Building a Health History NURS 6512 week 1 Discussion Post
Patient Overview – 38-year-old Native American pregnant female living on a reservation
Interview Summary
My interview would commence with the fundamentals: introducing myself to the patient and any accompanying individuals. Subsequently, I would engage with the patient directly and confirm their preferred mode of address, whether formal or informal. I would also ensure that the appointment isn’t hurried, so I’d schedule an extended duration, particularly since it’s the patient’s initial meeting with me.
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As an APRN, I need to be mindful of factors that can influence both my approach during the visit and the patient’s expectations from me as their provider. Factors like age, gender, race, ethnic background, cultural perspectives, regional disparities, and socioeconomic status all play a role in how patients seek medical care and how clinicians deliver it (Ball, et al., 2019). In my view, having knowledge about the patient and their background prior to the visit is a crucial component. The patient’s cultural heritage and diversity will impact how I cater to her specific needs. Health beliefs and practices can differ significantly among cultures and ethnicities, influencing how the patient perceives their current medical condition, the role of faith and spirituality in their care, and the level of involvement of specific family members.
In this particular scenario, the patient is a pregnant Native American woman. To begin with, as the clinician, I would need to be aware of the specific cultural dynamics at play. For instance, in Native American culture, women often hold significant roles within their communities due to the matrilineal nature of many of these communities. In such societies, women are decision-makers, and the matriarch should be involved in all decision-making (Cerario, 2001). Any procedures would be explained in meticulous detail, covering all potential side effects, outcomes, and complications to establish trust and transparency.
Nurse Practitioner Practice Agreement, Certification, and Licensure in Pennsylvania
Furthermore, I would make sure I’m well-versed in the specific practices related to pregnancy within this population. Childbearing is viewed as a part of the life cycle and follows a rhythmic pattern. During pregnancy, the focus of the pregnant woman tends to revolve around the pregnancy itself rather than other matters that come after, such as child-rearing or contraception (Cerario, 2001). Beliefs and values regarding pregnancy, labor, delivery, postpartum care, and newborn care can vary from tribe to tribe and individual to individual. As the primary healthcare provider, it is my responsibility to be familiar with commonly practiced traditions among Native American families.
In addition to these practices, conducting a health risk assessment is a significant part of ensuring appropriate patient care. At its core, a health risk assessment (HRA) evaluates an individual’s risk of developing specific conditions based on particular factors and underscores the role of preventive medicine in such assessments (Wu, 2015). As an APRN and an individual living with a chronic and potentially fatal condition, the emphasis on preventive medicine, rather than reactive medicine, holds great importance for me.
When formulating targeted questions, I aimed to blend the patient’s cultural background with the concept of the HRA.
Targeted Questions:
1. Which Native American tribe do you belong to?
2. Have any family members experienced pregnancy complications, and if so, what were they?
3. Is this your first pregnancy?
4. What is your vision for your birth plan?
5. What kind of support do you require or need from your medical staff?
In my perspective, the treatment of the patient ultimately boils down to a holistic approach. Neglecting any aspect only serves as a disservice to the patient I’m caring for.
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.
Cerario, S. (2001). Care of the Native American woman: Strategies for Practice, Education, and Research. Scholarship for the Care of Women, Childbearing Families, and Newborns, (30), 13-19.
Wu, R. R., & Orlando, L. A. (2015). Implementation of health risk assessments with family health history: Barriers and benefits. Postgraduate Medical, (1079), 508-513.
Response
Thank you for your comprehensive post! You’ve raised several important points. I concur that cultural awareness is crucial in your scenario. It appears you’ve gathered valuable research regarding the care of Native American patients.
Effective communication is pivotal in ensuring diagnostic accuracy, patient and family comprehension of treatment, and improved patient outcomes (Damm, Leiss, Habeler, & Ehrich, 2015). In your situation, communication techniques will be of utmost importance. It’s essential to be open and sensitive. Many Native American individuals and Indigenous patients often feel stereotyped, disregarded, and not respected by non-indigenous healthcare providers (Roessel, n.d.). Letting this particular patient know that she is respected and in control of her care will go a long way.
References:
Damm, L., Leiss, U., Habeler, U., & Ehrich, J. (2015). Improving care through better communication: Continuing the debate. EUROPEAN PAEDIATRIC ASSOCIATION, 167(2), 501-502.
Roessel, R. (n.d.). Effective Tools for Communications and Leadership in Indian Country. Retrieved from http://www.nativepartnership.org/site/PageServer?pagename=naa_livingconditions
Sample Response
You’ve done an excellent job in discussing communication techniques and targeted questions for your patient. I’d like to add that in order to establish trust and encourage the patient to open up, building rapport is essential. According to Ball, Dains, Flynn, Solomon, and Stewart (2019), a great technique to achieve this is by seeking connection, such as being a kind listener and using open-ended questions. It’s crucial for the patient to understand that all information provided will be kept confidential. Gaining the patient’s trust allows for open conversations about sensitive topics.
The National Congress of American Indians (n.d.) discusses ways to improve techniques within Native American culture, such as being humble, actively listening and learning, and simplifying medical jargon into common language. Understanding cultural preferences is vital when dealing with every patient, as being disrespectful according to the patient’s culture could hinder the interview and care delivery. It’s important for healthcare providers to determine what makes patients feel comfortable and consider all factors when discussing in-depth questions about their health history.
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.
National Congress of American Indians. (n.d.). Effective Tools for Communications and Leadership in Indian Country. Retrieved from http://www.nativepartnership.org/site/PageServer?pagename=naa_livingconditions
Sample Response 2
Great post! Your discussion highlights that appropriate communication skills are vital for an adequate health assessment of a patient. Effective communication not only establishes a positive patient-provider
relationship but also leads to higher patient satisfaction and compliance (Berman & Chutka, 2016). Interviewing a pregnant female living on a reservation requires cultural competence, considering the unique living conditions and disparities faced by Native American communities (Native American Aid, 2015).
Moreover, you rightly emphasize the importance of using a health risk assessment to collect comprehensive patient information, including medical and family history, environmental factors, and behavioral risks (Sullivan, 2019). In addition to the techniques you mentioned, qualitative interviews can be valuable in gathering patient insights (Hanson, 2012).
The HEEADSSS screening tool you selected is appropriate given the prevalence of substance use issues on Native American reservations (Park-Lee, Lipari, Bose, & Hughes, 2018). It’s a comprehensive approach to assess various health threats.
Your five targeted questions are well thought out and align with the patient’s cultural background and health risk assessment.
References:
Berman, A. C., & Chutka, D. S. (2016). Assessing effective physician-patient communication skills: “Are you listening to me, doc?” Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4951737/
Hanson, J. (2012). Understanding prenatal health care for American Indian women in a Northern Plains tribe. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4098117/
Native American Aid. (2015). Living conditions. Retrieved from http://www.nativepartnership.org/site/PageServer?pagename=naa_livingconditions
Park-Lee, E., Lipari, R. N., Bose, J., & Hughes, A. (2018). Substance use and mental health issues among U.S.-born American Indians or Alaska natives residing on and off tribal lands. Retrieved from https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/DRAIANTribalAreas2018/DRAIANTribalAreas2018.pdf
Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.
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