38-Year-Old Pregnant Native American female living on a reservation Essay

Case Study Discussion

The case study is of a 38-year-old pregnant Native American female who lives on a reservation. When interacting with patients from any demographics, it is critical to comprehend their background and history. This will allow the healthcare professionals to tailor communication that will consider the unique patient needs. The clinician should understand the patient’s unique needs and preferences to accurately interpret assessment results (Ball et al., 2019). The clinician should use open-ended questions and open body language techniques to make the patient comfortable and enhance the clinician’s understanding of unique patient needs.

A therapeutic relationship with the patient is critical. This can be achieved by honestly communicating to the patient about care goals and risks of care (Ball et al., 2019). The therapeutic relationship is essential since it will enhance the patient’s commitment to adhere to the treatment plan throughout her pregnancy. Trust can also be built by asking the patient about her care expectations and cultural expectations. Being aware of this will help the clinician implement patient-centered care. Patient-centered care considers the values and preferences of the patient when developing a care plan (Kuipers et al., 2019).

The social determinants of health (SDH) include education level, race, and socioeconomic status. Low socioeconomic status. education levels, and lack of access to healthcare services are some of the SDH that Native Americans face, which increases the risk of mortality and morbidity for their newborns (Johnson, 2020). The patient stated that she does not have a diploma or degree. She is also unemployed. It is important to ask open-ended questions about access to care. This will help the clinician determine the socioeconomic status of the patient. When evaluating health risks, it is essential to inquire about the patient’s medical history, family history, social history, and current medications. It is crucial to collect information concerning her diet, physical activity regimen, and previous pregnancies in this patient’s case. The patient denied any complications from previous pregnancies. She states that her diet consists of fries and burgers. Native Americans residing in reservations have higher risks for obesity, mental health issues, and substance abuse (Johnson, 2020). The patient should be asked about the history of abuse and family history of diabetes. It is also essential to ask the patient about her sleep hygiene and educate her on safe sleep hygiene (Johnson, 2020). The patient denied any history of abuse.

The first risk assessment tool for this patient is the Columbia-Suicide Severity Rate Scale (C-SSRS). This tool can assess the risk of suicide and help the clinician assess the patient’s overall mental health (Interian et al., 2017). The Adverse Childhood Experiences (ACE) tool can help the clinician determine any adverse childhood events and provide her with resources to meet the patient’s psychological needs (Ball et al., 2019). The Hirt-Insult-Threaten-Scream (HITS) is a tool that will assess domestic violence. This tool will determine how often the patient is physically abused, insulted, threatened, or screamed at (Ball et al., 2019). This tool will help the clinician gather information about the safety of the patient’s home environment.

It is always critical to ensure each patient’s assessment is patient-centered. There are basic structures and formats that all assessments follow. However, the clinician should tailor the questions to address unique patient needs and SDH. Clinicians should be aware of current social and health risks to implement patient-centered care.

Targeted questions

1. Can you describe your pregnancy history? Any complications?
2. Do you have any questions about your current pregnancy?
3. Have you felt depressed or anxious in recent times?
4. Do you think your living environment is safe for you and your unborn child?
5. Have you ever drank alcohol, smoke cigarettes, or used illicit substances?
6. Can you describe your childhood? Was there any trauma?

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.). St. Louis, MO: Elsevier Mosby.

Interian, A., Chesin, M., Kline, A., Miller, R., St. Hill, L., Latorre, M., Shcherbakov, A., King, A., & Stanley, B. (2017). Use of the Columbia-Suicide Severity Rating Scale (C-SSRS) to classify suicidal behaviors. Archives of Suicide Research, 22(2), 278-294. https://doi.org/10.1080/13811118.2017.1334610

Johnson, M. B. (2020). Prenatal care for American Indian women. MCN: The American Journal of Maternal/Child Nursing, 45(4), 221-227. https://doi.org/10.1097/nmc.0000000000000633

Kuipers, S. J., Cramm, J. M., & Nieboer, A. P. (2019). The importance of patient-centered care and Co-creation of care for satisfaction with care and physical and social well-being of patients with multi-morbidity in the primary care setting. International Journal of Integrated Care, 19(4), 315. https://doi.org/10.5334/ijic.s3315

Essay Instructions

To prepare:

• 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.
Write 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.

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.). St. Louis, MO: Elsevier Mosby.

Chapter 1, “The History and Interviewing Process”

This chapter explains the process of developing relationships with patients in order to build an effective health history. The authors offer suggestions for adapting the creation of a health history according to age, gender, and disability.

Chapter 5, “Recording Information”

This chapter provides rationale and methods for maintaining clear and accurate records. The authors also explore the legal aspects of patient records.

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