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.
There are specific considerations when an APRN is assessing a pregnant female and more so when assessing a pregnant teenager from an inner-city. An inner-city such as downtown Detroit Michigan, once a prosperous city popularly known as the "Motor City," is no longer the same after the economic downturn. Now the streets are filled with drug addicts, runaway teenagers, failing schools, and impoverished neighborhoods. An APRN must recognize poverty, poor education, lack of parental guidance or neglect, history of child abuse as the determinants of teenage pregnancy and put all that into consideration when assessing this patient (Yakubu, & Slisu, 2018).
Clinical reasoning must be applied when assessing a pregnant teenager, particularly with the 16-year-old white pregnant female from the downtown Detroit neighborhood (Ball et al., 2019).
Some Communication techniques include being empathic, non-judgmental, asking open-ended questions, and listening to the teenager. It is important not to talk down on the patient or use words such as "why," "don't you know better", or the use of ambiguous words but the simple language she can understand. This technique limits or creates a barrier between the provider and the patient (Alshammari et al., 2019). The Teach-back technique is also crucial because the patient is very young and without experience (Tran et al., 2019).
The APRN needs to show empathy by being in the patient's shoes, listening to the patient, and showing that one cares about this teenager's life. This opens the door for a more trusting relationship and better communication feedback from a teenager.
At 16 years, this patient might be terrified. Nurse-to-patient communication improves the patient's relationship with the nurse, provides emotional needs, and gives the patient a better understanding of what is expected during the pregnancy and beyond the postpartum period (Alshammari et al., 2019).
Effective patient-centered communication not only helps the patient but also enables the building of therapeutic relationships. This technique benefits healthcare providers to apply intelligent, sensitive, and collaborative approaches to communicate with patients about other services and adequately manage patients' lives while pregnant and after baby delivery (Alshammari et al., 2019).
Open-ended questions or conversations open the door for more indebt explanations and allow the patient to talk in detail about other things affecting her, which ordinarily are not obvious. When patients notice that you are listening, open up more about symptoms, questions, and concerns, which leads to more effective care and higher satisfaction.
The risk assessment strategy applicable to this patient would involve health screenings that would indicate or predict problems areas that exist (Ball et al., 2019). A risk assessment instrument is an essential tool used to analyze and evaluate risks associated with the patient and unborn baby. For this patient, the TACE model is ideal. This model is used to screens the risk for alcohol drinking in pregnancy. CRAFFT also screens for alcohol and substance abuse in adolescents. TACE and CRAFFT screenings can be used to get support services to protect both mother and baby (Ball et al., 2019).
The United Kingdom Manchester Teenage Pregnancy Partnership (MTTP) Risk Assessment is a risk factor instrument that addresses improvement outcomes for teenage pregnancy and early parenthood for young people. MTTP has been widely and effectively used in England and now gaining popularity in the United States (Loganathan, 2017).
Essential questions to be asked includes:
- What made you come here today?
- Did you bring anyone with you as friend or family support?
- When was the last time you saw your period?
- Tell me more about your living situation?
- Has anyone forced you into having sex?
- How is your eating?
- Do you drink alcohol or smoke?
- Do you feel safe at home?
- Do you have any other concerns with your health?
References
Alshammari, M., Duff, J., & Guilhermino, M. (2019). Barriers to nurse-patient communication in Saudi Arabia: An integrative review. BMC Nursing, 18(1). doi:10.1186/s12912-019-0385-4
Ball, J., 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: Mosby.
Yakubu, I., & Salisu, W. J. (2018). Determinants of adolescent pregnancy in sub-Saharan Africa: A systematic review. Reproductive Health, 15(1). doi:10.1186/s12978-018-0460-4
Tran, S., Bennett, G., Richmond, J., Nguyen, T., Ryan, M., Hong, T., . . . Thompson, A. (2019). 'Teach-back' is a simple communication tool that improves disease knowledge in people with chronic hepatitis B – a pilot randomized controlled study. BMC Public Health, 19(1). doi:10.1186/s12889-019-7658-4
Loganathan, K. (2017). A Risk Factor Tool for the United States Teenage Pregnancy ... Retrieved from https://corescholar.libraries.wright.edu/cgi/viewcontent.cgi?article=1199&context=mph
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:
Thank you for your discussion, it was very informative and descriptive. I agree, it is important to be non-judgmental and use open ended questions to communicate with a teenager. Communication, giving and receiving information, in general can be challenging. Some techniques to improve communication are increasing cultural awareness and understanding of various life experiences and cultures, developing empathy and compassion for people, being aware of one’s own body language and paying attention to the patient’s/other’s body language (Raypole, 2020).
The female in your case study is a 16-year-old female, which makes her at a higher risks of contracting a sexually transmitted infection. According to the CDC, youth between the ages of 15 and 24 make up half of the 26 million new sexually transmitted infections that occurred in United States. Furthermore, in the United States, 12.7% of sexually active adolescents and young adults who are on their parent’s health insurance won’t seek sexual and reproductive healthcare for fear that their parents would find out (Centers for Disease Control and Prevention, 2021).
References
Centers for Disease Control and Prevention. (2021, April 8). Adolescents and young adults. Centers for Disease Control and Prevention. https://www.cdc.gov/std/life-stages-populations/adolescents-youngadults.htm.
Raypole, C. (2020, January 16). 19 communication techniques to add to your arsenal. Healthline. https://www.healthline.com/health/communication-techniques#body-language.
response 2
Hi xxx. Your post resonates with issues most young girls encounter living in inner cities. In addition, there are several health concerns for the 16-year-old pregnant woman, such as the increased risk of high blood pressure, anemia, premature birth, having low birth weight babies, and experiencing postpartum depression (Help your teen cope with pregnancy, 2021). Brahmbhatt et al. 2014 assert that teen pregnancies are associated with an increased risk of maternal death, illness, and disability. Involving a psychologist or social worker while attending to her clinical needs would be wise for her mental and physical health.
Moreover, teenage pregnancies pose health hazards to both the mother and the fetus because teens frequently do not receive prenatal care early enough, leading to complications later on. Encourage the teen to eat healthily, stay active, seek regular prenatal visits to monitor her and the baby's health (Help your teen cope with pregnancy, 2021).
Furthermore, teenage pregnancy often hurts a teen's future as teen mothers are less likely to graduate from high school, less likely to attend college, are more likely to live in poverty, and are at risk of domestic violence. According to Krugu et al. (2016), adolescent pregnancy remains a public health concern, with diverse serious consequences, including increased health risk for mother and child, lost opportunities for personal development, social exclusion, and low socioeconomic attainments. Mathewos & Mekuria (2018) also hold that teenage pregnancy has long been a worldwide social, economic, and educational concern for developed, developing, and underdeveloped countries.
It is critical to obtain a thorough health history to fully comprehend the patient and their needs when assessing this patient. Because there are many social determinants in place when getting data, it's critical to match the right questions to the right audience or patient. Also, as practitioners, we must remember to support pregnant teens deal with the pregnancy and any challenges ahead. As a practitioner, I would also ask the following questions:
- Have you told your parents about the pregnancy?
- If yes, how is the situation at home right now?
- If no, any reasons for keeping it quiet?
- Are you keeping the baby?
- How will you keep yourself healthy during this pregnancy?
References
Brahmbhatt, H., Kågesten, A., Emerson, M., Decker, M. R., Olumide, A. O., Ojengbede, O., Lou, C., Sonenstein, F. L., Blum, R. W., & Delany-Moretlwe, S. (2014). Prevalence and determinants of adolescent pregnancy in urban disadvantaged settings across five cities. The Journal of adolescent health: official publication of the Society for Adolescent Medicine, 55(6 Suppl), S48–S57. https://doi.org/10.1016/j.jadohealth.2014.07.023
Help your teen cope with pregnancy. (2021, April 16). Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/tween-and-teen-health/in-depth/teen-pregnancy/art-20048124
Krugu, J. K., Mevissen, F. E., Prinsen, A., & Ruiter, R. A. (2016). Who's that girl? A qualitative analysis of adolescent girls' views on factors associated with teenage pregnancies in Bolgatanga, Ghana. Reproductive health, 13, 39. https://doi.org/10.1186/s12978-016-0161-9
Mathewos, S., & Mekuria, A. (2018). Teenage Pregnancy and Its Associated Factors among School Adolescents of Arba Minch Town, Southern Ethiopia. Ethiopian journal of health sciences, 28(3), 287–298. https://doi.org/10.4314/ejhs.v28i3.6
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.