Risk Assessment In Antenatal Health Care Discussion Paper

Posted: November 12th, 2022

Risk Assessment In Antenatal Health Care Discussion Paper

Discussion Response

This is an insightful piece! You have written an excellent post on the case of a 38-year-old Native American Pregnant Female, which is well-detailed. To be honest, I think you have some excellent focused questions for this client, and I think they are appropriate since they are open-ended. When conducting patient interviews, using open-ended questions is the recommended approach to employ designed to motivate clients to reveal deeper details about themselves. As nurses, we may obtain more information through open-ended inquiries in order to provide a more thorough and accurate examination. Avoiding medical terminology, utilizing an expansive area devoid of bulky things like furniture, and using a neutral voice tone are all recommended (Ball et al., 2019). Eye contact is regarded by Americans as an indication of attentive listening and, in many cases, honesty and transparency. Conversely, in some cultures, especially Native American, Middle Eastern, Asian, and Hispanic, eye contact is considered impolite or unpleasant, and the absence of eye contact does not always imply that someone is not actively listening. The ability to communicate with and care for patients in culturally diverse populations enhances cultural competency in healthcare providers. After completing the interview, there ought to be sufficient proof that the client’s issues have been thoroughly examined Risk Assessment In Antenatal Health Care Discussion Paper.

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The Rotterdam Reproductive Risk Reduction (R4U) scorecard, which is an instrument used by experts to evaluate pregnant women’s risk during the first prenatal appointment, may also be appropriate for this specific patient (Voss et al., 2015). It will give you the opportunity to identify medical and non-medical variables contributing to bad pregnancy outcomes regarding underlying illnesses, stressors, lifestyles, employment status, health, and social economics. When used in conjunction with other tools, this instrument assists the clinician in personalizing patient care and identifying issues that may jeopardize the patient’s health and that of the fetus Risk Assessment In Antenatal Health Care Discussion Paper.

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.).

Vos, A. A., Van Veen, M. J., Birnie, E., Denktas, S., Steegers, E. A., & Bonsel, G. J. (2015). An instrument for broadened risk assessment in antenatal health care including non-medical issues. International Journal of Integrated Care, 15(1). https://doi.org/10.5334/ijic.1512 

This is the initial Discussion Assignment instructions 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. 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 Risk Assessment In Antenatal Health Care Discussion Paper.

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. 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. RUBRIC FOR 1ST RESPONSE 17 (17%) – 18 (18%) “Response exhibits synthesis, critical thinking, and application to practice settings. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of Learning Objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English. MAIN DISCUSSION POST Communication Generally speaking, effective communication not only relays information appropriately to the recipient, it also requires a response. Successful dialogue is critical for patient coordination and good patient care. The way a provider communicates with a patient will vary on an individual basis due to several reasons. Language itself along with emotional status, significantly impacts how people interpret information. Age, gender, and context also effect understanding. Communication barriers subsist between cultures caused by semantics or by connotations. Bearing in mind tone of voice and body language is also crucial, as these aspects can and will set the mood within the environment. Social Determinants of Health and Health History Prenatal care is dependent on the dedication of the patient to both their own health and fetal health, along with the willingness to be in partnership with the provider (Ball et al., 2019)Risk Assessment In Antenatal Health Care Discussion Paper.

Factors that will likely influence the patient’s approach to pregnancy include: previous childbirths/experience with childrearing; the patient’s relationships; the patient’s desire for children; and, current life circumstances. When conducting the initial interview, it is imperative to obtain a past history, assess health practices, identify potential risk factors, and assess the patient’s knowledge, expectations, and perceptions of pregnancy (Ball et al., 2019). The health of a person or community is greatly dependent on access to social and economic opportunities, support and resources, quality of education, safety and cleanliness, and positive social relationships (Johnson, 2020). Social determinants within the Alaskan Indian/American Native (AI/AN) population are troubling, with 72% of the population earning a high school diploma compared with a national average of 85% (National Center for Educational Statistics, 2019 as cited in Johnson, 2020). In this particular case, inquiring about the patient’s educational and work background could be telling of educational status. This would in turn assist me in “getting on the patient’s level” of understanding, so that she would be more comfortable with the interview. The AI/AN population are among the most economically impoverished populations in the nation (Weinstein et al. 2017 as cited in Johnson, 2020). With this disparity in income comes an impact on general health and well-being. Some Native American tribes have been noted to have poorer health outcomes and a shorter life expectancy than the national average (Johnson, 2020). Also, access to care is a large disparity noted within the Native American population. This could be due to lack of healthcare providers, a lack of unreliable transportation, and household instability. Poor housing may not directly affect the patient’s access to prenatal care, but a potentially chaotic household (more than four members), a young maternal age, and being unmarried (can be indicative of less support) may negatively influence consistency of prenatal care (Johnson, 2020)Risk Assessment In Antenatal Health Care Discussion Paper.

If any of these particular instances are relevant to the patient, discussing and educating the patient on potential resources to facilitate continuity of care would be appropriate; an example of this would include gaining the patient access to public transportation (if applicable) or looking into more cost efficient routes so that the patient can continue receiving care. Risk Assessment Tools When it comes to patient care, there are a variety of risk assessment tools available. Among them include the TACE model and CAGE questionnaire used to assess for alcohol abuse; and, the Brief Screening Tool for Domestic Violence (it includes not only physical violence, but verbal as well) (Ball et al, 2019). The tools available for adolescents include: the HEEADSSS assessment (used to understand adolescent behavior and asses for risk-taking behaviors); the PACES assessment (discusses parents, peers, accidents, alcohol/drugs, cigarettes, emotional issues, school, and sexuality); and the CRAFFT assessment tool (acronym for Car, Relax, Alone, Forget, Friends, and Trouble; it is relevant to drug and alcohol use in adolescence) (Ball et al.2019). The risk assessment tool that I feel would be most appropriate for the 38-year-old pregnant, Native American patient would be the Pregnancy Risk Assessment Monitoring System (PRAMS). It is a tool utilized by the Centers for Disease Control and Prevention (CDC) as an initiative to reduce infant mortality, low birth weight, and promote safe motherhood (Schulman et al., 2018). Implemented in 1987 due to the sudden halt in the decline of infant mortality rates, the United States continues to have the highest rates among developed countries. Within the AI/AN population, the infant mortality rate is even higher than the national average as indicated by 9.21 deaths per 1,000 live births (Johnson, 2020); the national average is that of 5.79 deaths per 1,000 live births (Ely & Driscoll, 2019 as cited in Johnson, 2020). Another study indicated that the rates of maternal morbidity and mortality were twice as high among AI/AN women than non-Hispanic white women (Kozhimmanil et al., 2020 as cited in Johnson, 2020). Health Related Risks There are many potential health risks to consider regarding the specified patient. As mentioned previously, there are several health disparities within the AI/AN population. Based on the patient’s age and ethnicity alone, she is at risk for preterm labor (Raglan et al., 2015). Also, depending on her marital/relationship status, research shows that unmarried women are associated with greater risk for preterm delivery. Several medical conditions further increase a woman’s risk of preterm labor, and AI/AN women have higher rates of diabetes, chronic hypertension, and pregnancy-induced hypertension (Raglan et al., 2015)Risk Assessment In Antenatal Health Care Discussion Paper.

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Obesity is also highly prevalent among the AI/AN population, along with poor nutrition due to limited access to fresh foods and lower than average levels of physical activity and fitness. It is also of extreme importance to note that disparities exist, even among AI/AN people with access to public healthcare; they emerge due to mistrust of providers, along with perceived racial discrimination and disrespect towards religious beliefs (Raglan et al., 2015). Targeted Questions 1. Is this your first pregnancy? Tell me how you are feeling about this pregnancy. 2. When was your last menstrual cycle? 3. Do you suffer from any long-term health problems such as diabetes or high blood pressure? Are you taking any medications, including over-the-counter medication, herbal supplements, or vitamins? 4. Are you currently working? If not, tell me more about your day to day routine; I would like to know more. 5. Is the biological father involved? If not, I would like to know more about your support system. References Fibuch, E., & Robertson, J. J. (2019). Bringing value: Honing the fine art of communication. Physician Leadership Journal, 6(1), 64-67. 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. 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 National Center for Educational Statistics. (2019, May). Public high school graduation rates. https://nces.ed.gov/programs/coe/indicator_coi.asp Weinstein, J. N., Geller, A. M., Negussie, Y., & Baciu, A. (Eds.). (2017). Communities in action: Pathways to health equity. The National Academies Press. Raglan, G. B., Lannon, S. M., Jones, K. M., & Schulkin, J. (2015). Racial and Ethnic Disparities in Preterm Birth Among American Indian and Alaska Native Women. Maternal and Child Health Journal, 20(1), 16–24. https://doi.org/10.1007/s10995-015-1803-1 Shulman, H. B., D’Angelo, D. V., Harrison, L., Smith, R. A., & Warner, L. (2018). The Pregnancy Risk Assessment Monitoring System (PRAMS): Overview of Design and Methodology. American journal of public health, 108(10), 1305–1313. https://doi.org/10.2105/AJPH.2018.304563 Ely, D. M., & Driscoll, A. K. (2019). Infant mortality in the United States, 2017: Data from the period linked birth/infant death file. National Vital Statistics Reports, 68(10), 1-19. Kozhimannil, K. B., Interrante, J. D., Tofte, A. N., & Admon, L. K. (2020). Severe maternal morbidity and mortality among indigenous women in the United States. Obstetrics & Gynecology, 135(2), 294-300. https:// doi.org/10.1097/AOG.0000000000003647 Risk Assessment In Antenatal Health Care Discussion Paper