight?
- Are you on a special diet now?
- 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 Society, 23(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:
- Are you frequently bothered by nausea, vomiting, heartburn, or constipation?
- Do you skip meals at least three times a week?
- Do you try to limit the amount or kind of food you eat to control your weight?
- Are you on a special diet now?
- 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 Society, 23(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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