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.
Summary:
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Patient A.G is a 38-year-old pregnant female residing on an Indian reservation, presenting for a prenatal visit at 28 weeks of her third pregnancy. The patient’s vital signs are stable, and she is alert, oriented, and in a stable mood. There are no signs of acute distress, with normal heart sounds, clear lung function, and no respiratory distress noted. A comprehensive review of systems was conducted and yielded unremarkable results. The patient has no known drug allergies.
In terms of communication, I would adopt an open-ended dialogue and utilize the teach-back method. Recognizing the potential for communication barriers, employing the teach-back method allows the patient to summarize information learned, facilitating correction of any misunderstandings and reinforcing accurate knowledge. Open-ended questions serve as a communication technique to encourage the patient to elaborate on their feelings and experiences, enabling further evaluation and the development of a personalized care plan (Shepard, 2018).
For risk assessment, I would employ the PRAMS tool, standing for Pregnancy Risk Assessment Monitoring System. This tool aims to influence maternal behaviors throughout the stages of pregnancy, including before, during, and after, with the goal of reducing infant morbidity and mortality. The questionnaire covers various aspects such as attitudes and feelings about the most recent pregnancy, preconception care, content of prenatal care, Medicaid and WIC participation, breastfeeding, cigarette smoking and alcohol use, health insurance coverage, physical abuse, infant health care, and contraceptive use (CDC, 2021). Native American women face health disparities, particularly due to delayed and insufficient prenatal care. Communication barriers contribute to these disparities, with Native American women expressing concerns about physicians being too busy to address their questions, a perceived lack of care, and an overall distrust in modern medical practices (Hanson, 2014).
Targeted Questions:
1. Who will be the primary caregiver for the baby?
2. Do you have access to prenatal care?
3. Are you currently using or planning to use tobacco or alcohol during the pregnancy?
4. Have you experienced any pain or discomfort?
5. Do you incorporate traditional medicines and healing practices?
These questions were selected considering the high-risk status of Native American women for adverse birth outcomes, including delayed prenatal care, adolescent age, and substance use during pregnancy. Additionally, acknowledging the cultural context, the inquiry about the primary caregiver addresses the traditional family structure, recognizing that the mother may not necessarily assume this role. It is crucial to educate and support the family member who will take on the caregiving role, refraining from judgment about the family dynamic. Furthermore, understanding the cultural trait of stoicism among Native Americans during painful procedures or labor is essential to avoid misinterpretation of their pain experience (Cesario, 2001).
References
CDC. (2021, May 3). CDC – PRAMS Questionnaires – Pregnancy risk ASSESSMENT monitoring system – reproductive health. Centers for Disease Control and Prevention. https://www.cdc.gov/prams/questionnaire.htm.
Cesario, S. K. (2001, January 1). Care of the Native American Woman: Strategies for Practice, Education, and Research. JOGNN. https://www.jognn.org/article/S0884-2175(15)33875-2/fulltext.
Hanson, J. D. (2014, January). Understanding prenatal health care for American Indian women in a Northern Plains Tribe. Journal of transcultural nursing:official journal of the Transcultural Nursing Society. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4098117/.
Shepard, K. (2018, July 17). Nursing communication Skills: NurseZone. Nursing Communication Skills | NurseZone. https://www.americanmobile.com/nursezone/career-development/5-nursing-communication-techniques-that-work/.
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:
responses
Thank you for your input this week on building a health history. The nurse practitioner should maintain an open line of communication with the patient, focusing on elements of comfort, politeness, and affirmation, as emphasized by Ball et al. (2019). Utilizing a patient-centered approach in communication is a technique that enables a physician to establish a meaningful relationship with the patient, particularly during an evaluation. This approach is particularly beneficial for vulnerable patients, fostering trust and confidence in the practitioner. By prioritizing the patient’s comfort, the practitioner creates an environment conducive to open communication, making it easier for the patient to express the purpose of her consultation.
American Native women in the United States encounter acknowledged barriers to prenatal care, encompassing issues such as limited access to care, distinct communication styles, and inconsistent treatment continuation (Johnson, 2020). Given the well-recognized nature of these challenges, the nurse practitioner must assess and address the identified disparities, including the lack of access to care, variations in communication styles, and irregular continuation of care. Additionally, the age of the pregnant woman is a critical consideration, and the nurse practitioner should engage in discussions with the mother to provide counseling on the potential risks associated with advanced maternal age. While complications can arise during pregnancy for women of any age, it is a well-established trend that the likelihood of complications increases with age, as noted by Johnson (2020). Addressing this concern allows the nurse practitioner to provide valuable information to the mother about potential risks and considerations associated with her age during pregnancy.
In navigating these discussions, the patient-centered approach remains a preferred communication strategy. By adopting this approach, the nurse practitioner can not only convey crucial information effectively but also demonstrate empathy and understanding, fostering a collaborative and trusting relationship with the patient. This becomes especially important when addressing sensitive topics such as age-related pregnancy risks.
In summary, effective communication, grounded in a patient-centered approach, plays a pivotal role in addressing the unique challenges faced by American Native women in accessing prenatal care and managing potential complications associated with pregnancy. Through thoughtful and culturally sensitive communication, the nurse practitioner can contribute to building trust, empowering the patient, and promoting a more comprehensive and patient-focused healthcare experience.
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.
Bohn DK. (2020). Lifetime and current abuse, pregnancy risks, and outcomes among Native American women. Journal of Health Care for the Poor & Underserved, 13(2), 184–198. https://doi-org.ezp.waldenulibrary.org/10.1353/hpu.2010.0624
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.ezp.waldenulibrary.org/10.1097/NMC.0000000000000633
response 2
Thank you for your insightful post.
It’s indeed disheartening to acknowledge the existing lack of trust in healthcare providers among certain populations due to biases and empathy gaps. Your awareness of this uncomfortable truth reflects a crucial aspect of cultural competence and highlights the responsibility of future healthcare providers to address these disparities. The under-representation of Native Americans and other minority groups in clinical studies, despite federal statutes mandating their inclusion, underscores the urgent need for more inclusive and diverse research practices (Heck, 2020).
The utilization of the PRAMS risk assessment tool to mitigate infant morbidity and mortality is a commendable approach. This tool not only aids in assessing the well-being of the mother but also provides valuable insights into the quality of current prenatal care. Your emphasis on asking about the use of traditional medicines and healing aligns with the holistic and person-centered philosophy of care. Recognizing the influence of cultural practices, spiritual beliefs, and family support on a patient’s medical care is crucial, as emphasized by Ball et al. (2019). Your personal reflection on the integration of homeopathic medicine and allopathic treatments highlights the importance of transparent communication with healthcare providers about all types of treatments, including non-allopathic approaches.
As nurse practitioners and nurses, the holistic and person-centered approach places us in a unique position to contribute valuable insights to maternal mortality review committees, ultimately aiming for optimal patient care (Bradford, 2021). Your acknowledgment of the severity of potential outcomes in the patient’s scenario and the commendation for gathering necessary data to compile a comprehensive patient profile reflects a commitment to thorough and accurate assessment. Kudos indeed!
Nadia
References
Ball, J. W., Dains, J. E., Stewart, R. W., Professor of Medicine John A Flynn Med, & MPH, B. S. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). Elsevier Mosby.
Bradford, H. (2021). The essential role of nurse practitioners and midwives on maternal mortality review committees. Nursing for Women’s Health, 25(2), 107-111. https://doi.org/10.1016/j.nwh.2021.01.005
Heck, J. (2020). A phenomenological study of postpartum depression in women who are Native Americans or Alaska Natives. Journal of Obstetric, Gynecologic & Neonatal Nursing, 49(6), S1-S2. https://doi.org/10.1016/j.jogn.2020.09.004
Week 1: Building a Comprehensive Health History
According to a 2011 Gallup poll, nurses are ranked as the most trusted professionals in the United States. One of the most admired nursing skills is the ability to put patients at ease. When patients enter into a healthcare setting, they are often apprehensive about sharing personal health information. Caring nurses can alleviate the hesitance of patients and encourage them to be forthcoming with this information.
The initial health history interview can be an excellent opportunity to develop supportive relationships between patients and nurses. Nurses may employ a variety of communication skills and interview techniques to foster strong bonds with patients and to effectively facilitate the diagnostic process. In conducting interviews, advanced practice nurses must also take into account a range of patient-specific factors that may impact the questions they ask, how they ask those questions, and their complete assessment of the patient’s health.
This week, you will consider how social determinants of health such as age, gender, ethnicity, and environmental situation impact the health and risk assessment of the patients you serve. You will also consider how social determinants of health influence your interview and communication techniques as you work in partnership with a patient to gather data to build an accurate health history.
Learning Objectives
Students will:
- Analyze communication techniques used to obtain patients’ health histories based upon social determinants of health
- Analyze health-related risk
- Apply concepts, theories, and principles related to patient interviewing, diagnostic reasoning, and recording patient information
Learning Resources
Assignment: Course Acknowledgement
This mandatory assignment is an acknowledgement that you fully understand the course guidelines.
By Day 3 of Week 1
Submit your Assignment.
Submission and Grading Information
Submit Your Assignment by Day 3 of Week 1.
To complete this assignment, follow the link below and answer the questions provided.
Week 1 Assignment
Discussion: Building a Health History
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.
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.
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 1 Discussion Rubric
Post by Day 3 of Week 1 and Respond by Day 6 of Week 1
To Participate in this Discussion:
Week 1 Discussion
What’s Coming Up in Module 2?
Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images
In Module 2, you explore the impact of functional assessments, diversity, and sensitivity in conducting health assessments. You also examine various assessment tools and diagnostic tests used to gather information about patients’ conditions and examine their validity, reliability, and impact in conducting health assessments.
Next week, you will specifically examine functional assessments as they relate to diversity and sensitivity
Registration for Shadow Health
Throughout this course, you will participate in digital clinical experiences using the online simulation tool Shadow Health. The Shadow Health digital clinical experience provides a dynamic, immersive experience designed to improve nursing skills and clinical reasoning through the examination of digital standardized patients. Using Shadow Health you will participate in health histories, focused exams, and a comprehensive assessment.
There will be four Shadow Health assessment components that you will need to complete in Module’s 2 and 3:
- Health History Assessment (Week 3 & 4)
- Focused Exam: Cough (Week 5) for a pediatric patient presenting with cough
- Focused Exam: Chest Pain (Week 7) for an adult patient presenting with chest pain
- Comprehensive (Head-to-Toe) Physical Assessment (Week 9)
Before you can participate in these simulations, you will need to register for a Shadow Health account. To do this:
- Go to the Walden Bookstore and purchase access to Shadow Health and the required texts.
- Once Shadow Health has been purchased, an access code will be emailed to you from the bookstore.
- Review this video explaining how to register in Shadow Health: https://vimeo.com/275921826/c12d50ee6e
- Use the Shadow Health link located in the navigation menu on the left in the Blackboard course.
- Follow the prompts to register in Shadow Health. You will need the access code provided from the bookstore to register. Once registered, Shadow Health should always be accessed via the link in Blackboard.
- Use only Google Chrome when accessing Shadow Health and make sure all other programs are turned off on your computer. Other browsers do not work well and will not allow the Shadow Health speech to text function to work.
- Once registered, complete the Shadow Health Orientation in the Shadow Health website/program and review the videos designed to assist with navigating and completing assignments.
- Read the Shadow Health Nursing Documentation Tutorial located in the Week 1 Learning Resources.
Note: As nurses you typically use the word assessment to mean completing the physical exam. However, in the SOAP Note format, assessment means diagnosis so start getting in the habit of calling the physical exam exactly that.
Week 2 Case Studies
In Week 2, your Instructor will assign you a case study related to your Discussion by Day 1 of the week. Please make sure to review the “Course Announcements” area of the course to verify your assigned case study. Please plan ahead to ensure you have time to review your case study and your Learning Resources so that you can complete your Discussions and Assignments on time.
Photo Credit: Getty Images/iStockphoto
Practicum – Upcoming Deadline
In the Nurse Practitioner programs of study (FNP, AGACNP, AGPCNP, and PMHNP) you are required to take several practicum courses. If you plan on taking a practicum course within the next two terms, you will need to submit your application via Meditrek .
For information on the practicum application process and deadlines, please visit the Field Experience: College of Nursing: Application Process – Graduate web page.
Please take the time to review the Appropriate Preceptors and Field Sites for your courses.
Please take the time to review the practicum manuals, FAQs, Webinars and any required forms on the Field Experience: College of Nursing: Student Resources and Manuals web page.
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