20 Aug Nurse practitioners can use targeted communication strategies to gain a good relationship with their patients
FIRST POST
I was given a patient profile: a 16-year-old white pregnant female living in an inner-city neighborhood.
Nurse practitioners can use targeted communication strategies to gain a good relationship with their patients. Patients can be open to receiving information and health education if Nurse practitioners understand the importance of effective communication. Health assessment requires good communication skills to evaluate the patient’s problem and plan care effectively. Considering patient age, gender, and ethnicity when communicating is essential. Health assessment contains subjective and objective data, so effective communication will make the evaluation productive (Kinyon & Navarrete, 2021). Having good rapport between patients and Nurse practitioners helps patients share detailed information. Teenagers, especially pregnant females, could not be open about their health concerns to encourage them to speak out; assuring them is essential. A 16-year-old white pregnant female living in an inner-city neighborhood may have embarrassment, so the Nurse practitioner should be prepared to initiate the communication so the patient will be open to information needed to address her needs. The 16-years-old patient may have anxiety about the future and experience fatigue from pregnancy.
The assessment includes subjective data such as chief complaints using the patient’s words describing her feelings and experiences related to her health. When interviewing the 16-year-old white pregnant female about her current issue, ask her location, quality, severity, onset, aggravation, and associated factor of the problem (Bates, 2017). Also continues talking about a review of systems (R.O.S), so you can learn about her current situation, starting when the symptoms of the disease began (Bates, 2017). Next is the objective assessment includes her vital signs, physical evaluation findings, imagining results, laboratory information, and other diagnostics data (Bates, 2017). Once the Nurse practitioner ensures all aspects of the evaluation, documenting the information is essential. More in-depth documentation is necessary, including educating patients about what is discussed with the patient and what is decided (Jenkins & David, 2019). The decision includes referrals, additional testing, consultation, etc. The economic challenge could be one factor the patient worries about as a young pregnant female. Assessing the 16-year-old patient for risk is essential to determine the potential health problem. The nurse practitioner should as at least these questions:
When last did you see your menstrual cycle?
Do you drink or smoke cigarettes? If so, how much?
Is this your first pregnancy?
Do you use recreational drugs? If so, how much
Do you have a family history of mental illness?
Do you practice unsafe sex?
Have you ever had any major surgery?
References
Bickley, L. S. (2017). Bates Guide to Physical Examination and History Taking (12th ed.). Wolters
Kluwer Health/Lippincott Williams & Wilkins: Philadelphia, PA.
Jenkins ML., & Davis A. (2019). Transforming Nursing Documentation. Studies Health Technol
Informatics, 264, 625-628.
Kinyon, K., D’Alton, S., Poston, K., & Navarrete, S. (2021). Improving Physical Assessment and Clinical
Judgment Skills Without Increasing Content in a Prelicensure Nursing Health Assessment Course.
Nursing Reports 11(3), 600-607. https://doi.org/10/3390.
SECOND POST
In order to establish a positive relationship, I will focus on the unique needs of this patient while being courteous and attentive. Open-ended questions allow the patient time and space to express feelings and expectations. My relaxed body language and facial expressions can put the patient at ease and aid her in feeling comfortable disclosing her chief complaint, or reason for seeking care, and past medical history. Because this patient is a minor there may or may not be a parent or guardian present. Additionally, her history may not be complete, or she may not view her situation as being consequential due to her inexperience.
Social determinants of health will be addressed as well as emotional, spiritual and cultural concerns, and social and workplace concerns. The sensitive issue of pregnancy will be met without judgment. Asking about socioeconomic characteristics can reveal specific needs such as nutrition, housing, and continued health care. In an article by Norris et al. (2016) pregnant and new-parent adolescents and young adults commonly have a low level of education, are living below the poverty line, and are at risk for abuse and depression.
This patient should be screened for intimate partner violence because of her age and gender. The Partner Violence Screen (PVS) is a three-question survey to quickly identify at-risk individuals. Questioning this patient about abuse is important because adolescents are particularly vulnerable to sexual abuse (Ball et al., 2019). Additionally, adolescents may experiment with risky behavior. Education about sexually transmitted infections will be included. A good general assessment tool for adolescents is the HEEADSSS which assesses home environment, education, eating, peer-related activities, drugs, sexuality, suicide/depression, and safety from injury and violence. Mental health screening should be implemented as “results show that teenage pregnancy is a significant predictor of depression and substance use involvement” (Walker & Holtfreter, 2021, p.297).
Targeted questions:
Tell me your greatest concern that brought you in today
Is this your first pregnancy or do you have other children
Are you able to afford food, housing, and health care
Do you have a support system in place
Do you feel safe in your current environment
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.
Norris, S., Norris, M. L., Sibbald, E., Aubry, T., Harrison, M. E., Lafontaine, G., & Gandhi, J. (2016). Demographic Characteristics Associated with Pregnant and Postpartum Youth Referred for Mental Health Services in a Community Outreach Center. Journal of the Canadian Academy of Child & Adolescent Psychiatry, 25(3), 152–158.
Walker, D., & Holtfreter, K. (2021). Teen pregnancy, depression, and substance abuse: The conditioning effect of deviant peers. Deviant Behavior, 42(3), 297–312. https://doi.org/10.1080/01639625.2019.1666610
