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

            The patient I will interview is a 38-year-old Native American pregnant female living on a reservation. One very important part of building a good relationship with the patient is to build trust and help the patient feel comfortable to discuss anything she may need. It is important for me as the provider to have courtesy and build a connection with the patient (Ball, et al., 2019). Having kindness and building rapport with a patient is a great way for the patient to open up and for me to truly let the patient know they are valued and cared for.

            The approach I like best is the patient-centered approach. When this approach is used, patients are fully involved in their health care decisions. This is part of rapport building but also helps give the patient a feeling of autonomy, engagement, and control of their health (Bridges, et al., 2018). Health care is better when a patient feels respected and part of the decision process. Especially in this case of the pregnant Native American patient because when it comes to different cultures and when a patient is put first, their culture is not only acknowledged but included with sensitivity in their health care. The patient may have holistic care she would like to use or other cultural factors that I may not be fully aware of.

Order Custom Assignment 

As this patient’s provider, I would first meet the patient and ask her to tell me about herself. I would ask questions about her family and her support group. I would see what support and resources she has. I would see if she had health insurance through the government and see if she was aware of the resources available to her. According to Kramer et al. (2009) many Native American women have health disparities and do not access all the benefits they could receive through Indian Health care Services. I would make sure she had information given to her in order to speak to someone to utilize the services she could receive.

I would ask her about her familial history. Finding out about the patient’s risk is very important when assessing a pregnant female. When a provider can truly know the risks the patient may have and can talk about the perceived risks the patient may think they may have, then come to an agreeable level of risk, the baby’s health is positively associated with the congruence of knowledge (Cannella et al., 2013). It is important to truly know all the risk factors and perceived risk factors the patient may have. When the patient is given the time to talk and is not rushed, she may open up a bit more to me as her provider as well. It is important to be patient and to give the patient time to open up.

I would also feel it is part of my duty as a provider to ensure the patient has a safe place to live to ensure the baby gets good prenatal and postnatal care. The patient may not know the importance of eating healthy, taking prenatal vitamins, or about certain foods or drinks in a diet that are good or bad for her. It is important for the provider to make sure the patient knows their social determinants of health. Depending on the patient’s knowledge, she may not know about all the certain risks her culture, age, or health history may have in her pregnancy. According to Tesfalul et al. (2021) some providers do not tell the patients all their potential risks or determinants for health due to anxiety or knowing how to properly tell them. I would find it my duty to learn about and help my patients know about their social determinants of health. Some things would be about diabetes, living conditions, or even age, as over 35 years is considered a geriatric pregnancy. It is my job to recognize the potential risks and let the patient know of them and assess and manage her healthcare according to her social determinants of health.

I would ask my patient is she felt at risk for her or her child’s wellbeing or safety. I would want to make sure she felt safe and free from violence, poverty, or even mental health. I also definitely would make sure my patient felt she had good support during her pregnancy. I would ask the following questions:

1. Whom do you live with?
2. Do you feel safe in your home?
3. Was your pregnancy planned?
4. Do you have a partner that supports you?
5. Do you feel depressed or sad in any way?
6. What more could I do for you regarding your pregnancy so you feel supported so you can have a safe and successful pregnancy?

In conclusion, I would want to make sure that my patient leaves the first appointment feeling safe, knowledgeable, and supported. I want her to know I care about her and want the best care for her. I also want her to know I will respect any cultural decisions she makes in her health care. It is also important she knows of potential risks if she does not have good health care while pregnant. I would want to make sure she takes her vitamins, has a healthy diet, feels safe in her environment, and takes the necessary tests since she is considered a geriatric pregnancy. I would make sure she leaves my office feeling aware and empowered in her health care supported during her pregnancy. It is important to know the patient’s history and also future plan and ensure she is making the best decisions possible for her to have a successful and healthy pregnancy.

References

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.). Elsevier Mosby.

Bridges, J. F., Crossnohere, N. L., Schuster, A. L., Miller, J. A., Pastorini, C., & Aslakson, R. A. (2018). A patient and community-centered approach selecting endpoints for a randomized trial of a novel advance care planning tool. Patient Preference & Adherence, 12, 241–249. https://doi-org.ezp.waldenulibrary.org/10.2147/PPA.S150663

Cannella, D., Auerbach, M., & Lobel, M. (2013). Predicting birth outcomes: Together, mother and health care provider know best. Journal of Psychosomatic Research, 75(4), 299–304. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jpsychores.2013.08.004

Kramer, B. J., Jouldjian, S., Washington, D. L., Harker, J. O., Saliba, D., & Yano, E. M. (2009). Health care for American Indian and Alaska Native women. Women’s Health Issues, 19(2), 135–143. https://doi-org.ezp.waldenulibrary.org/10.1016/j.whi.2008.11.002

Tesfalul, M. A., Feuer, S. K., Castillo, E., Coleman-Phox, K., O’Leary, A., & Kuppermann, M. (2021). Patient and provider perspectives on preterm birth risk assessment and communication. Patient Education and Counseling. https://doi-org.ezp.waldenulibrary.org/10.1016/j.pec.2021.03.038

Effective communication is vital to constructing an accurate and detailed patient history. A patient’s health or illness is influenced by many factors, including age, gender, ethnicity, and environmental setting. As an advanced practice nurse, you must be aware of these factors and tailor your communication techniques accordingly. Doing so will not only help you establish rapport with your patients, but it will also enable you to more effectively gather the information needed to assess your patients’ health risks.

For this Discussion, you will take on the role of a clinician who is building a health history for a particular new patient assigned by your Instructor.

Photo Credit: Sam Edwards / Caiaimage / Getty Images

To prepare:

With the information presented in Chapter 1 of Ball et al. in mind, consider the following:

• By Day 1 of this week, you will be assigned a new patient profile by your Instructor for this Discussion. Note: Please see the “Course Announcements” section of the classroom for your new patient profile assignment.
• How would your communication and interview techniques for building a health history differ with each patient?
• How might you target your questions for building a health history based on the patient’s social determinants of health?
• What risk assessment instruments would be appropriate to use with each patient, or what questions would you ask each patient to assess his or her health risks?
• Identify any potential health-related risks based upon the patient’s age, gender, ethnicity, or environmental setting that should be taken into consideration.
• 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.

Order Custom Assignment 

By Day 3 of Week 1

Post a summary of the interview and a description of the communication techniques you would use with your assigned patient. Explain why you would use these techniques. Identify the risk assessment instrument you selected, and justify why it would be applicable to the selected patient. Provide at least five targeted questions you would ask the patient.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Read a selection of your colleagues’ responses.

By Day 6 of Week 1

Respond to at least two of your colleagues on 2 different days who selected a different patient than you, using one or more of the following approaches:

• Share additional interview and communication techniques that could be effective with your colleague’s selected patient.
• Suggest additional health-related risks that might be considered.
• Validate an idea with your own experience and additional research.

Sample response

Thank you for your insightful post. It was very inclusive regarding the care you would provide to your 38-year-old pregnant native American. Women who experience gestational diabetes (GD) are at greater risk for later developing type two diabetes and increases the risk of hypertension during the pregnancy (Center for Disease Control, 2021). Education regarding prevention and monitoring for symptoms of these two diseases will be optimal for early detection and care during their pregnancy. One way for prevention in gestational diabetes would be education. According to Stotz (2019), many native American women do not know what gestational diabetes is until they are diagnosed with it. Education may be provided on what gestational diabetes is and how it can be prevented to this individual.

Another area to look at within your interview would be to be culturally sensitive. Some Native American cultures incorporate different beliefs. One question that may be asked during the interview would be: are there any belief practices that you would affect care for yourself of infant? This is an open-ended question for the individual to incorporate any beliefs that they would like for the care of themselves during the pregnancy, delivery, and postpartum care. In previous experiences I have worked on reservations in Minnesota. I have not specifically cared for women during pregnancy however, I have for geriatric patients. When they are in the dying process one ritual that comes to mind would be the burning of sage after death. At the facility I was working at we were able to accommodate this request for the family.

Center for Disease Control and Prevention.  (2021, August 10). Gestational diabetes. https://cdc.gov/diabetes/basics/gestational.html

Stotz, S., Charron-Prochownik, D., Terry, M.A., Gonzales, K., & Moore, K. (2019). Reducing risk for gestational diabetes mellitus (GDM) through a preconception counseling program for American indian/Alaska native girls: Perceptions from women with type 2 diabetes of a history of GDM. Diabetes Educator, 45(2), 137-145. https//doi-org.ezp.waldenulibrary.org/10.1177/0145721718821663