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

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

The patient I’m going to talk about is a 38-year-old Native American pregnant woman residing on a reservation. One of the most important things in establishing a good connection with this patient is to build trust and create an environment where she feels comfortable discussing anything she needs. As a healthcare provider, it’s vital for me to be courteous and build a strong rapport with the patient (Ball, et al., 2019). Kindness and forming a connection with the patient are effective ways to encourage her to open up and make her feel valued and cared for.

The approach I find most suitable is the patient-centered approach. When using this approach, patients actively participate in making decisions about their healthcare. This not only contributes to building rapport but also empowers the patient, giving her a sense of control and engagement in her health (Bridges, et al., 2018). It’s essential for healthcare to be respectful and inclusive of the patient’s culture, especially in the case of a pregnant Native American patient who may have specific holistic care preferences or cultural considerations that I may not be fully aware of.

In my role as the patient’s provider, I would start by getting to know the patient better. I would ask her to share information about herself, her family, and her support network. Understanding the support and resources available to her, including any government health insurance, would be crucial. According to Kramer et al. (2009), many Native American women face health disparities and may not fully utilize the benefits offered by Indian Health care Services. It’s essential to provide her with information so she can access the available services.

NUR 550-Translational Research Graphic Organizer Template

I would also inquire about her family history. Gathering information about the patient’s potential risks is crucial when assessing a pregnant woman’s health. Understanding the patient’s risks, as well as her perceptions of those risks, is key. When a provider and patient can discuss and agree on the level of risk, it positively impacts the health of the baby (Cannella et al., 2013). Taking the time to allow the patient to express herself without rushing is important. Patience and giving the patient the space to open up are essential.

Furthermore, I see it as my responsibility to ensure that the patient has a safe living environment, which is crucial for proper prenatal and postnatal care. The patient may not be aware of the importance of a healthy diet, taking prenatal vitamins, or the dietary choices that can impact her and her baby’s health. It’s vital for the provider to ensure that the patient understands her social determinants of health. Depending on the patient’s level of knowledge, she may not be aware of all the potential risks related to her culture, age, or health history during pregnancy. According to Tesfalul et al. (2021), some providers may not fully inform patients of their potential risks or determinants of health due to anxiety or a lack of knowledge on how to convey this information. I consider it my duty to educate my patients about their social determinants of health, which may include factors like diabetes, living conditions, and age, especially if the patient is over 35 years old, which is considered a geriatric pregnancy. It’s essential for me to recognize potential risks, inform the patient about them, and tailor her healthcare accordingly based on her social determinants of health.

I would also ask the patient if she feels at risk in terms of her and her child’s well-being and safety. Ensuring that she feels safe, free from violence, poverty, and mental health issues is critical. Additionally, I would assess the level of support she has during her pregnancy by asking questions such as:

– Who do you live with?
– Do you feel safe in your home?
– Was your pregnancy planned?
– Do you have a supportive partner?
– Do you experience any feelings of depression or sadness?
– How can I further support you during your pregnancy to ensure your safety and success?

In conclusion, my goal for the initial appointment with this patient is to ensure that she leaves feeling safe, informed, and supported. I want her to know that I care about her well-being and want the best possible care for her. It’s essential for her to understand that her cultural preferences in healthcare will be respected. Moreover, she should be aware of potential risks if she does not receive proper healthcare during her pregnancy. I would emphasize the importance of taking prenatal vitamins, maintaining a healthy diet, feeling safe in her environment, and undergoing necessary tests, considering her geriatric pregnancy status. My aim is for her to leave my office feeling empowered and informed about her healthcare, supported throughout her pregnancy journey. Knowing the patient’s history and future plans, I would ensure that she makes the best decisions for a successful and healthy pregnancy (38-year-old Native American pregnant woman living on a reservation).

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.

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.

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.

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.

Discussion: Constructing a Health History

Effective communication plays a crucial role in building an accurate and comprehensive patient history. Various factors, such as age, gender, ethnicity, and the environment, influence a patient’s health or illness. As an advanced practice nurse, it’s essential to consider these factors when communicating with patients, as it can help establish rapport and gather the necessary information to assess their health risks.

Patient Assignment and Communication Techniques:
Each patient is unique, and therefore, my communication and interview techniques would vary based on the specific patient I’m assigned. For example, with a 38-year-old Native American pregnant female living on a reservation, I would prioritize cultural sensitivity and empathy. I’d aim to create a welcoming and non-judgmental environment where the patient feels comfortable sharing her health history and concerns. Building trust is vital in this process (Ball et al., 2019).

Tailoring Questions Based on Social Determinants:
To target my questions effectively, I’d consider the patient’s social determinants of health. These determinants encompass various factors, including economic stability, education, neighborhood and physical environment, social and community context, and healthcare access. For this patient, I’d ask questions related to her living conditions, access to healthcare resources on the reservation, and any cultural preferences or practices that might impact her healthcare decisions (Ball et al., 2019).

Risk Assessment Instrument and Questions:
I would select a risk assessment instrument that focuses on maternal and fetal health, given the patient’s pregnancy. One suitable tool might be the Pregnancy Risk Assessment Monitoring System (PRAMS), which assesses maternal behaviors and experiences before, during, and after pregnancy. I would use PRAMS to gather information about the patient’s prenatal care, smoking or substance use, and experiences during pregnancy.

Here are five targeted questions I would ask the patient:

1. Can you tell me about your prenatal care and any medical appointments you’ve had during this pregnancy?
2. Have you been smoking or using any substances during your pregnancy, including alcohol or drugs?
3. How has your experience been during pregnancy, including any challenges or concerns you’ve faced?
4. Are there any cultural practices or beliefs related to pregnancy and childbirth that you would like me to be aware of?
5. Can you share any information about your support system and the resources available to you on the reservation for prenatal and postnatal care?

Potential Health-Related Risks:
Based on the patient’s age, gender, ethnicity, and living on a reservation, there are several potential health-related risks to consider. These may include a higher risk of gestational diabetes, limited access to healthcare services, cultural differences in healthcare preferences, and potential environmental factors on the reservation that could impact maternal and fetal health. These risks should be taken into account when developing a care plan for the patient (Center for Disease Control, 2021; Stotz et al., 2019).

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.

Center for Disease Control and Prevention. (2021, August 10). Gestational diabetes. https://www.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 or a history of GDM. Diabetes Educator, 45(2), 137-145. https://doi.org/10.1177/0145721718821663